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'
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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
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