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Pain in posterior part of leg above malleolus. MRI, nerve conduction studies came negative. Any advice?

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Posted on Mon, 29 Apr 2013
Question: I have pain for the last 8 months on the posterior part of my right leg right on the top part of my ankle above the malleolus, have had MRI and nerve conduction studies which were negative. I play alot of sports. Its in the area where the extensor digitorum longus and I think the peroneous tertius tendons run. Nor firm diagnosis on it but I am supposed to get a cortisone shot but I do not think that will fix it. I can't run , jump, squat etc. at all. I do not really have pain in the toes, it does not swell it is irritated when I drive with foot on gas so I use cruise control. I have been taking it easy for 6 months and it has not improved.
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Answered by Dr. Luchuo Engelbert Bain (4 hours later)
Hi and thanks for the query,
The nature of onset of the pain is important. It is likely that this should be a lesion with either the ligaments or the tendons. Lack of signs of inflammation and intensification of pain on tension points towards a mechanical origin of the pain. Lesions such as mild tears within tendons could present as such.
A negative MRI however does not exclude in its entire these lesions.
Treatment from the beginning should be intensive, both medical and life style oriented.
1. avoid all positions as much as possible that intensify the pain
2. Local anti inflammatory drugs for a long time might help
3. Consider periodic injection of steroid for in bouts of three months, Triamcinolone 80mg IM/every three months with COX-2 inhibitors as oral anti inflammatory drugs from the start good starting points. oral steroids might cause gastritis and other signs of steroid intoxication (CUSHING s syndrome).
Failure of these measures should demand a reevalution by your treating orthopedic surgeon. Repeat x rays with different specific incidences could aid in the diagnostic process.
Thanks and best regards,
Luchuo, MD.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Luchuo Engelbert Bain

General & Family Physician

Practicing since :2009

Answered : 3092 Questions

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Pain in posterior part of leg above malleolus. MRI, nerve conduction studies came negative. Any advice?

Hi and thanks for the query,
The nature of onset of the pain is important. It is likely that this should be a lesion with either the ligaments or the tendons. Lack of signs of inflammation and intensification of pain on tension points towards a mechanical origin of the pain. Lesions such as mild tears within tendons could present as such.
A negative MRI however does not exclude in its entire these lesions.
Treatment from the beginning should be intensive, both medical and life style oriented.
1. avoid all positions as much as possible that intensify the pain
2. Local anti inflammatory drugs for a long time might help
3. Consider periodic injection of steroid for in bouts of three months, Triamcinolone 80mg IM/every three months with COX-2 inhibitors as oral anti inflammatory drugs from the start good starting points. oral steroids might cause gastritis and other signs of steroid intoxication (CUSHING s syndrome).
Failure of these measures should demand a reevalution by your treating orthopedic surgeon. Repeat x rays with different specific incidences could aid in the diagnostic process.
Thanks and best regards,
Luchuo, MD.