Lower extremity pain can follow any trauma or surgery. A number of different interventions, are performed on the lower extremity by orthopedic, vascular and plastic surgeons. These procedures include:
- simple immobilization
- operative fracture and dislocation treatment
- joint arthroscopy
- total knee or ankle joint replacement
- vascular bypass
- vein stripping
- soft tissue reconstruction for wound coverage
These treatments can successfully address the original problem (biomechanical, vascular, complex wound). A number of patients can be left with new, nerve related problems. These can present as compression neuropathies (numbness, burning), function loss (foot drop, numbness), or chronic pain that persists beyond the expected recovery time. A number of pain treatments are offered to patients by many different specialists. Since the majority of these treatments focus on treating symptoms only, a solution is seldom found. Unlike other specialties, peripheral nerve surgery focuses on treating the anatomical cause of the chronic pain, ensuring the best possible chance for a cure.
You should see Dr. Ducic for chronic lower extremity pain following surgery or trauma, if your symptoms persist:
- After common reasons for prolonged post-operative pain (infection, bleeding, tumor, biomechanical abnormalities) have been excluded by your initial surgeon
- Despite the medical care prescribed to you by your surgeon or primary care physician
- Despite supportive care, activity and work adjustments and physical therapy
- After six months of prescribed medical and conservative care
Patients with chronic lower extremity pain may report joint pain, a pins and needles sensation, a burning sensation or numbness over any part of the leg. Scar from previous surgery may be hypersensitive or painful. Ambulation and professional activities may be affected. Symptoms may be present at rest and exacerbated by activity. The extent of this presentation may vary, depending on the severity and etiology of injury, number of nerves involved and the intensity of pain. Failure to intervene in a timely manner poses a risk for chronic pain to evolve into a more complex presentation with involvement of your central and autonomic nervous systems. These complex syndromes (like RSD or CRPS) make treatment challenging and difficult. Therefore, peripheral nerve surgery has an important role in treating chronic leg pain, giving patients a chance to eliminate dependence on pain medications and improve their quality of life. Based on patient’s presentation and findings on physical exam, involved damaged sensory nerves are surgically removed so they can no longer continue to generate pain.
Nerve decompression techniques can be applied to nerves not directly damaged, but 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 symptoms. Trauma or surgery in can offset otherwise clinically silent neuropathy, so patients may present with mixed symptoms of compression neuropathy and neuroma-related pain. Lower extremity pains and paresthesias therefore require comprehensive evaluation and treatment. 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 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 with a bloodless dissection
- An incision is made over the involved lower extremity area(s) to access and remove damaged painful nerves and to release pressure of other compressed nerves.
- In most cases, the nerves involved are mainly 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 lower extremity 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.