Foot pain after spinal surgery

[dacox]

I'm 48 years old and have been suffering from increasing pains in both feet for two years. The pains take the form of sore, often swollen toes and patches, painful arches which can be dull pain or searing pain just like a severe sprain (prevents me from walking for several days). At no time has any physical event or injury triggered these symptoms - they just appear from nowhere. I also have mild osteoarthritis in both big toes caused by gout.

Problem became more acute last November - the pains in the arches became worse & from that point forward I have also suffered from continual dizziness and extreme fatigue and the foot pain has increased in frequency and severity.

Numerous investigations turned up nothing apart from recent activation of Epstein Barr virus (possible link with fatigue) and slight splenomegaly accompanied by slightly low platelets (135) and lymphocytes. I am told all these issues are consistent with active EBV.

I have just had fusion surgery to correct a spondylolisthesis at L5/S1 - the nerves at L5 were trapped and very inflammed - he advised that this will take some months to settle down.

My questions :

1) Can these various types of foot pain be explained by the trapped inflammed nerves at L5 (my Osteopath says it can but other medical professionals are sceptical) ?
2) If these pains are not caused by this injury can you think of any other condition that can cause this type of symptom (I seldom experience general tingling/burning over a large area - the pain is usually fairly localised and resembles pain caused by trauma/injury

[CCF-Neuro-M.D.-PW]

The L5 dermatome (sensory area supplied by the L5 root) is over the lateral aspect of the leg and most of the top surface of the foot. The sole of the foot is supplied by S1. There is some overlap though. The pain you describe does not sound like nerve root pain, but more suggestive of a local source of pain in the foot.

There could be a variety of causes for local foot pain from arthritis and gout (have plain xrays of the foot been done) to deformity from diabetic foot disease (get checked for diabetes) to causes for high arches (neuropathy) and swollen toes (psoriasis arthropathy, 'dacylitis')
Many of these causes are not neurologically related so you should seek a formal medical opinion on them

Good luck

[JoAnnaRF]

My injury occurred at L4-L5 with surgery and a year later I still have severe pain that is very present all the way to my toes with severe swelling etc.. Nerve damage to the spine can definitely cause pain in legs feet and toes.. Hope you feel better soon.

[rustyhd]

fusion on L5-S1 sack in may 2005 still having pain and numbness in my big toe & the next 2 toes and at times it wil go up mt ankle and i have real sharp pain in the lower part of my left butox my doc. has me going to a Functional Capacity Assessment dose this mean i have to live with this


TECHNIQUE

Thin section imaging with multiplanar reconstructions

FINDINGS: The thecal sac is filled with iodinated contrast per recent myelogram.

Overall vertebral body alignment to the L5- level is unremax:kable.. There is Grade I anterolisthesis of L5 on S1. with posterior fusion at the LS-Sl interspace. Of note vacuum disk phenomenon is present at the LS-SI level consistent with motion at this level.

At 11-2, no significant disk disease. Central car!al and foramen are widely patent with minimal facet arthrosis.

At L2-3, minimal disk bulge with widely patent central canal Neural foramen are widely patent as well.

At L3-4, bilateral facet arthrosis and ligamentum flavum hypertrophy are present. Central canal is widely patent. no significant foraminal compromise.

There is

At: L4-5, t..nera is minimal disk bulge effa.cing t.n.e ventral theca.l

sac. Posterior decompression with widely patent central canal. There is mild right.and mild to moderate left foraminal stenosis

-n..t LS-Sl, widely paten~ central canal status post-decompression There is se~Tere left and moderate right foraminal stenosis.

IMPRESSION: Multilevel degenerative disk disease with no central canal stenosis: Post-operative changes with widely patent central canal at the lower lumbar spine. Patient is status post-posterior fusion at LS-Sl with abnormal vacuum disk at this level consistent with motion. Bilateral foraminal compromised at L4-S and to a greater degree at LS-Sl as indicated above.