Pain in ankle and foot

I' had a laminectomy and partial disc replacement at L5-S1 in 1992 to resolve burning pain in left hip radiating to foot.  Surgery resolved pain completely. Some slight pain returned occasionally over the next 15 years.  Approximately 2 years ago, pain returned in left leg and laminectomy at L4-L5 resolved most of the issues. Over the next 2 years, pain in the left ankle and foot gradually increased and a large disc rupture at L4-L5 necessitated another lumbar surgery in September 2010. This surgery involved disc replacement and a fusion at L5-L5-S1.  However, pain in left foot has steadily increased in frequency, duration and intensity. EMG/nerve conduction tests on left ankle were normal 8 months before surgery. However, the words of the neurologist who performed a second EMG 3 months after this last surgery, the second EMG study was "anything but normal".  My surgeon and the neurologist are baffled. The last EMG test apparently does not indicate what the cause of the problems might be.  The neurosurgeon says that the L4 and L5 nerves are completely decompressed, the fusion was successful and laminectomys at L4 and L5 were also successful.  Some mention was made of peroneal neuropathy. I understand from the Dr's that this would be unusual in my case and there is no recent trauma to the ankle.  I did have a rather severe ankle injury that necessitated a series of casts over a period of 6 months about 45 years ago (no broken bones, however). Other than that old ankle injury and recent surgeries in the lumbar areas, I have not experienced any leg trauma.  Any thoughts about what might be causing this pain in my left ankle and foot.  The pain, incidently, is brought on by standing or walking for 30 minutes or so and then is relieved in an hour or so of sitting with leg elevated (recliner).  Multlple MRI, CT and xrays post surgery have revealed nothing.  Suggestions ??


This discussion is related to Pain after back surgery.

[Dr Sharma]

Hi there . I understand your predicament since you have undergone multiple surgeries. I can contemplate about two possibilities, either it is a peroneal neuropathy related to the old trauma as your EMG study is suggesting some abnormality. This could be a reflex sympathetic dystrophy or complex regional pain syndrome, which is a chronic pain condition where the sufferer experiences pain in glove and stocking distribution. You should take the advice of a pain physician in this regard. Take care.