ASK

I have the same symptoms as above aggrivated mainly by cold. No solution yet. Can anyone help?

samiam, Thank you. We submitted your question to a highly regarded podiatrist -- Dr. Marlene Reid, D.P.M., FACFAS, FACFAO. Here was her response.

"The symptoms you are describing sound like it is a nerve problem. Tingling, pins and needles all represent nerve pain. What is frustrating with nerve symptoms, is that they are not always consistent at first. If the sensations are occurring when you are off your feet - either while sitting or in bed - it is a better indicator that it is coming from a nerve. There are four nerves that go to every toe and irritation can be caused simply from shoes or a bone problem. I would start with a podiatric physician to first see if it is coming from your foot. I would inject the area to see if that calms down the nerve - usually it does! Lower back symptoms usually start in the back and shoot down the leg."

Does that help?

It's very helpful to know I can rule out lower back, so I'll make a call to my podiatrist. I'd hate to find out it's being caused by my running shoe - yikes!

Lower back issues can refer down your leg such as sciatica. However the lower joints in your spine also refer directly to your feet. So you can have some irritation to the lower spinal nerves without back pain or sciatica - but just toe discomfort.

Does this mean it is definitely from your lower back? No.

Most problems are a combination of a few minor factors. Most of which you can deal with your self at home and then see a practitioner if the problem persists.

Bu tit will be only a minor problem and simple to fix your self.

Cheers
Dr Graeme Teague
The Back Pain Advisor
www.back-pain-advisor.com
www.backpainadvisor.wordpress.com

Hi,

I have been experiencing pins & needles in my toes of my left foot more than a month ago and until lately, it worsened into rather severe pain at the base of the proximal phalanges of those 2 toes. At first, I thought the pain was coming from the 3rd & 4th toes but now, it seems like it's coming from the 2nd & 3rd toes. I consulted a general doctor & was advised to obtain an x-ray. However, results did not indicate any anomalies. I told the doctor that I took some voltaren to alleviate the pain and it worked after consumption for just 1 day. The doctor advised me to continue to wear normal working shoes once the pain stops & to monitor what happens next. I stopped taking the medication after 1 day and only wore sneakers to work and the pain eased for a couple of days until it returned again just a few days ago. The pins & needles & tingling sensation only come on intermittently and also only when I walk. On 1 occasion when I felt that my 2 toes were numb, I noticed that the 2nd & 3rd toes turned bloodless (most probably due to poor blood circulation) when the weather was cold. Despite me applying pressure & massaging the toes, they were still pale until I got onto my feet and walked for a long while. To add, I usually have cold hands and feet.

Initially, I suspected the pain resulted from ill-fitting shoes and after researching on the internet, it seems like the causes can be a few & I'm getting a little worried, especially now that I'm in the initial stage of pregnancy and am worried that any treatment (especially injections, medications/ surgery) would affect the fetus. I am thinking of consulting a podiatrist but I'm not sure if I should see a general doctor again before going direct to a podiatrist? Any advice on this would be greatly appreciated. Thanks!

A quick question for you -- Does your foot fall asleep? And I will pass this along to a podiatrist to see what we can find out for you. Thanks for writing.

First of all, congratulations on your pregnancy! Don't worry about about complicating the pregnancy just yet, there are a lot of easy things that might help.

It sounds like you have either a neuroma, which is inflammation of the nerve between the base of the toes or getting compression on the nerve that goes to the toes. If it is a neuroma, wearing flatter shoes can help and also having a spacing pad placed in the appropriate spot on the bottom of the foot. A podiatric physician is the best person to make the diagnosis.

The podiatrist will also rule out tarsal tunnel syndrome, which is like carpel tunnel syndrome, that can cause pressure on the nerve that goes to the bottom of the entire foot including the toes. Often arch supports can get rid of the symptoms.

It also sounds like you may have Raynaud's Disease which causes cold fingers and toes and this, too may be causing the nerve symptoms you are having. Be sure to mention the history of cold fingers and toes when you see the podiatrist.

Most Raynauds cases are simply an annoyance and don't require treatment, but if your fingers and toes are really turning white at times, you should discuss it with your primary care provider. I am assuming you don't smoke - that would be the first thing to change if you did!

No, I don't smoke. Thanks for your advice, Dr. Marlene, much appreciated.

Do you wear your orthotics in your running shoes?

I had custom orthotics made for my running shoes, by an elite athlete/technician who makes them for other elite athletes (I certainly don't fall in that category, I just seriously needed help), and they were fine - once I got used to them. But, last training season, someone raved about Sole Ultra heat moldable inserts. I tried them and have been a convert, ever since. They're so much more comfortable than my orthotics.

The problem with wearing your arch supports in running shoes is that, because running shoes should be larger (by as much as 2 sizes) than your dress shoes, the arch supports may not be hitting your feet properly as they're trying to compensate for the difference in arch placement in the shoe.

Just a thought, but I know that's what was going on with my running shoes before I found the solution that works for me.

The inserts in that come in the running shoes can be taken out and replaced with other inserts of your choice. Were your orthotics made to go under their own footbed covers?

My chiropractor thought that the pins and needles sensation I'm getting could be from a pinched nerve in my back. After my last alignment a couple of weeks ago, I haven't felt the pains.

So, it could be a pinched nerve, but it could also be a circulatory issue. Have you gone to a Chiropractor or Osteopath for an opinion?

I used to see an osteopath regularly and mentioned it to him previously. He thought it may be a trapped nerve and tried to release it - but it did not improve the situation. I spoke to him last night and he recommended seeing an osteopath again - so i am going to book an appointment. I originally thought a reflexologist may help - but I have since been advised to see an osteopath.

Thanks for letting me know.