Neuropathy - Again?

[Kathi49]

Hi All,

I know I posted something similar to this other day but I have another question.  I have noticed that the small fiber neuropathy is more prevalent in the lateral portion of my ankles (outside) and the first 3 little toes.  The rest of my foot (feet) are okay.  I know that the S1 dermatome can refer pain to those portions of the foot.  But can the L5 also?  Also, can L5 (left side) and S1 (right side) facet degeneration cause these pains in my ankles?  I also know that cervical problems can cause these same issues.  It almost feels arthritic and I have been told by my podiatrist that I do have arthritis in my feet.  I have been tested for S1 joint dysfunction and also urodynamics testing which is currently going on.  So far, the docs don't see anything except mild lumbar issues and they tested me yesterday for a rectocele.  To make a long story short I think they are trying to determine if I have nerve damage or a weak pelvic floor plus if there is any S1 joint dysfunction.  Again, the biggest problem is my ankles and they are killing me.  And...the neck is the worst as compared to my lumbar problems.  Thanks!

[CCF-Neuro-M.D.-SH]

First of all, keep in mind that I am unable to diagnose you because I am unable to examine you, this forum is for educational purposes.  The symptoms of pain in the lateral foot/ankles and the 3 smaller toes is consistent with an S1 distribution of pain.  However, S1 also includes the bottom of the foot is often affected in a S1 root lesion.  An L5 root lesion would be expected to cause sensory problems over the anterior (front) shin and the top/medial (inside) of you foot, which you are not describing.  I would expect your symptoms to be one sided or asymmetric if due to fascet degeneration, and the fact that your symptoms are on both sides equally argues for a cervical spine cause.  
   As we discussed before, It is possible to have a lumbar cause of your ankle pains, but ceratinly the most concerning thing is your cervical spine cord compression, which can also cause the pain as well as paralysis, bowel and bladder dysfunction etc.  I am glad to hear that you are ruling out other causes of bowel and bladder dysfucntion, and would encourage you to proceed with correcting your cervical spinal problem when appropriate.  If after your cervical spine is fixed you continue to have ankle problems, then I would suggest an EMG of the lower extremites and then possible intervention.  
I hope this has been helpful.

[Kathi49]

Thank you again!  I didn't really clarify the sensory symptoms.  There is NO sensory disturbance on or in my shins at all.  What I forgot to mention is that I do have the burning sensations on the lateral sides of my feet and also just a little on the bottom of my feet and some on the top but always more or less the sides of my feet.  I guess I am just trying to find the pain generator and more and more I agree with you that it is probably more cervical than anything else.  My Neurosurgeon never really addressed the PN but more or less told me that if I wait too much longer for a fusion, there may be permanent nerve damage.  So, I am scheduled for a C5/C6 ACDF in September.  Yes, the Urodynamics testing has ruled out a couple of things and I go to them tomorrow to discuss the proctogram I had.  I am trying everything to find out what is going on.  Oh, and I am scheduled for a L5 facet injection on Monday, so we will see if it helps.  It always seems these sensations and such are always worse on the left side. And, I thank you again! :)