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Suggest treatment for extremely painful, tingling toes in left foot

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Posted on Tue, 26 May 2015
Question: I have extremely painful, tingling toes in my left foot, mainly the two middle toes but my whole foot is painful (10 years duration). I have had back surgery, also an operation on my inner ankle (tendon) to try to reduce the pain. Currently I am taking Orudis caps and Cortisone twice daily. Recently my foot and lower leg swelled badly (which is why my rheumatologist prescribed the Cortisone). I had a subarachnoid haemhorage 20 years ago resulting in my left side being numb. Is it something to do with this? I have gradually regained a lot of the feeling in my left side. Hope you can help. XXXX
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Answered by Dr. Olsi Taka (31 minutes later)
Brief Answer:
Subarachnoid hemorrhage origin very unlikely.

Detailed Answer:
I read your question carefully and I understand your concern.

Your hypothesis about the subarachnoid hemorrhage being at the root of your symptoms is a valid one. Considering the numbness was present on the same side, it could in theory be a remain of damage to the cortex. However the numbness would usually present in a more extended area than some of the toes, so to be honest I would consider that to be highly improbable. Also adherences created by the blood can create compression of the nerve roots which could cause similar symptoms, but you’ve had also had surgery to relieve your nerve roots and it would also show o nerve conduction studies so that is improbable as well.

In my opinion the cause is to be found in the arthritis which you report to have been diagnosed with which can also cause similar symptoms due to compression of small nerves by inflammatory changes. It would not be picked on nerve conduction studies due to that exam being able to evaluate only greater nerves.

So while post subarachnoid hemorrhage origin can not be completely excluded, I would consider them as probable factor only when all other causes are ruled out and in your case you have a much more common and sensible explanation like distal joint arthritis.

I remain at your disposal for further questions
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Olsi Taka (1 hour later)
Thanks for our advice. What treatment would you advise to improve my condition and give me relief from the pain. I am taking Panadeine tablets every day and Panadeine Forte when I want to go out, as well as Cortisone, Plaquenil and Oridus for the rheumatoid arthritis. I can't even bear to wear closed shoes. XXXX
doctor
Answered by Dr. Olsi Taka (40 minutes later)
Brief Answer:
Read below.

Detailed Answer:
I can fully imagine the distress you are in and the disability these symptoms can cause to your walking and daily activities. You seem to already have tried most of the drugs used for pain like antiinflammatories, acetaminophen and opioids (the codein present in Panadeine). I would give Cortisone some more time since you mention to have started it only recently, one would prefer to use as few drugs as necessary since all carry a potential of side effects.
If it is not enough, the only untried option is with medication for chronic neuropathic pain, which are either antidepressants like duloxetine, venlafaxine or anticonvulsants like pregabalin, gabapentin.

I hope to have been of help.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Olsi Taka

Neurologist

Practicing since :2004

Answered : 3669 Questions

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Suggest treatment for extremely painful, tingling toes in left foot

Brief Answer: Subarachnoid hemorrhage origin very unlikely. Detailed Answer: I read your question carefully and I understand your concern. Your hypothesis about the subarachnoid hemorrhage being at the root of your symptoms is a valid one. Considering the numbness was present on the same side, it could in theory be a remain of damage to the cortex. However the numbness would usually present in a more extended area than some of the toes, so to be honest I would consider that to be highly improbable. Also adherences created by the blood can create compression of the nerve roots which could cause similar symptoms, but you’ve had also had surgery to relieve your nerve roots and it would also show o nerve conduction studies so that is improbable as well. In my opinion the cause is to be found in the arthritis which you report to have been diagnosed with which can also cause similar symptoms due to compression of small nerves by inflammatory changes. It would not be picked on nerve conduction studies due to that exam being able to evaluate only greater nerves. So while post subarachnoid hemorrhage origin can not be completely excluded, I would consider them as probable factor only when all other causes are ruled out and in your case you have a much more common and sensible explanation like distal joint arthritis. I remain at your disposal for further questions