In our last blog post, we discussed the fact that neuropathy is a generic term that refers to a dysfunction, pathology, irritation, disease or damage to a nerve.  It is commonly used inaccurately to describe a specific nerve condition, when in reality there are dozens and dozens of different type of neuropathies.

We also discussed the concept that nerves are divided into “central” or “peripheral” nerves, based upon their location relative to the spine.  Those nerves found within the spinal cord and brain are considered part of the central nervous system; whereas, those found outside the spinal cord are considered peripheral nerves.

Peripheral nerves include the part of the long spinal nerve “roots” that exit from the spine all the way down to the final termination of that nerve—even when it is at the tip of the big toe!  Each nerve root contains hundreds of individual nerve fibers that control everything from pain sensation, muscle function, position sense, vibratory sense, hot/cold sensation, light tough, deep touch, discriminatory touch, etc.

In our office we utilize several cutting-edge treatment technologies, to include MLS deep tissue laser therapy, and spinal decompression to treat various types of peripheral neuropathies.  But before we can determine how our therapy can be properly applied, we must understand the causative factors for each neuropathy.  And in many cases, there are more than one factor causing the peripheral neuropathy.

As the nerve roots exit the spinal cord they become more prone to injury than when they were inside the cord.  This is due to several factors.  The first is the fact that the spinal cord is well protected by the bony vertebral column and the protective cerebral spinal fluid that acts as a cushion to the cord and nerves.  But as the nerve root leaves the spine it gives up the protective fluid and passes laterally through an opening in the bones known as the vertebral foramen.  A foramen is basically an opening within the body, and in this case, an opening between the vertebral bones.

Between each vertebrae is a disc.  This disc is made out of a cartilage so that it has flexibility.  Each side of the disc is connected to both the vertebrae above and below it.  Without the flexible disc, we would not be able to bend (as bones don’t bend).  This allows a tremendous amount of motion between the protective vertebrae.  There are also several other ligaments that assist the disc in both keeping the bones together, but still allows movement in all 3 planes.

Now as the spinal nerve root exits the spinal cord deep within the spinal column, it changes direction from a vertical orientation to a horizontal one, in order to exit the foramen.  Spinal nerves are always in pairs, and there is a right and a left one at each level of the spine.   As they pass horizontally through the openings, they pass very close to the disc at that level that separates the vertebral bones.

We already mentioned that each disc is made up of cartilage.  Inside the center of the disc is a very thick, gelatinous material known as the nucleus.  The outside disc cartilage keeps the fluid in the center contained.  A good analogy is a car tire.  The outside rubber of the tire and steel belting underneath, keep the air of the tire contained.  When you puncture through those protective layers, air can leak out.

It is the same with the disc.  The outer layers are called the annulus fibrosus, and they keep the fluid contained inside the disc.  When those annulus fibers get damaged, the pressure of the fluid inside can start to “bulge” the outer part of the disc (annulus) outward.  We refer to this as bulging disc.  When the annulus tears, it is called a herniation.  This typically leads to the inside fluid (nucleus) squirting out in what we call a protrusion.  These bulges and protrusions usually cause problems for the nerve roots that are passing by as they attempt to exit the vertebral foramen.   This frequently causes  not only back pain, but more frequently  leg pain, numbness, tingling down to the feet and toes.

Now, back to what we discussed last week.  When there is damage, irritation, disease, compression, or any problem with this part of the nerve root, we refer to it as a proximal peripheral neuropathy.  These disc bulges/protrusions create one of the most common peripheral neuropathies in the body.  We call it a radiculopathy.  Many cases of leg pain, numbness, tingling, loss of muscle function in the foot or leg, or balance issues are caused by this proximal peripheral neuropathy.  All of these symptoms may originate from the irritation or pinching of the nerve root at the back (or neck for symptoms in the hands, arms and fingers).

But why do some only have numbness? Or tingling?  Why do I have pain only in my big toe and not the rest of my foot?  And the number one question….why can someone have severe leg pain, numbness or tingling in the feet, but no back pain at all?  Next week we’ll discuss this further.


  1. Tom Dart on April 11, 2019 at 11:29 am

    Really enjoyed the post on peripheral neuropathy

  2. Dan Austin on April 13, 2019 at 5:42 am

    Hi my name is Dan I’m 44 years old I’m in decent shape im not diabetic and I have been diagnosed with neuropathy in both feet the left foot hurts much worse than the right but they both hurt. I’ve never been injured that I know of that could cause this the doctors say all they can call it is “Idiopathic” in other words their way of saying they don’t know why this is happening! I’m normally a very outgoing and on the go kind of guy and a slight workaholic but with this problem im worried im gonna have to give up the things I love doing most…
    So far I hardly dip anything with my family unless I can sit I really would like to get out and just play with my kids but the pain has just gotten to much to bare, as for work I get up every morning and go to work and yes I limp all day and by the time I get off work all I can do is get off my feet this is not healthy for me I should be getting my second wind and doing what and good husband or father should do help with house chores taking the dogs for a walk playing with the kids ect. But I can’t the pain is unbearable at this point!!!
    I really need to find a way to make this better or by some miracle make it go away. I used to work 3 part time jobs now I work 1 full time and 1 part time job it kills me to think that if this gets any worse will I have to quit being a man and supporting my family and not pulling my own weight I just can not handle that… I’m sorry for going on or sounding like a cry baby but I really am trying to find help for this serious problem that is taking the quality of life away that my family should be able to experience with me until I’m old not crippled for no reason
    Thank You

    • mr mayhem on December 16, 2019 at 2:00 am

      I recommend seated hamstring stretches and piriformus stretches done correctly, slowly and with good holds. Make sure you are staying hydrated and take your breaks. for real take your breaks. work on correct posture and flexibility. definately look into physical therapy and improving your diet. you need water for your discs stay soft. everyday! sounds like your l-4 discs is deformed, probably l-5 as well.

    • Todd on January 4, 2020 at 1:16 pm

      I developed “idiopathic neuropathy” in mid 2016. After a year of testing with a neurologist, with every imaginable test, this became my diagnosis. As you understand, the “idiopathic” diagnosis is unacceptable, as there IS something causing the nerve pain. After pleading for a referral to a ortho office, he relented. An MRI showed spondyolisthesis and instability from fractures in the l4,l5. The ortho doc was certain this is what was causing the nerve pain.
      I am extremely active, working out every day (46 at that time) and after finally being diagnosed properly I literally tried about everything to alleviate the nerve pain, which at times would become unbearable. My last resort was surgery, so after epidural injections , intensive physical therapy, chiropractic, acupuncture, and even cupping I finally opted for fusion surgery. I am four weeks out from the surgery and, although some nerve pain still exists, it is different than before. I still have a large amount of swelling at the surgical site so that would hopefully explain some of maintained nerve compression. My hope is that in the coming weeks the pain will completely dissipate. I can let you know!!
      I saw your post and thought I would reply simply because I have not found many people who have had the same symptoms I have had and then the same “idiopathic” diagnosis. I feel your frustration!

      • Stephen Douglas on March 9, 2020 at 11:58 am

        Todd do you have a follow up to your post about your surgery? Wondering if it has improved?

    • Stan on February 2, 2020 at 8:44 pm

      Dan .Stan .same thing with 56 and im faced with A hopeful to just die soon.B spend all the money i have to my name and be forced to live under a bridge somewhere in agony. I choose A.Doctors wont prescribe any medication that will kill the pain because they are scared to .im out of options and fed up completely. Its a shame we the usa have the best medical care in the world but a 56 year old man cant get any relief from a extreme painful life happenstance. Hope you doctors who read this are proud .your killen people by neglecting there pain.

    • Joe Dolan on February 13, 2020 at 1:39 pm

      Dan, hey I read your comment, I am 53 yrs old from northeast Pa., and I swear that I would have written the same exact thing as you wrote, I was diagnosed also as Idiopathic, which is such a BS diagnosis. They threw me on Gabapentin, and said adios?? Now the gabapentin takes some of the pain away, I said, “some” but none of the numbness, coldness, burning, sharp stabbing pain every once in a while for no reason, etc, etc, etc…. I had an EMG, scans sugar test, A1-C, etc.. and all came back normal, So patients like us get the Idiopathic diagnosis. I’m afraid I will be in a wheel chair or a jazzy within 5 years if I don’t get to the root, of the problem, I am frustrated as can be, and am gonna see if they can look into a lower back or neck problem, I have no pain in back or neck, but have been told by some people experiencing the same problem that we have, that it can be the back or neck, that causes the neuropathy, and the pain the feet, hands, wherever, with no pain in the back. I played sports as a youth and in high school and college. so this, I am told can be an old injury that has not been addressed, due to no pain, when if fact it is an injury. I don’t know how me answering your 10 month old comment can help, but I would love to know how your neuropathy is doing, and have you had any treatment that has helped. Totally lost in frustration. Good luck Dan

      • Laura Tomblin on February 15, 2020 at 11:58 pm

        I have pinch nerves in my shoulders. Nerves hitting bone in my back so I have backaches that go down in my legs when I work .My feet hurt burns, aches, tingling feeling,I can wear shoes all day or tight clothes,panty hose makes my legs feel funny.Now the rest of my body above my weight aches to could be the nerves in my body. I also my Tyroid is going crazy and I heard it can cause pain in the hands and the body.So both can make pain to.Gapentin helps some not all of it.So what can I do?

        • Cameron Hatam on February 16, 2020 at 11:59 am

          Good morning Ms. Tomblin. I would recommend getting a thorough examination to determine what to do next. While gabapentin is good at relieving symptoms the root cause of your problems must be addressed first. If you live in the northern va area we would love to help you out. Please call us at 703-370-5300. Alternative you can email me at [email protected] to discuss your condition further.

  3. Amysusankeller on June 4, 2019 at 3:12 pm

    I am interested in receiving your emails. I have numbness, weakness, and pain in my legs, feet, and hands. I’ve had spinal problems for years- degenerative disc disease, bone spurs, bulging disc, arthritis. I just had an emg. Neurologist said my problems are on discs 4&5. He is sending me to a pain clinic. Not sure what is next to get to help with pain and numbness. I’ve had shots and ablations.

    • Cameron Hatam on September 10, 2019 at 9:44 am

      Good morning Ms. Keller, I apologize for the delay. Thank you for your interest in receiving our emails. We will do that for sure. We are all so sorry to hear of your chronic spinal conditions. We would do a thorough review of your history and all imaging including MRI’s and emg’s on your consultation. We would then come up with a catered plan to help decompress these discs and relax the underlying nerves. In addition laser therapy does two things. Two simultaneous lasers will enter the damaged tissue. The first one will act as analgesic and help with the pain. The second laser goes into the mitochondria aka the powerhouse of the cell and stimulate tissue repair. From your comments it seems a good combination of laser and cervical/lumbar decompression will give you the best chance to avoid surgery. However, this all will start from the examination. If you are interested in making an appointment please call us at 703-370-5300. Have a wonderful day!

    • Charlotte Corney on January 14, 2020 at 3:08 pm

      Hello….I also have similar symptoms to you with tingling in both hands and feet accompanied by what was a sporadic lower back pain which has just gone through the roof…Interested to hear the next part of your story if you’re will to share…I hope you’ve made a good recovery😀

  4. Donald Walker on August 17, 2019 at 8:58 am

    I had back surgery on lower back l4 and l5 herniated disk. Two weeks after surgery still have back pain and numbness in both big toes and tingling. I also had a annual tear and I had very little reflexes in my right leg before surgery. I’ve had these problems almost two years before surgery can you explain to me if I have nerve damage thanks.

    • Cameron Hatam on August 17, 2019 at 10:36 am

      Hi Mr. Walker, yes what you are explaining called radiculopathy. Each nerve of the lumbar spine goes down what is called a dermatome. A dermatome is a distribution area where you feel sensation innervated by the nerve. When there is nerve damage between L4 and L5 you will particularly feel the dermatome down the inner leg and the big toes. In addition patellar reflexes will be diminished and the muscle weakness will be felt lifting the great toes.

  5. Scott Wyatt on September 15, 2019 at 12:07 pm

    Please add me to emailing list for blog posts

    • Eve Mcardle on January 2, 2021 at 3:53 pm

      HIV I have severe burning in right lumbar spine and weakness also weakness in legs and numbness in big toes with burning in feet had thus after an accident had mri showed nothing no nerves pinched physio but makes it worse what is it ? Please I need to get better I don’t know what to do

      • Eve Mcardle on January 2, 2021 at 3:58 pm

        Sorry I mean hi not hiv I have had cortisone did nothing on L5S1 did nothing 3 shots
        Alabation on sacroiliac did nothing
        Nerve blocks in facets did nothing
        Emg on sciatica came back normal
        I am at my wits end
        Mild degenerative changes and mild facet arthrosis no nerve impingement?

      • Cameron Hatam on January 2, 2021 at 6:07 pm

        Hi there Happy new year. Do you live in the DC area by any chance? If so please come in for a consultation. You can call us at 703-370-5300 to schedule

  6. Jason Helm on November 1, 2019 at 3:42 pm

    Thank you, this was very informative.Being a patient of lower back pain I have been to mostly all the doctors and their medicines seemed to help me temporarily. Currently my doctor is of pain management doctors in rockland county ny and he has recommended me thermotherapy. Which has been quite helpful for me. The icing might help in injuries but I believe it would cause more pain if applied for joint pain.

  7. Clare baddeley on November 16, 2019 at 3:43 am

    Four weeks ago i over did it with some heavy lifting and bending i had to do. That.night i was admitted to hospital with a suspected slipped disc and sever pain in my back and hip. I had pain management and came home two days later pain free. During this time i had numbness tingling in my foot i told the doctor but it was dismissed. Since then it has got worse with skin sensitivity and sharp stabbing pains all ovef my foot so bad im unable to sleep. Im being treated with anti inflammatries and nerve tablets. The pain in my back has compleyely gone although at times i feel a pinch at the base of my spine. Is this footpain a result of my back injusy and will physio help? Please email me some information. Thanks

    • Cameron Hatam on November 18, 2019 at 5:11 pm

      Hi Ms. Baddeley we have emailed you.

  8. Harold Bubb on December 11, 2019 at 9:13 pm

    Any Doctors in North New Jersey? I’ve been in severe pain for almost 20 years. With a double laminectomy in 2012. I have pain and neropathy in the back of both thighs.

  9. Kevin Huttenlocher on December 20, 2019 at 11:50 am

    I am a 62 year old male, auto mechanic. Still working every day. Up until June of this year I had no know maladies, and I take -0- meds and I do not smoke or drink. So I got an infection on my left ankle from a mosquito bite and the ankle and foot swelled. Walkin clinic looked and wrote Bactrim script for 14 days. It made me nauseous but stayed on it for 12 days and infection went away. However, within a few days of quitting the antibiotic my left foot began to have some mild numbness in the toes, then by the next day it was in both feet in the toes and the pads just behind the toes. At this point I had not really felt “discomfort”. This numbness and tingling remained and became some pain, not disabling pain. I had blood taken and they checked me for Thyroid levels and Glucose and Cholesterol levels. All were not remarkable. My blood pressure is always normal. They said I had a reaction to the Sulfa in the antibiotic. Have you ever heard of this type of onset of Peripheral Neuropathy ? Now it is 6 months later and just within the last week I have started to feel ever so slightly a numbness in my hands but its not the same level all the time. And now, when I think back about this finger numbness I realize that it did happen before now but I only noticed it when driving and just shrugged it off. I could be wrong but a few times it seemed like the numbness in my hands increased if I was sitting down. Then when I thought about that I realized that most times I would notice it would be sitting down on my bed holding my phone, or at the desktop pc typing like now or often when driving and when I am out working and standing I never really feel this numbness unless it was immediately after getting up from a sitting position. The hands are not in pain nor does it impede my working with my hands or affect their flexibility which as a mechanic I absolutely need. I have all along since June assumed that my PN in my feet was caused by the bad reaction to Bactrim, but now I wonder. Could I have injured a spinal nerve maybe when I was doing an odd job back in June. I have done jobs that put me in very exerting positions like laying on my back in front of the front seat of a vehicle to work under the dash by the brake pedal often for 20 minutes and more while having my back bent and twisted where I support myself at the door sill. Right this minute I am typing now 15 minutes or more and my hands are at armpit level extended out to the keyboard and my hands have increased numbness in the last 10 minutes. I am a person that is always diagnosing causes on cars and I cannot help thinking that maybe it was not Bactrim that did my feet in. Maybe the numbness in my fingers (mostly in both thumbs) is related to the cause of PN in my feet. What say you?

    By the way, I can answer any of your questions about any car problems as I was a paid consultant by and answered 23000 questions on there in 3 years.

    Thank You,

    Kevin Huttenlocher
    Myrtle Beach, SC

  10. neurorehabilitation on February 27, 2020 at 9:04 am

    Shouldn’t something be said about little filaments? “Doctors are just presently learning the wide scope of side effects that little fiber polyneuropathy can cause. Tactile side effects incorporate everything from extreme consuming torment to ceaseless tingle,” Dr. Oaklander says. Side effects of autonomic little fiber neuropathy are more averse to be perceived, notes Dr. Oaklander, so they are frequently credited to different conditions. “For instance,” she says, “neuropathy of the autonomic nerves to the heart or veins can cause low circulatory strain, saw as constant exhaustion and faintness or tipsiness. Harm to nerve filaments serving the gastrointestinal tract may cause swelling, queasiness, processing issues, clogging, or looseness of the bowels; these are frequently marked as fractious entrail disorder. Autonomic neuropathy less regularly influences the bladder and sexual capacity.”

  11. John Kraft on February 29, 2020 at 7:14 pm

    Unfortunately I’ve had my left side L5 nerve cut as part of fusion surgery. I now have significant peripheral neuropathy with pain and numbness in my left foot and recently my left calf such that I cannot move my toes or ankle and have foot drop.

    Dr’s I have seen to date do not feel this pain/numbness is due to the L5 nerve.

    Any comments would be appreciated.

  12. Andre on March 10, 2020 at 11:29 pm

    Hi I’m 45 year old with burning pain in both my feet and soreness in my calves whenever I sit for long period of time. I’m able to alleviate these symptoms with back extension or just walking it off. I had a lumbar MRI which showed a L5-S1 small right paracentral disc hernation, moderate degenerative changes of the disc, retrolisthesis and moderate bilateral stenosis. These symptoms began after a jujitsu class approximately 4 months ago. How long does it take for a disc herniation to heal? Are burning pain in the feet common for radiculopathy? What can I do to help with the healing of my disc?

    • Cameron Hatam on April 12, 2020 at 10:33 am

      Hello Andre are you doing any therapy for the pain or burning? What was your doctors advice?
      Some simple advice at home of course is to always bend with your knees not your back and to avoid aggravating factors such dead lifts and squats at the gym. The discs are also made out of water so not drinking enough can lead to desiccation which is another term for dehydration.
      Another option patients use at home is an inversion table. Make sure you do not have dizziness or high blood pressure or any contradictions before trying this though.

      Good luck.

  13. Kenneth Spencer on April 12, 2020 at 1:32 am

    Good day
    I am a 63 year old male. I injured my back about 35 years ago, and it has troubled me since. I had a mri recently, and I was told that I have advanced degenerative disc disease. The mri showed no central canal or neural fominal stenosis. The doctor in the message said that there is no significant pinching of the spinal canal or nerves. The reason for the mri, is for the last few months I have been experiencing leg numbness and weakness, foot numbness, balance issues, occasional leg pain, and occasional sharp pain in one foot. I have been also been experiencing constipation. When I sleep on my back, it really starts hurting, and my legs feel as if I am going paralyzed. At times my lower back feels as though it is about to give out, as if it’s losing stability. The cortisone injection in my lower right back provided no comfort at all. My back is now hurting constantly, and no medications or therapy has worked. I am more concerned with symptoms I listed above, than my back pain as I have lived with it for decades. My pain management doctor is going to ask a neurologist about this. Do you have any opinions on this? What I can ask the doctor about options? Thank you for your valuable service.

    • Cameron Hatam on April 12, 2020 at 10:29 am

      Hi Mr Spencer I would have your doctor show you the MRI images of the lumbar spine specifically the sagittal T1 and T2 images and not just rely on the report. Look for any compression on the thecal sac of L4-L5 and L5-S1 and whether there is any protrusions irritating the nerve roots.

      Good luck!

  14. Elizabeth on April 29, 2020 at 10:54 pm

    Glad to find this post! Several months ago, I developed numb spots on the inside 1/3 of both big toes. As I have on autoimmune disease (thyroid), I immediately suspected other autoimmune issues. However, the neurologist did bloodwork (full neuropathy panel), along with an EMG and cervical spine MRI (as I have recurring neck pain) and found nothing. I do not have regular lower back pain — but I did start doing yoga regularly about a year ago, and have several times pulled muscles overdoing up dog or similar positions that can compress the lower back if done incorrectly. Is it possible that the toe numbness is resulting from damage in the L5 area, even though I have no active pain there (and the EMG revealed nothing)? Thanks for your thoughts! Elizabeth

    • Cameron Hatam on April 30, 2020 at 4:49 pm

      Hello Elizabeth, yes it is quite possible that this could be radiculopathy from the L5-S1 area even without pain. The best way to diagnose that would be thru a Lumbar MRI without contrast. If you live in the Northern Virginia area you can make an appointment in one of our offices for an evaluation and get a prescription for the MRI. 703-370-5300.
      Good luck 🙂

      • Elizabeth on April 30, 2020 at 5:20 pm

        Thanks so much for your input! Wish I was closer (my family is there!) but I’m in Ga., so I will check with my chiro here to get that scrip. Thank you!

        • Cameron Hatam on May 3, 2020 at 12:40 pm

          I have been to Marietta and Atlanta both wonderful cities. You’re quite welcome. Good luck 🙂

  15. Scott on May 3, 2020 at 11:46 am

    I was diagnosed with idiopathic peripheral Neuropathy in both legs/feet about a decade ago. I’ve had EMG’s, PT, loaded up on Gabapentin and have seen my share of Neurologists. The EMG’s revealed pretty significant nerve damage. Short story, they’ve all pretty much given up on me. My pn has been pretty much limited to below my knees, has most often not been overly painful (although seems to be getting worse, associated with sciatic pain in my left side). Fortunately although very numb, I don’t have the pins and needles like many have described. My biggest problem is drop foot; both feet, but especially on my left side. About a month ago, I needed a prescription refilled. At 63, I didn’t want to go anywhere near a doctors office right now so I opted for a video visit. My doctor had just retired so I met with his replacement (by default I suppose), a young doctor with about 6 years experience. Ironically I called to get the prescription refilled, which she forgot to do; but we somehow got into this lengthy discussion about my pn. She asked me if I had ever had an MRI? Although I hinted to such with my neurologists, they never bit. I’ve always had this nagging feeling (no pun intended), that the neurologists were brushing off the idea of getting an MRI. My doctor on the video visit wanted me to get one and gave me a referral.
    Fast forward to a couple weeks ago; I had the MRI. I got a call back from the doctor with the results: Some minor nerve compression in my lower lumbar (seemed to be of little concern as it is often associated with arthritis), moderate compression in both sides of L3 L4 (she thought probably not associated with my neuropathy), but severe nerve compression on the left side of L4 L5 which she thought could be associated with my drop foot (which again is much worse on my left side). She has referred me to a Physiatrist. I’ll just see where I go from here (referrals, second opinions, injections, surgery…). Anyway, I see some new hope for encouragement. My wife who has had chronic pain, had numerous MRI’s and has seen just about every neurologist on the west coast, says… whoa! slow down sparky and don’t get too excited. Although she appreciates my enthusiasm and wishes me the best, she cautions me to get too excited. I’d be interested in hearing more stories or prognosis’ similar to mine. Thanks

    • Cameron Hatam on May 3, 2020 at 12:42 pm

      Hi Scott thank you for sharing your story. Idiopathic peripheral neuropathy is never fun. If you are in the Northern VA area and would like to get a consultation for our neuropathy services please give us a call at 703-370-5300.

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