Foot guy is sending me to spine guy. What now?
July 25, 2014 3:19 PM   Subscribe

I saw a foot and ankle ortho guy to address bilateral neuropathy, a persistent rash, and excruciating pain that radiates from the outer foot up to my inner knee. (I do not have diabetes.) Dr. Foot & Ankle says all is (mostly) well with the foot and ankle, so he's sending me to Dr. Spine. Is this really the right guy to see next?

Dr. Foot & Ankle said that good news is that, other than some arthritis, bunions, and some signs that my metatarsus adductus was slightly overcorrected, everything with the foot and ankle is just ducky. He told me to get a cheap OTC orthotic to deal with slightly flattened arches and to address my symptoms with Dr. Spine next week.

Now, I realize that the nervous system is all interconnected and it makes perfect sense for a bilateral issue to originate with the spine. However, I just noticed a new symptom (that I reported to Dr. Foot & Ankle) when I has having my films taken. When the x-ray technician was instructing me to move or hold my feet in certain positions, I found that I thought I was responding to her commands when I was in fact not doing so. In order for me to turn and hold my feet in a given position, I had to be looking at my feet. With my left foot in particular, the x-ray technician sometimes had to physically move my foot into the proper position and I had to keep my foot within my field of vision in order to continue the hold. Since then, I've noticed that when I am going up and down stairs or walking on unfamiliar or uneven terrain I look down at my feet.

Because of this particular symptom that I never had the occasion to notice before, I feel like I should really be seeing Dr. Neurologist next. As Dr. Foot & Ankle is part of a large orthopedic conglomerate and Dr. Spine is a member of this conglomerate, I'm wondering if I'm in a hammer and nail situation. Dr. Foot & Ankle said that Dr. Spine is likely to order an MRI and nerve conduction studies, the results of which I'm sure I could share with Dr. Neurologist if necessary. So I don't mind seeing Dr. Spine next, if it truly makes sense. But money is an object, and these visits aren't completely free under my insurance, so I'd like to be as financially efficient as possible while I try to nail down the origin of this problem.

posted by xyzzy to Health & Fitness (8 answers total)
Absolutely. Neurologist next.
posted by 6thsense at 3:23 PM on July 25, 2014

Best answer: Proprioception is a sense that is transmitted through the spinal cord. I'm not saying it's wrong to see a neurologist, but this new symptom doesn't definitely indicate that you have a problem outside your spine. I don't think anyone here will be able to tell you for sure whether a neurologist or a spine doctor (orthopedist or neurosurgeon) can help you more, because you don't have a diagnosis yet, and it isn't obvious what your diagnosis is going to end up being.
posted by treehorn+bunny at 3:26 PM on July 25, 2014 [4 favorites]

Have you seen a skin guy?
posted by latkes at 3:50 PM on July 25, 2014

I type for an orthopedics ("spine guys" and "knee guys" and "foot guys" and so on) clinic as a transcriptionist. They deal with that kind of stuff all the time. If foot guy can't fix you, then spine or neuro guy is next in line. I often type about people who get an injection somewhere along the spine for foot, leg, arm, or hand pain. This is not at all unusual. Physical therapy might also help but foot guy (and spine guy, too) would probably prefer you have a definite diagnosis before sending you for that.

Spine guy will definitely move you along to neuro guy if necessary, but if foot guy thinks you should see spine guy first, then I'd go with that.
posted by AllieTessKipp at 4:19 PM on July 25, 2014

Response by poster: Skin guy is on the list, but the wait time for a dermatologist around these here parts is 6 mos. to a year.
posted by xyzzy at 4:52 PM on July 25, 2014

You can just get a referral to physical therapy and get their feedback before flipping the coin on Dr. Spine or Dr. Brain. In Canada they do PT all the time without imaging/diagnosis because we wait a long time for MRI. You might be able to get some symptomatic relief with an appropriate exercise program while you figure out the root cause of your symptoms.
posted by crazycanuck at 5:35 PM on July 25, 2014 [1 favorite]


I think you may have two different problems which can be addressed slightly differently.

I can put together your neuropathy and rash and this new problem figuring out where your feet go (proprioception), and the thing is, I am not sure that's something an orthopedic surgeon can fix. That sounds in the realms of neurology, and could be a variety of things both at the level of the spine or something more broad like an underlying medical condition (diabetes, etc). So that's going to need its own evaluation, and a neurologist is probably better equipped to look for those kind of broad problems. (For example, nerve conduction studies may or may not tell you something in this situation depending on the kind of neuropathy.)

The shooting pain going up your leg? That's something that an surgeon might potentially be able to fix, because that might be a pinched nerve somewhere.

So...if you ask who to see, I am not sure one doctor will fit the bill for all your symptoms, sorry!

Again, er, IANYN (and maybe when you have a hammer...)
posted by vetala at 8:39 PM on July 25, 2014

Best answer: A neurologist will be able to determine whether your problem lies with the spine and nerve roots or whether it's related to a circulation problem or a neuro abnormality or disorder because his speciality involves finding out what is causing the problem, and there are many possibilities here. The orthopedist, however, begins with the idea that the problem is related to your bones and joints and/or spine and nerve roots and he'll have to rule out all that before he can get around to sending you to a neurologist for a diagnosis. I'd be inclined to head for a neurologist first - and I'd get in as soon as possible since this seems to be progressing and needs to be identified and treated now. The rash, in particular, isn't usual for simple bone and joint complaints.

Yes - definitely the neurologist first. Don't go for any physical therapy until you've been seen by a neurologist - physical therapy is wonderful if the problem warrants it, but could cause real trouble or, at the very least, a delay getting the right diagnosis.

Best of luck.
posted by aryma at 12:04 AM on July 26, 2014 [2 favorites]

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