I'm not a physician but a mental health doc.
This is from ChatGPT
"Your described patternsymptoms at rest vs with prolonged standing/walking, unilateral or one-sided foot numbness/tingling that worsens with activity, relief with rest, and simultaneous erectile changesraises a few possibilities, some more urgent than others. Only a clinician who can examine you and review your history can give a definitive diagnosis.
Possible considerations (informed by your description)
- Peripheral neuropathy with mechanical/vascular triggers
- Tingles and numbness in the feet that worsen with standing could be due to nerve compression or poor nerve signals in the legs (e.g., from posture, footwear, or vascular insufficiency).
- Morton's neuroma (confirmed symptoms you mentioned) or related forefoot nerve irritation
- Typically causes sharp, burning, or numbness in the forefoot and toes; usually worsens with walking or wearing tight shoes. May appear more on one side.
- Peripheral artery disease (PAD) or compromised blood flow
- Symptoms that improve with rest and worsen with activity can occur if blood flow to the legs/feet is limited. However, PAD usually causes cramping (claudication) rather than numbness in early stages, and risk factors include age, smoking, diabetes, high blood pressure, high cholesterol.
- Nerve compression or radiculopathy
- Problems in the spine or nerves in the legs can cause numbness/tingling and sometimes autonomic symptoms, though erection changes are not typical as a sole symptom.
- Autonomic nervous system involvement
- Erections are mediated by autonomic nerves; changes could be coincidental or related to a broader autonomic issue, but a direct link to leg symptoms would be unusual without a broader pattern.
- Other possibilities
- Vitamin deficiencies (B12), diabetes-related neuropathy, thyroid issues, or certain medications can cause neuropathy.
- Restless legs syndrome or neuropathic pain syndromes.
- Vascular/venous issues such as edema or venous insufficiency can cause burning numbness with standing.
Important red flags that warrant immediate or urgent evaluation
- Sudden weakness or numbness in one side of the body or face, difficulty speaking, or vision changes (possible stroke)
- Severe leg pain at rest or sudden numbness/weakness in legs
- Erectile changes plus neurological symptoms without a clear benign explanation
- Painful, pale, cool, or pulseless legs (possible acute limb ischemia)
What you can do now
- Keep a symptom diary
- Note when symptoms begin (time of day, after standing/walking how long), which foot is affected, what footwear you wore, and what relieves or worsens them.
- Record any associated symptoms (dizziness, fatigue, chest pain, weakness, headaches, erections timing).
- Review risk factors and medical history
- Diabetes, high blood pressure, high cholesterol, smoking, alcohol use, medications, recent infections, or injuries.
- Footwear and posture
- Ensure properly fitted shoes with good arch support and wide toe box. Avoid high heels or tight shoes. Consider insoles or custom orthotics if Morton's neuroma is suspected.
- Self-care strategies
- If symptoms persist with activity, try a brief rest period to see if they resolve, and alternate with elevation if swelling occurs.
- Gentle foot and calf stretches, and gradual conditioning if advised by a clinician.
- When to seek medical care promptly
- If symptoms worsen, if you develop weakness, severe leg pain at rest, color or temperature change in the feet, loss of balance or gait, or if erections are suddenly and persistently affected (new or persistent changes deserve evaluation).
What to expect in a medical evaluation
- Physical examination
- Neurological exam of legs and feet (strength, sensation, reflexes), vascular exam (pulse checks in feet, capillary refill), and foot examination for nerve entrapment signs.
- Possible tests
- Blood tests: glucose/A1C (for diabetes), vitamin B12, thyroid function, inflammatory markers if indicated.
- Imaging: Ankle-brachial index (ABI) noninvasive screen for PAD; ultrasound if vascular issue suspected.
- Nerve tests: Nerve conduction studies or electromyography (EMG) if a neuropathy or radiculopathy is suspected.
- If Morton's neuroma is suspected, a focused exam and possibly imaging (ultrasound or MRI) may be used.
Key questions you may be asked
- Do you have diabetes, smoking history, high blood pressure, high cholesterol?
- Is the numbness limited to toes or forefoot, or does it involve the entire foot or leg?
- Do you notice any weakness, foot drop, or difficulty with balance?
- Is the erectile change persistent, or does it happen only briefly with certain activities or positions?
- Any numbness or weakness in arms, face, or other areas?
Next steps
- Schedule an appointment with a primary care physician or a physician specializing in neurology or vascular medicine. If you have risk factors for PAD or diabetes, prioritize evaluation.
- If you have access to a vascular clinic or a podiatrist, they can help with specialized assessment of nerve compression and blood flow to the feet.
- If you're experiencing any of the red flags, seek urgent or emergent care."
Best of luck!
