Brief Answer:
Reasons can be several.Vitamin B12 and Diabetes are among the commonest.

Detailed Answer:
Hi XXXX,
Thanks for being on healthcaremagic.com.
I am Dr.Ajay Panwar,a neurologist,here to answer your query.

If you would have presented to me as an outpatient with numbness and tingling in toes,I would have told you that-there can be several reasons for persistent numbness and tingling in toes which are-
1)Diabetes
2)Vitamin B12 deficiency
3)Peripheral neuropathy-These complaints are the classical complaints of peripheral neuropathy. Peripheral neuropathy can be caused by multiple etiologies.Diabetes is the commonest cause of peripheral neuropathy.Other causes can be-occupational related,drug induced,infection related,connective tissue disorders.
4)Radiculopathy-Radiculopathy due to spine degeneration or disc problems causing nerve root compression.
5)Multiple sclerosis-Though this disease is associated with remitting and relapsing course,but sometimes can start with tingling in toes(numbness is uncommon).Should be at the bottom of the list after all other common causes are excluded.
6)Anxiety-Last but not the least,anxiety is a common cause of tingling and numbness in toes.

Plan-Not to overinvestigate,I would like to advise you to get these investigations done initially-
1)Blood sugar-fasting and post prandial
2)Serum vitamin B12 and serum homocysteine
3)Nerve conduction studies
Meanwhile please be on the following therapeutic plan-
1)Start doing regular mental relaxation exercises/Yoga/meditation.
2)Tab.pregabalin 75 mg once a day.
3)Tab.methylcobalamin 1500 mcg once a day
4)calcium and vitamin D supplementation.

If the above investigations turn out to be negative-
MRI Spine to be planned.

Hope I have answered your query for now.If you have some follow up questions,I shall be glad to answer else,please close the thread-rate it and write a review.

Dr.Ajay Panwar,
MD,DM(Neurology)

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