Trying to cope with the pain

[shakinbaker]

Dear Sir or Madam,
I suffered an achilles tendon rupture in December.  Subsequent to the surgical repair I have suffered neuropathy.  I have lost dorsiflexion of my toes, lost sensation in a portion of the top of my foot and the big toe, and have heightened pain sensation to the plantar section of the foot.  I also have SEVERE shooting pains throughout the foot, (some in the heel, some in the instep, some in the toes, and some along the outer portion of the plantar foot.)  These pains are more intense than anything I have ever felt.  As a lifelong athlete, and former construction worker I have had pain before, but never like this.  I even nailed my foot to the floor with a pneumatic nailer and it didn't hurt as bad as these pains.  I am scheduled for an EMG in a couple of weeks.  I don't understand why they scheduled the test for 5 weeks after my initial workup, but thats beside the point.  I am currently on 2400mg of neurontin daily and that has cut the pain by about 70 percent in frequency, but the intensity is unchanged when the pains do come, (they are worst during sleep and when I wake in the mornings).  My PT is concerned that there may be some RSD in addition to the neuropathy because I can hardly stand the sensation when he massages the bottom of my foot.   What I really want to know is what specific nerve would cause these symptoms, and does it run in close proximity to the achilles tendon?  I am concerned because prior to surgery the ortho opted to forego an MRI and we discussed possible infections and wound complications, but there was no mention of possible neuropathy and me being in such severe pain that I if not cured, I would rather have the foot amputated.  Any other suggestions for pain reduction would also be welcome.

[shakinbaker]

At first report to the Ortho, he said he did not know unless they quote, "got into trouble with the nerve block.", whatever that means.  But he did not refer me to a neurologist at that time to begin determining the cause, but did prescribe neurontin, (often used to treat neuropathy), I have good insurance and have already met my max out of pocket.  At a later visit to the Ortho, he asked how I was and I told him that I was in excruciating pain and really just wanted to know why. He said,"The only thing I can think of is maybe while pulling on the tendon to get the foot back to neutral, I may have stretched the nerve."  He then pointed to the location at the head of the tibia where the nerve USUALLY runs and said as you can see, that is significant distance from the incision.  I said, well its about half an inch, but after the fact was concerned that what if my Tibial Nerve, (which he was pointing to) is not 100% anatomically correct, could he have severed this nerve, or even looped a stitch around it during the procedure or close out?  I just do not know exactly how this happened yet, but I do not believe standard of care was taken in at least two of these steps, (no pre-op MRI, and Non referral to a Neurologist).  Then to further complicate things, when he initially prescribed the Nerve medicine to me, He handed me a script and when I got all the way to my car, I looked at it and it was written to someone other than myself, but was for my drugs.  I crutched myself all the way back in and up to his office and the receptionists said they would have him call the correct script into the Pharmacy, (I thought not big deal and left).  Then on the immediate following visit, he was writing a script for percocet to assist with cutting the pain in the times when the neurontin is not cutting it and it is unbearable, and again he handed me a script that was for percocet, but was written to someone else, but not the same person he had written it to earlier.  This time I did not notice it until I reached the pharmacy and the tech said she could not fill it because it was not in my name.  I was furious, and asked for the document back to keep in my records.  I called his office and noted to them that at this point I was getting really concerned that I was and had been recieving substandard attention, and all of this is from one of the Sports Medicine leaders in my state.  Please respond and let me know what you think may have happened during the operation, and about the standard of care given all of the subsequent mistakes.  Thank You for expressing interest in this matter.

[abhijeet v ghosh]

hello dear shakinbaker,
your's is a pretty interesting case history.
I am surprised that why after tendo achillis repair, you lost your foot power as well as sensation? there is no co-relation at all. what did your doctors told you?

Regarding 5 weeks of wait between the work up as well as your EMG, it's a standard practice. Doctors wait for atleast 3 weeks before doing EMG/NCV as before that time , some nerves/muscles still shows pseudo contractions and the reading can be misinterpreting.

I still don't agree with RSD theory of your physiotherapist  but yes, you are having allodynia(hypersensitive response to mild stimulus)

Please answer me these questions as i really want to know why loss of power, etc happened.

regards
abhijeet