A neurosurgeon can do a lot, but he isn’t usually the first doctor a person sees for foot pain. A visit to this kind of surgeon usually comes after a lot of other treatment hasn’t helped. Treatments like, rest, medication, injections, physical therapy, and possibly other types of surgery. Our own neurosurgeon Dr. Christopher Winfree from the Pain Center 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 also many treatments. Dr. Winfree talked about several common nerve-related foot problems with surgical treatments both in the foot and in the spine.
One of the first problems Dr. Winfree discussed was entrapment neuropathy. This condition occurs 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. The tarsal tunnel is located on the inside of the ankle and is formed by several bones and one large ligament. The surgical treatment most used is called a “decompression.” Here the tunnel is made wider or fully opened to take pressure off the nerve.
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 numbness in the toes and a deep pain made worse by weight bearing. Here, surgeons can either go through the top or bottom of the foot to remove the neuroma.
A more baffling problem is called Complex Regional Pain Syndrome (CRPS). Even a minor injury, like a stubbed-toe, can trigger an “over-reaction” of the nerves in the area. If left untreated, it can result in exquisite tenderness, swelling, redness, muscle wasting, and even changes in the bones of the foot and lower leg. Dr. Winfree says, sometimes these patients benefit from a sympathetic nerve block, which involves injecting a numbing agent into the spine.
In some cases, a spinal cord or nerve stimulation device can be implanted in the spine can to over-ride pain signals in the foot (see the blog Turn Up the Static When Back Pain Won’t Stop Calling for a more detailed description of how that works).
Incisional Pain syndrome is another problem Dr. Winfree discussed. 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 and answered attendees’ many questions.
First published Jan 12, 2010
Updated April 10, 2017
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