Sural Nerve Problem: Email Advice

I am a 55 years old female. I'm 5'2 and weigh 120. I've always been 
physical fit, walking, biking, weight lifting and so on.I happened upon 
your site here and so appreciate your natural insight.

Two years ago I was diagnosed with Hallux MPJ on my right foot. I could 
not walk. After a cortisone  injection, much pain and wearing support shoes 
everyday, it is manageable and rarely flares up. In August of 2019,  I got 
a sports injury and was in excruciating shooting pain on my right lateral 
foot. It was unpredictable and would go from a 0-10 in seconds with this 
shooting pain very often.

I went to the podiatrist, who  did an MRI, and gave me a nerve block for 
pain. The MRI showed edema in 5th met base, Hallux, and 3rd met 
bursitis.She concluded I  impacted the Sural nerve and 5th metatarsal. I 
stayed completely off of it for 12 days, ice, pain patches, and it slowly 
improved. I also had six  laser  treatments.

After six weeks from the injury I was allowed to do light impact sports.and 
told it was acute, isolated in my foot and would  completely go away. I 
cautiously did yoga and walking still wearing only good support shoes and 
listening to my body. I never got back fully. The pain started to come back 
after two months occasionally. I stopped all exercise, managed it with 
ice , pain patches and splint.

I am now only doing water aerobics which seems to be the best sport for me. 
I still occasionally (2-10 weekly) feel it, the pain is there but nothing 
like it was. Today it  has been 12 days now and I have felt it occasionally 
a good six  times. It just randomly comes. It is not as intense but is 
there; It is always in the same spot,lateral right foot.

My question is ....is this normal when recovering from this type of sural 
nerve injury? Will it ever get 100% better?  Should I consult another local 
doctor? What kind?

Regards,
Dr. Blake's comment: Thanks for the email. Sural nerve pain is typically from rolling lateral on your foot. You irritate it by over-supinating your foot (too much weight on the outside of the foot), but can continue to irritate it with the pressure of shoes and socks. Pay attention to what you are wearing when it hurts to give clues. Also, it is definitely a nerve problem, the only type of pain that can be 8-10 for seconds, and then resolve, but it is sure frustrating. the MRI showed 5th met base edema signifying a stress reaction on that side of your foot. This problem with the 5th metatarsal can be triggering the nerve to protect you and you just have to give it time. It can easily take 6-12 months to resolve this type of bone problem. You treat this with daily or at least 5 time a week contrast baths each evening (which is quite helpful to relax nerves). Look at my blog on neural flossing, done 3 times a day, and as you pointe  your foot slightly invert the foot at the same time. Get some neuro eze or neuro one or another nerve cream like Topricin and massage in 3 times a day also. Have your biomechanics checked to make sure that some oversupination can be corrected. 
     Nerve pain can always come primarily from above the foot. The lateral side of your foot is the S1 nerve root, although other discs can be involved. Sometimes a good evaluation of the peripheral nerves and sciatic nerve programs with careful lifting are helpful. If the pain is related to sleeping or sitting at all, it may be all related to the nerves above the foot in the lowback, piriformis or hamstrings are common. Definitely nerves love motion, and do not like compression, immobilization, prolonged stretches, and anything like PT that is painful. There are PTs that specialize in nerves, there are podiatrist keenly aware of nerves, there are pain specialists or physiatrists. Any would be a good place.
     So, to summarize, you may a local foot problem, and perhaps one from higher up. Definitely your treatments should be nerve focused, but gait evaluation done to check for a supination tendency. I hope this helps my friend. Rich Blake

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