Alpine Toe?

Over a month ago I went on an alpine climbing trip to the North Cascades, and ever since I have had a strange numbness in both my big toes. Anyone know anything about this?

Here is what I know:
- I wore mountaineering boots for the actual climbing days, even for the rock portions.
- My boots fit! I didn't experience any kind of foot pain during the trip. I've worn my boots on long hikes before with no problems, using the exact same sock combinations.
- This is not a cold injury. I don't think temps were ever below 40F, and my feet were never really cold.
- It was a very wet trip, but I did dry my feet out and put dry socks on every night.
- I had rest days between all my climbs too, where I wasn't spending a lot of time on my feet.
- I can feel my big toes and they work fine, it's just like small parts of them are numb to the touch. It's difficult to describe and pinpoint.

And yes, I will see a doctor. It's not painful or serious so I'm not exactly in a hurry, but I'll go eventually. Just wondering if anyone has experienced this in the meantime.

Internet diagnosis from message boards is always completely accurate and scientific, right??

Hey Chance,
I had the same thing happen to me after my first alpine trip. Not knowing any better, me and my partner climbed Hallett Peak in RMNP and didn't bring approach shoes with us on the climb. The descent ended up being about 2 miles down a steep scree field. My feet ended up in my climbing shoes for between 10-12 hours. When I woke up the next day, certain areas of my big toes were numb. After a week or so, the feeling slowly started to come back. I think it's just the nature of wearing tight shoes for extended periods of time. It's more of an annoyance than a health issue, but nevertheless, I was concerned when it first happened. Give it time, make sure to take your shoes off whenever you can, and it will likely clear up unless you continue to do it. Nerves generally heal, but repeated damage can make it permanent.

I have a similar problem sometimes and while I haven't seen a doctor about it, I made the self-diagnosis of immersion/trench foot. Basically this is an injury resulting from your foot being cold (but not frostbite cold) and wet. I've heard of all sorts of manifestations of it, but mostly I get a numb big toe and sometimes the ball of my foot is numb too. It goes away eventually.

To avoid it, I have to work very hard to keep my feet dry. Definitely sleep with your socks off and try to get your boots dry. Let me know if your doctor has any additional advice...

I've had that happen on long backcountry trips. I was told it was related to the waistbelt of a heavy pack -- no idea if that's true. It went away slowly over the next month or two after I got back.

Chance, you don't need to go see a doctor, this is a pretty common issue. Same thing happened to me 2 summers ago when I spent 6 days on the CDT. My boots did not necesarrily feel too small but turns out they were, despite the fact that I had no pain during the trip. My big toes went a bit numb following the backpack and took about 3 months to heal 100%. This is the nature of minor nerve damage, just give it some time. And you might consider going up a half size in your boots.

Thanks for the info, folks. I will stop weeping while I rub my toes at night.

JohnL, your nomenclature is probably correct. I thought I was inventing a term, but apparently not!

So, is there a camel toe variation to this issue?

Mitch - thanks for the info on numbness of the great toe. I did a 100 mile hike through the Sierras a month ago, and my great toes still don't have all their sensation back yet. Good to hear yours cleared up in 3 months. I think/hope my inserts were just a little too long. I'm planning another trip next month, but don't want to hurt the nerves anymore. Any other tips?

Billy - best to let those nerves heal, but at the same time I understand...life's too short not to make those trips happen! It's important to have the laces of your boots nice and snug across the instep of the foot. This can prevent your foot from sliding forward on the downhill and smashing the toes. If you suspect your inserts are too long, then shove your fingers down into the toe box of your boot and feel if the footbed is being arched up (by being too long), I could see how this decreased volume could leave less room for your toes. If so, just trim it to fit. I can recommend aftermarket footbeds like Superfeet or Sole...these will decrease both pronation and foot splaying, which means less elongation. Ultimately, in my experience it is simply the length of the boot that directly relates to numb toes (or perhaps the volume in the toe box) Best to buy your boots a touch on the big side than too small.

I have numbness under both of my 2nd toes after a long day descending Mt Whitney. It isn’t due to too tight of shoes. I attribute it to a combination of all of the rocks I walked on down hill for hours and because my shoes didn’t have sturdy enough shoes. I wore Salomon XA Pro Ultras. Very comfortable and lightweight but I could feel the rocks through my shoes. No more trail runners or lightweight hikers for me...at least not over lengthy rocky trails. Hoping my feet heal. 

It is possible you some nerve damage from some aspect of your boot.   It happens.   Most recently lost feeling in my big toe for about 3 months after a Rainier trip. You can get a decent idea about which nerve if you look up dermatomes.  

As mentioned above some mild form of trenchfoot is possible as well.  

OP, nothing wrong with going and getting checked out, but I wouldn't get toooo freaked out in the mean time.

I live in Michigan and go hiking in the winter. I usually ware mountaineering boots but it still gets a bit cold. That numbness usually hangs around til spring. Never thought to ask my DR, but I will an my next physical

Briggs, unless there is a large distribution of pain/numbness it is less likely the damage is near the spine.  Damaging spinal root nerves is unlikely to cause only one or two toes to go numb.   Here is a chart of spinal nerve distribution.

Pinching a spinal nerve is much more likely to cause symptoms along the whole or most area of innervation.  In most of the mentioned cases that would likely be the area marked L4,L5.

The distribution on these is usually more in line with damage to a small nerve in the foot or ankle.   You are right that the pack may be part of the cause as it is increasing pressure on the feet significantly.  

• Interesting Briggs!  Maybe I am wrong and I certainly wouldn't say your specific diagnosis was wrong without examining you and knowing all the facts..... and even then I would refer anything that wasn't resolving as I am a generalist (pa) with an internal med bent, not an ortho/neuro guy. To me, localized and isolated numbness without weakness implies injury in a more terminal nerve area (in most cases from repeated trauma and/or overtightened boots.)  If partial irritation/compression of  l4/l5nerve roots was the usual cause I would expect more varied distributions.  Maybe there are and I am not seeing them, which is quite possible.   I will have to ask my buddy in neurosurgery what he thinks and maybe have him school me bit!

If a neurologist diagnosed him then there isn't much to argue about in his case but I'm skeptical that most people's numb toes are due to spinal nerve issues. 

Interesting info! Nick B, I am looking at the diagram you shared and actually kinda makes me wonder about isolated nerve damage at L5. Like many others, I've got numb toes after a totally average climb with the same old boots I've used without numbness for some years. The difference was a superheavy pack on the approach. Indeed, the numbness I'm experiencing is only in the medial aspect of my big toes! I wonder if you have thoughts about that as a possibility...

Lost feeling in parts of toes for a month or so after climbing Mt Shasta in almost-new ski boots that were slightly too small. It came back eventually. 

The heavy pack is affecting the impacts and pressure on your foot, not just your back.   In fact given the way fall forces work and the mechanics of walking I would aruging there might be an outsized increase in force on your feet compared to your back.   That said, I guess irritation of a spinal nerve could cause it, but I would expect wider and more varied distributions with a spinal nerve root irritation.  The localized, common distribution implies distal (foot) nerve damage to me.  Haven't been around any neurologists recently to talk it out with them.

Maggie Leslie wrote: Interesting info! Nick B, I am looking at the diagram you shared and actually kinda makes me wonder about isolated nerve damage at L5. Like many others, I've got numb toes after a totally average climb with the same old boots I've used without numbness for some years. The difference was a superheavy pack on the approach. Indeed, the numbness I'm experiencing is only in the medial aspect of my big toes! I wonder if you have thoughts about that as a possibility...

I had a spinal discectomy L4-L5 disk, and my two inner toes went completely numb and I developed a heel drop. The nerve dies and it takes a LONG time to get them to regenerate. My big toe is numb 10 years later. Best to get a proper fitting pack and to lighten the load a bit.  You don't want surgery for this, it sucks. I had it because otherwise I was doubled over in pain and was contemplating eating a bullet.

Briggs Lazalde wrote:

Glad you're still here man

There is NOTHING like chronic pain to make you want to die.  Because you know it isn't going to go away. I broke bones before, and they hurt, but you know eventually they won't hurt. Put some depression on top of that....

Chronic back pain is something else....because it is relentless, you cannot get comfortable, every position is painful. You can numb your pain receptors with opiates, but that doesn't even work sometimes. And I never tolerated them well, they made me nauseous.

So my advice to younger folks is make sure you take back health seriously. Don't skip deadlifts or planks when you train, they will protect your back by building up muscles that support your spine/ilium