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foot pain

My husband had his foot ran over by a trash truck a little under a year ago.  He still deals with extreme chronic pain.  They said surgery will only take care of twenty percent of the pain and leave his baby toe and other toe by it imobile.  They also said he will still have problems walking on uneven ground.  Is there something they can do besides surgey and if they do surgery what can he do for the other eighty percent of the pain.  He is only 28 and they said he will have to live with this for the rest of his life.  I am just looking for some advice.  He does not want to take narcotics because he does drive a trash truck for a living.
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The human foot takes an incredible amount of abuse; I sometimes wonder at how such a complicated system of bones, joints, and tendons can do such a complicated task thousands of times per day, while a toaster only cooks bread, on a level surface, but lasts a fraction as long as the average foot!  Unfortunately there is a delicate balance to the function of the foot, and once things are out of balance because of a broken bone or frozen joint the entire function is lost.  

I hate to keep passing people to specialists, but again, a good surgical podiatrist can do amazing things using orthotics custom-molded to the foot.  Moreover, podiatrists work on a different pay scale than orthopedists;  I have been shocked at times by the low bill of the podiatrist I have seen in the past.

I don't know in your case if the person you quote is referring to pain from continued inflammation of soft tissues, or continued non-union of broken bones, or from something like CRPS (complex regional pain syndrome) which arises after nerve injury, usually involving a limb.    In this last case, the treatment of choice is physical therapy, often in combination with sympathetic nerve blocks performed by anesthesiologists in pain clinics.  The other conditions may respond to a period of immobilization to allow the bones to fuse and the inflammation to go down.  Although your surgeon does not sound real optimistic about this type of treatment.

There are other things to help with chronic pain-- anti-inflammatory medication, anti-convulsants like gabapentin, anti-depressants like Cymbalta...  but none of these provide 'dense' pain relief.  I agree that narcotics would likely end in disaster in a case like your husband's, given his young age and the intensity of his pain.

I think the best result is likely to come from a combination of orthotics, physical therapy, and perhaps something to lighten the burden of that foot a bit, such as a brace or crutch.  Selective non-narcotic medications may add some help as well.  The primary thing going forward is to recognize that the foot is quite susceptible to repeat or further injury, so he will want to be careful with what he does, and keep his body weight down.
Take care,

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