Persistent Left Leg Pain: Possible Causes and Solutions

Q: Persistent Left Leg Pain: Possible Causes and Solutions

Hello： 1. Inferior vena cava obstruction may cause the reported symptoms. 2. MRI is very accurate for intervertebral disc diseases and spinal cord disorders, and there should be no blind spots. 3. Please consult a psychiatrist regarding whether antidepressants

Left foot numbness?

Hello Dr.
Chiu, I have been experiencing frequent numbness and tingling in my left leg, extending from my buttocks to my heel, particularly in the heel area.
The symptoms worsen when I stand still for a few minutes or squat down to use the toilet, but I have no issues walking, hiking, or running.
I initially thought it was sciatica and have been treating it as such, but there has been no improvement.
I have undergone two MRIs, and the doctors indicated that there are no bone spurs or disc herniations compressing the nerves.
I have also had nerve conduction studies, CT scans, and orthopedic X-rays, all of which showed no abnormalities.
Additionally, I have undergone physical therapy, including traction and electrical stimulation, for about eight months without any effect.
I have consulted with neurologists, orthopedic specialists, pain management specialists, and even suspected inferior vena cava thrombosis six months ago, which led to vascular imaging that showed some obstruction in the veins behind my navel.
I have been on "Coumadin" anticoagulants for about six months, but my symptoms have not improved.
Over the past five years, I have been seeking treatment from various doctors, including traditional Chinese medicine and massage therapy.
I would like to ask Dr.
Chiu the following questions:
1.
Is it possible for inferior vena cava obstruction to cause such symptoms, especially since I do not have swelling in my calves or thighs?
2.
Are there any blind spots in MRI imaging? It is a very precise instrument, and I have also considered plantar fasciitis and piriformis syndrome, but local steroid injections have been ineffective.

3.
I feel like I have exhausted all options.
About five years ago, I changed jobs and went through an adjustment period, during which I experienced stress and depression.
I took 1-2 antidepressants but stopped due to side effects.
Since then, I have been living comfortably without any depressive symptoms and have a healthy and happy life.
Could the antidepressants I took at that time, including "Prozac" and other antidepressants, have harmed my peripheral nerves?
4.
Could you please help explain why, after more than five years of seeking treatment across different regions, I have not found relief? Thank you!

ku ming ren, 40~49 year old female. Ask Date: 2008/03/26

Dr. Qiu Yushu reply Neurosurgery

Hello: 1.
Inferior vena cava obstruction may cause the reported symptoms.
2.
MRI is very accurate for intervertebral disc diseases and spinal cord disorders, and there should be no blind spots.
3.
Please consult a psychiatrist regarding whether antidepressants can cause peripheral neuropathy; an EMG can be performed to assist in determining if there is peripheral neuritis.
Best wishes, Dr.
Yu-Shu Chiu, Neurosurgery.

Reply Date: 2008/03/26

More Info

Dear Patient,
Thank you for your detailed inquiry regarding your persistent left leg pain. It sounds like you've been through a comprehensive evaluation and treatment process over the past five years, and I understand how frustrating it can be to deal with unresolved symptoms. Let's address your questions one by one.

1. Could inferior vena cava obstruction cause such symptoms?
While inferior vena cava (IVC) obstruction can lead to various symptoms, it typically presents with more pronounced signs such as swelling in the legs, abdominal pain, or changes in skin color. Since you mentioned that there is no swelling in your calf or thigh, it is less likely that IVC obstruction is the primary cause of your symptoms. However, it is essential to continue monitoring your condition with your healthcare provider, as vascular issues can sometimes present atypically.

2. Are there blind spots in MRI?
MRI is indeed a highly sensitive imaging modality, but it is not infallible. Certain conditions, such as small herniations, subtle nerve root compression, or issues related to soft tissues like muscles and fascia, may not be adequately visualized. Additionally, conditions like piriformis syndrome or plantar fasciitis, which you mentioned, can sometimes be overlooked on standard imaging. If you suspect these conditions, a targeted physical examination and possibly a referral to a specialist in musculoskeletal disorders may be beneficial.

3. Could past antidepressant use have harmed peripheral nerves?
While most antidepressants are generally safe, some medications can have side effects that affect nerve function. However, the likelihood of antidepressants causing significant peripheral nerve damage is low. If you experienced side effects that were concerning, it is crucial to discuss these with your healthcare provider. They can help determine if there is a connection between your medication history and your current symptoms.

4. What can be done after five years of ineffective treatments?
Given the complexity of your case, it may be beneficial to consider a multidisciplinary approach. This could involve a combination of physical therapy, pain management strategies, and possibly consultations with specialists in neurology, orthopedics, and pain medicine. Additionally, exploring alternative therapies such as acupuncture, chiropractic care, or even cognitive behavioral therapy (CBT) for pain management could provide some relief.
Persistent pain can also be influenced by psychological factors, including stress and anxiety, which may exacerbate physical symptoms. Engaging in stress-reduction techniques such as mindfulness, yoga, or regular physical activity may help improve your overall well-being and potentially alleviate some of your symptoms.

In conclusion, while it can be disheartening to deal with chronic pain without a clear diagnosis, continuing to seek care and exploring various treatment modalities is essential. I encourage you to keep an open line of communication with your healthcare providers and advocate for yourself in your treatment journey.
Wishing you the best in your pursuit of health and relief from your symptoms.

Sincerely,
Doctor Q&A Teams

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