Thank you for the detailed history. Based on your symptoms—progressive fatigue, difficulty with mobility, stiffness in the feet without knee pain, chronic constipation, and documented
Vitamin D deficiency—there could be more than one underlying issue contributing to your current state.
Your inability to tolerate milk could indicate underlying lactose intolerance, but more importantly, it raises concern for possible
calcium and other micronutrient deficiencies. The history of past alcohol use may also have long-term effects on nutrient absorption, especially fat-soluble vitamins like Vitamin D.
While Vitamin D deficiency alone can cause musculoskeletal pain, fatigue, and weakness, we also need to consider other possibilities such as osteomalacia, early neuromuscular disorders, electrolyte imbalances, or even chronic low-grade metabolic bone disease. The worsening with hot compress and specific stiffness in the feet could also suggest something biomechanical or neuropathic.
This case clearly warrants a detailed musculoskeletal and metabolic workup—just treating Vitamin D in isolation may not help unless we identify and manage the root cause.
A personal consultation would allow for a physical examination, targeted investigations (like serum calcium, phosphate, PTH, magnesium, CK, and possibly imaging), and a tailored treatment plan. I strongly recommend we proceed with that to prevent further progression.