Pain & numb on top of foot

by Esh
(Seattle WA)

Hi,

Thanks for taking time to read and answer so many questions. It is truly a public service!

I'm a 50 year old over-weight female. I've had a severely sprained right ankle as well as dropping a 20 pound barbell on my foot about 15 years ago. I've had few instances of numbness on my 1st& 2nd toe as well as numbness on top my right foot in the last year. No other problems except for occasional soreness on top my right foot that went away after walking bit.

A couple months ago I started bicycling about 10 miles a day a few times a week as well as walking 3 miles a day. No issues that I noticed. A few weeks ago I rode to work and when I got off my bike, the top of both feet felt numb and toes 1 & 2 were tingly and I had light cramps up one side of my leg which lasted, off and on, for a few days, (right foot longer than left) I saw my doctor who pointed me to a neurologist. The neuro said my EDB on the left was atrophied and the right EBD was smaller than expected and the nerve feeding each was slow. No other nerve issues. Reflexes and strength good. He thought the problem was from crossing my feet at my ankles. That seems odd to me.

Ive stopped crossing my ankles (for the most part) but still get cramp feeling in my right foot and low leg (on the outside) in the morning and occasional numbness between my 1st & 2nd toe also on the right foot. Do you think it's from simply from crossing ankles? Do you think riding my bike aggravates it? Walking? Would icing or heating my feet help them heal faster? Since feet are your speciality any insight would be appreciated!

Thank you,
Esh

RESPONSE
Hi Esh,
If you can bend your toes upward to any extent, then I am not overly concerned about the weakness in the edb muscle (extensor digitorum brevis). These are known as the short extensors and they work in conjunction with the long extensors, so that in itself is not an issue in my way of thinking.
When a person experiences numbness or tingling in the first and second toes that is usually an indication of damage to the superficial cutaneous nerve that innervates those two toes.
This is seen in individuals who put too much pressure on the skin on the top of the foot. Since the nerve is located directly under the skin, too much pressure such as lacing your shoes too tight, or excessive foot swelling, or a combination of both can irritate the nerve. This is also seen in a midtarsal fault, where the foot is collapsing at the highest portion of the arch and resulting bone spurring that occurs also irritates the nerve as it passes along the top of your foot.
If you tap on the top portion of your foot at the highest portion of the arch and feel a tingling going into your first and second toes, then you have irritated the superficial nerve. The fact that you dropped a weight on your foot years ago may have also caused some excessive bone spurring in that area. I would have to see any x-ray to confirm this.
You are not clear on this point, so I am guessing you have just started exercising. If that is the case, then I am not really surprised that you are having some issues. You are fifty years old and overweight; a formula conducive to foot and leg pain when attempting to do too much in the form of exercise.
Since I cannot examine you I cannot determine the source of your pain. But now that you know you have minimal neurological issues, I would go to a podiatrist who should be able to evaluate you in terms of your foot structure and activity level. My guess is you are doing way to much exercise and are just getting muscle pain from overuse.
You do not mention if your pains are debilitating or just annoying. In general, if they are annoying, you could probably continue with your exercise regimen, but if they are painful and you find yourself having difficulty walking, then you need some professional advice on the best way to regulate your exercise schedule.

Marc Mitnick DPM
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