I partially ruptured my tibia tendon on the posterior side, right at the ankle bone in 2005. My ankle was immobilized for 25 days. I was still experiencing pain after, so I took oral steroids, and then received cortisone shots (3). I was then diagnosed with tarsal tunnel syndrome. I had tarsal tunnel decompression surgery in 2006. My level of pain has increased in the past year, and my ankle tends to give out on me with exercise or carrying too much weight. I am also taking 120 mg of cymbalta which doesn’t do much but take off the edge of pain. My ankle is back in a cam walker, and I am limited on my physical activities. I am now being told that it is a muscular-skeletal injury with some nerve irritation and that is appears to be an overuse injury. My symptoms are as follows: constant throbbing, burning sensation from big toe to knee, sharp spasms of pain, stiffness, and ankle gives out with weight and exercise. I am requesting advice on what I should do next.

Doctor Joshua’s Answer:

First it needs to be determined if there is some cause for the symptom that might be surgically treatable. For this you would need to see an orthopedic surgeon, also a consultation with a physiatrist may be beneficial in order to assess the need for rehab&exercise.

Another possibility is that you have developed neuropathic pain, such as a complex regional pain syndrome (CRPS). Your description somewhat suggests neuropathic pain, at least as one component. CRPS can develop after and ankle sprain.

Take a look at the following list of common findings in CRPS:

EXAMINATION FINDINGS
Temperature/color change
Edema (SWELLING)
Trophic (THICK) skin, hair, nail growth abnormalities
Impaired motor function (WEAKNESS)
Hyperpathia/allodynia (PAIN/SENSITIVITY TO THE TOUCH)
Sudomotor changes (LOCAL SWEATING)

If you have four or more, a diagnosis of CRPS is made (of course, your doctor needs to make that diagnosis)

Treatment of neuropathic pain is different from the treatment of “normal” (nociceptive) pain. Talk to your doctors- if neuropathic pain is present, you’ll need to see a pain specialist who will be able to help with optimal medication and other means.