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Tuesday, January 8, 2013

Email Advice Regarding Nerve Pain and Swelling

Hi Dr. Blake.

   I am a 45 year old mom. Nine weeks ago I twisted my right ankle while stepping up onto a grassy curb. I began icing and elevation immediately. The next day, my foot was x-rayed with a report that there were no fractures. I kept up the ice and elevation, used crutches, but still couldn't support my weight on it three weeks later. Another x-ray. This one revealed an avulsion fracture of my cuboid bone.
   A week in a splint.
   Five weeks in casts.
   Today the cast was removed.
   I will begin contrast bathing tomorrow.
I am still using crutches and have a lot of swelling, but my main concern is that I have pins and needles on the bottom of my foot.  Ever since the initial accident, I have had swelling and a numb/tingling sensation at the base of my middle three toes. The doctor told me that it is probably a neuroma due to trauma. He suggested that massage could bring relief, and I should check in with him in four weeks.

Do I need to get an MRI or should I just take it easy and see how I am doing in a month? I wonder if I should go to a fracture clinic for a second opinion or just chill. Any thoughts?
Thanks for your help.
Marianne (name changed)

Dr Blake's response:

Hey Marianne, 

Thanks for the email. If there is swelling post injury, the pressure from the swelling pushes on the nerves and gets them excited. Numbness and tingling is a common sensation when that is occurring and that would be the most obvious explanation.

 Twice daily you should be doing contrast baths, and another 1-2 times 15 minute ice pack to reduce the swelling. See if you can get some compression socks/tubing from the doc or physical therapist.

 While you are doing the warm water part of the contrasts, move your foot around to get the circulation going. Once an hour do 10 ankle pumps (moving the ankle up and down) to get the circulation going, and elevate your foot AMAP when you can.

 Sure hope this helps. An MRI to rule out anything missed but important should be done in one month if you are not progressing like you should. Rich

Sent from my iPad

    

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