A Neurosurgeon can do a lot but isn’t usually the first doctor a person with foot pain sees. A visit to this kind of surgeon usually comes after rest, medication, injections, physical therapy, and possibly other types of surgery have not fixed the problem. Our own neurosurgeon Dr. Christopher Winfree from the Pain Center recently talked about how he treats foot pain at the New York Podiatric Clinical Conference and Exhibition.
He explained that, as there are many causes for foot pain, there are many treatments. Dr. Winfree talked about several common nerve related foot problems and their surgical treatments both in the foot and in the spine.
One of the first problems Dr. Winfree talked about was entrapment neuropathy. Simply put, this is when a nerve gets damaged because it is passing through a space that is too narrow. The specific example he gave was tarsal tunnel syndrome. In this case, a nerve is pinched in the ankle’s tarsal tunnel on on its way to the foot. This tunnel is formed on the inside of the ankle by bones and a large ligament. The surgical treatment is essentially to open the tunnel to take the pressure off the nerve, or to “decompress” it.
Dr. Winfree also talked about sensory neuromas. These are highly sensitive bundles of scar tissue that can form when a nerve is injured. He used the example of, Morton’s neuroma which occurs in the ball of the foot. It is characterized by numbing of the toes and a deep pain made worse by weight bearing. Surgeons can either go through the top or bottom of the foot to remove the neuroma.
Sometimes a painful growth within the nerve is actually a tumor. Tumors that grow within nerves are usually benign and like the neuroma can be surgically removed.
A more baffling problem is called Complex Regional Pain Syndrome (CRPS). Even a minor injury, like a stubbed-toe, can trigger what is, in a sense, an over-reaction by the nerves in the area. The result is exquisite tenderness, swelling, redness, muscle wasting, and even changes in the bones of the foot and lower leg if left untreated. Dr. Winfree says, sometimes these patients benefit from a sympathetic nerve block, which involves injecting a numbing agent into the spine. Also, implanting spinal cord or nerve stimulation devices in the spine can overide pain signals in the foot on their way to the brain (see the blog Turn Up the Static When Back Pain Won’t Stop Calling for a more detailed description of these types of procedures).
Incisional Pain syndrome is another problem Dr. Winfree sees. Patients have described this as a “constant burning pain” along a scar, long after the wound has healed. This can also be treated by implanting nerve stimulation devices at the spine.
At the end of his talk, Dr. Winfree presented two cases of intractable foot pain that were successfully treated with different forms of nerve stimulation. See these two blogs for more about these patients: A New Way to Give an Old Vet Relief and Surgeons Use Ultrasound, Not to Find a Baby, but a Nerve.
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