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Neurology (Expert Forum)
Searching for answers
Answered by
Lama Chahine, MD - Neurology
Cleveland Clinic
Cleveland - OH
This forum is for questions and support regarding neurology issues such as: Alzheimer's Disease, ALS, Autism, Brain Cancer, Cerebral Palsy, Chronic Pain, Epilepsy, Fibromyalgia, Headaches, MS, Neuralgia, Neuropathy, Parkinson's Disease, RSD, Sleep Disorders, Stroke, Traumatic Brain Injury.
Searching for answers
by achilles2, Nov 01, 2009 09:07AM
In Dec 2007 I rolled my ankle in the snow and ended up with tarsal tunnel syndrome in the right foot. In May 2008 I had surgery for tarsal tunnel (even though EMG was negative. The doctor found the muscle belly of flexor digitorum longus in the tarsal tunnel and was strangling the posterior tibial nerve. He cut the muscle sheath and decompressed the nerve.
All was well until about a week after being dismissed from p.t. Then the outside of my right foot started to hurt and with in a month the Achilles started to hurt as well. Two MRI's on the, a bone scan of foot/ankle and multiple nerve blocks (mostly in the sural nerve)later I am still having the nerve pain--dull to intense burning. The pain has also moved up the leg and into the thigh and right hip area as well. I have also had an MRI of my back and it showed a mild herniation at L5-S1 which physical therapy has helped the back pain associated with that but did nothing for the nerve pain. A neurosurgeon did find I had positive Hoffman's sign but MRI of the neck was negative for stenosis and Chiari Malformation.
I am frustrated and searching for answers, any guidance and help would be appreciated.
Thanks
All was well until about a week after being dismissed from p.t. Then the outside of my right foot started to hurt and with in a month the Achilles started to hurt as well. Two MRI's on the, a bone scan of foot/ankle and multiple nerve blocks (mostly in the sural nerve)later I am still having the nerve pain--dull to intense burning. The pain has also moved up the leg and into the thigh and right hip area as well. I have also had an MRI of my back and it showed a mild herniation at L5-S1 which physical therapy has helped the back pain associated with that but did nothing for the nerve pain. A neurosurgeon did find I had positive Hoffman's sign but MRI of the neck was negative for stenosis and Chiari Malformation.
I am frustrated and searching for answers, any guidance and help would be appreciated.
Thanks
Doctor's Answer
by Lama Chahine, MD, Nov 05, 2009 06:24PM
, Nov 05, 2009 06:24PM
Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with your doctor.
Without the ability to examine you and obtain a history, I can not tell you what the exact cause of your symptoms is. However I will try to provide you with some useful information.
The foot top and outside (lateral aspect) of the foot are innervated by the superficial peroneal, sural, and tibial nerves. A problem with the nerves in this area would typically cause local symptoms, rather than spreading up the leg to the hip. A herniated disc at L5/S1, on the other hand, can cause pain higher up in the leg, but if the herniation is mild, this would be unlikely to be cause severe symptoms; the extent of impingement on the nerve can be determined on MRI. One possibility, if there is limb pain following trauma and/or surgery is called complex regional pain syndrome, CRPS, previously known as reflex sympathetic dystrophy. This causes pain, burning, color, and skin changes.
It is important to keep in mind that arthritic cause of hip pain and leg pain should always be considered, though burning pains are not a typical symptom of arthritis.
The treatment in general for neuropathic pain includes physical therapy and medications such as gabapentin (neurontin) and pregabalin (lyrica) as well as other medications used for other indications (such as epilepsy and depression) that also work for pain. Anti-inflammatories are used as well. If the pain symptoms persist, and a cause can not be found after appropriate workup (which may include another EMG), referral to a pain management specialist for further management of the pain is indicated.
Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.
Without the ability to examine you and obtain a history, I can not tell you what the exact cause of your symptoms is. However I will try to provide you with some useful information.
The foot top and outside (lateral aspect) of the foot are innervated by the superficial peroneal, sural, and tibial nerves. A problem with the nerves in this area would typically cause local symptoms, rather than spreading up the leg to the hip. A herniated disc at L5/S1, on the other hand, can cause pain higher up in the leg, but if the herniation is mild, this would be unlikely to be cause severe symptoms; the extent of impingement on the nerve can be determined on MRI. One possibility, if there is limb pain following trauma and/or surgery is called complex regional pain syndrome, CRPS, previously known as reflex sympathetic dystrophy. This causes pain, burning, color, and skin changes.
It is important to keep in mind that arthritic cause of hip pain and leg pain should always be considered, though burning pains are not a typical symptom of arthritis.
The treatment in general for neuropathic pain includes physical therapy and medications such as gabapentin (neurontin) and pregabalin (lyrica) as well as other medications used for other indications (such as epilepsy and depression) that also work for pain. Anti-inflammatories are used as well. If the pain symptoms persist, and a cause can not be found after appropriate workup (which may include another EMG), referral to a pain management specialist for further management of the pain is indicated.
Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.
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