Left Foot Weakness: A Comprehensive Neurological Evaluation

Q: Left Foot Weakness: A Comprehensive Neurological Evaluation

Hello Mr. <br>Gao： You mentioned that in January 2022, you noticed weakness in pressing down and lifting up your left foot, as well as involuntary muscle twitching in the left foot. <br>It seems that similar examinations are being conducted, and the lumbar MRI has been repeated.

Weakness in the left foot?

The current situation is as follows: Since November 2021, there has been poor walking posture.
In January 2022, weakness was noted in the left foot, with an inability to press down or lift up.
Additionally, there have been frequent involuntary muscle twitches in the left foot.
In January, a surface nerve conduction study was performed at the postal hospital, and in February, a lumbar MRI was conducted.
The doctor believed that although there were some issues with the lumbar spine, they were not severe enough to cause weakness in the left foot, so a referral was made to National Taiwan University (NTU).
After performing a needle electromyography and reviewing the MRI, the neurologist at NTU concluded that there was indeed a problem with the lumbar spine and recommended rehabilitation instead of surgical treatment.

Upon returning to the postal hospital, treatments included electrical stimulation for the left foot, heat therapy for the lumbar region, and lumbar stretching rehabilitation.
After more than ten sessions, the condition not only did not improve but worsened.
The rehabilitation doctor suggested seeking opinions from other specialists, leading to a referral to the neurosurgery department at the postal hospital.
After reviewing the imaging, the neurosurgeon also concluded that there were no issues with the lumbar spine and recommended returning to NTU.

The neurosurgeon at NTU reviewed the imaging and similarly stated that there were no problems with the lumbar spine but could not provide further treatment, so a referral was made to the neurology department at the Veterans General Hospital.
After arranging another needle electromyography and reviewing the imaging, the neurologist determined that there was a lumbar issue.
To be thorough, a referral was made to the nerve repair department.

The nerve repair department arranged for the following examinations: a brain CT scan, cervical and lumbar MRIs, X-rays of various regions from the neck to the knee, ultrasounds of both legs, electromyography (assessing the brain's response to various body parts), and a needle electromyography (scheduled for May 27).
Today, after reviewing the aforementioned examinations (excluding the needle electromyography yet to be performed), the doctor concluded that there is a slight issue with the cervical spine, but it should not cause weakness in the left foot.
We will have to wait for the needle electromyography results, with a follow-up appointment on June 14.

Given that the symptoms are becoming increasingly severe, I would like to inquire if there are any suitable hospitals or doctors who can provide treatment.

Gao Mingchuan, 60~69 year old female. Ask Date: 2022/05/20

Dr. Jiang Junyi reply Neurology

Hello Mr.
Gao: You mentioned that in January 2022, you noticed weakness in pressing down and lifting up your left foot, as well as involuntary muscle twitching in the left foot.
It seems that similar examinations are being conducted, and the lumbar MRI has been repeated.
This is because there is a higher chance of nerve root compression occurring.
1.
The pain has a burning, electric quality.
2.
Symptoms have a specific dermatomal distribution, and touching or pressing can provoke the symptoms.
3.
Accompanied by muscle soreness and weakness.
I wonder if you have any other underlying medical conditions, such as hypertension or diabetes.
With aging, there may be many age-related diseases.
The recommended principle for seeking medical care is to find a nearby hospital with an emergency department to consolidate your medical information in one place.
It is also advisable to undergo a brain MRI to rule out cerebrovascular diseases.
Thank you for your inquiry, and feel free to discuss any related issues! Wishing you good health and peace.
Dr.
Jiang Junyi, Taoyuan Medical Center, cares for you.

Reply Date: 2022/05/20

More Info

Based on your detailed description of symptoms and the extensive evaluations you've undergone, it appears that you are experiencing significant left foot weakness and associated neurological symptoms. The progression of your symptoms, including the inability to lift or press down with your left foot, involuntary muscle twitching, and the worsening condition despite various treatments, raises several important considerations.

Firstly, the symptoms you describe could indeed be indicative of a neurological issue. The fact that you have undergone multiple tests, including nerve conduction studies and MRI scans, suggests that your healthcare providers are taking your concerns seriously. The findings of mild cervical spine issues and the ongoing evaluation for lumbar spine problems are critical, as both regions can affect nerve function and muscle strength in the lower extremities.

The left foot weakness you are experiencing could be attributed to several potential causes:
1. Radiculopathy: This condition occurs when a nerve root in the spine is compressed or irritated, often due to herniated discs or spinal stenosis. Given your history of lumbar and cervical spine evaluations, it is possible that nerve roots supplying the left leg are being affected, leading to weakness and abnormal sensations.

2. Peripheral Neuropathy: This condition involves damage to the peripheral nerves and can result from various factors, including diabetes, vitamin deficiencies, or autoimmune diseases. The involuntary muscle twitching you mentioned could also be a sign of peripheral nerve involvement.

3. Muscle Disorders: Conditions such as myopathy or muscular dystrophy could lead to weakness and muscle twitching. These would typically be evaluated through specific blood tests and possibly a muscle biopsy if indicated.

4. Cervical Spondylosis: While your doctors have indicated that cervical spine issues may not be the primary cause of your left foot weakness, it is essential to consider that cervical spondylosis can lead to upper motor neuron signs, which might manifest as weakness in the lower limbs.

5. Functional Neurological Disorder: In some cases, neurological symptoms can arise without a clear structural cause, leading to functional issues. This diagnosis is often considered when other potential causes have been ruled out.

Given the complexity of your symptoms and the inconclusive results from various specialists, it may be beneficial to seek a multidisciplinary approach. Here are some recommendations:
- Neurology Consultation: Continue to work closely with a neurologist who specializes in neuromuscular disorders. They can provide a comprehensive evaluation and may recommend additional tests, such as an electromyography (EMG) to assess muscle function.

- Physical Medicine and Rehabilitation: A physiatrist can help develop a tailored rehabilitation program that focuses on improving strength, flexibility, and function in your left foot. They can also address any pain management needs.

- Pain Management Specialist: If pain is a significant component of your symptoms, a pain management specialist may offer interventions that can improve your quality of life.

- Second Opinion: If you feel that your concerns are not being adequately addressed, seeking a second opinion from a different medical center or a specialist in a specific area of neurology or rehabilitation may provide new insights.

In conclusion, while your symptoms are concerning, they do not definitively indicate a single diagnosis such as amyotrophic lateral sclerosis (ALS) or other severe conditions without further evidence. It is crucial to continue pursuing a thorough evaluation and to advocate for your health. Keep a detailed record of your symptoms, any changes, and the effects of treatments, as this information can be invaluable in guiding your healthcare providers toward an accurate diagnosis and effective treatment plan.

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