Nerve pain after foot surgery

Hi Gina, I had a flat foot reconstruction. Sprained my ankle years ago and my ligament tore. My feet are flat so it made it worse. I had swelling and pain all the time and couldnt walk long distances and even short ones was becoming challenging. I had therapy and orthotics and nothing seemed to really help. So they reshiffted my heal bone back under me and they had to cut through the calcaneous bone, took a ligament from my big toe to put in the inside of my foot, achilius lenghtening. I had 4 incisions all together. They put 2 screws in the bottom of my foot, a small plate and screw to hold my foot up on the outside and basically created me an arch. I noticed the nerve pain around 7 weeks after I got my cast off. It was primarily on the outside if my foot and it zapped, i then started getting sharp pains that would fly through my foot various places, then my toes at times, it was awful. They put me on Gabapentin to help but i dont like pills. BUT i take one before bedtime. And i was on opiods but they stopped after 6 weeks and gave me tramadol. So the nerve pain had lessened, but i am still dealing with some. I have started desensitizing techniques on my skin that seems to be helping. My foot still swells so much whenever i attempt to stand to exercise it. Anytime its not elevated it swells so much and that cause lots of pain and discomfort. They said thats gonna happen for a while. And because if COVID havent seen doctor but on video. Had one in person PT session and they gave me exercises but i start PT at another place who is taking patients still. im hoping to be relieved of the nerve pain soon. Thanks for your input. The ice does help. Trying to get an ice therapy machine.

I hear you on the swelling! I call it sausage foot, one foot looks normal, the other packed like a sausage! I have had very little pain from my broken ankle and foot, but the nerve issues have been plentiful. It has been the biggest issue of this experience. I still am dealing with it even though I am in an aircast and fully weight bearing, but am finding that it is lessening every day (except now and then) as I walk and do my ROM exercises. I guess it is part of the process, but it sucks! Just trying to ignore it the best I can and continue on as normally as I can. Hope your subsides quickly! Be safe and good luck!

Gina

Hi HEKM,

I am so sorry you are having that much trouble! Nerve pain has been the worst part of the process for me and I don't think mine is where yours is at. Did you have a nerve block during your surgery? I ask because even though nerve issues seem to come with every foot break and surgery, the people who seem to have it the worst from my observation have had nerve blocks. I was offered one, but declined because the anesthesiologist told me that it can cause prolonged nerve issues in some people and that scared me. I found that ice helped ease mine temporarily, but time and being able to weight bear has helped the most. But for the record, I still feel my nerves - the numbness, pins and needles, major discomfort at times - in all the places you described, even today. I think it is part of the normal process, but it is still reassuring to hear that from a doctor. I think they forget that we don't see this everyday and it's not a normal experience. I had ORIF on my left ankle to reattach the tip of my displaced fibula bone. That was March 5th, very close to the same time as you. Also, when my foot is down for a good portion of the day and it swells, I can barely move my toes either. Don't know if we are experiencing the same issues, but you are certainly not alone in them. I really hope you feel better quickly! Much healing and health to you!

Gina

Hi Gina,

Thank you for taking the time to respond. Yes, I actually did have two nerve blocks, both saphaneous and popliteal blocks. They were both heavily recommended by the anesthesiolgist AND orthopedic surgeon. Interesting. It would be nice to have some reassurance from my surgeon, but unfortunately, he has been more un-reassuring in relaying that yes, pain is typically experienced by patients, but nerve pain....not normally. Of course, this then made me more anxious that something was truly wrong and that I am some type of anomaly. It is reassuring to hear you had/have similar symptoms, albeit not as bad. And yes, when I am as active as I can be, my foot tends to bother me more, turn purple/red in color, etc.. I hope at some point I start to notice improvement. This has been the most discouraging aspect of the whole experience.

I really hope you get answers, relief and reassurance very soon. I am so sorry you are going through this. It is difficult enough under normal circumstances, but with times like they are, so much harder. I truly wish you quick healing and peace. You deserve to make that progress.

hi everyone!

im so sorry you've all been experiencing such horrible nerve pain. I have been too!

in fact, HEKM, i think you responded to my post a couple of weeks back. It seems like we have had similar injuries - I was in a car accident and severely dislocated my left ankle, fractured my talus and multiple bones in my foot. I had two nerve blocks that I took home with me that lasted for three days. interestingly, I didnt have nerve pain till after my third surgery (it took three to fix everything) and i also didnt have a nerve block for the first two. I wondered if nerve blocks correlated to more nerve pain in recovery but I never asked my surgeon.

I am ten weeks post op and I am just now getting to a point where my nerve pain is tolerable (though it is still a constant). I have to say, I believe gabapentin has been a huge help for me. lafawn, I know you said you dont like taking medication but gabapentin is relatively gentle and very safe, compared to many other medications that relieve pain. HEKM, I know you said you are taking gabapentin already but you may talk to your doctor about taking it three times per day - it didnt start making a difference for me until i increased my dose to 300 mg 3 times per day (900 total). And give it a week or so of consistency to start really working!

It has also helped me sleep through the night. A couple of other things to consider:

finding an acupuncturist who specializes in trauma/sports injury. I know it might be hard till covid lockdown is over, but I recently found an intelligent acupuncturist and he has been such a huge help for me (more than i ever would have known)

also, icing can be wonderful for swelling and pain reduction, but for some with nerve pain (myself included) icing was unfortunately too much around my incision and other areas where nerve pain has been at its worst. I still do ice, but i try to keep it under my knee, or on the bottom of my foot. I also sometimes set a bowl of cold water with a few ice cubes and a washcloth next to the bed and do cold compresses on my foot when the burning gets particularly bad. it is cold, but not cold enough to shock the nerves.

i too have been terrified of having CRPS or some other more serious complication, but remind yourself that nerves are easily damaged, take a terribly long time to heal, and that CRPS is very uncommon. I believe you both are experiencing "normal" pain, and that you will heal up just fine with time. it is such a long process and i think we should all give ourselves about a year to get out of the weeds. be gentle with yourselves, this has been so scary and isolating for me... I hope you all find comfort and an ease in some of your symptoms soon.... wishing you all the best.

XOXO

Amelia,

It is so good to hear from you. Yes, I absolutely remember your post, because like you, I fractured my talus (along with my tibia). I fell hard and perfectly on my ankle from 5-6 ft, wearing ballerina flats. I cannot even begin to imagine what your trauma involved. I know it has undoubtedly been a long, painful journey. Thank you for ALL the advice and calming words of wisdom. Yes, it does sound like I need to up the dosage of gabapentin....I have been taking 100-200 mg at bedtime....clearly not enough. And, when I am able to think rationally, I agree, CRPS, is likely not the correct diagnosis for you or me. Although my cast could theoretically come off next week, my appointment is not until the week after, and I cannot wait for the opportunity to apply arnaca, ice or cool water, etc. I had also planned on pursuing accupuncture and was even considering hypnotism. I really hope that in 5 more weeks I am able to report SOME improvement and be in a better spot, like you!! Please keep us (me) posted. I seem to so easily become disheartened, discouraged, and disappointed. Take care and again, it is so reassuring to hear from you.

Hi Amelia,

How are you? Have you started bearing weight on your foot/leg? I was able to move up my appointment, and had my hard cast removed last Thursday. My surgeon said I could bear full weight on the foot if I wanted to - bones have healed "perfectly." I know that is wonderful news, but nerve stuff continues. My surgeon thinks I have "post op tarsal tunnel." Honestly, I don't know if this is another name for nerve damage because my foot had negligible swelling when the cast came off, none I could appreciate in the tarsal tunnel region. . At this point, the nerve issues have evolved into burning and hypersensitivity on the plantar surface of my foot. I can definitely sense temperature variations on the bottom of my foot and feel things, it is just very sensitive. As for range of motion, well, I don't have much. I can barely plantar flex or dorsi-flex my foot, it is SO STIFF. Luckily, I started physical therapy on Friday and I felt so hopeful after. I will go to PT three times per week for as long as it takes. I have been walking around the house with two crutches and have been standing unassisted. I am currently taking gabapentin, 300 mg at night, and am only waking up 2-3 time pee night vs every hour. I think I am slowly recovering.

hi HEKM!

so sorry i was MIA for a while there. I took a pretty bad fall last week... One of my crutches slipped right out from under me. I was just out of the shower so i wasnt wearing my boot. I landed pretty hard on my "bad" foot. It was pretty upsetting as you can imagine. my surgeon took x-rays of my foot the next day and said its healing up very well, and that when i fell i must have just had a small sprain. but unfortunately, all of my nerve pain is back just as bad as it was a month ago. this is baffling to me, because i was feeling dramatically better right up till i had the fall! im hoping in a few more days it will get better again... as for weight bearing, no word on that yet! but im hoping for next week. my surgeon is moving from usc to cedars sinai and is just very busy, i imagine. but when i do start weight bearing itll be about 25 pounds per week for four weeks, at which point ill be full weight bearing. so amazing that you are able to stand on both feet!!!! how does it feel? and are you in a cam at all times? the lack of range of motion is disturbing at first but it WILL get better, and very rapidly i think. and your sessions with PT are going to help so much! my physical therapist often reminds me how slow nerve regrowth is... and that nerve pain is unfortunate but normal... my nerve pain feels less painful when i am less afraid of it. i think it sounds like you are right where you should be. im so happy for you!!!

oh, and regarding the temperature variations, that still happens for me sometimes too. even though your bone is healed, im sure your body is still sending extra blood flow to the area.

let me know how you are feeling now! ill make sure to check this site every day or two in case i hear from you.

xo

Amelia!!

I am SO SORRY TO HEAR YOU FELL! I can only imagine how upsetting that must have been. Glad to hear it was only a sprain and bones are healing/not damaged!!!!! Its amazing how resilient our bodies are! I don't need to wear my boot all the time and honestly felt like my foot hurt more in it than out of it. But, on Friday, after PT, I started walking with the boot on, no crutches, and have had it on when walking all weekend. Walking on Friday, unassisted, was one of the happiest moments for me in recent history. Mind you, my foot becomes uncomfortable if I am walking around too much, and I feel like the nerve stuff gets worse too, the more I walk...along with swelling, which I can now appreciate. When I don't have the boot on, I use two crutches (trying sometimes with one) and practice exaggerated movements of walking with my foot. Initially, when I first put weight on my foot and tried to walk, it felt really uncomfortable in my actual foot, like I could feel all the pressure on the bones in my foot. But that sensation has been improving quickly. I have been worried about the nerve stuff though, I don't know what "post op tarsal tunnel syndrome" means....and I worry the surgeon is going to recommend another surgery to "release" my tibial nerve...such a surgery would set me back as far as healing/walking goes...and I don't know if I would even trust this surgeon to operate again. I am so tired of the burning, waxing/waning stinging/numbness, etc. I know nerve damage is slow to heal, but I don't know if tarsal tunnel syndrome is due to swelling or something that can't heal on its own! As usual, the anxiety is getting the best of me. I see the surgeon in two weeks, this will be the 10 week mark from surgery. Previously he had mentioned sending me to neurology for EMG if nerve paresthesias persisted beyond 8 weeks....so, this also makes me worried that what I am experiencing is not normal at ALL....since nerve issues persist (and now past 8 weeks). I will keep my fingers crossed that you will get the green light to start weight bearing this week!! That is a HUGE step (literally). And yes, range of motion is coming back quickly 😃

HEKM, hi!!!

my fall was SUCH a bummer. but im already feeling much better! And im weight bearing now!!!! it feels so exciting. To finally be able to do something proactive is wonderful. I guess we're really on the home stretch, arent we?

How is your weight bearing going? It feels so strange to put my foot on the ground after four months. I've also noticed that my nerve pain really flares up when i walk around! Im still on crutches just doing about 25-50% of my body weight.

I read a bit about tarsal tunnel... it seems pretty early to diagnose that, just because nerve pain after surgeries like ours really just seems to be an unfortunate part of the healing process. but i also dont know too much about your surgery, or where your incisions were. The anxiety has been the hardest part of this whole process for me, after the physical pain. I just keep reminding myself that so many people on this forum say that they've experienced so many different types of pain for months after surgery. And after a traumatic injury and such a big surgery... I LIKE to think that what you are experiencing is normal, albeit very painful. I've found through this whole process that doctors seem to casually toss out possibilities based on the "averages" that they see rather than patients individually. I hope that you've found a little clarity since you wrote this a few days ago! please let me know how you are doing! Also maybe you can see your doctor a little sooner! What area are you in? The surgeon i have been so lucky to find seems to fly all over doing conferences with other orthopaedic specialists... Maybe he knows an expert within a reasonable distance from you that he could recommend! Might be a long shot, but who knows.

xx

Hello Amelia!

Thank you for always providing rational assurance lol! I can't tell you how much you have helped me. It is reassuring to hear your nerve pain flares up when you are up and about too!!! Congratulations on FINALLY bearing some weight! Huge! My orthopedic surgeon took a posterior approach to access my talus. However, I had an external fixator during surgery, which was secured in my calcaneous and tibia to crank that space open (medial aspect)....right near my tarsal tunnel. To hell with the boot by the way - I ditched that uncomfortable boot at the end of last weekend, and just started walking without/unassisted! I walked into PT on Monday, lol, in my sneakers. So now, next hurtle (beyond nerves)....the limp. Mind you, I am not walking 24/7, and when I am at work, I have still been wearing the boot, and roll around on my knee scooter, with some walking, which increased as last week progressed. At PT, my therapists said the limp is normal (wow - for once, some professionals in my life are reassuring!!!) because the muscles in my lower extremity are still so weak. This weekend, I have been walking around the house all weekend, rarely picking up a crutch to assist! I suspect the limp is getting better (maybe?), but imagine this will also be slow going. My foot and lower leg are mildly swollen when compared to my other, and the discoloration in my foot and lower leg when in a dependent position (like walking), has improved, but still is noticeable. I can see the congestion, and just hope, with time, this all improves....and as a result, nerve symptoms improve too. I think the nerve stuff is about 25% improved? I am trying to quantify, so when I see my surgeon on Thursday, I can relay something tangible to him??? I am still taking gabapentin at night, but am thinking I may TRY to wean it this week.....will see how it is going/I am feeling. My big toe is doing something funky too, when I try to dorsiflex my big toe, the part of my big toe beyond the last joint doesn't dorsi-flex....I think this is something associated with my hallucis longus tendon? Could this be a clue? Has scar tissue wscarred down this tendon? Who knows. I am in Scottsdale, AZ - so, I would gladly drive to L.A. to see your surgeon (I have family in Santa Monica)!! You are at USC, right? I keep telling myself that a year from now, this will be a distant memory. I keep telling myself that I am getting better and need to stay positive. The most frustrating component of all of this is the nerve stuff. Like right now, I am just sitting here with my foot propped up on several pillows, yet, the bottom of my foot feels asleep. Although nerve "pain" has pretty much subsided, it is the in-and-out-of numbness, tingling, and sometimes burning that is so incredibly frustrating and tends to get my anxiety going, especially at night, when I am tired. Can't wait to hear about your week - I hope you make fast progress now that you are weight bearing!!!! I hope your pain is manageable. Maybe I have been fortunate in a way, because beyond nerve issues, I have had no other type of pain. Maybe this is also why this is so frustrating for me.