Toe Weakness: Causes, Symptoms, and Treatment Options

Inability to flex a single toe?

Hello Dr.
Lee,
On May 28, I applied hydrocortisone ointment and mupirocin ointment to the left fourth distal phalanx, which resulted in adverse drug reactions causing the toe to be unable to bend, weakness, and soreness when forced to bend.
The left fifth toe is also affected, and there is a sensation of heaviness and poor circulation throughout the entire left foot, leading to abnormal balance.
The symptoms include:
1.
The first three toes are unable to support, with a collapsed arch, resembling posterior tibial tendonitis.
2.
Difficulty in single-leg support on the left foot.
3.
Right lower back soreness.
4.
Standing in a staggered position (with the right foot supporting).
5.
A popping sound while walking.
6.
After standing for a few minutes, the soles of the feet and ankles begin to feel numb due to poor circulation.
The symptoms include:
1.
Visible blood vessels on the inner ankle and calf of the left foot, with a sensation of pressure and numbness.
2.
When there is weight on the left foot, there is also a sensation of pressure and numbness.
In terms of diagnostics: X-rays, ultrasound, blood tests, nerve conduction velocity (NCV) tests, lumbar spine, and spinal examinations are normal.
For treatment: Acupuncture has improved the pressure and numbness in the ankle and calf.
Neurology medications have suppressed the numbness.
Elevating the foot, stretching, and soaking in warm water have provided some relief.
I am unable to understand the following phenomena:
1.
The side effects of hydrocortisone and mupirocin ointments should not be this severe.
2.
Pressing on the left fourth toe causes numbness in the calf.
Regarding my personal medical history: No family history, no drug allergies, and no trauma.
-----------------------------------------------------------
The left fourth toe is weak, and the underlying issue remains.
Once the effects of these treatments wear off, all the abnormal balance and poor circulation problems slowly resurface.

Doctor, what should I do next (other tests, treatment directions), or what could this condition be called? The symptoms have persisted for 24 hours, and my left foot feels heavy, significantly affecting my daily life.

David, 20~29 year old female. Ask Date: 2021/07/03

Dr. Li Yanheng reply Rehabilitation

This situation cannot be fully diagnosed or advised based solely on online text descriptions.
It is recommended to continue follow-up treatment with a neurologist or rehabilitation specialist, and consider undergoing nerve conduction studies and electromyography at a hospital.

Reply Date: 2021/07/03

More Info

Toe weakness, particularly in the context you described, can be attributed to several potential causes, including neurological, muscular, or vascular issues. Given your symptoms and the treatments you've undergone, it is essential to consider a comprehensive approach to diagnosis and management.

Causes of Toe Weakness
1. Neurological Causes: Conditions such as peripheral neuropathy can lead to weakness and sensory changes in the toes. This can be due to various factors, including diabetes, vitamin deficiencies, or exposure to certain medications. In your case, the use of hydrocortisone and other topical medications may have contributed to nerve irritation or dysfunction.

2. Muscular Causes: Weakness in the toe muscles can arise from muscle strain or injury, particularly if there has been an imbalance in muscle use. The symptoms you describe, such as difficulty with single-leg support and a collapsed arch, suggest that there may be an underlying muscular issue, possibly involving the posterior tibial muscle or other intrinsic foot muscles.

3. Vascular Causes: The sensation of heaviness and poor circulation in your left foot could indicate vascular insufficiency. This can lead to symptoms like numbness, tingling, and weakness, particularly when standing or walking.

Symptoms
Your symptoms include:
- Inability to flex the fourth toe and weakness in the fifth toe.

- Sensations of heaviness and poor circulation in the left foot.

- Difficulty with balance and single-leg support.

- Pain and discomfort in the ankle and lower leg.

- Visible signs of vascular issues, such as blood vessels on the inner ankle.

Diagnostic Approach
Given that you have already undergone X-rays, ultrasounds, and nerve conduction studies (NCV), it may be beneficial to consider the following additional evaluations:
- MRI of the lumbar spine: To rule out any potential nerve root compression that could be affecting the lower extremities.

- Electromyography (EMG): To assess the electrical activity of the muscles and help identify any neuromuscular disorders.

- Vascular studies: Such as Doppler ultrasound to evaluate blood flow in the lower extremities.

Treatment Options
1. Physical Therapy: Engaging in a structured physical therapy program can help strengthen the muscles of the foot and improve balance. A physical therapist can design exercises tailored to your specific needs, focusing on strengthening the intrinsic muscles of the foot and improving proprioception.

2. Medication Review: Discuss with your physician the side effects of the medications you are using. If the topical medications are contributing to your symptoms, alternative treatments may be necessary.

3. Pain Management: If you experience significant discomfort, consider discussing pain management options with your healthcare provider. This may include non-steroidal anti-inflammatory drugs (NSAIDs) or other analgesics.

4. Lifestyle Modifications: Elevating your foot, using compression stockings, and engaging in low-impact exercises can help improve circulation and reduce symptoms.
5. Alternative Therapies: As you mentioned that acupuncture has provided some relief, continuing with this therapy may be beneficial as part of a holistic approach to your treatment.

Prognosis
The prognosis for toe weakness largely depends on the underlying cause. If the issue is primarily muscular or related to nerve irritation, with appropriate treatment, many individuals experience significant improvement. However, if there are vascular concerns or more complex neurological issues, the management may require ongoing care.

Conclusion
It is crucial to maintain open communication with your healthcare providers regarding your symptoms and treatment responses. If your symptoms persist or worsen, further evaluation and a multidisciplinary approach may be necessary to address the underlying issues effectively. Always consult with your physician before making any changes to your treatment plan.

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