Ankle Sprain- Injury to the Superficial Peroneal and/or Intermediodorsal Branch of the Fibular Nerve

Stretch Nerve Injury of the Superficial Peroneal Nerve and/or the Intermediodorsal Branch of the Fibular Nerve

Ankle injuries are quite common in life and they generally require little, if any, special medical attention.  A sprain is a stretch injury of a ligament or tendon, and rates of healing depend in large on patient age, health and nutritional status.

The most common sprain involves 'inversion of the ankle.  

More times than not, these sprains mend on their own in as little as 6 weeks (for children and adolescents) and the length of time tends to double with each decade of life, after the age of 30. 

When the pain does not abate with time, the likelihood increases that pain is due to  stretch injury of the the Superficial Peroneal Nerve (SPN) and/or Intermediodorsal Branch of the Fibular Nerve (IBFN).  These nerves are tethered by the ligament that surrounds the lateral ankle,

and as it is turned inward, the nerves become frayed at the leading and trailing edges of the ankle.

  The Nerve tissue is thin, delicate and easily damaged through violent stretch. The precise location of pain will depend entirely on the fibers that are injured.

Pain can be rather incapacitating with pressure over the lateral portion of the ankle, and it can be worse with tight fitting shoes or boots. 

These fibers will be compressed by certain types of shoes, sandals and boots, as can be seen in this picture.

Swelling will go away long before the pain is entirely gone.

Treatment of this problem consists of a combination of oral anti-inflammatories, oral anti-convulsants, and topical anti-inflammatory medicines. 

The topical anti-inflammatory of choice may be a combination of flurbiprofen and ketoprofen in an isopropyl alcohol with NDMS enhancement. This is a compounded product, available by prescription. 

An alternative that is available without prescription is 'kink-ease,' which is a high potency MSM salve.  In either case, the topical should be used first thing in the morning, last thing at night and once or twice during the day.

The Keto/flurbo compounded mixture must be ordered by your physician.  It costs about $40 per ounce. 

Kink ease is available, without prescription, at a cost of about $4.50 an ounce. It can be found at this web address:   www.kinkease.com or at www.stages-of-life.com/

More will be written on this in my 'Health Article Series.'  When it is finished, I will come back to this post and insert the appropriate link.

David S. Klein, MD, FACA, FACPM
Pain Center of Orlando, Inc.