Knee Injury: Related Calf and Foot Discomfort

Knee injury accompanied by discomfort in the calf and foot?

Hello, Doctor.
A week ago, I visited a rehabilitation specialist due to an old knee injury that has persisted for four to five years.
This injury occurred after I fell while playing basketball, landing on my knee.
Since then, I have experienced weakness and mild soreness in my knee after intense exercise or climbing multiple flights of stairs.
However, my knee feels normal during regular walking or moderate activities without pain.
During my visit, the rehabilitation specialist conducted a knee examination.
I was asked to lie flat and bend my knee while the doctor rotated it to check for pain, which I did not experience.
Then, while I was lying down, the doctor pressed on my knee and instructed me to push down against the pressure and then relax to let my knee rise.
When he pressed on my right knee, I felt a sudden loud "pop" as I relaxed and let it rise.
At that moment, I did not feel any significant pain and did not pay much attention to it.
The doctor then ordered an X-ray, but since I mentioned that both knees had old injuries and experienced weakness, only my left knee was imaged.
After the X-ray, the doctor said there were no issues with the bones and advised me to undergo rehabilitation (heat therapy and electrical stimulation) a few times, with a follow-up if symptoms persisted.
However, when I returned home that day, I noticed that my right leg felt somewhat weak while walking, and my right foot felt unstable when placed on the floor.
Additionally, my right knee would catch and feel stiff at certain angles when bending or straightening.
A day or two later, I even experienced pain.
Going down stairs, my right knee would catch and feel uncoordinated when bending, and sometimes it would hurt.
I then tried to squat down and found that my right knee could hardly bend fully; it felt stuck at a certain angle.
If I forced myself to squat, my entire right leg felt very tight, and my knee was quite painful.
After a day or two, the symptoms worsened instead of improving.
Whenever I sat for a short period or lay on my back with my right leg straight, I felt tightness and numbness along the outer side of my right calf to my right foot, sometimes accompanied by soreness.
While walking or going up and down stairs, I also felt tightness and numbness in the outer side of my right calf and foot.
When I tried to lift my right foot on my toes, I could do so, but my calf to foot felt tight, and I worried that I might have injured a nerve without realizing it while continuing to move.
Lastly, I would like to ask if I can directly request an MRI from my doctor.
I am very concerned that I might have a torn anterior cruciate ligament or a meniscus injury.
Thank you.

David, 20~29 year old female. Ask Date: 2016/05/29

Dr. Shi Guozheng reply Orthopedics

An MRI must be performed based on a physician's assessment of necessity.

Reply Date: 2016/05/29

More Info

It sounds like you are experiencing a complex situation with your knee injury, which has been ongoing for several years. Based on your description, it appears that you may have developed some complications related to your previous knee injury, and the recent examination and treatment may have exacerbated your symptoms.
First, let's break down your symptoms. You mentioned that after engaging in intense physical activity or climbing stairs, you experience a feeling of weakness and slight soreness in your knee. This is not uncommon in individuals with a history of knee injuries, especially if there is underlying damage to the ligaments, cartilage, or other soft tissues. The fact that you have a history of a fall that resulted in knee trauma raises the possibility of chronic issues such as patellar tendinopathy, meniscal tears, or even ligamentous injuries that may not have been fully addressed.

The sudden "pop" sound you heard during your rehabilitation session could indicate a few things. It might suggest a mechanical issue within the knee joint, such as a meniscal tear or a problem with the patellar tendon. If the knee feels unstable or "catches" during movement, this could be a sign of a meniscal tear or damage to the ligaments, particularly the anterior cruciate ligament (ACL) or posterior cruciate ligament (PCL).
Your description of feeling tightness and numbness extending from your knee down to your calf and foot is concerning. This could indicate nerve involvement, possibly due to swelling or inflammation in the knee joint that is compressing nearby structures. The tightness you feel when trying to lift your toes or when squatting could also be related to muscle imbalances or compensatory patterns that have developed due to your knee injury.

Given the persistence and worsening of your symptoms, it is advisable to seek further evaluation. An MRI (Magnetic Resonance Imaging) would be a valuable tool in this situation. It can provide detailed images of the soft tissues in your knee, including the ligaments, cartilage, and any potential tears in the meniscus. This imaging can help your physician determine if there are any significant injuries that require more aggressive treatment, such as surgical intervention.

In terms of managing your symptoms in the meantime, it is crucial to avoid activities that exacerbate your pain. Continuing with physical therapy is essential, as it can help strengthen the muscles around your knee and improve stability. Focus on exercises that enhance flexibility and strength without putting undue stress on the knee joint.
Additionally, consider discussing your concerns about nerve involvement with your healthcare provider. They may recommend further assessments, such as nerve conduction studies, if they suspect that your symptoms are related to nerve compression or injury.

Lastly, it’s understandable to feel anxious about your injury and its implications. Chronic pain and injury can lead to psychological stress, which can further complicate recovery. It may be beneficial to incorporate relaxation techniques, such as mindfulness or gentle yoga, to help manage anxiety related to your injury.
In summary, given your symptoms and history, pursuing an MRI is a reasonable next step to clarify the nature of your knee injury. Early intervention can lead to better outcomes, so don’t hesitate to advocate for your health and seek the necessary imaging and follow-up care.

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