nerve? pain proximal tibiofibular joint

by Els
(Netherlands)

Healthy, sportive, woman, 49, athletic, slim built.

I had a high tibial, closed wedge osteotomy (9 degrees) on my left knee six years ago. Since then I have progressive pain at the proximal tibiofibular joint radiating to the superior tibia at the front. Pain worsens when walking especially when walking longer then about 40 minutes, but also often even when I start walking.

One legged balance exercises cause symptoms.

Sitting in a plane or car for more then 45 minutes make me want to scream. Lying on the couch with straight legs and feet crossed cause severe symptoms. Just as lying in bed on my right side with bend knees. Lying on my left side isn't possible for more then a few minutes. The pain lessens when I stretch my legs but it takes quite a while before the pain goes.

The strength in my left lower leg is quite a bit less then in my right. Climbing stairs is difficult as is walking uphill. It feels like I have to drag my left leg along. It feels as if there is hardly any transfer of power.
When walking my left foot doesn't unroll completely. But you can't see it unless you pay very good attention.

I don't have ankle pain but the ankle moves like shit according to the physio and orthopedic surgeon. There is also pain radiating to the lateral side of my leg and along the tibia.
Sometimes my left lower leg feels like is it is ice cold. It feels as nerve pain.

Orthopedic surgeon doesn't understand it and doesn't take it seriously, phyio thinks it may be some kind of subluxation. Manual therapist said the fibula is displaced superior. He manipulated it several times. And that felt great. I felt life streaming back into my leg, it tingled and felt much better, lighter but within a few hours it went back into it's wrong position. EMG was good. What is this and what can I do? I am quite desperate. Thanks, Els.

Dag Els, maar ik zal in het engels schrijven.

I know the EMG is good, but I'd like to see testing of each of the muscles in the lower limb done. Some you could do yourself, but it's rather technical.

For example, can you raise your big toe, and can you raise your heel off the ground, standing on one leg. Does the knee give, and is there wasting of the quad, or other muscles?

Is climbing stairs difficult because of pain or weakness? In the knee or ankle? That lack of movement in the ankle is very real pointer; work out specifically which muscle is involved.

Could your manuele therapeut teach your husband how to reduce that subluxation of the fibula head? Perhaps if it was done regularly you might get some lasting benefit.

Ask someone to do Noble's test for an ITB.

Test the pulses in the ankle and foot with the knee straight and bent.

What was the reason for the osteotomy? An injury in gymnastics or something similar?

Time for an opinion from a different orthopaedic surgeon; your current guy hasn't a clue obviously and worse, sounds like he's in denial.

I fear you may be in for a total knee replacement, this is obviously very disabling.

You might look for a chiropractor with a FICS post graduate qualification; sports injuries. Contact the NCA and they will give you some names.

I fear I haven't contributed much, but perhaps a few pointers.

Doe het kikkerlandje de groetjes!

Dr B

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