[69M] With progressive numbness in toes

Patient Description

A 69-year-old male presents with a progressive loss of feeling in the bottom of his toes on the right foot, which has been present for the past 30 days. Initially, the numbness was limited to the three smallest toes but has since progressed to all toes on the right foot. The patient also reports starting to feel some loss of sensation in the big toe on the left foot. The numbness is described as a complete lack of feeling, with sensitivity still present on the tops of the toes. The patient denies any pain, tingling, or burning sensations, as well as any weakness, balance issues, changes in gait, or difficulty walking. There is no history of diabetes or other chronic medical conditions, and recent blood tests did not show elevated sugar levels. The patient has not experienced any recent injuries, infections, or illnesses. Current medications include Omeprazole 40 mg daily and Rosuvastatin 40 mg daily, both taken for over 14 years to manage high cholesterol and gastric reflux. There are no known allergies or adverse reactions to medications, and the patient is not taking any other prescription, over-the-counter medications, supplements, or herbal remedies.

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Arora's Assessment

What might be happening

Based on the information you have provided, here are some possible explanations for your symptoms:

  • Peripheral Neuropathy: This condition involves damage to the peripheral nerves, often causing numbness, tingling, or weakness, typically in the hands and feet. It can be caused by various factors, including prolonged use of certain medications, such as statins, or underlying conditions like diabetes, even if your blood sugar levels are normal.

    • Treatment: Treatment often involves managing the underlying cause, such as adjusting medications or addressing nutritional deficiencies. Medications to manage symptoms, physical therapy, and lifestyle changes may also be recommended.
  • Vitamin Deficiency: Deficiencies in certain vitamins, particularly B vitamins, can lead to nerve damage and symptoms like numbness and tingling in the extremities.

    • Treatment: Treatment involves dietary changes and supplementation to correct the deficiency.
  • Spinal Issues: Conditions such as spinal stenosis or herniated discs can compress nerves and lead to numbness or loss of sensation in the feet.

    • Treatment: Treatment may include physical therapy, medications, and in some cases, surgery.
  • Tarsal Tunnel Syndrome: This condition is similar to carpal tunnel syndrome but affects the feet. It occurs when the tibial nerve is compressed as it travels through the tarsal tunnel in the ankle.

    • Treatment: Treatment options include rest, ice, anti-inflammatory medications, physical therapy, and in some cases, surgery.

What you can do

While it's important to consult a healthcare professional for a formal diagnosis and treatment plan, here are some steps you can take in the meantime:

  1. Monitor Your Symptoms: Keep track of any changes in your symptoms, including any new areas of numbness or other sensations. You can use MDandMe to journal your symptoms, track progress, get insights, and share longitudinal medical notes with your provider.
  2. Check Your Footwear: Ensure that your shoes are comfortable and provide adequate support. Poorly fitting shoes can contribute to nerve compression.
  3. Maintain a Healthy Diet: Ensure you are getting a balanced diet rich in vitamins and minerals, particularly B vitamins, which are essential for nerve health.
  4. Stay Active: Gentle exercises, such as walking or swimming, can help improve circulation and nerve function. However, avoid activities that exacerbate your symptoms.
  5. Avoid Alcohol: Excessive alcohol consumption can contribute to nerve damage, so it's best to limit or avoid alcohol.

What you should look out for

Seek medical attention if you experience any of the following:

  • Worsening Symptoms: If the numbness spreads or becomes more severe, or if you start experiencing pain, tingling, or burning sensations.
  • Weakness or Coordination Issues: If you notice any weakness in your legs or difficulty with balance or coordination.
  • New Symptoms: If you develop new symptoms, such as changes in your gait, difficulty walking, or any other concerning signs.

Remember, while this information can help you understand your symptoms, it is not a substitute for professional medical advice. Please consult a healthcare provider for a thorough evaluation and appropriate treatment.

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5 mo ago


People Also Ask


What is peripheral neuropathy and what causes it?

Peripheral neuropathy is a condition where the peripheral nerves are damaged, leading to symptoms like numbness, tingling, or weakness, often in the hands and feet. It can be caused by factors such as diabetes, prolonged use of certain medications, infections, or nutritional deficiencies.


Can vitamin deficiencies cause numbness in the feet?

Yes, deficiencies in certain vitamins, particularly B vitamins, can lead to nerve damage and symptoms like numbness and tingling in the extremities. Correcting the deficiency through dietary changes and supplementation can help alleviate these symptoms.


How can spinal issues lead to numbness in the toes?

Spinal issues such as spinal stenosis or herniated discs can compress nerves that travel to the feet, leading to numbness or loss of sensation. These conditions may require treatments like physical therapy, medications, or surgery to relieve the compression.


What is tarsal tunnel syndrome and how is it treated?

Tarsal tunnel syndrome is a condition where the tibial nerve is compressed as it travels through the tarsal tunnel in the ankle, similar to carpal tunnel syndrome in the wrist. Treatment options include rest, ice, anti-inflammatory medications, physical therapy, and sometimes surgery.


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