Runner injured on Track - seeking help with diagnosis

[Dr Damien]

Dear Annie DC

I would have another look at your back again. Any muscle weakness...?
your description is of the L4/L5 specifically, I would trace that...anyone looked at your proximal fibula? you might have a compression there? perhaps your foot maybe unstable causing some torsion in your tibia...try tapping on your fibular head to see if this reproduces some of your symptoms...
did you have your ankle sprains before this episode or after? what part of your foot gets numb and were do you get this swelling and heat?

Are you diabetic?

The challenge will be to reproduce your symptoms....with a test...

[AnnieDC]

Thank you for your reply Dr Damien,

In reply to some of your questions, yes I do think my back / hip / sacrum area may be involved. I did only start having symptoms in this area a year ago and I have had my injury for 2.5 years now.
The chiropractor that I saw found weakness in my quadricep on the left side with the hip flexed but in neutral int.ext rotation, it was weaker when hip was in external and internal rotation. I feel I have restriction in my hip flexor on the left side when I extend beyond 90' which I feel may explain why I have pain particularly on walking as it involves this action repeatedly. However no pain with yoga?!
Chiro reports some restriction of SI joint. However after 3 months of Chiro I have had no change in my symptoms.
I certainly have had various people check the proximal tibia/fibula area but no-one has mentioned any abnormality. Would this show on an MRI? Have has 2 of those of lower limb.
Tapping the fibula head doesn't produce symptoms or seem uncomfortable.
The foot cannot now regulate tempreture so at night I have to sleep with it out of the douvet and by the window otherwise I get painful burning heat. Ice does help. Both surfaces of the foot are hot and red when this happens and the slight swelling is noticible on the anterior surface of the foot.
I am not diabetic and have no other health problems of note. I eat a health conscious diet supplementing with fish oil tablets, vit B, and Glucosoamine,

Any thougths that you may have would be gratefully received,
Thank you!

[memgem]

Annie it does seem like you have a very uncommon presentation.

I am just thinking if maybe seeing as you have a had all these tests in the lower leg nerves such as tibial nerves etc, and found no answer, maybe the problem is more proxmial with radiating/referred symptoms.

Can you explain what you mean with neutral int.ext rotation, do u mean just no rotation and in 90 degree flex.

When you flex your left hip past 90 degree , besides stiffness do you have any neural pain. Is the stiffness there at the same point when passively moved.

Is there any one movement that you have do, any palpation that you can do, or during any tests with chiro, did u feel the pins and needles, burning come on immediately.

My reasoning behind why it may be more proxmial is that in relation to Dr Damiens comment about your back. It'd be interesting to assess your lumbar spine. The femoral nerve originates at L2-L4 and is the main nerve which innervates the anterior thigh muscles. Any compression ( usually found with idiopathic femoral neuropathy) may cause weakness in the hip flexors. The neural pain may orginate in the groin and travel through the medial aspect of the leg proximally but can radiate through the saphenous nerve down to the region where you are experiencing problems. I have not read of any instances where the problem from a compression proxmially presents more distally but i have seen stranger things happen before!

In addition if you have any stiffness or tightness or muscles shortening which may be causing any nerve compression, the yoga and stretching may be giving you short term benefit by lengthening the muscle so i wouldnt expect it to cause you trouble. The fact you cannot run also indicates that immediate compressive forces cause you problems which goes in conjuction with my reasoning.

I feel that from what you have said and from the information ive read, you have had so many inconclusive investigations, id definately look closely at the femoral nerve from origin along its root and to see if any tests may provoke your symptoms. I feel that if you have any compression on the femoral nerve in your lower back or via musculature on the nerve root it may produce similar symptoms to what you have said, especially as you are now saying that you have pain in your groin too.

Like i said this is purely my own idea and i hope ive reasoned my thoughts well. Im not a narrowed minded practioner at all so would love to see other physio's inputs so we can get a clear answer!

Keep me posted