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Having numbness on top of feet, more on metatarsal area. Taking paracetamol nocte for pain. Suggest?

Apr 2013
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General Surgeon
Practicing since : 2008
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6 months ago started with slight numbness to top both feet, which has progressed to numbness more on the left under foot 5th 4th & 3rd metatarsal area & arch. 59yr old female RN, married 38yrs, 5 children. Take 1g paracetamol nocte for aches & pains, including back.
Posted Tue, 18 Jun 2013 in Back Pain
Answered by Dr. Ivan R. Rommstein 11 hours later
Thanks for your query.

There are many possible causes of toe and foot numbness that you are describing and most of them are not serious or life threatening. In first case these are circulatory and neurogenic cause. Also, considering your pregnancies and vaginal repairs there could be some nerve damage too. Of course obesity is definitely risk factor for loss of sensation in legs and feet. Sometimes there is no particular reason for numbness and it can be part of ageing and nerve degeneration.

So you first need to check legs blood flow and nerve conduction. To check this you should do doppler ultrasound or CT angiography and EMG. There can be nerve compression in lumbar spine so CT scan of lumbar area should be done. Also, diabetic,alcoholic or toxic neuropathy should be ruled out by checking blood sugar, protrombine time, GGT, urea and creatinine.
These tests should be enough to rule out most common causes.

If this is negative then we must consider peripheral neurogenic disorders and the only way to verify this is to perform nerve biopsy.

Treatment depends on underlying cause but helpful can be warm salty baths,avoiding cold water and whether, take B12 vitamin and calcium supplements, stop smoking and lose some weight.

If you experience toe numbness with loss of bladder or bowel control, paralysis, confusion, weakness in the foot, or slurred speech, seek immediate medical attention in an emergency facility.

Wish you good health. If you have any questions I ll be glad to help.
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