Q: I am a 45 years old male suffering from burning sensation and weakness in my left foot and toes. I also have a slight pain in my lower back. I had this problem eight years back and the problem has reappeared now. I consulted orthopedics, neurologists and general physicians and they were not able to diagnose my problem properly. A doctor told me that back pain might be due to sciatic problem. I am not a diabetic, weigh 63 kg and my body mass index is normal. What mode of treatment should I take?

A:The symptom of burning sensation in the toes with some backache is most likely due to a nerve irritation in the back. At your age, it is likely to be a disc problem. You say that you have already shown an orthopedic surgeon and a neurologist without any diagnosis. I find that unusual. Because a disc prolapse is usually clear on history and examination. There are very few conditions that present like this. Occasionally, the classical signs of a disc may not be there if it is a large disc in the canter or a disc that is very eccentric or a disc that has completely damaged the nerve. Merely getting an MRI may not solve the problem as quite often MRI may give a false positive disc. You have to correlate the clinical signs with the MR findings. I recommend that you get a second opinion from a good orthopaedic surgeon or a neurosurgeon. Confirm the clinical diagnosis and then plan for an MRI of your back.