I rolled my ankle and my foot hurts here. What is it? Well, that’s what we’re talking about today on the Doc On The Run Podcast.
Ankle sprains are really common among runners. In fact, they’re common among people in general. They account for about 10% of all the visits to Emergency Rooms in terms of musculoskeletal injuries, and there’s thousands of them every day that go to the Emergency Room. So it’s very, very common, but you can get lots of different kinds of pain that result from an ankle sprain.
I got an interesting question from somebody who basically rolled his ankle. And when we talk about rolling your ankle, what does that mean? Well, big toe’s over here, little toe’s over here. You roll your foot underneath you and you start to fall, but the foot flips underneath you and stresses and strains all the ligaments on the outside of the ankle.
So why is that a problem? Well, it’s really a problem because you can injure lots of different things. And in this case, I got a picture from someone who had scheduled a consultation call to do a webcam call to get an idea of what was going on. And here’s what he sent me. Well, he sent me a picture of his foot. And in short, when you’re looking down at the foot, you’ve got all kinds of structures, but he was worried that he had a tendon or ligament injury.
The first thing was, is he had pain back here. And that spot is where you can actually get a fracture of the bone, called the fifth metatarsal bone, where the peroneus brevis tendon that actually pulls your foot and holds it underneath you when you roll your ankle, it’ll rip the end of the bone off. And he had done that. So he had a styloid process fracture, or a fracture of the fifth metatarsal bone there. And that explained why he had pain right here.
But that’s not what this episode’s about. This is about something different. He also, in his picture, I said, “Put a mark anywhere you have pain.” And he had pain on his foot marked with a bunch of little dots like this. And he said, “I have pain all along here. It goes all the way out to that space between my fourth toe and my fifth toe.” So he had pain in two areas, really. He had pain back here, which he knew was where his fracture was because he had had an x-ray. He clearly had a fracture, and that was not confusing to him. But what this is, is he was told that maybe what he had is that he had some sort of ligament underneath here that was sprained, and he was told that that would probably get better as the ankle sprain healed.
Well, it’s not. This is something different. So what you have exactly in that location, not surprisingly exactly where he drew all those dots, is this thing called the intermediate dorsal cutaneous nerve. So that is intermediate dorsal, dorsal just means top of your foot, cutaneous has to do with skin, and it’s a nerve. It is a branch of the superficial perineal nerve. So it starts up by your knee, doesn’t really matter where, but it comes down, goes across in front of your ankle and then goes right here like that, straight out to the toes. If anywhere along there, let’s say I took some local anesthetic, like something like Lidocaine or Marcaine, or like the stuff the dentist injects you with when you’re going to have a tooth fixed, and I injected a little spot right here. All that pain would go away. Why? Because that’s where the nerve goes. That’s the course of the nerve.
It was very interesting that in exactly the anatomic location of this nerve is where he actually had drawn all these dots where his pain was. What that is, if you look at the foot, if we actually bend your foot over in that same motion when you roll your ankle and bend your foot all the way up under you, it will stretch the superficial perineal nerve. It’ll stretch the intermediate dorsal cutaneous nerve, and you can actually see it most of the time through the skin. When I see patients at home that have this issue, I will actually put an alcohol swab, I’ll wipe the skin right there, and then you can actually see the nerve through the skin. And if I push on it and that nerve is what’s irritated, sometimes it’ll cause pain that goes out toward the toes. Sometimes the pain will go up toward your ankle. But we know then it’s a thing called traction neuritis. That’s really not a complicated condition, but traction means you pulled. Right?
So when you have traction neuritis, all that is is, itis is inflammation. So it’s irritation and inflammation of the intermediate dorsal cutaneous nerve because you stretched it when you rolled your ankle, and there’s really not that much you need to do about it. It will calm down eventually, but it does not calm down quickly. The nerves don’t like to be stretched. They don’t do well when they get stretched and they get really irritated. So it may be that way for a while, but it’s not a thing that you have to support like you would a sprained ligament or a torn tendon. It’s completely different. It’s a nerve issue. It’s not actually a sprain issue, even though it resulted from an ankle sprain, rolling your ankle.
Hopefully that helps you understand a little bit more about traction neuritis, about why you can get pain in this area when you roll your ankle, and what it really means. Now, if you like this episode, please like it, please share it, and I’ll see you in the next episode.