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What Causes Weak Ankle Dorsiflexion And Foot Eversion?

Posted on Tue, 22 Dec 2015

Question: In 2012, I had peroneal brevis tendon surgery for degenerative tears which was more than 50 percent of tendon. The podiatrist attached the brevis to the longus tendon. I did physical therapy twice, but still continuously have pain in the ankle. The area above where they did surgery has some lumps that are firm and tender. I still have issues walking on uneven surfaces and cannot lift up on that foot by itself and cannot stand on that foot. If I do I loose balance. Below the ankle bone if I press on the area, I will get nerve pain and that goes to my lateral part of foot too the last 2 toes. My lower leg that had surgery is smaller than the other. I saw a podiatrist last year who did not listen to my complaints and just issue orthotic due to flat arches that are acquired. I do have complete rupture of plantar fascia in the same leg I had the tear, and plantar fascia release in the other.

I have seen a new provider who order a new MRI but won't be until end of the month. Can you give me some ideas of what can be going on. I have poor dorsiflexion and 0 degrees eversion of that foot.

Answered by Dr. Aashish Raghu (39 minutes later)

Brief Answer:
Could be Peroneal tendon degeneration progressing or peroneal nerve entrapm

Detailed Answer:
Hi there.

Thanks for the query.

If you have poor dorsiflexion and eversion, it indicates peroneal dysfunction.

I believe that the peroneal surgery which was done has now caused peroneal longus dysfunction which could be degeneration.

The flat foot could be due to the plantar fascia tear aggravated with excess body weight of you are overweight.

Pain over the lateral surface of the foot could be due to entrapment of the superficial peroneal nerve in the Anterior tarsal tunnel or could be weakness and degeneration of the peroneal musculature.

The causes of nerve compression like ganglion cyst, degenerative oedematous peroneal tendon, ankle arthritis etc. need to be ruled out only in an MRI after a thorough clinical examination.

Till then, elastic crepe bandage application, wearing basketball shoes will keep the ankle stable to some extent. If there is no dorsiflexion, I suggest you get muscle charting done by a Physiotherapist and do apply a Foot drop splint. Apply hot packs for pain relief. Avoid strenuous activity and stair climbing.

Kindly do follow up with me on the MRI for a better understanding of your present status and the available specific treatment options.

I hope I have answered your query.

I will be available to answer your follow up queries.

Regards,

Dr. Aashish Raghu

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Aashish Raghu (23 minutes later)

If this is the case what would be treatment option. Would it require more surgery?

Answered by Dr. Aashish Raghu (26 minutes later)

Brief Answer:
Better to wait for the MRI

Detailed Answer:
It would be wise to content only after getting to see the MRI as jumping into conclusions may not solve anything.

Any source of nerve compression can be relieved with physiotherapy or removal of the structure by surgery.

Tendon dysfunction needs tendon grafting.

Note: For further queries, consult a joint and bone specialist, an Orthopaedic surgeon. Book a Call now.

Above answer was peer-reviewed by : Dr. Raju A.T