Do you have toe numbness or foot numbness?

What doctor to see for numbness of foot or toe?

There are several causes for numbness of the foot, and treatment options are available according to the underlying cause. If you experience numbness of feet, legs, or toes, seeing a podiatrist (foot and ankle specialist) is recommended. Podiatrists are uniquely qualified and specifically trained in treating all conditions involving foot and ankle, and they are the leading experts in foot and ankle ailments. But if it involves other body parts like weakness, numbness, or problems with bladder or bowel control, you should see a neurologist.

What is toe numbness or foot numbness?

Toe numbness is a loss of sensations often preceded by a tingling or burning sensation called paresthesia. It is not a disease but a symptom of an underlying cause.

It may be temporary or chronic. Conditions ranging from minor to serious can cause complete or partial numbness.

Numbness can make walking difficult or even painful.

It can lead to injuries and wounds about which you might remain unaware.

It is a cause of concern but not a medical emergency.

What are the signs and symptoms of the foot or toe numbness?

Numbness can occur in one or both feet or any part of the foot depending upon the underlying etiology. Signs and symptoms include:

• Total loss of sensations ( unable to feel touch, cold, heat, vibration)
• Pins and needles feeling
• Insect crawling
• Tingling sensation
• Burning sensation
• Freezing sensation
• Weakness
• Discoloration
• Tightness
• Cramping
• Sensitivity to touch
• Pain and swelling if numbness is due to fracture or nerve compression
• Feeling of leather on bottom of feet
• Itching

These sensations can make walking difficult or even painful

If serious signs and symptoms occur along with numbness, such as:

• Paralysis
• Weakness
• Confusion or loss of consciousness
• Slurred speech
• Loss of bowel or bladder control
• Difficulty breathing
• Difficulty walking
• Dizziness
• Changes in vision

Seek immediate medical help in an emergency.

What are the causes of toe numbness?

Toe numbness can be due to several diseases or disorders that cause

• Nerve injury
• Restrict the blood flow
• Infection
• Trauma
• Malignancy

Human body consists of a complex network of nervous system. In case of any injury to nerves, there’s toe numbness, weakness or tingling.

Suppose toe numbness is temporary due to prolonged pressure on nerves (sitting or standing for a long time )or tight-fitting shoes. In that case, it can be relieved by movement or change of posture, but if the numbness persists for a longer duration, it indicates chronic causes such as:

Neurological causes:

• Chronic alcohol consumption
• Heavy metal poisoning such as lead poisoning
• Peripheral neuropathy
• Guillain-barre syndrome
• Multiple sclerosis
• Transverse myelitis (neurological disorder characterized by inflammation of spinal cord)
• Nerve compression such as Morton’s neuroma (affecting ball of foot)
• Sciatica
• Charcot marie tooth disease
• Spinal cord injury
• Vitamin B-12 deficiency

Vascular causes:

• Peripheral artery disease (narrowing of arteries due to buildup of fat and cholesterol in arterial walls, leading to decreased blood flow to the extremities)
• Deep venous thrombosis (blood clot in leg that can break and cause pulmonary embolism, heart attack or stroke)
• Buerger’s disease (acute inflammation and clotting of arteries and veins)
• Raynaud’s disease
• Vasculitis(inflammation of blood vessels)

Endocrine causes:

• Hypothyroidism
• Diabetes

Rheumatic causes:

• Rheumatoid arthritis
• Systemic lupus erythematosus (disorder in which the body attacks its healthy cells and tissues)

Orthopaedic causes:

• Back injury
• Broken toe
• Degenerative disk disease
• Herniated disk
• Nerve entrapment or nerve pressure(such as from tight-fitting shoes)
• Osteoporosis
• Tarsal tunnel syndrome(affecting tibial nerve)

Other causes:

• Physical injury
• Frost bite
• Shingles
• Chemotherapy and drugs
• Trauma
• Radiations
• Bone marrow disorders such as lymphoma.
• Benign or Malignant tumours or growth that press on the nerves.
• Liver disease
• Kidney disease
• Bacterial infections
• Viral infections

Medical Emergency:

It can also be a sign of more serious neurological event if associated with sudden numbness and weakness of one side of the body such as

• Seizures
• Stroke
• Transient ischemic attack(TIA)

Common causes of toe or foot numbness:

• Footwear:

Wearing tight, short or narrow shoes or socks and high heels can restrict the blood flow to toes or compress nerves  causing tingling and numbness. Any injury or fracture managed by tight cast or wraps can also interfere with foot blood circulation, leading to foot and toe numbness.

Wear Properly fitting shoes & socks and avoid high heels to maintain proper blood circulation of feet.

• Posture:

Maintaining the same posture for a longer duration also restricts the blood flow causing numbness and tingling.

It can be avoided by changing posture regularly so to lift pressure on feet.

• Heavy exercise:

Exercising for a long duration, such as running or walking, may temporarily numb toes and feet, and it subsides on stopping the exercise.

• Temperature:

Exposure of feet to cold temperature such as going out barefoot or wetting feet in cold weather can also numb the toes.

To avoid damage due to cold temperature, avoid going out barefoot, avoid wetting feet and wear thick socks and slippers.

If numbness occurs due to extreme cold temperature, slow re-warming should be done to avoid tissue damage as it may be due to frost bite and can even lead to amputation if not treated properly.

• Diabetic neuropathy:

Diabetic neuropathy is a complication of long-standing and untreated diabetes. Diabetic neuropathy occurs when high sugar levels damage nerves. When it affects feet, legs, hands, and arms, it is called Peripheral neuropathy, causing numbness and tingling.

In addition to numbness and tingling, excessive thirst, hunger, urination extreme fatigue, blurry vision, or wounds that heal slowly is also observed.

People with diabetes should regularly monitor their sugar levels and manage sugar levels with lifestyle changes(increased physical activities and dietary modifications) and medications.

Regular checking of feet for any changes, wearing properly fitting shoes, and avoiding going barefoot is also advised.

If diabetes remains unrecognized or untreated, it may develop major complications (of nerves, kidney, eyes, etc.), ulceration, and require amputation.

• Peripheral artery disease:

People with diabetes are also at high risk of developing atherosclerosis, the most common cause of Peripheral Artery disease.

The buildup of fatty plaque in the arteries causes arterial thickening and narrowing, which restricts the blood flow to limbs or can even block the blood circulation leading to tissue ischemia, death (gangrene), and may require amputation.

Symptoms include pain, weakness and numbness, cramping, difficulty walking or skin colour changes of extremities. The cause may be high blood pressure, high cholesterol levels or diabetes.

Treatment includes lifestyle changes such as regular exercise, healthy diet and quitting smoking. Some people may also require medications or surgery depending upon the severity of the disease.

• Hypothyroidism:

Hypothyroidism occurs when the thyroid gland isn’t making enough thyroid hormone to meet the body’s requirements. It can cause numbness of arms, hands, legs, feet or toes. Over time, it leads to fluid buildup in the body that puts pressure on the nerves of the leg, thus damaging the nerves leading to numbness and pain in the affected area. The under-active thyroid gland can also cause mental health issues, fatigue, and weight gain.

Treatment includes medications to maintain normal thyroid hormone levels in the body.

• Raynaud’s phenomenon:

When the body is exposed to a cold environment, blood circulation is cut to extremities like the nose, ear, fingers, and toes to increase the blood supply to vital organs like the brain, heart, and lungs. This response is exaggerated in Raynaud’s phenomena.

In people with Raynaud’s phenomenon, exposing the skin usually of extremities to cold temperature or stress causes spasm or constriction of superficial arteries thus restricting the blood flow to outer parts of the body leading to:

• White to blue to red discoloration
• Numbness and
• Tingling of fingers, toes, ears and tip of the nose.
• Feet may also develop sores and infections, which can potentially lead to tissue death(gangrene)

Cause can be primary or secondary. Primary happens by itself, the cause is unknown and it is generally mild and resolves on its own. Secondary occurs in association with an auto-immune disease like rheumatoid arthritis or systemic lupus erythematosis. Symptoms of secondary Raynaud’s phenomena include:

• Joint pain
• Redness
• Warmth

Medical treatment is required to prevent long-term damage. Management includes keeping the body warm to prevent the symptoms and medications from maintaining proper blood flow.

• Bunions:

A bony bump at the base of the big toe is called a bunion. It is made from bone which displaces from its place from the front of the foot. The big toe points inwards towards other toes while the base of big toe joint protrudes out. It is formed due to wearing tight shoes that push the big toe inwards, which leads to bony deformity over time. It causes the tip of the big toe to press heavily on the second toe.

It becomes difficult to find a properly fitting shoe due to bunion. Shoes may be too tight in the toe area, causing toe numbness which can eventually lead to inflammation and nerve compression of nearby areas causing toe numbness, tingling and pain.

Seeing a podiatrist for bunion treatment and wearing footwear of the correct size and width may help relieve the pressure and numbness of the toe.

• Toe fracture:

Toe injury due to accident, fall or hit with a hard object may cause toe fracture leading to numbness and tingling of the toe.

Seeing a Podiatrist for the treatment of broken toe in order to ensure proper bone healing and relieve of associated symptoms such as pain, numbness and tingling is recommended.

• Morton’s neuroma:

Non-cancerous thickening of tissue around one of the nerves in the ball of the foot that leads to the toes is called Morton’s neuroma. It usually occurs between the third and fourth toes but also between the second and third toes.

The pressure on that nerve causes pain in the ball of the foot,  numbness, and burning of the feet. Toes may give a sensation of pebbles, marble or other object under the ball of your foot. It may be worsened by a certain type of activity and shoes.

Symptoms include sharp, burning pain in the foot and numbness of toes. It mostly develops in women due to wearing high heeled or narrow-toed shoes.

It can be treated with:

• Reducing activity or taking rest from athletic activities to help heal the foot
• Wearing wide shoes
• Avoid high heals and tight shoes
• Use of shoe inserts or pads to relive pressure on nerves
• Steroids to ease pain
• Surgery, if no improvement occurs

• Multiple Sclerosis:

A chronic and potentially disabling disease of the brain and spinal cord. In MS, the body’s immune system attacks the protective sheath that covers the nerve fibres necessary for signal transmission,n thus causing communication problems between the brain and rest of the body.

It may cause fatigue, numbness, weakness, pain,  tingling, difficulty in walking, visual disturbances, mental changes, difficulty in speech and swallowing, bladder & bowel problems etc

Treatment includes steroids and rehabilitation

• Guillain-barre syndrome(GBS):

GBS is a rare neurological disorder in which the body’s immune system attacks covering peripheral nerves,s causing muscle weakness and sometimes paralysis. The cause is unknown yet but it is found out that viruses or bacteria can trigger GBS.

Symptoms include numbness and tingling of toes, ankles, fingers or wrist, muscle weakness, difficulty in speech, swallowing & breathing, coordination problems, rapid heart rate, changes in blood pressure, pain that worsens at night etc. Muscle weakness starts from hands and feet and spreads to the upper body(ascending weakness).

If a person develops symptoms of GBS, prompt diagnosis and immediate medical care is required as it can spread rapidly. Treatment includes hospitalization, supportive care, immunoglobulins, plasmapheresis, and rehabilitation.

• Vitamin B-12 deficiency:

Vitamin B12 is necessary to form red blood cells and maintain a healthy and functioning nervous system.

Decreased dietary intake as in strict vegetarians or decreased body absorption of Vitamin B12 as occurs in Pernicious anemia may lead to large sized RBCs. Deficiency of Vit B12 damages the myelin sheath that surrounds and protects the nerves. Once the protection is lost, nerve ceases to function properly causing peripheral neuropathy.

Person may feel weakness, tiredness, light-headedness, shortness of breath and irreversible nerve damage causing numbness and tingling of extremities.

It can be treated via dietary modification such as eating animal food(meat and dairy) and Vitamin B12 injections.

• Spinal cord injury:

Spinal cord is responsible for transmission of nerve messages from brain to the body and from body to the brain. Any injury to spinal cord may cause numbness in the toes or inability to feel touch and heat sensations. Injury to spinal cord can occur through:

• Road traffic accident
• Inflammation/infection
• Malignancy

Seeing a doctor immediately is recommended in case of any traumatic injury to head, neck or back. In case of injury, movement should be restricted and emergency services should be called for help.

• Stroke:

A life threatening medical emergency due to interrupted or reduced blood supply to part of brain, preventing tissue oxygenation and nutrition. It may cause weakness, numbness, paralysis of one side of the body.

Treatment includes medications and rehabilitation to regain normal activity and function.

• Vasculitis:

An auto-immune disease causing inflammation of blood vessels of the body. Vasculitis may occur in association with the following diseases:

• Systemic lupus erythematosis
• Rheumatoid arthritis
• Hepatitis B & C

It can cause disturbances in the blood flow, thus causing numbness and tingling.

Treatment is usually steroids and other medications to decrease the inflammation of blood vessels.

• Metatarsalgia:

Metatarsals are the long bones in the foot between the arch and toes. It may start with pain in the ball of the foot or come with numbness and tingling of the toes.

Causes of metatarsalgia include altered shape of foot such as high arches, bunions, curled toes, over-work, running or obesity

It can usually be treated without medical help such as changing shoes, wearing shoe inserts, rest and ice. If pain and numbness still persists for longer duration, then seeing a doctor is advised

• Hallux limitus and hallux rigidus:

These foot conditions occurs when the metatarsophalangeal joint at the base of big toe becomes stiff and inflexible.

Hallux limitus refers to some movement at metatarsophalangeal joint while hallux rigidus refers to no movement at metatarsophalangeal joint.

It can cause numbness, tingling when the bone spurs that form on top of the metatarsophalangeal joint compress the nerves.

• Carpal tunnel syndrome:

It affects the nerves of hands and arms. It is not a serious problem but can be painful.

• Herniated disk:

It is a condition when spinal disc is damaged and herniates. This puts pressure on the spine causing pain and numbness

• Myasthenia Gravis:

It is a rare disorder causing muscle weakness and fatigue.

• Muscular dystrophy:

An inherited disorder that affects muscle structure and function.

• Charcot-Marie-Tooth disease:

It is an inherited disorder that causes nerve damage mostly of arms and legs.

• Amyotrophic lateral sclerosis(ALS):

It is a progressive, ultimately fatal disorder that attacks nerve cells in the brain and spinal co, and it affects all muscles involved in movement, speech, swallowing and breathing.

• Chemotherapy:

Chemotherapy is a life-saving treatment for various cancer,s but it has many side effects,s including numbness and tingling of various body parts.

Seeing your doctor is recommended if you develop any adverse effects of chemotherapy.

When to seek medical help?

Both Immediate or gradual toe numbness is a serious medical condition and requires medical check-up. If toe numbness occurs along-with the following symptoms, immediate medical care is required:

• Sudden head injury
• Confusion
• Dizziness
• Loss of sensations of one side of body
• Difficult speech
• Weakness
• Visual disturbance
• Facial drooping
• Loss of balance
• Sudden excruciating headache
• Abnormal movements
• Lower back pain
• Muscle spasm
• Loss of bladder or bowel control
• Rash

How a doctor diagnosis cause of toe or foot numbness?

If toe numbness is due to non-medical causes, it can be relieved by changing posture, movements, rest, warmth or wearing well-fitting footwears.

But if it is not relieved and there’s no obvious cause, medical help is required.

History:

Doctor may ask the following questions to make a differential diagnosis:

• Since when did the numbness start?
• How long does the numbness last?
• How it started (slow or sudden)?
• Is there any specific time when you feel the numbness?
• Where are you feeling numbness/distribution?
• Is it progressing?
• Are your daily life activities disturbed due to numbness?
• What are the associated symptoms like pain, burning or itchiness etc
• Are there any factors/activities that exacerbate your condition?
• What factors relieve the numbness?
• Questions about current health.
• Are you taking any medications?
• Lifestyle
• Drinking habit
• Occupation/exposure to toxins
• Family history

Examination:

Doctor will perform a comprehensive foot examination to check the sensations of:

• Touch
• Pressure
• Temperature
• Vibration
• Proprioception (orientation in space)

And motor functions:

• Muscle tone
• Power
• Reflexes
• Coordination tests

To access the degree of damage.

Investigations:

Doctor may order following investigations to reach a definitive diagnosis:

• Blood tests:
  • Anemia
  • Vitamin B12 deficiency
  • Infection
• Blood glucose levels:
  • To rule out diabetes
• Imaging tests:
  • CT
  • MRI

To look for stroke, spinal cord injuries, tumours or other abnormalities affecting blood vessels and nerves.

• Nerve function tests:

Electromyography (EMG) records electrical activity of muscles at rest or when they contract by inserting a needle(electrode) into the muscle. It is used to detect any muscle or nerve damage

• Other Nerve tests:

These include:

• Autonomic nerve fibres work
• Sweat test (to measure body’s ability to sweat)
• Nerve fibre density testing
• Quantitative sensory testing

• Nerve biopsy:

Removal of a small section of nerve usually sensory nerve through a small incision and examination under microscope to look for any nerve abnormalities such as nerve degeneration, inflammation (neuropathies) etc

• Skin biopsy:

Removal of a small portion of skin under local anesthesia  and then examination under microscope to look for reduction in nerve endings.

How toe numbness is treated?

Treatment of toe numbness depends upon the underlying cause. Doctor may advise the following treatment:

General Management:

• Foot exercises
• Foot hygiene
• Cutting toenails straight across
• Daily inspection of feet for wounds and injuries
• Wear well-fitting shoes and shoe inserts
• Wear comfortable shoes that don’t rub against the bunion
• Avoid wearing too tight shoes and high heels
• Wear socks made up of soft and natural fabric
• Cessation of smoking as it constricts the blood vessels and can worsen toe numbness, peripheral neuropathy and Raynaud’s disease.
• Wear warm socks and avoid exposure to cold and damp places.
• Ice the area
• Wear orthotics to relieve numbness and pain.

Numbness of the feet Specific Management:

Foot numbness treatment:

• Doctor may prescribe pain-relieving anti-inflammatory medications such as Ibuprofen, Acetaminophen etc
• If the cause is nerve compression of foot due to pressure then changing the shoes is advised
• Anti-depressants and anti-convulsants to treat nerve pain such as duloxetine and pregabalin
• Tri-cyclic anti-depressants such as amitryptyline.
• Supplements such as Vitamin b12 and alpha lipoic acid
• If the cause is alcohol consumption, then doctor may advise to stop drinking and taking multivitamins.
• If numbness is due to diabetes, then lifestyle changes such as exercise, dietary modifications and quitting smoking are advised. Regular monitoring of sugar levels along with medications to keep sugar levels under control to prevent complications.
• If the cause of numbness is hypothyroidism or peripheral artery disease doctor will advise medications to control blood sugar levels
• If the numbness is due to hallux limitus or hallux rigidus, surgery is required for correction.
• If numbness is due to frost bite then immediate medical treatment is required. Move out of the cold area, dry the feet and slowly re-warm in warm water for around 30 minutes. For severe frost bite medical help is required.
• If numbness is due to Raynaud’s disease, then quitting smoking, avoiding cold temperature, staying indoor, wearing warm clothes is recommended. If it is still not controlled, medications are prescribed to maintain proper blootoelow.

Toe or foot numbness surgical management:

If numbness of toe, foot or legs is due to entrapment of nerve then surgical decompression of nerve either in the leg or foot or at spinal cord level may provide relief.

What are the potential complications of toe numbness?

Toe numbness can be progressive and complicate depending upon the underlying cause. As toe numbness may be due to a serious medical condition, failure to seek immediate medical treatment may lead to permanent damage and complications. So seeking medical help immediately after developing numbness and compliance with medications after diagnosis is necessary to prevent the complications. Potential complications can be:

• Permanent pain
• Permanent loss of sensations
• Inability to walk
• Paralysis
• Disability