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pain in my ankle goes up my calf to my knee

I have experiencing pain that starts in my ankle on my right leg and radiates to my calf which swells and goes to my outer knee. I cannot walk for long without having severe pain in the outside part of my knee. I have seen a vascular doctor that does not think that it is vascular. I have seen a Podiatrist who diagnosed me with Mortons neuroma in both feet a year ago. He has given me shots and now I have been waiting for my orthotics. I have fibromyalgia and have not been able to exercise

as I should. Any suggestions?

RESPONSE

Hi,

I would think that potentially the most dangerous problem that might cause this type of pain would be a deep vein thrombosis, but apparently you have been to a vascular specialist and that has been ruled out.
You mention that you have been to a podiatrist who has made a diagnosis of Morton's neuroma. The neuroma in itself would not give you the type of symptoms that you are experiencing. The only connection I could make between the neuroma and your knee pain and swelling might be if the neuroma in your right foot is so painful that it is causing you to change your gait. A compensatory change in gait could cause pain elsewhere. If that is the case, then once the neuroma is quieted down either through the use of orthotics or other treatment, in theory, the knee issue would also resolve as you return to a more normal gait.
Assuming your problem is not related to the neuroma, then the most likely cause would be an issue with the gastroc-soleus muscle combination that leads to the achilles tendon and attaches into the heel.
The gastrocnemius muscle attaches into the area of the lateral (outside) portion of the knee, extends downward and in combination with the soleus muscle forms the achilles tendon.
So, here is the scenario I picture. You may have what is known as a tight heel cord, meaning your foot cannot bend upwards as far as it should. When you are walking, you are therefore putting excessive strain on the gastroc-soleus muscle combination. Because of this and possibly because you have fibromyalgia, the gastrocnemius muscle is being strained where it attaches into the lateral side of the knee. A tight heel cord may also cause the calf to swell because your calf muscle is the gastrocnemius-soleus muscle combination.
It should be mentioned that there is also a muscle known as the plantaris muscle. This too originates in the area of the lateral side of the knee and also attaches in the back of the heel bone. It is a muscle that serves no function and is so thin, that in anatomy classes it is known as "freshman's nerve" because many medical students mistake it for a nerve. That is how thin a muscle it it. I bother to mention it, because in theory it could also be the source of your knee pain, but would probably not cause the calf to swell.
What bothers me about the possibility of a gatroc-soleus problem is that I would have thought that either the vascular specialist or the podiatrist would have ruled this out.
On your next visit to your podiatrist ask he or she to check on this possibility as the source of your leg pain.

Marc Mitnick DPM
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