Question
Hi Dr. Newhart, I injured my left ankle falling down so stairs 6 weeks ago.
I have been to an orthopedist who keeps putting off an mri until the
swelling in my ankle goes down. He has an idea that I have a high ankle
sprain as well as some nerve damage. I have numbness in my big toe
and the toe next to that to the point that it feels like it is somebody elses
toes. I have also noticed in the past few days that when I rub the top of
my foot very lightly I get a pins and needles sensation and I also have a
small lump (about dime sized) on the top of my foot. Do you have any
thoughts on this? Is it something I should be concerned about? You
should also know I am 22 years old and have had several bouts of
sciatica as well as get frequent swelling in my lower back (prior to this
injury) I don't know if any of it is related, but any insight would be greatly
appreciated as I am not seeing the orthopedist for a few more weeks.
Thank you!

Answer
Dear Jessica,

I have noticed that you have not had an answer from Dr. Newhart, so if you will permit, I would like to take a stab at this for you!

Falling down the stairs can cause a lot of injuries, some obvious and some not so obvious.

Priority number one... rule out any fracture or dislocation. Have you had any x-rays of the ankle, foot, and lower leg?  If you are also having back pain, have you had any x-rays of the back to rule out a possible spinal compression fracture?

Even if early x-rays did not show any broken bones, new x-rays a couple of weeks after injury can show hidden fractures because the bones will begin showing signs of healing.  An MRI will show soft tissue injuries much better than x-rays. Soft tissues include discs and ligaments. Muscle strains are often much harder to see, even with an MRI.

I find your history of sciatica to be interesting in this case. Sciatica is most often the result of a bulging or herniated lumbar disc. If you landed hard on your behind when you fell, you very well could have further injured a lumbar disc. This could easily explain the "pins and needles" sensation that you are getting in the foot... much better than the diagnosis of an ankle sprain...

Final Advise:
1) Ask your MD orthopedist to evaluate your lumbar spine for possible injury. If he won't, find another doctor (preferably a good chiropractor)
2) Make sure that you have had a good set of x-rays of the ankle, foot, and lower leg.
3) An MRI would only be beneficial if you and your doctor believe that there is deep cartilage or ligament damage within a lower leg joint, or if there is a possible lumbar disc injury.
4) A CT scan is best in seeing if there is a hidden broken bone.
5) If you have sustained a sprain/strain injury to the ankle, that is going to take you some time to get over. Sprain/strains often require weeks to months. Chiropractic and physiotherapy can help get you through the healing process.
6) Even if the leg symptoms are purely the result of a lower leg injury, you should have an on-going working relationship with a chiropractor that you trust that can help you with your lower back condition.

Jessica, I know that it can be frustrating when you are hurting, and so I hope that this answer has at least given you some additional things to think about. I wish you the absolute best of luck, and if you have more questions, you can contact me at [email protected]

Good luck with your leg and back!