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Unusual neuropathy

Discussion in 'General Issues and Discussion Forum' started by pod at home, Mar 29, 2011.

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  1. pod at home

    pod at home Active Member


    Members do not see these Ads. Sign Up.
    I'm hoping you might be able to give me help with a patient I have seen recently who complained of peeculiar sensations in her feet. She describes the sensation as a change rather than lack of feeling 'as if you've been out in snow and got wet shoes and your feet become slightly numb'
    The patiuent is an active but slightly over weight 62 year old, she has been tersted for diabetes, thyroid, aneamis and all tests have come back normal
    On examination the feet were normal temperature for the ambient conditrions and temp gradient was normal - but both hallux were slightly cooler then other diogits
    Pulses were biphasic regualr and palpable, patient has no circulatory issues or varicose veins and miniml telengectasia to posteror of knee
    Testing with monofilament revealed lack of sensation to all digits reduced ensations to met head are, all othjers okay. Neuotip couldn't be differentiated at same area ir felt but rear foot again had normal sensation. Vibration was absent to hallux 1st & 5th met but presnt at all malleoli and tib tub.
    Patient has no unusal skin lesions or apparent foot function problems there is no hitory of trauna to the liombs
    The only significant trauma to occur is back trauma duringa netball incident which led to 2 broken arms so back was ignored due to pressing need to manage arm trauma, this was approximately 15 years ago. The current symtpms have been ongoing for approx 12 months but a gentle deteriortion oif senstion
    I think due to the almost symmetrical results to the tests and the bilaterral nature of the complaint that the neuropathy may be due to compression/trauma at the spune area.
    So has anyone seen these symptoms before any suggestions for causes etc
    Any advice is always appreciated
    Thanks
     
  2. Craig Payne

    Craig Payne Moderator

    Articles:
    6
  3. drsarbes

    drsarbes Well-Known Member

    Hi Pod:
    Symmetrical hypoesthesia makes one consider a generalized neuropathy. i.e., Diabetic, alcoholic, idiopathic, etc...

    An early bilateral Tarsal tunnel, or a variation of, might be the next DD.

    You might want to test the upper extremities as well.

    Good luck

    Steve
     
  4. conp

    conp Active Member

    Craig ....you made my day with the link to 'wet sensation on the bottom of the foot'. Interesting thread. The following response caught me off guard and I had a really good 'belly laugh'

    Re: wet sensation bottom left foot
    Yesterday I too had a "wet sensation" on the bottom of both of my feet. I then realized that I was in my swimming pool, so all is ok now.

    Regards,
    Con
     
  5. footdrcb

    footdrcb Active Member

    Me too....Very enjoyable. At least I did learn the correct spelling of a few words..

    FDCB

    Feeling like Billy Crystal in Analyse this,,,"get a life"
     
  6. Aims

    Aims Member

    To make sense of strange sensation is sensational, though submerged somatic pathways seldom surrender their secrets with simplicity.

    Could the wet feeling be related to the reduction in nerves not relating homeostatic information therefore not controlling blood flow with changing climate?
    Patient: Female Fat over Forty = trouble
    What we know is where the problem will be along the somatosensory pathway.
    It sounds like the initial red flags have been ruled out (diabetes and plantar nerve damage/impingement) and I’m sure we all agree reduced sensation being bilateral points to higher up or systematic issues.
    Some food for though could be…….
    With her weight and age there could be a high chance of Osteoporosis that is often seen in the high weight bearing area of the spine L4, leading to compression of the nerve, that happens to be the origin of the lateral and medial plantar nerve.
    Maybe if diabetes is off the cards there could be a B12 deficiency, often seen in alcoholics, but also in older women with poor diets ie. the overweight.
    Women of that age are also at a higher chance of MS, a lesion in the cerebral cortex in the parietal lobe could cause these symptoms.
    That being said if she has tight pointed shoes ? bilateral mortons neuromas
     
  7. pod at home

    pod at home Active Member

    Thanks for the replies and the links, just wanted to clarify that it isn't a wet sensation she describes it as cold induced numbness - but I was thinking along the same lines as Aims
     
  8. jesspt

    jesspt Member

    If looking for something spinal, have you checked reflexes, especially for all segments from L3 though S1?

    Given that MS was mentioned, has the patient described any symptoms consistent with Lhermitte's sign? Have you looked for upper motor neuron signs such as clonus, Hoffman's reflex, Shimazu reflex, etc?
     
  9. podnz

    podnz Welcome New Poster

    A bit of a lurker here, but check her for clonus she may have cervical myelopathy, it often starts with unusual numbness in the foot.
     
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