Back issues, ankle weakness, but no major pain??
 

I'm glad to find this group, but I couldn't find a thread (or recent thread) of anyone with similar symptoms...and I really needed to vent. :(

The story:
I tripped in very short heeled shoes leaving from work (back at the end of August) - sprained my R ankle pretty bad and went to the doctor. After a week on Prednisone, the swelling still didn't go down & significant R ankle weakness/partial foot drop was noted. I was referred to Ortho.

See the Ortho doctor - exam done, questions asked - and he asked about falling - which I do have a history of. After the assessment/history review, he recommended I have stress x-rays, let me know that he didn't think I had muscular issues that it is possibly neurological & recommended I see Neuro. He also recommends an AFO - which I get for the R foot, but totally stinks & pinches at the calf (stock AFO's are NOT made for short big girls!). I found out custom orthotics aren't paid for by my insurance unless referred to a podiatrist who then recommends it (which my primary didn't do).

X-rays done of both ankles (negative) and go to see Neuro. She tells me that I have drop foot in both feet with the R worse than the L, continually asks me about back pain (I do have, but not horrible - more like a dull ache) and recommends an EMG of the back/legs.

EMG done & shows nerve damage at the knee level. My primary doctor doesn't like her recommendations about anterior compartment syndrome (due to no major trauma to my lower legs). He also didn't like that she said I had drop foot in both legs because his exam only showed issues with the R foot. I let him know that I still have issues walking long distances - even noticeable by co-workers (after awhile, I had to work so hard to lift up my foot & put it down flat so I wouldn't trip over myself). I also don't have a "true" drop foot, I can lift my foot with the great toe, but it causes my foot to supinate (turn inwards)....so, initially walking, I'm fine, but the longer I go, the worse it gets. So my primary doctor orders a CT of the lower back.

CT of T12-S1 shows degenerative disk disease, most pronounced L4-L5 - which shows facet hypertrophy & ligamentum flavum thickening with a broad-based disk bulge. Moderate canal narrowing is present. Mild bilateral neural foraminal narrowing is present. No evidence of severe canal or neural foraminal stenosis identified at any level.

The issue:
I follow-up with my primary doctor, who is very conservative. Keep in mind that I'm a 37yr old mom & nurse - I need to walk and walk fast & I've been very frustrated with the fact that my walking has gotten noticeably worse. I ask him about surgery - I know, very extreme, but like I said, I've been very frustrated. He's treating me with Prednisone, Tylenol #3 and Valium at night (I have muscle twitching & spasms of my legs at night. I have an appointment next week to see how it goes, if not, he says we'll explore the epidural cortisone injection. Then we'll wait...until MARCH! He went through options - PT, accupuncture, pain management, etc. The problem is, I really don't have pain - or I don't feel it as excruciating pain. I've had tightness in the back of my thigh, but it's better after I stretch - it's just the frustration of not being able to walk distances.

Co-workers & friends with lumbar spine issues have the sciatic nerve pain, or other back pain but not so much the weakness like I do. My husband did find the Dorsi-Lite Foot Splint (front of foot as opposed to over the back of the heel) - which I've just started wearing this week - so far, so good. It even has given me a little hope that I can gain a little bit of my life back & continue to do my job. How bad does this weakness have to get before a doctor will consider surgery? Mine told me I was too young - my recovery would be long & he couldn't guarantee the lower leg muscle weakness getting any better. Does anyone have the weakness, but not the pain?

Two questions: do you have a L5-S1 spondy and why have you not had an MRI?

No L5-S1 spondy. And as for the MRI, no clue - Primary MD didn't order it.

They should order an MRI--
 

--of lower thoracic/lumbar/sacral spine; MRI's are better at picking up nerve impingment at those levels than CT.

Also, it's entirely possible, given that the CT results were not severely abnormal (most of us have disc bulges/arthritic changes in a number of areas in the spine as we age, but not all of us encounter symptoms) that the issue is coming from farther down the leg, along the thigh (piriformis areas), at the knee (a site at which compressive neuropathies are common) or even at the lower calf/tarsal tunnel areas.

Take a look at:

http://www.myfootshop.com/detail.asp...nel%20Syndrome

http://emedicine.medscape.com/article/1234809-overview

http://emedicine.medscape.com/articl...overview#a0104

Thanks for the links - the doctor actually explored tarsal tunnel syndrome - but didn't do much further with that. At this point, he's tried prednisone & now I'm taking Indocin which seems to be ok. Still have the weakness, but it's much better walking around with the AFO's. Needless to say, I'll probably be shopping around for another doctor come benefit choice period time.