Foot numbness due to tendon problems

[Dufour]

I am a 58 year old male and in the past 12 months the ball of my feet have become progressively numb. I still have feeling when I touch the skin but there is a loss of feeling when I walk a lot or swim. At first it was thought to be diabetic neuropathy as I am a borderline type 2 diabetic but my glucose levels are mostly within the normal range, when monitored. Nerve conduction tests were also normal. The latest theory is that it might be tarsal tunnel syndrome and I have had cortisone injections with limited success. I have no regular pain in my feet but they mostly feet tender and they hurt easily when barefoot. One thing I have noticed is that the tendons in the ankle area are often sore and when my legs are stretched and my foot is pointed upwards then I experience the same kind of numbness in the underside of my feet. Could this be tarsal tunnel?

[Kevin Pho, MD]

Tarsal tunnel is certainly possible - although it would be difficult to say for sure without examination.

The presence of diabetes would certainly increase the risk of neuropathy - although with the normal nerve conduction studies it would make nerve disorders less likely.  

To know for sure, I would suggest a referral to a podiatrist for further evaluation.  If cortisone injections are not helpful, you may inquire about surgical correction.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
kevinmd_b

[B_Johnson]

What you are experiencing is some form of nerve compression of the Medial Tibial Nerve which innervates the ball of the foot.  

This nerve is a branch of the Tibial nerve which courses down the back of your lower leg, wraps around the heal on the lateral side and then travels down the dorsum (sole) of your foot.  This nerve travels below many muscles including the muscle groups that you described in the ankle.  It also travels thru a flexor retinaculum (essentially a canal or tunnel) similar to that of the median nerve of your hand which is reponsible for carpal tunnel syndrome.

Other things that travel thru this 'tunnel' are arteries, veins and muscles which control movement of the foot and toes.  As these muscles become larger during exercise, they may compress the nerve as there is limited space in the tunnel.  This can lead to the symptoms of pain or numbness.  The nerve can also be compressed by a muscle outside of the tunnel and lead to the same symptoms.  

Does this only occur on one side?

Do to the localized nature of the complaint, I believe that this is the best explaination for such symptoms.  The diabetic neuropathy you were concerned about would progress in a different fashion starting at the toes and would most likely be bilateral accompanied with some tingling.

Exploratory surgery would be a complicated option but might provide a cure if you are really concerned.

My advice would be to try some simple stretching exercises before you do any major activity involving your feet.  The main exercise which might help you is dorsiflexion stretching.  There are several techniques and many runner use them.  It involves flexing your foot upwards so you feel the stretch in the sole of your foot as well as the back of your calf and lower leg.

Technically these exercises allow your muscles to provide the same amount of strength without growing as much in diameter, thus causing less space occupying compression.

You might also consider shoes that you are wearing which may be putting pressure in the wrong area.

Because of your age circulation in your feet may also be a concern.  But due to the localized nature of your numbness this may be less likely but worth mentioning to your physician.

Please consult with your physician to see if this might be an option for you.

Feel free to ask any more questions that you may have.

-Dr. J

[arries]

What's is the difference from an accucheck result, and a Glucose level from a lab?

I used to work in a hospital, and the nurses always used an accucheck to check the patients blood level, if it was low or high they of course would take action on that.

I had mine done during those times, and I've had low blood sugar levels as low as 30, but everytime I do a fasting blood sugar they are usuall borderline normal.  The last one I did was I think 102 past results were 87, 110, & 97, and I assume this is normal?  I have chronic pain in my legs, with loss of feeling after having severe numbing pain and stiffness.  I recently was diagnosed with an ulnar neorpathy in my left arm, and my left leg feels the same pain as my left arm, but my legs were never tested. My left side of my face near the lips and teeth get numbness from sitting down for a few minutes, as does my right hand after putting it on egonomic bead pad.  I'm constantly fatigued, moody of course, from pain.  

Some labs:
positive ANA 1:320 Nucleolar pattern in 1992 1:640 Nucleolar pat.
ESR 23 H
RF <20.0 [0-20]

Any thought anyone?