Painful tingling toes

Tingling Toes Facts

The sensation of tingling toes can be caused by various reasons. It may appear due to some nerve injury or damage. Sometimes it doesn`t have to have anything to do with the toes at all. Tingling may last from a couple of minutes to a couple of hours. However, if the tingling sensation in your foot or toes lasts for more than one day, then you should definitely visit a doctor.

Causes of Tingling Toes

Some people may experience the tingling in their toes because they sat with their legs crossed for a long period of time, or their legs were hanging in the air for quite a while. These are often harmless symptoms and they go away in a couple of minutes. However, there are some serious causes of tingling toes. Any kind of foot injury can cause a tingling sensation in the toes, but it may also appear due to the surgery on the vertebrae.

Another cause of tingling toes can be a condition called tarsal tunnel syndrome. When the tarsal tunnel is compressed, the tarsal tunnel nerve becomes inflamed and a person may experience swelling in feet, tingling in ankles, burning, and pain in toes or legs, etc.

There is a similarity between tarsal tunnel syndrome and carpal tunnel syndrome noticed in hands. Causes of tarsal tunnel syndrome include improper exercise or sports activities, diabetes, rheumatoid arthritis, etc. The sciatic nerve, which expands itself from the spinal cord over the hip and buttock area and finishes in the lower part of your leg, usually leads to severe pain in your back, which is followed by tingling in your toes. The condition is called sciatica and its symptoms may be numbness in the toes or a tingling sensation.

The next cause of tingling toes may be pregnancy. Gaining weight during pregnancy can lead to compression of the sciatic nerve, herniated disc, or sciatica and these symptoms cause numbness, back pain, and tingling in toes and feet. However, the tingling sensation in the toes and feet during pregnancy subsided after the birth of the child.

The diagnosis of chronic exertional compartment syndrome (CECS) can be challenging as other pathologies involving bone, muscle, nerve and vascular structures can mimic the syndrome. The incidence of reported CECS is between 14 and 27% in active individuals. When accurately diagnosed, the standard of care for CECS is surgical compartment release. The purpose of this Fellow’s Case Problem is to describe the clinical decision-making and physical therapy (PT) differential diagnosis regarding a 25-year-old patient with un-resolved neurovascular complaints following CECS surgical release.

After surgery, the patient’s previous complaint of numbness and tingling in the plantar surfaces of her first and second toes of right foot was still present. The patient’s concordant symptoms in toes were reproduced proximally in the lumbar spine and distally in the tarsal tunnel.
The lumbar spine can refer symptoms to the lower extremities and needs to be ruled out as the source of the patient’s complaint whenever neurovascular symptoms such as numbness and tingling are present. The discovery of the relationship of the lumbar spine with the tingling in the toes addressed one of the patient’s primary concerns that was not resolved from the surgery.
Before diagnosing a patient with an isolated peripheral nerve entrapment, the lumbar spine should be evaluated. The lumbar spine can refer symptoms to the lower extremities and should be ruled out as the source of the patient’s complaint whenever neurovascular symptoms such as numbness and tingling are present.
In the subjective examination, the patient reported increased symptoms in toes when driving and sitting, which would be uncharacteristic of symptoms related to CECS or even post-operative soreness. The FiT’s discovery of the relationship of the lumbar spine with the tingling in the toes addressed one of the patient’s primary concerns that was not resolved from the surgery.
The osteochondroma that developed on the posterior tibial metaphysis could have caused a neuropraxic injury to the tibial nerve causing her concordant symptoms in toes. Additionally, her work and lifestyle consisted of sitting approximately 40 h per week with a flexed lumbar spine. This theoretically could have caused more stress on the nerve root and produce symptoms associated with a double-crush injury.

Post-operative rehabilitation for anterolateral compartment fasciotomies is guided by tissue healing times and physical impairments present. However, this unique case highlights several important lessons for clinicians following surgical procedures and chronic complaints. First, it is important for a thorough proximal to distal examination to be performed on all patients with potential neurovascular symptoms in the foot. Secondly, knowledge of the distribution of the nerves in the lower legs can assist a clinician in making an accurate diagnosis.

✓ Fact confirmed: Differential examination, diagnosis and management for tingling in toes: fellow’s case problem Cody J. Mansfield, Jake Bleacher, Paul Tadak, and Matthew S. Briggs; 2017 Dec

There are many more causes of tingling toes among which are multiple sclerosis and lumbar spinal stenosis.

Treatment

The most important thing in the process of curing a certain disease is making the right diagnosis. There are several ways for the treatment of tingling toes.

Surgery, physical therapy, or medications are some of the possible treatments. In the case of tarsal tunnel syndrome, a combination of physical therapy and medications is used. Sometimes, the doctor will take an X-ray for a more appropriate diagnosis. As in any other medical condition, it is essential to pay attention to the symptoms.