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pins and needles in the morning
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pins and needles in the morning

I'm  a 41 yr. old female and have been waking up in the am for the past month and experiencing pins and needles in both feet, primarily the toes, every morning when I first step out of bed.This subsides after I take a few steps but then I have a vibrating sensation in my feet throughout the day.I had this happen with my right hand on only one am though.I had bloodwork which was normal(Tsh,cbc,sed) but my B12 was 285(I was told the normal is 200-1100).Some weird sx that may /may not be related (new onset oily scalp,brittle,bumpy fingernails).I took a 6 cycle course of zithromax which ended in Sept. for ?infection on my fingernails(yellowing and bumpy, I have excema).I have read a lot about vit B deficiency and wonder could this be it?I had restarted multi vits 5 days prior to my B12 check.I have an Mri scheduled (had a negative Mri 4 yrs. ago for a stabbing headache) but would like any input!Thanks!
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Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with your doctor.

Without the ability to examine you and obtain a history, I can not tell you what the exact cause of your symptoms is. However I will try to provide you with some useful information.

One cause of morning foot pain is called plantar fascitis. The plantar fascia is the tissue in the sole/mid foot among the tendons. Plantar fascitis is inflammation of this tissue. The pain typically occurs in the inner side of the heel. The pain typically occurs after taking the first few steps in the morning and improves with continued walking. The pain may radiate up the leg. Causes are mechanical, often due to abnormal inward turning of the foot due to poorly fitting shoes, walking for a prolonged time on uneven surfaces, etc. Treatment for plantar fascitis consists of arch support, anti-inflammatory medications, ice massage and stretching. Injections and surgical treatment are reserved for severe cases that rail conservative management.

Vitamin B12 deficiency can cause some of the symptoms you describe but if your blood test level was normal, even if you were taking supplementation, then it is a deficiency unlikely cause of your symptoms. It seems like your vitamin B12 level was on the lower end of normal (low normal), and a confirmatory blood test called an MMA (methylmalonic acid) can be ordered if vitamin B12 deficiency is suspected. In some cases of vitamin b12 deficiency that are autoimmune, there is an associated anemia. This is called pernicious anemia. in these cases, if there is documented vitamin b12 deficiency or low MMA levels, oral supplementation with vitamin B12 may not be adequate and injections may be necessary. This is only indicated in documented cases of pernicious anemia (otherwise excess amounts of vitamin b12 can be as harmful as a deficiency).

What is atypical of your symptoms for plantar fascitis is that you have continued symptoms throughout the day. These may or may not be consistent with a neuropathy. There are 2 types of nerves in our body, large and small. The small nerve endings supply the skin and sweat glands. There are two types of sensory neuropathy: small fiber and large fiber (depending on the size of the nerves affected). With small fiber neuropathies, symptoms including burning or buzzing or other vague symptoms starting in the feet and hands then in some cases spreading to other parts of the body. There are several causes of small fiber neuropathy, including diabetes, vitamin deficiencies, autoimmune problems

The other type of sensory neuropathy is called a large fiber neuropathy. There are several categories of this type of neuropathy, and there are many many causes. Sensory neuropathies can involve just one nerve or several nerves in the body. The symptoms are sensory loss and if motor nerves are involved ,weakness. Some types of sensory neuropathies occur and progress very slowly, others sort of wax and wane (with flare-ups) and some are progressive. One of the most common causes of neuropathy is diabetes, and sometimes only glucose intolerances, or abnormal rises in blood sugar after a glucose load can be the only indication (this is called a oral glucose tolerance test. Other causes include but are not limited to hereditary/genetic causes, autoimmune problems and demyelinating diseases (such as CIDP). Vitamin B12 and B6 deficiency, as well as excess vitamin B6, can also cause neuropathy. Some toxins can cause large fiber sensory neuropathy. Other causes include abnormalities of protein metabolism.

The diagnosis of large fiber neuropathy is made by findings on a test called EMG/NCS which assess how well the nerve conduct electricity and how well muscles respond. Small fiber neuropathy is diagnosed by skin biopsy. Other tests are ordered based on the history and clinical picture.  

The same processes that affect large fibers can affect small fibers. For example, diabetes can typically do this.

I recommend continued evaluation by your primary doctor for further work-up of yours symptoms with referral to a neurologist should a neuropathy be suspected.

Thank you for using the forum, I hope you find this information useful good luck.
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