Member Case Study: Tightness and Numbness in Anterior Left Leg

author : AMSSM

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I started having trouble a couple months ago with a tightness and almost numbness in my anterior left leg and top of foot during running. It feels sort of dead.

Question from skijour

I started having trouble a couple months ago with a tightness and almost numbness in my anterior left leg and top of foot during running. It feels sort of dead. At first it was only on the treadmill and always right after swimming (I think this was the nature of most of my runs at that point), and I thought it had something to do with the way I was kicking during my swims. Also, at first, it seemed reminiscent of the shin splints I experienced in high school track, but I haven't actually had any pain in that area and don't think I've been pounding on it very hard.

Recently, the treadmill and swimming association doesn't seem to be there; it just happens during any run (most but not all workouts). I've tried massaging and stretching that area (ankle flexors) and stretching my quads and gastrocs before and during runs. Sometimes it seems to help a little, but not always. The two differences in my running from past years is that I'm working on higher cadence, usually 86 to 88, and HR training, meaning Z1and Z2 for these first few months. Between the two, my stride is very short and choppy with little toe push-off, as I'm still pretty slow.

Like everyone, I'm reluctant to back off on my running. I don't think I'm doing enough as it is and my A race for this year is a HIM in August. This is starting to cut my workouts short, though. Yesterday it worried me enough to stop running - I did stairs instead, which didn't seem to bother it at all. I'm out of ideas. Help!

Answer from Laura Dunn Goldberg, MD
Member AMSSM

The symptoms described may be due to peroneal nerve dysfunction. The peroneal nerve is a branch of the sciatic nerve and supplies movement and sensation to your leg, foot, and toes. The nerve roots originate from your spinal cord, and symptoms may be due to low back problems, entrapment of the nerve at the knee, or increased pressure at a branch of the nerve in the front of the calf from repetitive muscle contraction during exercise. Sensory symptoms include decreased sensation, numbness, tingling, heaviness, and leg or foot pain. Motor involvement causes weakness in your foot and ankle.

Trauma or injury to the knee such as fractures around the knee, knee dislocation, and surgery increase one’s risk, but many experience symptoms without preceding injury. Other risk factors include lumbar disc disease (low back problems), chronic alcohol use, diabetes, habitual knee crossing, prolonged constriction of lower leg (with cast or other), or pressure due to sleep positions. A rapid increase in running coupled with large calf muscles can precipitate compression of the deep distal branch.

Diagnosis may be evident on exam if you have weakness and/or sensory loss. However, it is often necessary to obtain further diagnostic testing including blood tests, x-rays, an electromyelogram (EMG tests nerve activity in muscles), an MRI (magnetic resonance imaging), or measuring the muscle/compartment pressures before and after exercise.

Treatment is aimed at the cause, if identified, and alleviation of symptoms. Without a history of trauma, conservative treatment is recommended. Anti-inflammatory medications and therapy techniques, and occasionally corticosteroid injections, may be used to decrease swelling and pressure on the nerve. Physical therapy to stretch and strengthen the involved muscles can be helpful. Attention must be given to the lumbar spine if there is any suggestion of sciatic nerve involvement. Surgery may be required of the symptoms persist or worsen despite conservative management.

It is a good idea to see a sports medicine specialist to help you determine an accurate diagnosis and treatment plan. In the interim, I would recommend focusing on your cycling which does not usually exacerbate this problem like running does. A good cycling base can often compensate for limited run training for a half-Ironman. It is always better to approach a race undertrained and healthy than overtrained and injured. Good luck.

Laura Dunn Goldberg, MD
Cleveland Clinic Lorain
Department of Orthopedics
Primary Care Sports Medicine
Cleveland, OH
 

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date: May 12, 2008