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Saturday, April 16, 2016

Possible Sural Neuritis: Email Advice

Hello:

I saw you blog and figured I'd give it a go.  I also want to walk to Camino in Spain - I need to conquer this sural neuritis first.

Anyhow - I'm male and 44 - basically healthy. It started about 7 months ago ( about a month after I'd taken cipro) with ankle pain - the podiatrist said it was plantar fasciitis - then Achilles tendinitis - then I got an MRI and there was a small tear in a minor tendon than goes to my ankle - in which I was referred to another podiatrist/orthopedist who diagnosed the sural neuritis and gave a nerve block which did nothing - I have pain in my heal, outside ankle and Achilles - it's barely noticeable in the early morning and gets worse throughout the day as I'm on my feet quite a bit.   I many times find that sitting later in the day is the most painful and walking is better.  I used to run and could easily stay on my feet all day with no pain.  My current Dr. Says it's just a waiting game now to see if it heals - he says I can do any athletic activity I'd like but I might pay for it in the following days (and I do).  While my ankle is completely stable - it goes numb (ish) after 2 miles walking and my toes get painful and feel cold - but aren't physically cold...  I just say when a doctor "suspects" a cause, I feel like a bit more investigation would be in order - or does my description sound like sural neuritis and it's just that hard to accurately diagnose...

Anyhow - thanks for your time.

Dr Blake's response:
     Thank you so very much for your email. Sural neuritis is diagnosed two ways: you tap on the nerve and you get a tingling or other nerve symptoms in the area of your pain, and you inject the nerve and the pain goes away for 5 plus hours. If this is not the case, then something else is going on, and that could be many things. You can treat sural neuritis with nerve flossing and NeuroEze gel application (both done 3 times a day), and see if another injection of long acting local anesthetic would help. You can also shot gun the approach to wellness with 2 months in a removable cam walker (midcalf in height) and 8 visits of physical therapy. The physical therapist would see you twice a week and probably get a good handle on what is wrong. If the only thing wrong on the MRI is a small tear in one of the peroneals (which sometimes is only an artifact of the technique), then the removable boot would help that. Have the physical therapist really test the strength of both peroneal tendons and see if one is painful and weak signifying a tear. Hope this helps some. Rich

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Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.