Horrible pain down leg, numbness in toes

Horrible pain down leg, numbness in toes

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missy9
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Horrible pain down leg, numbness in toes

Hi,

I have been dx with DDD and a herniated disk and have had back problems for over 7 years. It has become constant in the last 8 months now. I have sciatica going down my left leg to the foot and the pain is hard to deal with. My big toe and toe next to that are numb. I cannot feel anything on the top side of the toes and it has been permanent for the last 3 or so years. Could it be caused from a pinched nerve? I have been reading here and found it may be permanent?

I have done P/T a few months ago that helped get the pain out of my leg but did not help the back pain at all.
For the last 2 weeks I have had the worst pain in my leg that is not going away! It is like a pulsating shooting pain all the way down to the foot. I have been unable to sleep, walk much, and I cannot sit at all without it hurting even worse. I have tried to do the "push ups" that I learned in P/T but they are not working and are too painful. I am on 25 mcg/hr fentanyl patch and 10 mg Endocet for break through pain. The meds are not even helping! Any suggestions? The pain has become unbearable.

Thanks for your help,

Missy

dilauro
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Welcome Missy

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What has been the action plan of your doctors? I assume you have had a MRI. Which disc is herniated?
DDD is probably the most misunderstood spinal problem. The words degenerative and disease just dont sound too good. But in reality, DDD is normal, its really the aging of our spines. Almost everyone by the time they reach 25 will show some signs of DDD. It can come on sooner or more advanced due to Trauma, Prior Surgery or Genetic situations. For the most part, DDD is treated through over the counter NSAIDs and an approved exercise program. Only in severe cases will surgery be required for DDD alone.

Sciatica pain can be very disturbing. Once you start with it, you will find that there are not many positions where you can get comfortable. And when you find a position, its just a little while before the tingling pain down from you hip to your toes start in. When people here about others suffering from herniated disc they view it as pain directly in the back. Most cases, the pain starts in the hip and travels down.

When you said you have had some nerve problems for a number of years now, it very likely could be the result of some dead nerves. Depending on how badly the disc(s) pressed on a nerve root. You can verify the extent of the nerve damage via an EMG test.

Spinal problems and corrections to it are not that difficult as it was 20 years ago. There are so many conservative treatments... I would go for all of those before considering surgery.

But the bottom line for all of these decisions are with you and your doctor. We can only provide personal suggestions, the formal medical actions need to come from your doctor.

Good luck and Welcome to Spine-Health!

Ron DiLauro Spine-Health System Moderator
Dont laugh at me

gwennie17
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Joined: 12/30/2008 - 12:07am
Welcome to the board ~

Have you had a recent MRI and a flexion/extension X-ray? Have you ever been told you have spondylolisthesis or a "slippeage" of one vertebra over the other?

When you had PT that helped your leg pain, did it also help the pain in your toes? Sciatic-type pain is often caused by a problem in the lower back, and sometimes in the cervical spine, too. It can be caused by the compression of a spinal nerve root.

It is impossible to say whether the numbness is indicative of permanent nerve damage. You can have a nerve conduction study done by a neurologist or a physiatrist that will indicate the type of damage and the degree of damage, but it cannot indicate whether the nerve is capable of regeneration or if the damage is irreversible. But I am a big believer in never giving up (much to the consternation of one of my surgeons~). I was misdiagnosed with peripheral neuropathy in 2001 and did not develop back pain until 2005. It was only last year that someone finally put things together and realized my numb feet were caused by a pinched nerve in my lumbar spine. I had a fusion surgery almost two years ago to relieve pressure on the nerve. My toes are still numb, but I have more feeling in them than I did previously and the situation is very gradually improving.

If you aren't doing so already, I suggest you make an appointment with a fellowship-trained spinal specialist to be evaluated, and hopefully, get a diagnosis for your problems.

missy9
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Ron, My pcp sent me to a

Ron, My pcp sent me to a neuro who said I am a good candidate for spinal fushion surgery but he wanted to do a couple of tests firtst, bone scan & flexion/extension x-ray. I did thoose a few weeks ago and the neuro was supposed to call me with the results as he said he would at my 1st appointment. He called yesterday and said his assistant was going to call w/ in a few days to schedule an appt. for him to go over my results and treatment plan. I have no idea what is going on or why he cannot tell me over the phone what my tests revealed like he said he was going to. So I am not scheduled to go in again until Dec 23! Does that seem strange or am I just reading too much into this?? It kinda makes me worry it he wont tell me on the phone when he said he was going to.

My DDD is pretty bad according to my neuro and is from l5-S1. I believe the herniated disk is also in the same area. The neuro showed me the disks involved and they are completely black. He said it was basically bone on bone and was probably hereditary. My dad and my aunt, and sister all have bad backs that started at a young age. I also have developed mild scoliosis of the thoracic spine as an adult too. My back is all screwed up!

I have tried motrin for a long time and was taking 800mg every 8 hours but it didn't work well and it started to bother my stomach so much I had to stop taking it. I have tried other meds too, tramadol, celebrex, etc. None have really helped. I have also had the pain in my hip and before the mri I had wondered if it was my hip and not my back bothering me.

Gwennie, yes I had both those tests done but have not got the results for the flexion xray. Due to pain I wasnt able to flex much but the neuro ordered it because I told him I can actually feel my back "slip" when it goes out. Can not being able to move much alter the results? My pcp accidentally popped my back several times by pushing on it and he said my spine was too mobile. He actually made me have worse pain than when I got there!

My MRI didnt show spondylolisthesis. Also P/T did not help with the numbness in the toes at all. It is more numbness than pain. It has never gone away and on the rare moments they are not numb I have severe pain in the toes. That has only happened a few times over the years though. They are usually just numb all the time. I am glad to hear it may not be permanent. I have dealt with my numb toes for so long now it wouldnt be the end of the world if they stayed that way. Things could be worse!

Thank you both so much for your responses! Which is better a neuro or an Ortho? I originally saw an ortho who specializes in the spine but he told me that my insurance wouldnt pay for surgery until I was in constant pain for a year! My pcp said that was carp and sent me to the neuro who did his back surgery a few months ago. This neuro said I was a good candidate now. Since my pcp had a good experience with him and is doing well I feel confident with him as my dr.

Do they usually do steroid shots for sciatica? I cannot have any steroids and my neuro seemed ok with that but I have read on here that sometimes insurance requires it. I sure hope not!

Hugs,

Missy

jsirabella
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Joined: 08/21/2009 - 7:34am
You are in good hands all around...

I think that your situation is quite severe given the DDD and the L5-S1 situation but based upon your posts I would go with the advice from your PCP to see the neurosurgeon especially given your PCP had great success with this neurosurgeon from personal experience so you can not ask for anything better.

While I admit that insurance companies can be difficult I think it all depends on the case. To say that you must suffer for one year before they will allow a surgery or force you to do an ESI treatment if you can not for medical reasons is a bit silly. They may give the doctor trouble but lets be honest here also.

It is part of the doctor's job to tell and convince the insurance company that you need the surgery now. From my own experience the doctor would tell me bluntly that they would have to write certain things on the insurance claims, true or not to get the process moving. Unfortunately that is the US system but given what I hear about the NHS system I do not feel that bad.

-js

gwennie17
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Joined: 12/30/2008 - 12:07am
Hi --

There seems to be a prejuidice on this board toward using a neurosurgeon for spinal surgery, but I do not share that bias...especially with doctors who have trained within the last fifteen years or so. The fellowship training to become a spinal specialist is very similar now. More important I believe is where the doctor did his training, his overall experience with the type of surgery you need, and then minor things like how the office is run, the surgeon's personality

If you feel comfortable with this neurosurgeon, that is the important thing.

Spondylolisthesis does not necessarily show up on MRI. That's why I asked if you had the flexion/extension X-rays? Mine did not show up and I'd been told I only had degenerative changes common to my age group...so I went to my first surgeon expected to be told I was not a candidate for surgery. Instead I was told I had no other option but to have fusion. I was in shock! I had no symptoms except for terrible sciatic-type pain....

They do usually suggest six weeks of conservative treatment before recommending surgery. I do not know if insurance "requires" it or just recommends it. Steroid injections are commonly given as sometimes they do resolve the situation. However, if you can't take them, you can't take them and they will do something else!

If you have your instability at L5-S1, that refers to one segment. There is one disc between the lumbar 5 vertebra and the first sacral (S1) vertebra. It is the second most common area for instability and for disc problems after the L4-L5 segment. The L4-L5 segment takes the brunt of the body's movement, and as a result, is often the first to show signs of degeneration or disc herniation.

It may be that your problem is sufficiently complex that the doctor does not feel comfortable trying to discuss it over the phone. He probably wants to show you the MRI and use it to describe the problem and show you how he would fix it. I wouldn't worry about it. This is a busy time of year and that may be the first time he had open.

missy9
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Js, I do feel confident in

Js, I do feel confident in my choice so far. My pcp is doing really well after his surgery which makes it an easier choice. The neuro didnt act like it was a problem that I couldnt have the steroid shots. I was just wondering because I have been reading on here that insurance companies like that sort of thing. I am glad to hear that is not always the case.

Gwennie, Thanks for all the info. I do not know much about the back. I am assuming the neuro may have found something more than he originally thought when he told me he would call with the results. He was trying to be nice since it is an hour drive for me to get to his office. Whatever showed up must be a bit more complex than he originally thought so you are right he probably needs to explain in person.

I just hope he doesnt tell me I dont need surgery anymore! I guess that is what I fear the most, that he wont be able to fix what is wrong. I just dont know how much longer I can take this pain and being confined to my home and bed.

How are you doing since your fusion? I know it doesnt always take away all the pain but does it help with quality of life? I notice from your sig. that you have had a lot of problems too!

Hugs,

Missy

missy9
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Last seen: 4 years 5 days ago
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Joined: 12/02/2009 - 3:34pm
I have all the info now!

The hospital I had my tests done has an online patient account where I can see all my medical records. My recent tests where finally posted!

My Mri says: There are degenerative bone marrow signal changes at endplates abutting L5-S1. There is disk dessication. There is a small left paracentral disk protrusion which abuts the left S1 root and the subarticular recess but does not significantly deviate its course.

Flex/extension xray: minimal retrolisthesis of L3 on 4. (doesnt give a measurment of how much)

Bone scan: Normal (Yeah)

So basically my disk is slipped backwards?? I wasnt able to flex very far front or back. Can that alter how much slippage they can see on xray? Could the retrolisthesis and/or the disk protrusion be the cause of my sciatica?

thanks for any help!

Missy

missy9
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I cant take this pain anymore!!!

anyone? Are the disks I posted above touching my nerve? Could the retrolisthesis and/or the disk protrusion be the cause of my sciatica?

I am just so tired of this. The back pain is much easier for me to deal with but the leg pain is almost unbearable. Nothing including pain meds seem to help much. The only thing that seems to help a little is if I stay in bed all day, find a comfortable postition and dont move. I cant live like this anymore. I just hope when I finally have surgery this will improve.

mejames21 (not verified)
Title: Member
Tried Lyrica

Missy - have any of your docs suggested you taking Lyrica? I too was suffering from unbearable sciatic leg pain from top of thigh down to my toes. I then had a steroid injection at my herniated disc location (L4-L5). The injection actually made it worse!

However, while at the hospital (could not take the pain - no position - even laying flat like you say was helping so I went to the Er) they started to give me Lyrica along with traditional pain meds (OxyCotyn in my case). I still have considerable pain, but the Lyrica cut it in half.

Best of luck to you. It sounds like you have a couple of problem areas - the first thing you need to do is get rid of the pain - it is absolutely dibilitating and erodes your faith and psyche.

God Bless & Good Luck!

jsirabella
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Joined: 08/21/2009 - 7:34am
Series of meds and life style changes...

missy,

I am going by my experience for a L4-L5 herniation so bear that in mind but I find that the course of action my doctor took is pretty much the same as others.

1) Your current doctor should be giving you an anti-inflammatory like, advil, aleeve, diclofeic sodium. I had great success with the diclofeniic. Next nerve drugs like Lyrica or Neurotin and third a muscle relaxer like soma.

2) Your current doc should be doing some form of PT. For some they hate it but I have found the exercises on this site to do wonders. Keep in mind they are not exercises in more traditional sense but meant to stengthen core and get you mobile. The worse thing you could do is loose mobility. Walking is by far the best thing for your back.

3) Lifestyle changes as this is the most important, try to stand more at work and walk often. Do things to relieve pressure off your back like laying on the floor and putting your legs up on a chair. No bending, twisting and put your legs up on a foot stool while sitting.

4) Ice/Heat 20 minutes atleast 3 times a day of each on your lumbar area. This is a must.

Be ready for a battle mentally....you need to focus on your recovery and not just your life. This will take time and you have to understand that.

Hope you get better sooner than later...

-js

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