Pain from outer ankle across side of foot and little toe

by Ellen
(Boston)

I fractured my ankle last July falling in to a hole at the beach. Spend 7 weeks in a boot cast to the knee. Shortly after getting the cast off I noticed that my little toe does not move when I bend my toes. I mentioned this to the ortho who brushed it off as something that would go away now that I didn't have the cast any longer.

10 months later I experience a pain/burning sensation from my ankle down the outside of my foot on a daily basis and my little toe is now kind of on top of the toe next to it. The area that was fractured is frequently tender to the touch.

I have called for an appt but have a few week wait. any ideas what coulD be causing this?

RESPONSE

Hi Ellen,

I will assume the ankle was x-rayed before you were discharged and the fracture site was either totally closed or virtually closed. If it was not totally closed at the time of the final x-ray there is always the chance that the fracture site did not heal through and through and you may have what is known as a non-union, which is basically a condition where the fracture (crack) heals with scar tissue and not bone. It could cause tenderness in the area when pressure is applied. It generally would not cause pain down the side of the foot.
The fact that your little toe did not move initially after the trauma is suggestive of either tendon damage to the toe or damage of the nerve that powers the toe.
In either case I would have said the same thing to you when the cast was removed. The movement in the toe would eventually come back.
The fact that the pain you are now experiencing runs down the side of the foot, my first thought would me more nerve damage than tendon damage, for the simple reason that if this problem occurred as a result of pressure of the cast on your foot and ankle, the cast itself could not have done that much damage to the tendon for you to still be having issues. So, that leaves us with possible nerve damage.
Keep in mind I am only guessing from the other side of the internet, but nerve damage would be my first thought.
What you can do about it becomes another question. If the possibility exists that one of the nerves that innervates the foot is caught in scar tissue, then there are procedures that will free up the nerve and perhaps restore function, but in most cases where there has been nerve damage for a prolonged period of time, there is very little that can be done.
If your doctor decides that it is actually the tendon than is involved, then physical therapy might be an avenue to pursue in trying to regain function of the little toe.
As I stated earlier, in the area where you have tenderness to touch, the old fracture site, there is a possibility that the fracture line is completely closed, but, there is also the possibility that you just have residual tenderness from the old fracture. A bone scan or an MRI might be a better option than another x-ray in determining what is actually going on in the painful area.

Marc Mitnick DPM
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