Expert: Dr. J. Shawn Leatherman - 12/26/2006

Question
Hello Dr. Leatherman:

Three months ago, I bought boots with did not support my arch well enough and stretched even more.  Also, I carry a bit on my right-side and do not lift my shoulder up to compensate as that aggravates my bag.  I tend to crunch slightly on the right.  I was walking a lot in Manhattan while job hunting and started working at Thanksgiving.  

About two months ago, I noticed my little toes on one or both feet going slight numb and tingly.  Didn't pay enough attention to it, and now it's much worse.

One and half weeks ago, I started getting numb/tingling and burning in both feet equally from toes going towards arch.  From Wednesday to Saturday, it spread and I am numb from my waist down in varying degrees, including the front up to my ribcage, stomach area, not as much up my back as it is the front and both legs down equally.

I am in good physical shape, but have extra-joint mobility.  

I went to a Chiropractor, had x-rays, have nothing impacting my spine and have a good spine in general.  The vertebrae (13 & 14?) that affect gallbladder etc are tweaked out (not the disc, more position as tendons pull).

The chriropactor I saw said it would take 6-8 visits to fix.  

I am going to check, but I had surgery in May (left ovary removed with 6.5 inch complex cyst, no cancer) and believe that they tested for diabetes and maybe lyme prior to surgery.  

Is there anything else that could cause this?  

My first two chriropractor appointments were the Thursday and Friday last week before Christmas.  After the first visit, some of the tinging/burning increased instead of just being number. My assumption is that this is good as it signals some feeling returning.

At the end of a day where I stood or walked too much (christmas eve dinnter), there was more pain, spasms, sharp needle like pains. It gets better when I rest or stay sittin lying down and builds as I walk or do anything.  Just walking makes the tingling burning worse in my feet the longer I am on them, starting after the first couple of minutes.

Any suggestions or comments????

I don't have insurance and have to plan medical care carefully.

Thank you,
Jennifer

Answer
Dear Jennifer,

Ascending numbness/tingling is not a common sign.  In practice we usually see it going down the legs to the feet not vice versa.  This could be a result of something more system wide than just a musculoskeletal problem.

Concerning the chiropractic visit, with nothing visualized on x-ray to cause a problem peripherally down the leg, this leaves sort of a black box of diagnostic criteria...not to mention I don't have any examination findings to correlate with.  In addition, you did not mention any examination of the feet or ankles, as you had mentioned arch problems. I need to ask some more questions of you.

How old are you?  Concerning the "extra joint mobility", have you ever been diagnosed with a connective tissue disorder, or is there any family history of such?  Have you had any other neurological symptoms in the last two years:  loss of sensation, loss of taste, eye sight problems, other numbness?  Systemic problems such as diabetes, Lymes disease, multiple sclerosis, and other chromosomal abnormalities can have these types of symptomatology, and they need to be ruled out if you do not get any results from the chiropractic care in the next week or so.  There is a definite possibility that these symptoms can be the result of spinal cord compromise as well, but this is less likely....things such as a syrinx formation in the cord (kind like a cyst in the cord), can produce bilateral symptoms of numbness and tingling.

Blood testing can often find abnormalities when you have an idea what to look for.  You had mentioned the previous testing from your surgery, I would encourage you to get the results as well as thinking of ordering some new tests.  Concerning the multiple sclerosis and the syrinx formation thoughts, these would have to be validated with MRI's, so clinical correlation is important before ordering expensive imaging.

The bottom line is that your symptoms are vague but progressive, so right now the sky is the limit, and this should be followed up on.  I would give it a few more adjustments from the Chiropractor you are seeing now for a reduction of symptomatology.  If there is no improvement, than you should get a referral or seek out a consult and examination from a medical neurologist.  I understand that healthcare is expensive and your lack of insurance, but you need to find the root cause of the problem.

Jennifer, I will be on vacation for the next week, but after, please let me know if you have any follow-ups, and get back to let me know how you do.

Respectfully,
Dr. J. Shawn Leatherman