Persistent Leg Numbness: Causes and Treatment Options

Q: Persistent Leg Numbness: Causes and Treatment Options

Hello, sir： Thank you for your inquiry. <br>Here are my responses and recommendations：<br>1. <br>Based on your symptoms, it appears to be a case of radiculopathy, specifically from the buttocks to the heel, with exacerbation of symptoms when standing or squatting (due to tension)

Lower limb numbness and tingling?

Hello Dr.
Chen, I have been experiencing frequent numbness and tingling in my left leg, extending from my buttocks to my heel, especially in the heel area.
It becomes very pronounced when I stand still for a few minutes or squat down to use the toilet.
However, I have no issues when walking, hiking, or running.
I initially thought it was sciatica and have been treating it in that direction, but there has been no improvement.
I have undergone two MRIs, and the doctors said there are no bone spurs or herniated discs compressing the nerves.
I have also had nerve conduction studies, CT scans, and orthopedic X-rays, all of which showed no abnormalities.
I have undergone physical therapy, traction, and electrical therapy for about eight months, but none of it has been effective.
I have consulted with neurologists, orthopedic specialists, pain management specialists, and even suspected inferior vena cava thrombosis six months ago, for which I had angiography done.
They noted some obstruction in the veins behind my navel, and 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.
Chen the following questions:
1.
Is it possible for inferior vena cava obstruction to cause such symptoms, especially since I do not have any 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.
Due to stress, I experienced some depression and took 1-2 antidepressants, but I stopped due to side effects.
Since then, I have been living comfortably and without depressive symptoms, leading a healthy and happy life.
Could it be that taking medications like Buprenorphine and other antidepressants harmed my peripheral nerves?
4.
Could you please explain why, after more than five years of seeking help from various places, I have not found relief? I appreciate your assistance!
5.
If the cause and treatment remain elusive, could consulting a rheumatologist provide any answers?

Mr. Dong, 40~49 year old female. Ask Date: 2008/04/11

Dr. Chen Xianchang reply Rehabilitation

Hello, sir: Thank you for your inquiry.
Here are my responses and recommendations:
1.
Based on your symptoms, it appears to be a case of radiculopathy, specifically from the buttocks to the heel, with exacerbation of symptoms when standing or squatting (due to tension), rather than from activities like hiking or running (which would involve gravitational compression).
Therefore, it is not a common case of bone spurs or herniated discs compressing the sciatic nerve.
2.
Consider the possibility of compression or adhesion at a more proximal location, specifically at the conus medullaris and cauda equina.
This condition is rare but has been documented.
3.
An MRI with contrast is necessary to visualize the spinal canal and surrounding structures clearly.
Additionally, positron emission tomography (PET) imaging can help identify tumors or adhesions smaller than 0.5 cm, but this would be out-of-pocket, costing approximately 40,000 to 60,000 NTD, and is only available at medical centers and select hospitals.
4.
The symptoms of lower limb venous obstruction do not seem to match.
Pain from the piriformis muscle occurs with internal rotation of the hip, and there is tenderness about an inch posterior to the joint, which can help differentiate it from plantar fasciitis, where heel tenderness aligns more closely with your symptoms.
5.
The medication's topical neuropathy is more diffuse and less localized, whereas your symptoms are along the entire nerve pathway, which does not fit.
Your issue does not appear to be an autoimmune or rheumatic problem, and the cause should be sought higher up in the spinal cord.
Finally, I wish you peace and happiness!

Reply Date: 2008/04/11

More Info

Dear Patient,
Thank you for sharing your detailed history regarding the persistent numbness and discomfort in your left leg. It sounds like you have been through a challenging journey over the past five years, and I appreciate your patience and determination in seeking answers. Let’s address your concerns one by one.

1. Could inferior vena cava obstruction cause such symptoms? While inferior vena cava (IVC) obstruction can lead to various symptoms, including swelling in the legs, it is less likely to cause isolated numbness or tingling in the foot without accompanying swelling. The absence of swelling in your calf or thigh makes it less probable that IVC obstruction is the primary cause of your symptoms. Typically, venous obstruction would manifest with more pronounced symptoms, including edema and possibly skin changes.

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 or subtle changes in soft tissue, may not be easily detectable. Additionally, conditions like piriformis syndrome, which involves compression of the sciatic nerve by the piriformis muscle, may not be visible on MRI. If you have already ruled out significant structural issues like disc herniation or bone spurs, it may be worth exploring functional issues or soft tissue problems that could be contributing to your symptoms.

3. Could antidepressants have harmed peripheral nerves? While some medications can have side effects that affect nerve function, the risk of peripheral neuropathy from common antidepressants is generally low. However, certain classes of medications, particularly older tricyclic antidepressants, can have side effects that may impact nerve health. If you suspect that your medication history may have contributed to your symptoms, it is essential to discuss this with your healthcare provider to evaluate any potential links.

4. What should you do next? Given that you have already consulted various specialists without resolution, it may be beneficial to consider a multidisciplinary approach. This could involve working with a pain management specialist, a neurologist, and possibly a rheumatologist to explore any underlying autoimmune or inflammatory conditions that could be contributing to your symptoms. Conditions such as fibromyalgia or chronic pain syndromes can sometimes present with similar symptoms and may require a different treatment approach.

5. Could a rheumatologist provide answers? Consulting a rheumatologist could indeed be a valuable next step. They specialize in autoimmune and musculoskeletal disorders and may be able to identify underlying conditions that have not yet been considered. They can also conduct specific tests to evaluate for conditions like vasculitis or other inflammatory processes that could affect nerve function.

In summary, your symptoms are complex and multifactorial, and it is crucial to continue seeking a comprehensive evaluation. It may also be helpful to keep a symptom diary, noting when the numbness occurs, any activities that exacerbate it, and any other associated symptoms. This information can be invaluable for your healthcare team in determining the best course of action.

I wish you the best in your continued search for answers and relief. Please do not hesitate to reach out for further assistance or clarification on any of these points.

Best regards,
Doctor Q&A Teams

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