title: Neuropathic pain and dysesthesia of the feet after Himalayan expeditions.
abstract: High altitude peripheral nerve disease secondary to frostbite or trauma is a well-recognized medical problem during mountaineering expeditions. However, in our experience as medical professionals on 19 expeditions to the Himalayas in the years 1977 to 2000, an unusual syndrome of neuropathic pain and/or dysesthesia in both feet apparently unrelated to frostbite or trench foot was observed in 8 (4.8%) of 165 European mountaineers. Mountaineers complained of persistent and continuous pain, which was consistently described as a "corky" sensation in their feet, associated with severe lancinating exacerbations. Pain improved with cold and worsened with heat and gentle pressure. Symptoms were incapacitating in a third of the cases. Treatment with carbamazepine was effective, and the disorder evolved to total resolution in 4 to 8 weeks. We present the case of a patient who had this syndrome and in whom complete work-up studies done on his arrival home, 14 days after its presentation, were unrevealing. The paucity of information regarding this particular variety of neuropathic pain of the feet may be due to lack of clinical suspicion in the field, favorable outcome, and difficulties for further study and evaluation.
authors.affiliation: The Mountain Medicine Studies Institute Dr. Castelló Roca (IEMM), The Spanish Society for Mountain Medicine. ricart.demesones@retemail.es
authors.forename: Antoni
authors.initials: A
authors.lastname: Ricart de Mesones
authors.forename: Janina
authors.initials: J
authors.lastname: Turón Sans
authors.forename: Mercedes
authors.initials: M
authors.lastname: Misiego
authors.forename: Hisao
authors.initials: H
authors.lastname: Onaga Pueyo
authors.forename: Rosa
authors.initials: R
authors.lastname: Real Soriano
authors.forename: Javier
authors.initials: J
authors.lastname: Botella de Maglia
mesh_terms: D000328:Adult; D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use; D002220:Carbamazepine / Q000627:therapeutic use; D005534:Foot Diseases / Q000188:drug therapy / Q000209:etiology*; D006801:Humans; D008297:Male; D009051:Mountaineering; D009437:Neuralgia / Q000188:drug therapy / Q000209:etiology*; D010292:Paresthesia / Q000188:drug therapy / Q000209:etiology*
chemical_list: D018712:Analgesics, Non-Narcotic; D002220:Carbamazepine