Peroneal Nerve Damage and Stress Fractures

author : AMSSM

comments : 0

Is there anything that I can do to lessen the chances of stress fractures. I have had no luck with the doctors I have seen. Some have advised orthotics, some say there is nothing that can be done.

Question from AzTriathlete73
Three years ago I was unlucky enough to have a quite spectacular crash while riding my mountain bike. I landed on the left outside edge of my left knee. The next morning I awoke to the most severe pain I have ever felt, and my leg was numb from knee to foot. I had complete foot drop in my left foot. An EMG showed that I had severe damage in my peroneal nerve (below where it crosses the outside of the knee). The leg has since re-inervated but I stiil have little-to-no feeling on the left side of my calf, and no skin sensation in my left foot (except my big toe)

Since the accident I have had three (3) sets of stress fractures in my left foot (the 3rd and 4th metatarsal/midshaft - confirmed by nuclear bone scan, xrays and MRI). These fractures always follow any attempt to follow a running plan. These fractures require me in a stiff walking boot/cast for 6-8 weeks.

Is there anything that I can do to lessen the chances of stress fractures? I have had no luck with the doctors I have seen. Some have advised orthotics, some say that there is nothing that can be done.

Any advice or help would be greatly appreciated.

Answer
Steve Hartsock, MD - It sounds as though your circumstances are particularly challenging. In an attempt to regain a level of training and competition that suits you, specific variations to your regimen are required.

Orthotics are a good place to start. Nerve damage in the peroneal nerve can lead to anatomical changes in your foot that can alter the way you absorb forces as you contact the ground. A nerve deficit may also change your running mechanics, such as how your foot strikes the ground during your running stride. Most of these changes can be aided with the use of orthotics. There are several types of orthotics and in your case, with multiple stress fractures, look for those with the most cushioning.

Also, choose running shoes that provide adequate support, but also have a good cushion. Contrary to the popular notion of “breaking in” your running shoes, if they don’t feel good in the store, they are not the right pair for you. Owning several pairs of running shoes will allow you to rotate your shoes and have them function at their best any time you run. Appropriate turnover will ensure that you run in shoes that are in good shape with little wear and tear.

With your history, no predetermined running plan is necessarily going to be right for you. You will likely have to come up with your own schedule and modify it as needed. In the beginning, try running very short distances even if it doesn’t feel like much exercise. Typically, you should increase mileage by 10% per week. Start with low impact, elliptical machines or treadmills and build up to low impact with regular runs. The essential restriction for you is to stop if you begin to feel the pain you felt with your stress fractures. Do not run through this. Your running plan will be different than anyone else’s, but it needs to be to allow you to compete and train at a level that you want. Please see a sports medicine physician for any further information. Happy running!

Steve Hartsock, MD

Gary Arends, DO - The biggest source of problems I see in triathletes and runners who develop stress fractures or overuse injuries is biomechanical in origin. If you were my patient, I would assess your biomechanics and send you to my top sports medicine physical therapist to work on any biomechanical deficiencies or gait dysfunction. I would have them concentrate on special treatments to reduce any neurotension, improve gait and work on stability and flexibility. This would need to be assessed during walking, jogging, running and during anaerobic phases of exercise. I would also have you assessed to determine if you needed an AFO (ankle-foot-orthosis); one that would be appropriate for an athlete and runner who may have foot drop from a peroneal nerve injury. This could also be combined with a sport orthotic to ensure proper foot mechanics if needed. This evaluation would need to be performed by a licensed and professional orthotist * one who makes orthotics and prosthetics.

Also, one of the most important areas to correct is shoe wear. A biomechanical foot problem will only be exacerbated in the wrong shoe. This often will lead to stress fractures of the metatarsals and lower extremity. Arch type and ankle biomechanics would need to be assessed at a local running shoe store, also. They would perform a quick gait analysis and arch evaluation to ensure that the proper footwear is being worn.

This is my typical approach to anyone with a history of nerve injury and stress fractures in the lower extremities. Good luck and happy swimming, biking and running.

Gary Arends, DO


 

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date: July 3, 2006