Unexplained Right Leg Numbness in a 70-Year-Old: Seeking Answers

Q: Unexplained Right Leg Numbness in a 70-Year-Old: Seeking Answers

Hello： 1. It is recommended to further evaluate whether it is a cerebrovascular accident (stroke) or a condition affecting the upper cervical and thoracic spinal cord nerves. Consider if there is room for further treatment. Best wishes. // Dr. Lai Chao-Kang, D

My father is 70 years old and experiences numbness in his right foot, but various tests have not revealed any underlying cause?

Dear Doctor,
My father is 70 years old and has been experiencing gradual numbness in his right foot for about two years (the left foot has not shown any symptoms during this time).
Recently, the numbness has worsened.
He often lies on the sofa without realizing he hasn’t taken off his right slipper, and he feels weak after walking for extended periods, requiring frequent breaks.
Initially, we suspected sciatica or a herniated disc, so we went to National Taiwan University Hospital for an MRI.
However, the MRI results showed no significant issues; the doctor mentioned a "very mild" herniated disc that does not require surgery and is unlikely to be directly related to my father's symptoms (which does not explain why the right foot is particularly numb).

Subsequently, we consulted the orthopedic, rehabilitation, and anesthesiology departments at the same hospital, undergoing various tests including an electrocardiogram, nerve conduction studies, blood tests, and lumbar steroid injections.
We ruled out common issues such as piriformis syndrome, bone spurs, and disc problems, but still could not find a clear cause.
Later, I came across an article stating that "some cases of foot numbness are not due to sciatic nerve compression or poor blood circulation in the lower limbs, but rather due to stenosis of the inferior gluteal artery in the pelvic cavity, which prevents certain nerves from receiving adequate blood flow.
A new treatment has been developed involving the placement of a stent in the inferior gluteal artery to improve blood flow, with all patients experiencing symptom relief within a week." The article suggested that if traditional examinations do not reveal the cause of foot numbness, one should consider checking the inferior gluteal artery.
Thus, we visited the cardiology department at National Taiwan University Hospital for a CT scan, which indicated mild blockage in the inferior gluteal artery, but the blockage in the bladder-related vessels was more pronounced.
Therefore, the doctor could not guarantee that placing a stent would resolve the foot numbness issue, only that it might improve urinary function (which was not our primary concern, as my father does not have significant difficulties in that area).
Since the condition of both inferior gluteal arteries is similar, this still does not explain why my father's right foot is particularly numb.
I would like to ask how we can proceed.
Currently, we are considering scheduling a follow-up appointment for continued observation and postponing the stent placement for now, as stents are expensive and we are uncertain of their effectiveness for this condition.
The persistent numbness in what seems to be a common issue is indeed quite distressing.
Regards,
Kyle

Kyle, 20~29 year old female. Ask Date: 2017/01/18

Dr. Lai Zhaokang reply Neurosurgery

Hello: 1.
It is recommended to further evaluate whether it is a cerebrovascular accident (stroke) or a condition affecting the upper cervical and thoracic spinal cord nerves.
Consider if there is room for further treatment.
Best wishes.
// Dr.
Lai Chao-Kang, Department of Neurosurgery, Changhua Hospital

Reply Date: 2017/01/18

More Info

Dear Kyle,
Thank you for sharing your father's situation regarding his right leg numbness. It sounds like a complex case, and I can understand how frustrating it must be to seek answers without a clear diagnosis. Let's break down the possible causes and management strategies for his symptoms.

Firstly, it's important to recognize that numbness in one leg, especially when it is unilateral (in this case, the right leg), can arise from various underlying conditions. Given your father's age and the gradual onset of symptoms, several factors could be contributing to his condition.

1. Nerve Compression or Injury: Although the MRI did not show significant issues, it's worth noting that even mild herniations or degenerative changes in the spine can lead to nerve compression. The sciatic nerve, which runs down the leg, can be affected by issues in the lumbar spine. However, since the MRI results were deemed not significant, this may not be the primary cause.

2. Vascular Issues: You mentioned the potential for lower pelvic artery stenosis, which could indeed affect blood flow to the legs. While the findings were mild, it’s essential to consider that even slight vascular insufficiencies can lead to symptoms like numbness or weakness. If the blood flow is compromised, it could lead to ischemic symptoms, particularly during activities like walking.

3. Peripheral Neuropathy: This condition, often related to diabetes, vitamin deficiencies, or other metabolic issues, can cause numbness and weakness in the legs. It might be worthwhile to check for any underlying metabolic conditions, including blood sugar levels, vitamin B12 levels, and thyroid function.

4. Musculoskeletal Issues: Conditions such as arthritis or muscle imbalances can lead to altered gait mechanics, which might contribute to symptoms in one leg. Physical therapy focusing on strengthening and flexibility could be beneficial.

5. Other Neurological Conditions: While less common, conditions such as multiple sclerosis or other neurological disorders could present with unilateral symptoms. A thorough neurological examination might be warranted if other causes remain elusive.

Given the complexity of your father's symptoms, here are some recommendations for further management:
- Follow-Up with Specialists: Continue to work closely with neurologists and vascular specialists. Given the mild findings in the pelvic arteries, it might be worth discussing the potential for further vascular imaging or even a trial of conservative management to see if symptoms improve.

- Physical Therapy: Engaging in a structured physical therapy program could help improve strength and mobility in the affected leg. A physical therapist can assess gait mechanics and provide exercises to address any imbalances.

- Pain Management: If your father experiences discomfort along with numbness, discussing pain management options with a pain specialist could be beneficial. This might include medications, nerve blocks, or other interventions.

- Monitoring and Observation: As you mentioned, continuing to monitor the situation is prudent. Keeping a symptom diary could help identify any patterns or triggers that might provide further insights.

- Consider a Multidisciplinary Approach: Sometimes, a collaborative approach involving multiple specialties (neurology, vascular surgery, physical therapy) can yield better insights and treatment options.

In conclusion, while it can be challenging to pinpoint the exact cause of your father's right leg numbness, a comprehensive approach involving further evaluation, physical therapy, and possibly pain management could provide relief and improve his quality of life. Please keep an open line of communication with his healthcare providers, and do not hesitate to seek second opinions if necessary.
Wishing you and your father the best in finding a resolution to his symptoms.

Best regards,
Doctor Q&A Teams

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