The Nervous System

Full Answer Section

• Past Medical History: Inquire about any pre-existing medical conditions like diabetes, back problems, or autoimmune diseases.
• Medications: Review current medications as some can cause nerve side effects.

2. Physical Examination:

• Inspection: Look for any visible signs of injury, swelling, redness, or skin discoloration on the foot and leg.
• Palpation: Palpate the foot and leg to assess for tenderness, temperature differences, and muscle weakness.
• Motor Function: Evaluate muscle strength in the foot and ankle by asking the patient to perform movements like dorsiflexion (lifting toes upwards) and plantarflexion (pointing toes downwards).
• Sensory Testing: Use a light touch and pinprick to test for sensation differences in the toes, foot, and lower leg compared to the unaffected side. This helps determine if the numbness affects all types of sensation or is specific to touch or pain.
• Reflexes: Test the ankle reflex (tapping the Achilles tendon) to assess nerve function in the reflex arc.

3. Additional Tests (if indicated by initial findings):

• Monofilament Testing: This uses calibrated nylon fibers to assess the perception of light touch, which can be more sensitive than pinprick testing.
• Vibration Testing: A tuning fork is used to assess vibration perception at the ankle.
• Tinel's Sign: Percussing along the course of a nerve (e.g., peroneal nerve) can elicit tingling or pain if it's irritated.

• The history helps identify potential causes like diabetes, nerve compression, or vitamin deficiencies.
• Physical examination assesses muscle function, nerve integrity, and sensory deficits.
• Sensory testing helps pinpoint the location and type of nerve involvement.
• Reflexes provide further insight into nerve function within the reflex arc.
• Additional tests can refine the location and severity of nerve damage.

• Peripheral neuropathy (damage to peripheral nerves)
• Tarsal tunnel syndrome (compression of the tibial nerve in the ankle)
• Lumbar radiculopathy (pinched nerve in the lower back)
• Vitamin B12 deficiency
• Diabetes complications

Sample Answer

A patient presenting with numbness and tingling in their toes on their right foot warrants a neurological assessment to determine the cause and potential underlying condition. Here are some neurological assessments you might perform:

1. History Taking:

• Onset and Duration: Ask about the start time of the symptoms, whether they were gradual or sudden, and if they are constant or come and go.
• Severity and Distribution: Assess the severity of numbness and tingling (dull ache, pins and needles) and if it spreads to other areas like the ankle or leg.
• Aggravating and Relieving Factors: Explore if specific activities worsen the symptoms (tight shoes, walking) or if anything provides relief.