Dear Dr. Gott: About three years ago, in a slip and fall, I suffered a separation of the quadriceps from the left kneecap. The surgery went well, and I have complete recovery and use of my left leg. About six months later, I started to feel numbness in the toes of my right foot. This has been getting worse and spreading into the ball of my foot. There is no pain.

My doctor ordered a scan of the lower lumbar area. He read the scan and said that he saw a possible arthritic spur in contact with the nerves and that it was the cause of the numbness. He then sent me to a pain clinic, where two doctors studied my scan and concluded that I had a compressed disc that could be contacting the nerves. These differing diagnoses have left me puzzled. All three recommended cortisone injections.

I went to a chiropractor and an acupuncturist, with no help. I had an electronic test of conductivity of the nerves between the calf and my toes, but no abnormality was found. I went to a university hospital and saw a foot and ankle specialist, who could find no reason for the condition. My family doctor sent me to an anaesthesiologist who examined my scan, but he saw nothing that would be helped by cortisone. He said that he would give me a shot if I wanted it, but it would do no good. I thanked him very much for his candor.

Can you help me? Thank you.

Reply: You appear to have covered many of the bases thus far in your search for an answer. I do, however, have a few more suggestions, but first, I have some questions.

What type of scan did you have? An MRI? CT scan? X-rays? I can't determine if you should undergo more sophisticated testing without knowing what you've already had done. For example, if you had only an X-ray, a CT may help clarify the results. An MRI is another step up from the CT scan. Because there is some controversy about the results, this may be a good starting point.

Next, do you have any other medical conditions such as diabetes or high blood pressure? These conditions (and many others) can lead to complications, especially in those who are not receiving treatment or are poorly managed. If you're not sure whether you have any of these conditions, now is the time to have blood work and a physical exam to rule out or confirm a possible underlying condition.

Because you have already seen most of the specialists I would recommend, request a referral to a neurologist. Testing can determine whether the nerves of your foot are involved and whether you have neuropathy.

There are several treatment options available, depending on the cause. These may include chiropractic manipulation, rubbing mentholated chest rub on the affected areas, cortisone shots, nonsteroidal anti-inflammatory drugs (NSAIDs), prescription pain relievers, physical therapy, Anodyne therapy and surgery. If an underlying disorder, such as diabetes, is the cause, treating the disorder may relieve your numbness.

To give you related information, I am sending you a copy of my Health Report 'Managing Chronic Pain'. Other readers who would like a copy should send a self-addressed, stamped number ten envelope and a $2 cheque or money order payable to Newsletter and mailed to PO Box 167, Wickliffe, Ohio 44092-0167. Be sure to mention the title or print an order form from my website, www.AskDrGottMD.com.

Dr. Peter H. Gott is a retired physician and the author of several books, including 'Live Longer, Live Better', 'Dr. Gott's No Flour, No Sugar Diet' and 'Dr. Gott's No Flour, No Sugar Cookbook', which are available at most bookstores or online. Contact him c/o United Media, 200 Madison Avenue, fourth floor, New York, New York 10016.