Conversation: The conversation between human and AI assistant.
[|Human|] I was shot through the right ankle area from inside to outside with 22 magnum bullet on Nov22 2014. It missed the artery, the bones, and most of the tendons. The doctor removed the parts of the bullet that was at the skin on the outside of the leg and left the small bits of shrapnel inside the leg. The wound has healed quickly and cleanly. The bullet seems to have hit or at least damaged the tibial plantar nerve. I am experiencing an interesting assortment of sensations in my foot. The area forward of the instep on the bottom of the foot has no feeling to touch but fizzes, bubbles, burns, tingles, stabs, and electric shocks causing me no shortage of miserable hours. It is generally worse evenings and unbearable at bedtime. My big toe and the one next to it are bending to the right and bend downward if I lift my toes toward my shins. My first question is: If the nerve is severed why am I having all these sensations in my foot? If it s not severed is it likely to heal and give me the feeling back in my foot? Can nerve damage cause my toes to bend and twist or does it sound like some other hidden damage. Even though I have no feeling in the foot, I m walking, with some difficulty, since I do have to earn a living. Will walking on it benefit circulation or is it detrimental? Thanks for allowing me to pile on the questions. M
[|AI|]  Hello. Thanks for asking from Chat Doctor. I can understand your concern. As bullet injury occurred from inside out, it might have caused medial plantar nerve injury or tibial nerve injury just before bifurcation. It can only be confirmed by examination of your foot. Medial plantar nerve damage cause sensory loss or tingling/burning sensation on medial plantar area between big toe and adjacent toe. There will be weakness of big toe and adjacent toe plantar flexion. In your case, most symptoms are resembling medial plantar nerve damage. Now coming to your queries. 1. Severance or disconnection of nerve can be complete or partial. Partial disconnection can cause abnormal connection between nerve ends (neuroma). This can cause irritation symptoms like burning/tingling/insect crawling like sensations. Complete disconnection leads to loss of all sensations in affected region. Confirmation of it can be made by NCV/EMG studies.2. It is right that partial injury has more chances of healing than complete injury. Presence of some sensation is considered a good sign. Nerve regeneration and healing in such cases can occur unto 18 months, but maximum healing occurs in first 12 months. Even surgical repair of nerve shows some good results in first 12 months. But there is one problem. If irritation symptoms are severe and not decreasing even after medication, sometimes nerve is severed by doctor to relieve discomfort.  3. Walking or physical activity has nothing to do with healing of nerve. But it helps in stretching of muscles and acts like physiotherapy, which is good for muscles supplied by the nerve. You can passively stretch your toes up and down. It also prevents permanent spasm or contracture of joints and thus deformity. Do not overdo it. It can damage muscle. Some tips-Do not take any medications for healing of nerves as after 1 year of injury, Chat Doctor.  -You are having small sized peripheral nerve injury. Repair of such type nerve is very difficult and results are not very promising.-You can take help of physiotherapist to learn about toe exercise. Thanks. Hope it will help you. Take care