pin and needles and numbess of Toes

I've just started treating a new client who after a back accident about 3 months ago is now experiencing numbness, pins and needles in her right foot. The sensation starts at her 2nd and 3rd toes on right hand side, this can go to her ankles and sometimes her shin after 5 minutes of standing. The back problem was an acute sprain with possible underlying Kidney Yang Xu.

I'm not sure on the tcm diagnosis for the numbness pins and needles. Could it just be on obstruction of Qi and Blood along the meridian due to Cold/Damp? She has very little signs and symptons to try and fit into a pattern and wasn't very forth coming when doing the consultation.

 Any advice of tcm diagnosis and points would be helpful.

Points I have been using.
Liv 3 Li4
Sp6 Sp10
Points to strengthen lower back
Bl40
L4/5
Bl 17


Comments

hagc's picture

Numbness & tingling sensation on lower extremities

For numbness and tingling along with pins & needle sensation I've combined points such as Bafeng or Ba Xie (extra points) and added scalp acupuncture as well. Combining this along with certain points according to your diagnosis is highly effective. Some of my patients have reduce occasions of numbness, tingling sensations after using these points.
Feng Mei's picture

 I believe this is sciatic

 I believe this is sciatic pain, you must do the test of her "Lasegue sign"(straight leg raise) to make a correct diagnosis, if you don't know how to do the "lasegue sign", please let her go to hospital check CT on her back spine specially at lower back area, this will make sure to prove of the diagnosis.

rachael86's picture

Thanks for the comments Jean

Thanks for the comments Jean and Feng.

 

Can I ask Feng why you think this issue maybe sciatica? She does not present with any of the usual symptoms of sciatica. No pain in the leg or calf, no pain in buttocks or lower back now. The numbness and pins and needles is on the front part of the leg. I just wouldn'f of thought of sciatica so the points I have been using have reflected this.

Feng Mei's picture

To prove the sciatic pain,

To prove the sciatic pain, you must do the test of "lasegue sign", before the test, you can not make any diagnosis. For my experience, sciatic pain can be anyway of feeling on the feet, you can not make a diagnosis only by the patient feeling complain, sometimes it may be a mistake feeling, because the sciatic pain on the nerve transfer could be any direction on the leg and feet, you must check the body to prove the diagosis even do the CT scan to advance diagnosis. Please google the "lasegue sign" and "sciatic diagnosis". To be a quality practitioner, please don't follow the patient's feeling, you should use the correct way to check and prove it and make a diagnosis!

AbigailOK's picture

sciatic pain

You recommend a practitioner to google something in order to treat someone? 

Since when is listening to the patient the worse thing on earth? That is what is the beginning of administering anything be it regular or alternative medicine. 

Maybe a disc is not in the right position in her spine or at another place in the back. So please, be very careful.

 

kubera's picture

Pinning sensation in foot and back sprain

For back sprain I have treated several patients effectively with the points H9 and Si3. For numbness and pinning sensation in foot UB66 (urinary blabber) and St41 will be effective.

Chad Dupuis's picture

Before I offer some advice,

Before I offer some advice, what type of results have you had so far?  Any improvement at all?  And what frequency and over what period of time have you been treating?

rachael86's picture

I saw her yesterday after 2

I saw her yesterday after 2 previous treatments. No real improvement but i wasn't expecting such at this time. I'm seeing her once a week at the moment. I did the straight leg test as Feng suggested to rule out sciatica. This was fine, no pain at all. I added St41 and moxa to treatment yesterday. Hoping for more positive results. Her back also still feels weak.

Thanks in advance

Chad Dupuis's picture

Unless the pins and needles

Unless the pins and needles feelings is from a deeper neuropathy of some kind, your patient should be feeling better within 2-3 treatments at least.  Note I say better, not completely resolved.    I'm not sure moxa on ST 41 would add much value to her condition overall.  As others have pointed out the nearly universal cause of this (in the absense of neuropathy or an auto-immune condition like MS) is spinal issues in the low back - which can exist with no or limited pain in the area.  Another possibility is a morton's neuroma but given the history of the accident and with no damage to the foot from it this would be unlikely (and it's usually between the 3rd and 4th - but not always).

I would generally do something like the following (many of the more common points are on our low back pain treatment page):

  • GV 20 - motor cortex
  • GB 20 - circulation/communication head/body
  • Huatuo of T1 - bone marrow (any bone problem, anywhere)
  • Huatuo of T7 - circulation to the lower abdomen, back, and legs, any blood/circulatory problem
  • Huatuo of L4 & L5 - the most likely cause of this pain.
  • If you were going to use moxa and you feel the patient is KD Yang Deficiency - then UB 23 would a good place to do this.
  • UB 31
  • UB 32
  • UB 40
  • UB 57
  • UB 60
  • Then perhaps bafeng points on the affected toes.
  • Deep Tuina in the low back, through the calf and down the leg into the foot.

 

Feng Mei's picture

How did you do the "Lasegue

Hi, Rachael:

How did you do the "Lasegue Sign"?  "Straight leg test" or "Straight leg raise test"? What do you mean: "This was fine, not pain at all"? What was fine? Where not pain at all? I think you should transfer the patient to M.D. for diagnosis.

Feng Mei's picture

Hi, Rachael:  I tell you the

Hi, Rachael:

  I tell you the truth, the spinal nerve root of L5 control the feeling of first, second and third toes and shin. The Straight leg raise, also called Lasègue's sign, Lasègue test or Lazarević's sign, is a test done during the physical examination to determine whether a patient with low back pain has an underlying herniated disk, mostly located at L5 (fifth lumbar spinal nerve). Basic on the patient had accident on back 3 month ago, so I strongly recommend you do the Lasegue sign or Straight leg raise. With the patient lying down on his/her back on an examination table/or exam floor, the examiner lifts the patient's leg while the knee is straight. If the patient experiences sciatic pain when the straight leg is at an angle of between 30 and 70 degrees, then the test is positive and a herniated disc is likely to be the cause of the pain. Sciatica ( /saɪˈætɪkə/; sciatic neuritis) is a set of symptoms including pain that may be caused by general compression or irritation of one of five spinal nerve roots that give rise to each sciatic nerve, or by compression or irritation of the left or right or both sciatic nerves. The pain is felt in the lower back, buttock, or various parts of the leg and foot. In addition to pain, which is sometimes severe, there may be numbness, muscular weakness, pins and needles or tingling and difficulty in moving or controlling the leg. Typically, the symptoms are only felt on one side of the body. Pain can be severe in prolonged exposure to cold weather. For the answer of Lasegue sign test, you should answer "positive" or "negative", this is the professional answer.

nuno lemos's picture

another aproach

Hello

According to Traditional chinese acupuncture, in point combination the first principle is local and distal points. I have noted that you don´t even use local points.

What I´m going to propose is a different metodology to select points. Instead of choosing acupoints accordind to syndrome differentiation (that is not even the correct way in TCM) try to think in terms of nervous system.

The local points continue to be the best and extremely important points such as bafeng should be used.

Then you have other points as ST41, GB40, GB41 and the shixuan if necessary.

as distal points ST36, GB34 and BL39 are extremely importante.

If you wish to use points in lower back you should focus on huatuojiaji for the foot.

After this selection you should start think in eletric stimulation.