Left Toe Numbness: Possible Causes and Solutions

Numbness in the third and fourth toes of the left foot?

Hello Dr.
Jiang: About four months ago, I started experiencing a tingling and numbness in my left toes when I stood on my tiptoes, similar to an electric shock sensation.
Later, during the Qingming holiday, I noticed that my left third and fourth toes felt numb, and when I got out of bed and stepped on the floor, I experienced a sharp pain.
This sensation extended to my entire left leg and buttock, causing soreness in my left buttock and the back of my thigh while sitting, and soreness in my calf while standing, resembling a cramping feeling.
I subsequently visited a neurologist and underwent X-rays, nerve conduction studies, and electromyography (EMG).
The doctor indicated that the first two tests were normal, but the EMG showed reduced strength in my toes.
Upon examination, the doctor noted that my toes could not touch the ground and that my arch was higher than normal, suspecting a polyneuropathy.
The doctor also asked if I would drop my flip-flops, but I do not.
The doctor mentioned that polyneuropathy can be congenital or acquired, so I was scheduled for blood tests and a lumbar MRI, with results to be reviewed on May 18.
I researched the symptoms of polyneuropathy online, and it seems quite alarming, including weakness in the legs and muscle atrophy, among others.
Here are some details: 1.
I started doing core exercises about five months ago, and I stretch afterward, about five days a week for approximately 30 minutes each session.
2.
Initially, my left leg was sore, but after heat therapy and stretching, it has improved significantly, and I hardly feel soreness now.
3.
The doctor prescribed Chuanli coated tablets for me, which have improved the numbness in my toes by more than half.
I would like to ask: 1.
Based on the above information, is the possibility of polyneuropathy high? 2.
With the EMG showing abnormalities, is it possible for the lumbar MRI results to be normal? 3.
There are no similar conditions in my family; could this be a case of congenital polyneuropathy? 4.
Or could it simply be due to poor exercise posture? Thank you, doctor, for your patience in reading this.
I apologize for my concerns, but I am really worried.

Ms. Li, 30~39 year old female. Ask Date: 2023/04/27

Dr. Jiang Junyi reply Neurology

Dear Ms.
Li,
You mentioned "polyneuropathy," which typically shows abnormalities in nerve conduction studies.
The symptoms you described, such as soreness in the entire left leg and buttock, as well as soreness in the left buttock and posterior thigh while sitting, and soreness in the calf while standing, may need to first rule out compression of the sciatic nerve or the fifth lumbar nerve root.
A common issue is a herniated disc causing localized inflammatory responses that lead to lower back pain, which may extend to one or both sides of the buttocks or hips.
If a herniated disc compresses a nerve root, it can result in neuropathic pain (sciatica), with symptoms often located in the posterior thigh, lateral calf, heel, and even the dorsum of the foot and toes.
Some cases of piriformis syndrome can also present similar symptoms.

I recommend consulting a rehabilitation physician for muscle ultrasound or other examinations.
Thank you for your inquiry, and feel free to discuss any related questions!
Wishing you good health, peace, and happiness.
Dr.
Jiang Junyi, Taoyuan Hospital

Reply Date: 2023/04/27

More Info

Dear Patient,
Thank you for sharing your concerns regarding the numbness and discomfort in your left toe and leg. Based on your description, it seems you are experiencing a range of symptoms that could be indicative of several underlying conditions. Let's break down your situation and address your questions systematically.

Possible Causes of Left Toe Numbness
1. Nerve Compression or Entrapment: One of the most common causes of numbness and tingling in the toes is nerve compression. This can occur due to various reasons, such as a herniated disc in the lumbar spine, which may compress the nerves that innervate the lower extremities. This could explain the symptoms you are experiencing, especially if they are exacerbated by certain positions or movements.

2. Peripheral Neuropathy: This condition involves damage to the peripheral nerves, which can lead to symptoms such as numbness, tingling, and weakness in the affected areas. Diabetes is a common cause of peripheral neuropathy, but other factors such as vitamin deficiencies, alcohol use, and certain medications can also contribute.

3. Muscle Imbalance or Poor Posture: Given that you have been engaging in core exercises, it's possible that improper form or overuse could lead to muscle imbalances, which may in turn affect nerve function and lead to symptoms like those you described.
4. Circulatory Issues: Although less common, issues with blood flow can also cause numbness and tingling in the extremities. Conditions such as peripheral artery disease (PAD) could potentially lead to these symptoms, especially if there are risk factors like smoking or a history of cardiovascular disease.

Addressing Your Questions
1. Is the likelihood of polyneuropathy high?: Given that your doctor has suggested the possibility of polyneuropathy and that you have experienced symptoms like weakness in your toes, it is a valid concern. However, the results of your nerve conduction studies and electromyography (EMG) will provide more clarity. If these tests show abnormalities, it may indicate a neuropathic condition.

2. Will the MRI of the lumbar spine show normal results?: While the EMG may show signs of nerve dysfunction, it is possible for the MRI to be normal, especially if the nerve compression is not significant enough to be visible on imaging. The MRI will help rule out structural issues such as herniated discs or spinal stenosis.

3. Could it be a hereditary form of polyneuropathy?: If there is no family history of similar symptoms, it is less likely that you have a hereditary form of polyneuropathy. However, some conditions can manifest without a clear family history, so it is essential to discuss this with your neurologist.

4. Could poor exercise posture be the cause?: Yes, improper posture during exercise can lead to muscle strain and nerve irritation, which may contribute to your symptoms. It is crucial to ensure that you are using correct form during your workouts and to consider consulting a physical therapist for guidance.

Recommendations
- Follow-Up with Your Neurologist: It is essential to discuss your concerns and symptoms with your neurologist, especially after receiving the results of your blood tests and MRI. They can provide a comprehensive evaluation and recommend further testing if necessary.

- Physical Therapy: Engaging in physical therapy may help address any muscle imbalances and improve your posture, which could alleviate some of the pressure on your nerves.

- Lifestyle Modifications: Continue with your core exercises, but ensure you are using proper form. Incorporate stretching and strengthening exercises for your legs and feet to improve overall function.

- Monitor Symptoms: Keep a detailed record of your symptoms, including when they occur and any activities that seem to exacerbate them. This information can be invaluable for your healthcare provider.

In conclusion, while your symptoms are concerning, there are various potential explanations, and many can be managed effectively with the right approach. Please continue to seek medical advice and follow up with your healthcare providers as needed. Your health and well-being are paramount, and addressing these issues early can lead to better outcomes.

Best wishes for your health and recovery.

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