Viewing 2 posts - 1 through 2 (of 2 total)
  • Author
    Posts
  • volume26
    Member
    Post count: 1

    I’m starting to feel very frustrated and wonder if my symptoms are simply atypical. Months of pt including stretching and core strengthening haven’t resulted in any meaningful improvement. Pt has noted that pelvis is rotated and tipped but not always the same side from visit to visit.

    My symptoms started as cold spots on top of my feet and then burning in my toes in both feet about 6 months ago. Then both shins would burn. All of this was mostly when sitting. About three months later my tailbone started hurting when sitting which evolved into more of an intense ache in the left medial buttock starting at the top of the cleft. All of this happens when sitting or standing still. I’m pretty symptom free when I’m moving.

    SLR test negative
    MRI of coccyx was normal
    L4-5 circumferential bulge with superimposed central protrusion that slightly indents ventral thecal sac. No canal stenosis. Slight left facet hyper trophy without foraminal stenosis
    L5-s1 dd with moderate loss of height. Circumferential bulge approaches s1 sheath. Slight bilateral foramina encroachment without canal stenosis or nerve root impingement in the foramina.

    Would one of these (or both) of these levels be causing these symptoms? I had no history prior to these toe symptoms that started 6 months ago.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8656

    Generally, I look at the symptoms and try to explain what could cause the symptoms. I then take a different tack and look at the images and think of what these finding could cause. A meeting of the two approaches then generally settles the cause of the symptoms as related to the disorder.

    In your case, these symptoms could be from different disorders. Your initial symptoms (“My symptoms started as cold spots on top of my feet and then burning in my toes in both feet about 6 months ago) leads me to think of peripheral neuropathy. Look for this disorder on the website. Burning symptoms are uncommonly associated with nerve compression but commonly associated with peripheral nerve disorders, especially the symmetry of the symptoms (equal in both feet).

    This is not to say that these symptoms cannot be caused by symmetric nerve compression but nerve compression symptoms typically are not symmetric, typically start in the buttocks and radiate down to the feet.

    Coccyx pain (tailbone pain) can be caused by nerve compression but much more common is coccydynia (pain from a strained coccygeal ligament) or pudendal neuropathy (S2-4 nerves that service the coccyx). The S2-4 nerves generally do not become compressed from spinal origins.

    You have degenerative changes of the lower two lumbar vertebrae. This can cause lower back pain but you do not complain of that symptom. I would think that your problem is associated with neuropathy and not spinal compression.

    Dr. Corenman

    PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
     
    Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.
Viewing 2 posts - 1 through 2 (of 2 total)
  • You must be logged in to reply to this topic.