Brief Answer:
Consult an Orthopedic specialist.

Detailed Answer:
Hi,XXXX,
Thanks for the query through HCM.
I have gone through your query & understand your concern.
Yes, what you think seems to be most possible from the information given .There are few causes I feel to be investigated to reach perfect diagnosis- like diabetes, Vitamin B12 deficiency, Spinal & disc problems,
You will need few investigations like-
- Blood Complete count,
-Serum B12 level/ serum calcium/ serum Vit. D
- fasting & post meal blood glucose,
- X ray/ CT scan/MRI of lumber spine,
I noted that you have had some of those test already. But if any test is missing, please get it ordered during the next doctor visit.
* I feel looking at your age/ your exposure to over work & constant back ache you have,... that, Spinal problem ( spondylitis, prolapse disc) seem to be more possible - which causes compression/ clinching of the nerve roots arising out at the affected spinal level ( Mostly L3-5 )to cause the symptoms you have. Again,increased symptoms while sleeping on side, also suggests in creased compression at spinal level..Its good that you do not have any motor loss, the loss is only sensory .


In short, yes, consultation of an Orthopedic doctor would be more needful than a foot and ankle specialist alone. After Physical findings after detailed physical examination he will order for investigation as per need ( which may include few of above mentioned ones)-- He will advise you specific treatment.
- Usually Vitamin B12 supplement, calcium/ vit D supplement/ anti diabetic medicines are prescribed as per cause along with anti inflammatory drugs/ Prednisones are used as per need. as per need.
- Physiotherapy forms a major part in management of the problem
- Some times , Endoscopic spinal surgery is needful to treat unrelieved symptoms..
Self care-
- Try to reduce weight,
- Avoid forward bending, lifting weight,
- Control of diabetes ( if present),
- Regular physiotherapy.

I hope, the answer was both informative & guiding to you. In case you have any follow up query, I will be happy to help.wish you a fast recovery.
Thanks.

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Brief Answer:
Consult Spinal orthopedic surgeon first.

Detailed Answer:
HI XXXXXXX ( XXXX),
Thanks for your follow up query.
I agree that working with an orthopedic field for years together, you aught to gain sufficient experience enabling you have some impressions about your own problem. That indicates the interest & sincerity you had in your working field. I also understand your feeling of awkwardness while differing with your doctor.
I would say it won't be unreasonable to deny the foot & ankle appointment & go for spinal workup first- by politely requesting your doctor/ taking second opinion of an experienced Orthopedic doctor because-
- Involvement of foot & ankle joint after sensory loss following spinal nerve compression is common because of the undue stress to the joints because of less judgement of movements(due to numbness of the part.)
- History of excessive work in last 6 months,pain in back,support the spinal involvement.
- Your age also favors possibility of osteoporosis & spinal disc problem after exertion.
- You do not have any other symptom suggesting local neuropathy due to nerve pressure by cysts, spurs, tendonitis, neurofibroma that could cause local nerve pinching at tarsal tunnel / tibial nerve.
* It's always better to go to the root cause of problem & get specific treatment for fast relief., So looking at the most likely possibility, I would again advise for a through check up of spine for your problem.
.Hope, the answer helps you to find way out of the dilemma. any more follow up query is welcome.
Wish you fast diagnosis/ recovery
Thanks.

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Brief Answer:
Continue with your plans.

Detailed Answer:
Hi XXXXXXX

Thanks for your follow up.

Yes . Back ache should not be taken as an emergency unless associated with some accident./ life threatening symptoms- A deep history, observation & investigations are needed for it's diagnosis.You sir's opinion/ your impression both stand true.
You had also mentioned about low blood pressure in your 1st query. But as you did not mention any associated symptoms like dizziness, fainting, & you could stand the hard task for 6 months- I did not think it could be to the extent to cause symptoms like feet paresthesia.
Still, Long standing diabetes/ low blood pressure remain to be excluded- which will be done by the spinal surgeon you are meeting to.

It's good that you have rearranged your appointments. As detection/ exclusion of major problem is desirable to avoid further damage by early detection & careful management. I still feel you are taking reasonable step..

Hope, that satisfies you. Any further query you have I am ready /happy to help you.please grade the answer before you close the query.

Thank you & wish you all the best.

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Brief Answer:
Low back pain supports spinal cause for your feet paresthesia.

Detailed Answer:
Hi,

Thanks for clearing the misunderstanding! It does happen many a times with the short forms we use in medical practice.

Never mind, It has not done much of difference in our discussion.Rather the possibility of spinal cause for your feet paresthesia is favored by the back ache you had..So we seem to be on right path baby! Go with the plans as you have already decided.

I would definitely like to know about the line of treatment your spine doctor plans for.

I would be happy to help for any other query you have.

Thanks.

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Brief Answer:
Physiotherapy with medications do have chance to resolve the problem.

Detailed Answer:
Dear XXXX,
Thanks for informing me about developments/ result of your tests
It's good that you consulted a proper person,in time. I understand your concern.
I do understand the change in medical practice in these days. You are amused to note, that the reports were not shown to you( any way you got it from assistant- & can make a note of, for your information.) This is due to the newer developments in X ray techniques, which are mostly 3D X rays with electronic viewer. Doctor can take readings while viewing it, there is no need of taking out X ray film- unless, asked for by patients/ needed for records in accident cases.- Because it has only diagnostic value. It can be preserved in hospital records as an image only.
Please don't worry, if at all there is no improvement/ aggravation of symptoms in 4-6 weeks & you have to go for surgical management- CT scan/ MRI testing becomes essential.
Again, you will be shown & explained the reports that time - for an applied consent of patient is essential for surgery.
I would advise you to be relaxed, do the physiotherapy sincerely, avoid bending/ weight lifting . Take medicines regularly follow instruction given strictly. Be positive. There are chances of recovery & you may not need further intervention.
The new generation doctors are well versed with modern techniques, which are less invasive & more effective & you always have option of second opinion if surgery is needed.
I hope that satisfies you. Any other help you want, I am happy to help.
I would request you to grade the answer before you close the discussion.
Wish you all the best!
Thanks.

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