Heel Walking and Toe Lift Issues After a Motorcycle Accident

Walking on the heels (unable to lift the toes of the right foot)?

Hello Doctor: Three years ago, I fell off my motorcycle and injured my lower back.
Now, when I walk, I can lift the toes of my left foot, but I cannot lift the toes of my right foot.
Could this be due to nerve compression? I would greatly appreciate your help in clarifying this.
Thank you for your hard work.

A Jin, 50~59 year old female. Ask Date: 2020/07/12

Dr. Jiang Junyi reply Neurology

Hello, based on your description, there are many potential causes for leg weakness, such as muscle atrophy and lumbar nerve compression, which need to be evaluated.
Your symptoms may suggest peroneal nerve dysfunction, one of the most common localized neuropathies in the lower extremities.
The most common site of compression is near the fibular head on the lateral side of the calf.
Common symptoms include pain and numbness in the anterolateral aspect of the calf, weakness in the foot preventing dorsiflexion, and atrophy of the lateral calf muscles.
In more severe cases, individuals may frequently trip over objects or struggle to step over thresholds.
Common causes of peroneal nerve compression include prolonged cross-legged sitting, excessive knee flexion, prolonged kneeling, fibular head fractures, or mass compression.
Commonly affected groups include office workers, betel nut vendors, security guards, farmers, and individuals practicing meditation.

Treatment for foot drop due to peroneal nerve compression at the fibular head includes pharmacological therapy: administering appropriate neuroprotective agents or muscle relaxants to aid recovery of the injured nerve and muscle tissue.
Physical therapy modalities, such as ultrasound, laser therapy, and transcutaneous electrical nerve stimulation for pain relief, may also be utilized.
The use of a plastic ankle-foot orthosis can help prevent foot drop and reduce the risk of falls.
Additionally, patient education is essential to improve sitting posture and avoid crossing legs or sitting in a lotus position.
I recommend that you consult a neurologist for further evaluation and treatment.
Wishing you good health and happiness.

Sincerely,
Dr.
Jiang, Neurology, Taoyuan Medical Center.

Reply Date: 2020/07/12

More Info

After a motorcycle accident three years ago, you are experiencing difficulty lifting the toes of your right foot while walking on your heels, while your left foot functions normally. This situation raises concerns about potential nerve compression or injury, particularly affecting the peroneal nerve, which is responsible for toe dorsiflexion (lifting the toes) and eversion (turning the sole of the foot outward).

The peroneal nerve runs down the leg and can be susceptible to injury or compression due to various factors, including trauma from an accident, prolonged pressure (such as from crossing legs), or even swelling in the surrounding tissues. Given your history of a motorcycle accident, it's plausible that the injury may have led to some form of nerve damage or entrapment, resulting in the inability to lift your right toes.

In addition to nerve involvement, other musculoskeletal issues could contribute to your symptoms. For instance, muscle weakness or tightness in the calf muscles (gastrocnemius and soleus) or the anterior compartment of the leg (which includes the tibialis anterior muscle) could affect your ability to perform heel walking and toe lifting. Scar tissue formation from the initial injury could also play a role in limiting mobility and function.

To address your concerns, it is crucial to undergo a thorough evaluation by a healthcare professional, preferably a neurologist or an orthopedic specialist. They may recommend imaging studies, such as an MRI or ultrasound, to assess the integrity of the nerves and surrounding structures. Electromyography (EMG) and nerve conduction studies can also provide valuable information regarding nerve function and any potential damage.

In the meantime, consider engaging in physical therapy, which can help improve strength, flexibility, and overall function in your affected leg. A physical therapist can design a tailored rehabilitation program that focuses on strengthening the muscles responsible for toe lifting and improving your overall gait mechanics. Stretching exercises for the calf and anterior leg muscles may also alleviate tightness and enhance mobility.

If nerve compression is confirmed, treatment options may include conservative measures such as rest, ice, and anti-inflammatory medications. In some cases, corticosteroid injections may be considered to reduce inflammation around the nerve. If conservative treatments fail to provide relief, surgical intervention may be necessary to relieve nerve compression.

In summary, your difficulty in lifting the toes of your right foot after a motorcycle accident could be indicative of nerve involvement, muscle weakness, or other musculoskeletal issues. A comprehensive evaluation by a healthcare professional is essential for accurate diagnosis and appropriate management. Engaging in physical therapy can also be beneficial in restoring function and improving your quality of life. Remember to listen to your body and avoid activities that exacerbate your symptoms while you seek professional guidance.

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