Pain, tingling, loss of sensation below left ankle

by Bea
(Indio, CA)

I had a simple closed fracture of my left fibula on April 23. It healed well after 6 weeks in a cast and four weeks in a boot. The pain from the fracture was mild and manageable with ibuprofen.

I had out-patient surgery under general anesthesia to remove a ganglion cyst near my left medial ankle on September 15. The wound was dressed, I was told to keep my foot elevated and iced, and received a prescription for 30 Norcal 5 mg, one or two tabs every 3-4 hours for pain. I weigh approx. 185 pounds. I slept for most of the remainder of the day.

At 11 p.m. I awoke with extreme pain and tingling in my toes. The pain extended to my instep. It felt like electrocution or burning. It was unbearable. The worst of the pain was in my big toe. I took the Norcal and woke up every hour thereafter in the same pain. On the morning of September 16, I called the doctor's office and described my symptoms. I was told that these were "normal".

I continued in the same excruciating pain over the weekend. My husband attempted to loosen the ace bandage but was afraid to disturb the other layers of the dressing.

On Monday September 19, I called the doctor's office and again told them of my continuing pain and tingling and informed them I was running out of pain medicine. I said I could not imagine this was "normal". I was told I was taking too much pain medicine. However, luckily, the nurse told me to come in that day.

A nurse removed the three layers of my dressing. When I saw the physician's assistant (the orthopedic surgeon here has almost zero patient contact in my experience), he said that the dressing had become like a tourniquet when my foot swelled after the surgery and that 5 mg of Norcal was too low a dose for someone of my weight. He removed the dressing and replaced it with another kind of bandage that does not wrap around my foot.

The pain decreased immediately. I still have tingling and cramping in my toes and occasional severe stabbing pain that doesn't last long. The worst thing now is that I have noticed an approximately 2 x 3 inch area above the incision in which I have absolutely no sensation.

I would like to know whether my problems are likely to improve or deteriorate over time. I would also like to know whether it would be wise to seek a referral to a neurologist. I have no intention to sue anybody - life is too short.

RESPONSE

Hi Bea,

It does sound like the dressing was wrapped too tight and it could have put excessive pressure on the nerves that innervate the toes. These things happen.
What bothers me is that it is four weeks post surgery and you are still having issues and nobody seems to care. I love the attitude of some surgeons, they did the surgery, any problems afterwards are your problems.
It sounds like you have some degree of nerve irritation/damage. In general it may slowly improve but I cannot guarantee that. There are things that can be done, such as cortisone injections, physical therapy, these are things that will calm down the nerve. The problem is that the longer a nerve stays irritated, the greater the chance of the problem becoming permanent.
So, you are right. I think a second opinion by someone who can actually examine your foot would be indicated as I do think there are things that can be done.

Marc Mitnick DPM
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