altered sensation for 3 months (pain at times but able to acheive full range of movement)

I was horse riding approx 3 months ago and began having right ankle pain in the saddle (no fall or twist/sprain etc) I could not put weight through my ankle the remainder of the day and that evening gradually experienced significant loss of sensation all over top of my foot and lateral side of my leg. I could not sleep and significant burning pain led to a visit to A&E. I was advised probable peroneal nerve damage but I did not have any impact injury and no pain in my knee? I could not weightbearing for 1 week then once I could walk again the sensation was still altered and remains the same 3 months on! If I rub my finger over the side of my ankle a weird movement sensation radiates from my ankle to foot and tingling begins but no change occurring over time. My Dr told me nerve regeneration would be approx 4 weeks so i am now concerned about the length of time this has been going on, any advice welcome!

RESPONSE

Hi,

Based on your narrative it does sound like you have damage to the peroneal nerve, particularly the superficial branch.

I do not ride horses but if I am not mistaken, "riding" boots extend up the leg fairly high. My guess is that the top of the boot, if extended high enough, irritated the outside of the leg just below the knee. This is where the peroneal nerve becomes very superficial and close to the skin, leaving it open to injury.

So, that would probably explain how this problem began in the first place without any history of trauma.

The problem with nerve injuries is that they do not clear up as quickly as you have been lead to believe. The nerve has been irritated and without some type of intervention, the problem will persist. To make things worse, if not treated in time, the problem can be permanently damaged, even though nerve tissue is the one tissue in the body that has the ability to regenerate, albeit very slowly.

Tapping on the outside of the ankle with your finger resulting in numbness on the side of the foot and partial top of the foot, suggests that the sural nerve which is an extension of the peroneal nerve is also specifically involved. This can happen in a situation where the riding boot is too tight around the level of the ankle and thus it gets pressed against the boot and becomes irritated.

So, I think it is safe to say that just waiting for your symptoms to go away is not your best strategy.

My suggestion would be to be examined by a neurologist to make sure that nerve damage is the proper diagnosis.

Assuming it is nerve damage, some of the therapies you might want to consider, would include anti-inflammatory medication, since the nerve is inflamed, by taking oral anti-inflammatory medication or even oral prednisone might quiet down the inflammation and reduce your symptoms.

A cortisone injection, perhaps at the neck of the fibula bone (just below the knee on outside of leg) might also be very helpful as well as a cortisone injection on the outside of the ankle.

A cortisone injection will reduce inflammation of the nerve as well as break up some scar tissue which may have formed around the nerve which exacerbates the problem.

Physical therapy may also be of benefit to reduce the inflammation around the nerve.

If your doctor ends up recommending some of the anti-neurolytics like Lyrica, Pamelor, etc. I would decline them as all they do is reduce the symptoms. At three months post injury I would work to regenerate the nerve, not mask the symptoms.

Marc Mitnick DPM
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