Q: I have fibromyalgia. One of my most bothersome symptoms is numbness and tingling in my feet, and nothing my rheumatologist prescribes seems to help. Do you know what causes this? Should I see another type of doctor?

If numbness and tingling are chronic and confined to your feet, I would suspect a condition besides fibromyalgia might be involved. Fibromyalgia is a syndrome characterized by diffuse widespread pain associated with at least 11 discrete tender areas of the body. Fibromyalgia can also include fatigue, headaches, restless sleep, irritable bowel syndrome, memory changes and, as you are experiencing, numbness and tingling.

The cause of numbness and tingling in fibromyalgia is unknown. These symptoms don't follow any anatomic or nerve pattern, and they tend to come and go in different parts of the body.

Other conditions that might cause numbness are diabetes, alcohol use, obesity with fluid retention around the ankles (which causes the compression of nerves in the tarsal tunnel of the lower extremities) and compression of nerves in the low back.

Your rheumatologist should be able to help you sort this out by your history, physical exam, lab tests and X-rays. Depending on what he finds from these tests, your rheumatologist can arrange to test the nerves in your feet (nerve conduction test) and refer you to a specialist for additional treatment if needed.

James McKoy, MD, Rheumatologist