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Dr. Bob
Dr. Bob, Neurologist (MD)
Category: Neurology
Satisfied Customers: 5485
Experience:  Neurology & Int Medicine (US Trained): 20 yrs experience
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Advice re burning pain outer calf, numb area under knee and

Resolved Question:

Advice re burning pain outer calf, numb area under knee and tingling under toes
Submitted: 7 months ago.
Category: Neurology
Expert:  Dr. Bob replied 7 months ago.
How long have you had this? Are you on any medications?
Customer: replied 7 months ago.
Since October. Taking gabapentin -no improvement
Customer: replied 7 months ago.
I have been taking gabapentin, now on 600mg three times daily but no improvement. Calf pain started in October. Had MRI, doctor said no nerves impinged in my back, just wear and tear. Have also seen an osteopath and a physio who did myofascial release but no real improvement from either.
Expert:  Dr. Bob replied 7 months ago.

Even if there are no nerves impinged in the back this does not mean a nerve is not being impinged further down the leg. Have you experienced any foot drop or weakness in the leg? If your common fibular nerve is being compressed at the level of the fibular head, for example, this could cause burning pain and/or numbness downstream in the calf or foot. This nerve can become compressed or injured from crossing one's legs too much or wearing high boots. Similarly, the tibial nerve going into the leg sends branches to the calf behind the knee and also into the foot. Certain activities such as running, hiking and weight-lifting can cause the muscles of the legs to hypertrophy and press upon the nerves. I would suggest you get nerve conduction testing (NCV/EMG) to look at the integrity of all the nerves from the back down to the foot to see which ones are affected and at what location.

Customer: replied 7 months ago.
Thanks, ***** ***** drop and can still walk on my heels, lift toes etc, just tingling under toes. No pain in foot, just side of calf, occasionally twinge of pain at buttock on same side. If the nerve was impinged at my back would it definitely show up on an MRI (only asking as the osteopath said it might not as I was lying down?!) should I persevere with the gabapentin- been taking it for at least three months, doctor keen for me to try 800mg three times daily - but if I don't feel any difference on 600mg three times a day would the increase be likely to help? Do you think I would be better to ask if I could try something different? Many thanks for your help.
Expert:  Dr. Bob replied 7 months ago.

A pinched nerve should show up on MRI. While this provides detailed anatomic information, however, it does not provide any functional data (i.e how the nerves are working or malfunctioning). You would need NCV testing to look for this. In the meantime, gabapentin is an excellent nerve stabilizer and pain control agent. Most people that will benefit from it do so at 600 TID, but because there is a "threshold effect" for some, you might need to hit the higher level before noticing any improvement. You can use this agent in addition to non-steroidal anti-inflammatories or even a course of prednisone, both of which reduce inflammation and can take pressure off a compressed nerve.

Customer: replied 7 months ago.
Thanks, ***** ***** also ask due to NHS waiting list I have been waiting 3 months for my neurology appointment and still don't have a date - concerned re the length of time the nerve might have been impinged - can it still heal after this amount of time? Or am I likely to have long term pain now?
Expert:  Dr. Bob replied 7 months ago.

Peripheral nerves can repair and regenerate quite readily once the cause of the damage is determined and ameliorated. That said, it tends to do so at its own pace, about 1-3mm per day. Only when the nerve has been severely injured for a prolonged period or actually severed does it fail to improve. If your symptoms have been stable or improving slowly, this should not be a major concern. If they are worsening, you should press upon your GP for a sooner appointment with neurology or get NCV testing, which will give him the information he needs to make an informed judgement about this.

Customer: replied 7 months ago.
Last question! The most painful area initially started nearer my knee, now I feel the most painful area is just below mid calf and less sore nearer my knee. Is this the direction a nerve would heal or would it be the other way round and it would mean more of the nerve is injured if I am feeling pain further down from my knee? Thanks for your help and advice - much appreciated.
Expert:  Dr. Bob replied 7 months ago.

The nerve should heal proximally first. If the pain has actually moved down, this might indicate a different type of problem such as a muscle or deep tissue injury, or a vascular issue. Getting an MRI of the leg (or a CT, or possibly an ultrasound) would help to sort this out.

Expert:  Dr. Bob replied 7 months ago.

Does this make sense? Do you have any follow up questions about this?

Customer: replied 7 months ago.
My symptoms haven't been improving, probably exactly the same or slightly worse - having pain on and off at buttock on same side is a new symptom - tends to be when I have been on my feet for a long time and my calf is very sore, my thigh doesn't get sore though. Do you think it is connected? How long would you say would be safe to leave things before seeing a neurologist? I'm concerned this has been going on for about 7 months and hasn't improved and I haven't had a diagnosis. Would it be worth seeing a physiotherapist or similar again? Or if it is an impinged nerve after all this time would the only way to release it be surgery? Many thanks.
Customer: replied 7 months ago.
I sent one more message with a couple of questions yesterday- did you get that? Then I will complete rating etc. Many thanks.
Expert:  Dr. Bob replied 7 months ago.

There is a good chance this is sciatica, an irritation of the sciatic nerve which runs from the spine, through the buttock region and down into the calf and beyond. Pain can persist or recur for many months or years and yet very often nothing shows up on MRI. Physiotherapy is an excellent idea as they are almost always able to help. They can also help you get into neurology sooner if they detect something on exam that is worrisome to them. Surgery is not likely to be necessary in the presence of a normal MRI of the lumbar spine. However, you might need further imaging studies such as a CT or MRI of the pelvic region if thing continue to progress and an answer is not forthcoming from your healthcare providers.

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