Foot and ankle pain can follow any trauma or surgery. If a biomechanical abnormality is a potential cause of the foot and ankle pain, different orthopedic treatments should be tried first. These procedures can range form:
- simple immobilization
- operative fracture and dislocation treatment
- ankle arthroscopy
- total ankle replacement (TAA).
Despite successful biomechanical treatment by orthopedic specialists, it is estimated that over 5% of these patients will end up with chronic pain persisting beyond the expected recovery time. From this point, a number of different pain treatments are offered to patients by many specialists. Since the vast majority of these treatments are focused on treating symptoms, a permanent solution is seldom found. Unlike other specialties, peripheral nerve surgery is focused on treating the anatomical cause of the chronic pain, ensuring the best possible chance for a cure.
You should see Dr. Ducic for chronic foot and ankle pain following surgery or trauma, if your symptoms persist:
- After common reasons for prolonged post-operative pain (infection, bleeding, tumor, biomechanical abnormality, and others) have been excluded by your initial surgeon
- Despite the medical care prescribed to you by your surgeon or primary care physician
- Despite supportive care, such as activity and work adjustments, physical therapy
- After six months of prescribed medical and conservative care
Patients with chronic foot and ankle pain may also report joint pain, a pins and needles sensation, a burning sensation or numbness over any part of the foot or ankle. Scars from previous surgery may be hypersensitive or painful. Ambulation, daily and professional activities can all be affected. Symptoms may be present at rest and exacerbated by activity. The extent of this presentation may vary, depending on number of nerves involved, etiology of injury and intensity of pain. Failure to intervene in timely manner, poses a risk for chronic pain to evolve into a more complex presentation with involvement of your central and autonomic nervous system. These complex syndromes (RSD or CRPS) make treatment fare more challenging and difficult. Peripheral nerve surgery has an important role in treating chronic foot and ankle pain, giving patients a chance to eliminate dependence on pain medications and improve their quality of life. Based on a patient’s presentation and findings on physical exam, involved sensory nerves are surgically removed so they can no longer continue to generate pain.
Alternatively, nerve decompression can also be applied to nerves that are not damaged, but rather compromised with adjacent swelling or scarring. This is particularly true if injury occurs in diabetic patients, who are at a much higher (several fold) risk than the general population for experiencing compression neuropathy (like tarsal tunnel) symptoms. Trauma or surgery in such case can exacerbate otherwise clinically silent neuropathy, so a patient may present with mixed symptoms of compression neuropathy and neuroma-related pain. Foot and ankle pains and paresthesias therefore require comprehensive evaluation and treatment. Again, an appropriate and timely evaluation and intervention by a peripheral nerve surgeon may help prevent irreversible nerve damage.
During surgery for chronic foot and ankle pain:
- You will receive anesthesia so you won’t feel any pain during the surgery.
- Unless you had a previous stent or bypass, a tourniquet is used to assist bloodless dissection
- An incision is made over the involved foot and ankle area(s) to access and remove the damaged and painful nerves; and to release pressure on the other compressed nerves.
- The nerves involved are usually sensory nerves, so no motor deficits are expected.
- The skin is closed in anatomical layers
- Ambulation with crutches is allowed immediately following surgery, as tolerated.
- Peripheral nerve surgery for foot and ankle pain is an outpatient procedure; your dressing will be removed about 5-7 days after surgery, while sutures are removed about three weeks later.
If you are not sure about your eligibility for surgery, and if you are not in the Washington, D.C. area, you can send me your records so I can determine if you are a good candidate for treatment. Visit my patient forms page for a downloadable form.