Leg Pain and Numbness After Injury: A Neurology Perspective

Numbness in the limbs and foot pain?

Hello, doctor.
I gave birth on November 7, 2015, and on February 19, 2016, I suffered a fibula fracture in my left calf with slight displacement.
I was treated by an orthopedic doctor and had a cast for one month, followed by one month of non-weight bearing on my left leg, and then one month of gradual weight bearing.
I have had no issues walking since then, but when I first place both feet on the ground each morning (2.5 months after the fracture), I experience some pain in the soles of both feet along with a tingling sensation.
This discomfort resolves after some movement.
I initially thought this was a side effect of stiffness from the fracture, but if that were the case, only my left foot should be affected, not my right foot.
I later suspected that I might have forgotten how to walk properly after the fracture, but I have been consistently exercising during this period (using a glider for low-impact exercise), so there should be some improvement, right? However, whenever I maintain a fixed position for too long, I still experience some pain and tingling in my feet when I get up to move.
This issue has even progressed to a point where I occasionally feel tingling in my hands and feet.
During this time, I have tried acupuncture and massage with traditional Chinese medicine, as well as ultrasound therapy for both feet with no success.
What should I do next?

Miss Zheng, 30~39 year old female. Ask Date: 2016/08/12

Dr. Gao Chunde reply Neurology

There may be intermittent numbness and pain in the extremities, particularly noticeable in the soles of the feet.
This could indicate a peripheral nerve dysfunction.
As for the type of neuropathy and its underlying cause, further examination by a neurologist may provide clarity.

Reply Date: 2016/08/12

More Info

Experiencing leg pain and numbness after an injury, such as a fibula fracture, can be concerning and may indicate several underlying issues. Based on your description, it seems that you have been through a significant recovery process, including immobilization and gradual weight-bearing. However, the persistent pain and numbness in both feet, particularly upon waking and standing, suggest that there may be more than just residual effects from the fracture.

Possible Causes of Your Symptoms
1. Nerve Compression or Damage: After a fracture, especially if there was swelling or improper positioning during recovery, nerves can become compressed. This can lead to symptoms like numbness and tingling in the feet. Conditions such as tarsal tunnel syndrome, where the tibial nerve is compressed as it passes through the ankle, could be a possibility.

2. Altered Gait Mechanics: It’s common for individuals recovering from a lower limb injury to unconsciously alter their walking patterns to avoid pain. This can lead to compensatory movements that strain other muscles and joints, potentially causing pain and discomfort in both legs. Even if you have been exercising, if the exercises do not focus on correcting your gait, the underlying issues may persist.

3. Muscle Imbalance or Weakness: After a period of immobilization, certain muscle groups may weaken, while others may become overactive. This imbalance can lead to pain and discomfort, especially when transitioning from rest to activity.

4. Circulatory Issues: Although less common, circulatory problems can also lead to numbness and pain. If blood flow is compromised, it can result in symptoms similar to what you are experiencing.

5. Post-Traumatic Stress: Sometimes, psychological factors can contribute to the perception of pain, especially after a traumatic event like a fracture. Anxiety about re-injury can lead to muscle tension and pain.

Recommendations for Management
1. Consult a Specialist: Given the complexity of your symptoms, it would be beneficial to consult with a neurologist or a pain management specialist. They can perform a thorough evaluation, including nerve conduction studies if necessary, to assess for any nerve damage or compression.

2. Physical Therapy: Engaging in a structured physical therapy program can be incredibly beneficial. A physical therapist can assess your gait and provide targeted exercises to strengthen weak muscles, improve flexibility, and correct any compensatory movement patterns.

3. Gait Analysis: A detailed gait analysis can help identify any abnormalities in your walking pattern. This can be done by a physical therapist or a specialist in biomechanics.

4. Pain Management Techniques: If the pain is significant, discussing pain management options with your healthcare provider may be necessary. This could include medications, nerve blocks, or other interventions.

5. Continued Rehabilitation: Since you have already tried acupuncture and ultrasound therapy without success, consider exploring other modalities such as electrical stimulation, massage therapy, or even hydrotherapy, which can provide relief and promote healing.

6. Mind-Body Approaches: Techniques such as mindfulness, yoga, or tai chi can help manage pain and improve overall well-being. These practices can also help reduce anxiety related to your injury.

7. Regular Follow-ups: Keep regular appointments with your healthcare providers to monitor your progress and adjust your treatment plan as necessary.

Conclusion
The symptoms you are experiencing after your fibula fracture are not uncommon, but they do warrant further investigation to ensure that there are no underlying issues that need to be addressed. By working closely with healthcare professionals, including neurologists and physical therapists, you can develop a comprehensive plan to manage your symptoms and improve your quality of life. Remember, recovery is a process, and it’s important to be patient and proactive in seeking the right care.

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