Pain in outside of lower leg

[stamford]

I'm looking for some advice on what muscle/tendon this could be and possibly any exercises that could help the problem.

I occasionally get a sharp / ache / fatigue pain in the outside of my lower left leg. Its not exactly on the outside, more 1/2 between outside and back of my lower leg. And the pain is roughly 3.5-6 inches above my ankle. (I'm 5-5 if that matters)

It typically starts to hurt when I am wearing a tight fitting motorcycle track boots. The boots are shin high. If I just stand there it doesn't hurt but the second I get into riding position (sport bike) with the ball of my foot on the peg the pain comes a minute or 2 later. I can slightly relieve the pain if I put my heel on the peg.

The other time it hurt was when I went snowboarding. It got to be extremely painful by the time I got to the top of the ski lift. It was the leg strapped into the snowboard hanging down and the weight of the board slightly bending the foot inward and down. The pain immediately went away after I unbuckled the boot to relieve all pressure and would very slowly go away if I just stood there.

It doesn't hurt when I run, ride a bike, walking or do any other physical activities. Only wearing tight fitting shin high boots w/ extended pressure on the ball of your foot, even minor pressure.

So from my description can any one tell me what tendon or muscle that is? Along with any possible long or short term exercises I can do to help avoid the pain?

Thanks for your help!

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[gcoe]

Hi Stamford

Was the ski lift snowboarding event the first time?

Do you get any other symptoms on the outside of the lower leg or the foot such as pins and needles, shooting (like an electric shock) pains?

Whether you do or not what first came to mind was that you may have given yourself a compression injury of the Superficial Peroneal nerve. This could be so even if you don't get the above symptoms but any of the above symptoms would add weight to this conjecture. this particular nerve runs down the side of your lower leg and gives the "power supply" to the two muscles that turn your foot outwards (Peroneus longus and brevis). It also supplies sensation to the skin on the outside of the lower leg and over the back of the back of the foot. The business of positioning your foot on the motorbike peg may be stretching the nerve at the same time as the boot is pinching the nerve . We call this "adverse neural tension" and it is often a combination of pinching and stretching that really gets it going. Relieving the pain by resting the heel on the peg may change the position of the ankle joint and thereby relieve the amount of stretch on the nerve.

Nerves are extremely delicate tissue as well as being of immense value to the body. So nature provides a protection of making the outside of the nerve very sensitive to anything that may potentially injure the nerve. Sort of a warning signal - and the warning signal is marked pain - " OI! DON'T TOUCH! ME". Once irritated it can be very easily stirred up - out of all proportion to the force you apply to annoy it.

In contrast muscles and tendons are fairly robust tissues and are not likely to be bothered by the wearing of a boot unless there was some fairly major trauma to the area.

How sure am I? 70-80%. The nerve doesn't run exactly where you described it - tends to be on the outside but a bit more towards the front than the back - Still sounds like it could be close enough to be the problem. There is also a lot of normal variation of exactly where these nerves lie. It could be you are unlucky to have part of the nerve very close to the surface where it can be sandwiched by pressure between the boot and possibly the underlying bone (the fibular) and the covering around the muscles. Another touchy point is when the nerve is sandwiched between layers of muscles.

I suggest you get it checked out. If I am right treatment options may be:

* a careful and skillful mobilisation of the nerve - This is a gentle manipulative therapy procedure but this has to be within what the nerve can handle.

* Some minor alteration to the shape of the boot may relieve the pressure may prevent it happening. Your physical therapist could advise you.

You have to get the pressure off the nerve. Every time you irritate it you are just making matters worse.

[stamford]

First, thank you for the response!

Hi Stamford

Was the ski lift snowboarding event the first time?

Yes, it was my first time.

Do you get any other symptoms on the outside of the lower leg or the foot such as pins and needles, shooting (like an electric shock) pains?

No, no other pains what so ever. And the pain I do get I wouldn't exactly call it "sharp" like pins and needles. Its more of a sharpish/ache type feel and the longer it hurts the more intense it gets. I don't know how to describe it really.

Whether you do or not what first came to mind was that you may have given yourself a compression injury of the Superficial Peroneal nerve. This could be so even if you don't get the above symptoms but any of the above symptoms would add weight to this conjecture. this particular nerve runs down the side of your lower leg and gives the "power supply" to the two muscles that turn your foot outwards (Peroneus longus and brevis). It also supplies sensation to the skin on the outside of the lower leg and over the back of the back of the foot. The business of positioning your foot on the motorbike peg may be stretching the nerve at the same time as the boot is pinching the nerve . We call this "adverse neural tension" and it is often a combination of pinching and stretching that really gets it going. Relieving the pain by resting the heel on the peg may change the position of the ankle joint and thereby relieve the amount of stretch on the nerve.

Nerves are extremely delicate tissue as well as being of immense value to the body. So nature provides a protection of making the outside of the nerve very sensitive to anything that may potentially injure the nerve. Sort of a warning signal - and the warning signal is marked pain - " OI! DON'T TOUCH! ME". Once irritated it can be very easily stirred up - out of all proportion to the force you apply to annoy it.

In contrast muscles and tendons are fairly robust tissues and are not likely to be bothered by the wearing of a boot unless there was some fairly major trauma to the area.

How sure am I? 70-80%. The nerve doesn't run exactly where you described it - tends to be on the outside but a bit more towards the front than the back - Still sounds like it could be close enough to be the problem. There is also a lot of normal variation of exactly where these nerves lie. It could be you are unlucky to have part of the nerve very close to the surface where it can be sandwiched by pressure between the boot and possibly the underlying bone (the fibular) and the covering around the muscles. Another touchy point is when the nerve is sandwiched between layers of muscles.

I suggest you get it checked out. If I am right treatment options may be:

* a careful and skillful mobilisation of the nerve - This is a gentle manipulative therapy procedure but this has to be within what the nerve can handle.

* Some minor alteration to the shape of the boot may relieve the pressure may prevent it happening. Your physical therapist could advise you.

You have to get the pressure off the nerve. Every time you irritate it you are just making matters worse.

Ok sounds like a place to start. What would cause a compression injury? I know I've been in a few motorcycle accidents and dozens of dirtbike accidents but no leg injurys. I do ride ALOT so that could be where it comes from. And to try and describe the exact location of the pain would be if you flex your left lower leg standing up there appears to be a muscle that goes kind of from the outside portion of your shin diagonal down to your ankle bone area.

On the backside of that bulge heading towards the back of your lower leg your leg kind of has a valley then another muscle bulge that extends from the back of calf down to the back of your heel area. The pain is in lower end of that valley area, maybe more on the back vertical muscle described above. Is there any thing I can do to test if it is that nerv? Put prolonged pressure on a certain spot?

Oh and perhaps and unrelated event I crack my left ankle ALL the time. I'm not really sure where the sound comes from only that is in the lower leg / ankle area. Can that irritate any nervs?

[gcoe]

Hi Stamford

If the snow boarding incident was the first incident then that may have been the causative event - what started it all off. that would have been the mechanism of the injury. And now the area is sensitivsed so whenever you put the boot on it squeezes the nerve and that is what sends it off.


Yes I still think that is quite likely to be the nerve. The sharpish/ache may be more to do with the nerve endings covering the nerve are involved rather than the the nerve itself. Sorry - but I couldn't make sense of you description of where the pain is. It is quite hard to describe this sort of thing over the net.


An alternative to the nerve theory is that you could have something wrong with the joint where two calf bones meet at the top of the lower leg (the superior tibio-fibular joint). However this is harder to reason through given the clear description you have of when the paint comes on. If the ankle cracks easily then that is probably unrelated. However it could indicate a dysfunction of the inferior tibio-fibular joint/ankle joint which is related to the superior tibio-fibular joint. I think this is much less likely anyway. And no cracking the ankle shouldn't cause nerve problems.

There is a couple of clinical tests that can confirm the likelihood of it being nerve pain. One test stretches the course of the nerve so if there is a problem it is quite a youch factor when it is performed. The other test you tap over the course of the nerve to see if you get a sharp pain /electric shokc like response when you hit the site of compression. However these are really quite hard to do yourself and I don't think I could accurately describe them to you. Why not get it looked at by PT? It would be worth it, given it is interfering with your bike riding.

[stamford]

Sorry no that wasn't the first time it hurt, it was my first time snowboarding...Sry I got confused. Thanks for the response. Maybe I'll go get it looked at.