mnjodyParticipantSeptember 20, 2020 at 6:55 pmPost count: 19
I have pain from my butt area down, and my left foot is numb. When raising my toes, my right foot is fine, but my left toes barely raise up. I notice while going on eliptical that I am using much more right foot/leg strength. Other issues I have noticed are lots of leg cramps in the back of my leg, and my toes are more curled on my left side. All of my issues are on my left. The MRI mentions right side. Does this make sense?
Notes from last GP visit neuro exam performed on lower:
Manual Strength Testing:
Hip flexion (L2): 5/5 on the right and 5/5 on the left
Knee extension (L3): 5/5 on the right and 4/5 on the left
Ankle dorsiflexion (L4): 5/5 on the right and 4/5 on the left
Great toe extension (L5): 5/5 on the right and 3/5 on the left
Plantar flexion (S1): 5/5 on the right and 5/5 on the left
Sensory Testing (light touch) dermatomal patterns:
Medial thigh (L2): normal on the right and normal on the left
Medial knee (L3): normal on the right and normal on the left
Medial malleolus (L4): normal on the right and diminished on the left
1st web space dorsal foot (L5): normal on the right and diminished on the left
Lateral malleolus (S1): normal on the right and normal on the left
Patella (L4): normal on the right and normal on the left
Achilles (S1): normal on the right and absent on the left
Ankle Clonus: absent on the right and absent on the left
Plantar response (Babinski): toes downgoing on the right and toes downgoing on the left
L5-S1: Disc space narrowing with desiccation of the disc with central and RIGHT
paracentral disc protrusion encroaching upon the RIGHT side of the thecal sac
and S1 nerve root. There are mild degenerative changes of the posterior facets.
There is also foraminal stenosis on the LEFT.Donald Corenman, MD, DCModeratorSeptember 20, 2020 at 7:39 pmPost count: 8468
Your MRI notes a right disc herniation affecting the right S1 nerve root. Your symptoms don’t reflect the right S1 nerve but do indicate the left L5 nerve. Failure to raise your toes is an L5, not an S1 nerve disorder. You do have an S1 reflex deficit on the left (“Achilles (S1): normal on the right and absent on the left”) but that sometimes does not indicate a significant problem. The motor weakness is a pure L5 root deficit (“Ankle dorsiflexion (L4): 5/5 on the right and 4/5 on the left…Great toe extension (L5): 5/5 on the right and 3/5 on the left”
What is significant from the MRI report is “There is also foraminal stenosis on the LEFT” at the L5-S1 level which will compress the left L5 nerve root. Typically, the worst symptoms of foraminal stenosis come from standing and walking and improve with sitting and bending forward. However, when symptoms have been present for some time, sitting can be problematic. See https://neckandback.com/conditions/foraminal-collapse-lumbar-spine/
Dr. CorenmanmnjodyParticipantSeptember 22, 2020 at 6:45 pmPost count: 19
In your opinion are most issues like this resolve without the need for surgery? Or does it continue to get worse?Donald Corenman, MD, DCModeratorSeptember 23, 2020 at 7:33 amPost count: 8468
This can go either way but what is concerning is your motor weakness. Generally, I recommend surgery if there is motor weakness as surgery is the best chance to gain better function of the disabled nerve root.
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