Is your foot pain from a trapped nerve?
Nerves are responsible for much of our brain’s ability to control our muscles. An injury to a foot and ankle nerve can cause the connected muscle to not function properly, or it can cause a person to lose feeling in the affected area. Here we will discuss the different types of nerves that may become a problem in the foot, and what we can do to help you!
Nerves are a part of the human body that carry electrical impulses between the brain and rest of the body. Motor nerves carry the signals needed to make muscles move, whereas sensory nerves are what allows different areas of the body to respond to pain, pressure, and temperature.
A nerve is covered in a sheath of tissue, much in the same way electrical wires are sheathed in plastic for protection. Nerve fibres are called axons, which are separated into bundles within the nerve.
What are the different types of foot and ankle nerve injuries?
Foot and ankle nerve conditions can occur because of injury, stress on the foot or ankle, diabetes or an autoimmune diseases. Here are some of the most common types of nerve disorders.
Morton’s neuroma
The tissue around the nerves that lead to the toes thickens, causing burning pain, tingling and numbness in the ball of your foot and into your . The reason the nerve starts to swell is unknown, but current research suggests it is likely to be the result of entrapment of the nerve which triggers swelling and thickening. A Morton's neuroma usually develops between the third and fourth toes.
Patients frequently describe the sensation of having a pebble or marble under their forefoot as they walk. Problems with shoe wear are common. High-heeled shoes can aggravate the condition. Tight, narrow shoes also aggravate this condition by compressing the toe bones and pinching the nerve.
Morton's neuroma will not disappear on its own. Usually, the symptoms will come and go, depending on the type of shoes you wear and how much time you spend on your feet. Sometimes, the symptoms will go away completely.
Tarsal tunnel syndrome
The tarsal tunnel is the passageway that contains tendons and nerves that let the foot flex and move, including the tibial nerve. If the tibial nerve is compressed or damaged, you may experience numbness, tingling, burning or shooting pains into the inside of the ankle and the bottom of the foot and toes.
This condition may be due to swelling from an injury, such as a sprained ankle, an abnormal growth, such as a bone spur, lump in the joint (ganglion cyst), swollen (varicose) vein, flat feet or a high arch, or body-wide (systemic) diseases, such as diabetes, low thyroid function (hypothyroidism), arthritis.
Sometimes the symptoms of the syndrome appear suddenly. They are often brought on or aggravated by overuse of the foot, such as in prolonged standing, walking, exercising or beginning a new exercise program.
Baxter’s nerve entrapment
The lateral plantar nerve runs across the bottom of your foot from the inner ankle side to the little toe. If the nerve becomes compressed in the heel, the result may be numbness and pain on the inside (medial aspect) of the heel and sole.
The exact cause is unknown, but often Baxters nerve entrapment occurs together with plantar fasciitis. Other causes may include poor foot mechanics, compression from poor footwear, heel pad atrophy, repetitive overuse or trauma to the nerve during certain activities e.g. running.
Peroneal neuropathy (foot drop)
The common peroneal nerve branches from the sciatic nerve and runs below the knee. Damage to the peroneal nerve (neuropathy) can cause pain, tingling or numbness at the top of the foot and the lateral aspect (outside) of the lower leg.
It may become difficult to raise your toes, your toes or ankle may feel weak, or your foot may feel like it is dropping when walking. In severe cases, you may be completely unable to lift your toes or foot or turn your ankle.
The peroneal nerve can be injured by trauma and nerve compression, such as from an injury like a knee dislocation, fracture, knee or hip replacement surgery. It may also be due to compression of the peroneal nerve in the leg, from swelling or a nerve sheath tumor or nerve cyst.
What are the causes of a foot and ankle nerve injury?
Injuries that put pressure on or stretch the nerve can cause the conductive fibres within to break without disrupting the outer sheathing. Conversely, when a nerve is cut, both the axons and insulation are severed.
If the insulation remains intact, the nerve fibers farthest from the brain die. The end that is close to the brain remains alive, and over time may begin to heal.
If the nerve and insulation are both severed and the nerve is not repaired, the growing fibers can form a painful scar, called a neuroma.
What are the risk factors involved in developing nerve injuries or neuropathies?
Factors that may increase your risk of developing neuropathy and nerve entrapment in your foot or ankle include:
Alcohol abuse
Autoimmune diseases such as rheumatoid arthritis or lupus
Chemotherapy
Diabetes
Exposure to toxins
Family history of neuropathy
Infections such as Lyme disease or shingles
Injury to the foot, ankle or lower leg
Repetitive movements of the feet and ankles
Vitamin deficiencies, especially some B vitamins
What are the possible symptoms of a trapped nerve in your foot or ankle?
Symptoms of foot and ankle neuropathy and nerve entrapment depend on the cause, but the most common symptoms include:
Numbness
Sharp or burning pain
Tingling sensations or feeling that your foot has fallen “asleep”
Weakness in your foot, toes or ankle
How are nerve injuries and neuropathies diagnosed?
When assessing a nerve injury, your healthcare professional will begin with a careful history and proceed with a comprehensive clinical and neurologic exam.
In order to locate and fully determine the extent of the nerve injury, a GP may order tests to evaluate how the muscles and nerves are functioning, including:
Electromyography, which measures ongoing muscle activity and response to a nerve’s stimulation of the muscle.
Nerve biopsy
Nerve conduction study, which measures the amount and speed of conduction of an electrical impulse through a nerve.
CT scan
Ultrasound
MRI
What are the treatment options for ankle nerve injuries?
Depending on the location and degree of the nerve damage, your healthcare professional may prescribe different courses of therapy. If the problem is caused by an underlying illness, it is important to address that issue.
Nonsurgical Treatment
Many treatment options, often used in combination, are available to treat nerve injury.
Rest. Staying off the foot prevents further injury and encourages healing.
Ice. Apply an ice pack to the affected area, placing a thin towel between the ice and the skin. Use ice for 20 minutes and then wait at least 40 minutes before icing again.
Oral medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, help reduce the pain and inflammation.
Immobilization. Restricting movement of the foot by wearing a cast is sometimes necessary to enable the nerve and surrounding tissue to heal.
Physiotherapy during recovery will help the affected joints retain flexibility so they function properly once the nerves are healed. In the case of a sensory nerve injury, care should be taken to not burn or cut the affected area because there will be no feeling. Gait (walking) retraining can help you improve your mobility. After the nerve heals, sensory re-education may be necessary to regain full control over the affected area.
Injection therapy. Injections of a local anaesthetic provide pain relief, and an injected corticosteroid may be useful in treating the inflammation.
Orthotic devices. Custom shoe inserts may be prescribed to help maintain the arch and limit excessive motion that can cause compression of the nerve.
Shoes. Supportive shoes may be recommended.
Bracing. Patients with flatfoot or those with severe symptoms and nerve damage may be fitted with a brace to reduce the amount of pressure on the foot.
Surgical Treatment
Some injuries may require nerve surgery, which may include decompression surgery, nerve repair, grafting or transfer, or a tendon transfer.
How long do foot and ankle nerves take to recover?
Recovery from a nerve injury varies depending on injury location and severity. For many people, symptoms improve or disappear completely with nonsurgical treatment.
If you have surgery for a nerve injury, recovery time varies. Generally, you’ll limit activities for the first six weeks after surgery. After six weeks, you can start increasing activity levels slowly. Full recovery usually takes around three to four months.
How can you prevent nerve injury in the foot and ankle?
You can help reduce your risk of developing foot or ankle neuropathy and nerve entrapment by taking these precautions:
Avoid repetitive movements or excessive stress on the feet and ankles.
If you have a medical condition that raises your risk, get treatment to manage it.
If you have risk factors, take steps to address them.
This is absolutely not written to substitute medical advice and it is always important to see a qualified health care professional for a formal diagnosis. If any of the exercises cause pain during or after the exercise, discontinue and consult a physiotherapist.
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