tightness in both feet, big toes turning up

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potomachomesalf
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June 17, 2011 at 12:48 pm

Post count: 1

#4636

Dr. Corenman –

I have been dealing with a myriad of symptoms for 2 years. It is easier to chronologically summarize my journey. Prior to the onset of these symptoms, I have been in excellant health. My question is do you have thoughts on a cause of my current symptoms (see 1/11 entry).

7/2009: acute onset of bilateral foot (level of arch to toes) tingling, burning pain
6/2009: acute onset of bilateral hand/finger(1-4) burning, tingling pain
12/2009: having much difficulty walking & using my hands from pain. No hand/foot weakness. MRI: Chiari Malformation with very small cervical syrinx
2/2010: underwent Posterior fossa decompression for CM, all symptoms completely resolved initially then gradually returning
5/2010: all original symptoms returned
8/2010: developed tingling in posterior upper/lower legs, buttocks, ba20ck, arms
8/2010: Lumbar MRI results “disc degeneration of the L4-5 and L5-S1 with probable L5-S1 annular tear. Mild to mod central canal stenosis at the L4-5 level secondary to facet hypertrophy and ligamentum flavum thickening”
9/2010: developed significant tightness in both feet, L>R. eventually both great toes began turning up (hyperextension of 60+ degrees)
after multiple tests, doctors..still do not know what is cause of symptoms.
11/2010: consulted with neurosurgeon who determined I had severe cervical stenosis (8-9.5 mm). physician states stenosis may be common with Chairi Malformation
12/2010: Underwent ACD with fusion of C4-C7.
1/2011: hand/arm symptoms primarily resolved. feet/leg symptoms continue with worsening (tightness in feet, big toes turning up, decreased sensation to pain & temperature in both feet, burning in posterior and medial section of upper/lower legs, buttocks. (No radiating symptoms)
5/2011: referred for EMG of lower ext to r/o tarsal tunnel syndrome. EMG (knees to toes) shows tibial nerve impairment. referred to podiatrist for injections & PT
6/2011: Podiatrist does not believe it to be TTS. Tinel’s sign negative; in 30 yrs of practice has never seen bilat TTS much less with the same onset of symptoms in each foot; dermatones affected do not match with TTS. referred for repeat Lumbar MRI
6/16/11: Lumbar MRI completed. all physicians who previously reviewed the 8/10 lumbar MRI state cause not originating in Lumbar region. Today I viewed both lumbar MRI’s for comparison & do not see any real change.

Will be seeing another neurologist with new Lumbar MRI in a few weeks.

Thank you for any thoughts you have!

Donald Corenman, MD, DC
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June 17, 2011 at 3:48 pm

Post count: 8660

#4637

I’ll start with interpretation of what has occurred.

Symptoms started in mid 2009 from spinal cord compression at the base of the skull. You mention Arnold Chiari Malformation which is an alteration of the normal relationship of the brain stem with the skull base. There is overcrowding in this region and symptoms of myelopathy with brain stem dysfunction occur. The posterior fossa decompression surgery enlarges the foramen magnum and possibly part of the back of C1 is removed. The symptoms abate but not completely (not uncommon).

You start with symptoms again in both upper and lower extremities but suspicion is given to lower back as there is mild-moderate stenosis. You however do not give a history of pain or numbness that starts out in the sacrum and extends to the buttocks and then posterior thighs with walking that is relieved with sitting or bending forward. These are the symptoms consistent with lumbar stenosis.

Tightness occurs in both feet (not a typical symptom of stenosis) and you develop up-going toes (could be a Babinski sign) which could indicate a cord problem. There is no cord in the lower back below L1. Cervical stenosis is diagnosed (a possible cause of your unusual symptoms). Cervical stenosis would be easily visible on an MRI. 12-2010 you undergo an ACDF at C4-7 for the stenosis. Surgery did help the upper extremities but not the lower extremities. Lower extremities exhibit loss of pain and temperature and develop burning symptoms.

You have a neurologist (I presume) perform an EMG/NCV test which demonstrates bilateral tibial nerve involvement. You do not indicate where the lesion is suspected but indicate it is bilateral. Another lumbar MRI is performed with no change in images. Do I have it right?

Everything written here is on assumption. You don’t state your age but i assume you are in your 50-60s. The symptoms in your legs which include loss of pain and temp as well as the burning symptoms lead me to consider peripheral neuropathy. This would also explain the delay in conduction in your EMG tests bilaterally. If this was from the cord, the EMG would be negative. You don’t mention weakness or imbalance symptoms. The up-going toes could be a residual from your prior cord problems as surgery is designed to prevent further progression but damage that was already done may not improve.

The neurologist seems to be the way to go. You might need another EMG/NCV as these tests are very operator dependent and the skill of the test giver makes all the difference in the world. There are various vitamin deficiencies that can cause these symptoms as well as disease processes and even alcoholism and various types of infections.

Please let me know what the conclusion of the neurologist is.

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.
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Donald Corenman, MD, DC

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81 reviews

Eric S

Sep 26, 2021

by Eric S on Donald Corenman, MD, DC

Successful pars repair at 46 years old

Back in November of 2018 (at 46 years old) I came from Vancouver BC to have a pars repair done with Dr. Donald Corenman at the Steadman Clinic in Vail Colorado. I'm finally posting this review nearly three years later in late 2021. The reason I waited so long was I wanted to know the final result before I posted my review. Unfortunately in that time Dr. Corenman has retired. Nevertheless, I want to post this review of Dr. Corenman and his staff at the Steadman Clinic in their excellent treatment of my L5 pars interarticularis.

I fractured my pars at age 42 back in 2014 when rolling on the gym floor, and was denied treatment by the Canadian healthcare system, probably due to my age. First my GP told me there was no surgical option for a pars defect, which was quite incorrect! I tried to live with it, but the symptoms worsened (periodic random spine slippage and weeks of resultant pain after just bending over to tie my shoe, so I eventually learned to mostly squat and hardly bend). When I finally consulted with Canadian spine surgeons, I was told they believed my pars defect had been congenital (since birth). This was absurd, considering I had done extreme martial arts (including jiu jitsu) for years prior, as well as 5 years of reinforcing steel full time in my 20s, probably the hardest job on the back you can find. No pars defect like mine would possibly have allowed this--ergo it was impossible that I had had the defect since birth. I did however have an asymptomatic congenital spina bifida occulta that made me more susceptible to a pars fracture. In 2014 in one instant, I went from having the strongest back people I knew said they'd ever seen, to being unable to safely bend over and tie my shoe without a non-negligible risk of my spine slipping randomly (which would lead to weeks of pain after each occurrence). This was due to the unilateral L5 pars defect, otherwise known as spondylolysis. It was when lying in pain on the floor 4 years later after maybe the 6th spine slippage event post injury, that I had had enough, and resolved to have surgery. If Canada's "universal health care" said no, I would make lemonade from lemons, and find the very best surgeon in the world at pars repairs. That was Dr. Donald Corenman. Dr. Corenman back in 2018 ran a website https://neckandback.com/ that dedicated many pages to the science of every aspect of pars repairs, from eligibility (good discs on MRI), to best surgical techniques (minimal open compared to minimally invasive), best imaging to use (i.e., O-Arm with Stealth imaging vs. older fluoroscopy), the ideal amount of BMP to use and why not use too much or too little, and much more, all to do with pars repairs, pages upon pages of his site just on the pars, with scientific references and his own extensive expert opinion. As a health research statistician, I was very impressed with this. It was in stark contrast to the websites of other spine surgeons which barely gave the pars a word or two, focusing almost exclusively on fusions. I had found the best surgeon in the world for pars repairs, and so after Dr. Corenman personally screened my MRI to ensure my discs were healthy, I booked the surgery.

Being 46 years old at the time of surgery in 2018, with a 4-year-old pars fracture from 2014 combined with a congenital SBO meant my pars fragment was somewhat atrophied, but it was "very solid", said Dr. Corenman in the operative report. Nevertheless, it was challenging with two things to fix, the pars and SBO, and OR time was around 4 hours. Recovery over the following months was guided by a very clear "Spine binder" from the Steadman Clinic with strict rules of "no BLT" (no bending, lifting or twisting), and illustrated physiotherapy guidelines. They even warned patients to avoid fish oil supplements, which could excessively dampen inflammation and hence slow bone healing. They answered many questions I had during months of recovery, with responses coming from the very supportive Lori Fugate (then director of Dr. Corenman's practice), and Ehrich Bean (then physician's assistant at the practice), as well as a couple calls with Dr. Corenman himself after two of the CT scans. Ehrich Bean offered great advice for taking the spine binder conservatively due to the nature of pars repairs vs. fusions. The final post-op CT scan I had was a couple weeks ago at 34 months post-op, and Dr. Corenman had retired, but I got a very positive and informative call from Eric Strauch (current PA at the Steadman Clinic under Dr. Corenman's replacement there, and who had also worked with Dr. Corenman previously). The staff at the Steadman Clinic were extremely supportive all the way through the process. I should mention, the local Canadian spine surgeon did offer me very good post-operative support including antibiotics as needed to deal with a mild surface incision-site infection early on, booking numerous x-rays when I felt something was amiss, as well as booking all four of my post-op CT scans. I am very grateful for that support also.

My final result shows plenty of solid bone across the pars and a healed SBO, with my vertebral body now a solid bone ring instead of being broken at two places as it was pre-op. Does my spine hold up in the real world? You bet! I have recently dug and moved several yards of dirt and sand and gravel by myself (shovel and wheelbarrow!) to fix our water main, pulled roots from the yard, moved several "portable" (these are HUGE) air conditioners up several flights of stairs my myself, and lifted weights. I now run 2 miles (3.2 KM) several times weekly with a hard 100 meter dash in the middle. I bend deeply before each run I go on, with no spine slippage. My spine feels amazing. I can bend over to do exercise, or real word tasks, with no risk of spine slippage.

My sincere thanks to God, Dr. Donald Corenman, Lori Fugate, Ehrich Bean, Eric Strauch, and the Steadman Clinic, as well as the Canadian spine surgeon who offered me excellent post-operative care back in Canada. You have all given me a new lease on life.

Sincerely,
Eric S

Robert S

May 11, 2021

by Robert S on Donald Corenman, MD, DC

Back Fusion Surgery

I had my entire lumbar spine fused in November of 2018. I had scoliosis , with pinched nerves that were so painful I could hardly walk - and standing for more than a few minutes was impossible. Even sitting was painful.
The fusion surgery produced immediate relief! And the recovery was much easier than I expected.
To this day I can do all the activities I love from hiking, to standing in a stream fly fishing to riding my bike long distances - or just walking down the street with my wife.
Kudos to Dr. Corenman and his staff, (including the two Erics) for taking such good care of me!

Leslie R

Jul 9, 2020

by Leslie R on Donald Corenman, MD, DC

TLIF

I had my TLIF surgery on 6/24/2020 by Dr. Corenman, I can not say enough good things about the Dr or his staff. I was always treated with respect and explained everything throughly, that made it easy for everyone to understand. I highly recommend Dr. Corenman and the Steadman Clinic.

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