In our previous blog, we discussed the possibility of a nerve-related problem, such as compression or injury, being responsible for chronic pain months following an ankle sprain or related injury.
So let’s now say that a nerve-related issue has been confirmed, and that surgical management is determined to be a reasonable option for relief. What should a patient expect from such a procedure and its recovery?
Please note that situations will naturally vary from case to case and patient to patient, so the information we provide below should always be considered as general and tentative. If a surgical procedure is being considered, we will always discuss the pertinent details for your particular situation directly with you.
Nerve Release – Operation and Days After
A nerve release, also known as nerve decompression, is a procedure whereby a nerve that is under excess pressure has that pressure physically relieved.
This procedure may involve releasing tight tissues, fibrous bands, or vessels that are interfering with the nerve, which allows the nerve a better opportunity to recover from trauma and function normally.
Most lower extremity nerve decompressions or releases tend to be a relatively straightforward outpatient experience, performed at a surgical center. Most frequently, these procedures are performed under deep sedation with the assistance of nerve blocks in the leg, performed by our anesthesia teams.
A nerve block (a direct injection of anesthetic close to the nerve itself) will allow a patient to wake up with minimal pain for approximately 24 hours after completion of the procedure. If a nerve block was given, a patient should not be expected to walk for about 24 hours, as the area is usually completely numb and the patient is unable to move their foot during this time.
Many patients will choose general anesthesia over deep sedation, so they will be completely unconscious during the procedure. Each patient may have preferences depending upon past experiences. Some of these procedures may be longer or more delicate than others, which could potentially push the decision toward general anesthesia.
In most cases of nerve release surgery in the lower extremity, a relatively speedy recovery is expected—usually after a few weeks. Depending upon the exact nature of the surgery and where the incisions are located, a patient will likely be able to bear weight on the foot and ankle within a few days of the procedure.
Some patients will experience relief of their neuropathic pain almost immediately, while others may take much longer depending upon the severity of disease and length of time it has been present. Unfortunately, there is always a small percent who do not show signs of improvement.
For patients in which a nerve had to be removed because it was either stuck in a previous surgical scar or injured in a previous operation, there tends to be a slightly slower recovery, to protect the nerve endings that were divided and buried.
Surgical dressings will need to be maintained, but are usually removed approximately a week following surgery. All sutures tend to be beneath the skin, so will not need to be removed. One exception, however, is when the surgery is performed on the inside of the ankle, such as in the tarsal tunnel. External sutures are often used, as there is more movement in this area.
Sutures will often need to be removed if they are present on the inner ankle, approximately 3 weeks after surgery.
Follow-up appointments are usually scheduled at 1 week, 2 months, and 5 months after surgery to check on the progress of healing. There may, of course, be variations in scheduling depending on patient availability and circumstances. This is all right.
Will I Need Physical Therapy? When Can I Get Back to Sports?
Physical may or may not be a requirement following nerve release surgery for the lower extremity. This is considered on a case by case basis.
Our favorite post-surgical exercise tends to be a self-directed or professionally monitored aqua therapy program. This includes walking in a swimming pool and anything that can provide some strengthening resistance without placing too much weight on the ankle.
Walking, the use of an elliptical trainer, or exercise bike can also be helpful for improving range of motion, tolerance, and endurance.
Exercise under a professional physical therapist is ideal. Many patients perform physical therapy on their own, and that is often all right. This is a topic open for discussion with us. Some patients may need more guidance, advice, and assistance, and a professional physical therapist may be a preferred option.
In terms of getting back to physical activity and sports, it is impossible to give general guidelines for that here. A multitude of factors are involved with that decision, including general health, age, condition treated, and what types of activities one would like to return to. This is something best left discussed directly between a patient, their family, and Dr. Williams.
What if Things Become Worse After Initial Surgery?
While the intent of surgery following an ankle sprain or fracture is to improve the situation, there is always a possibility of a complication that makes matters worse. Perhaps the nerve is trapped within scar tissue, or nerves do not respond to decompression.
In some situations, a nerve that was cut as part of a past surgery may develop painful growths called neuromas. There is always the possibility this may happen during a procedure we conduct as well.
In the cases of nerve removal or release from scar tissue, patients may occasionally experience more hypersensitivity and burning. Greater care will be necessary during recovery and post-op physical therapy may be longer, which may affect a return to activities. Everything must pass the commonsense test.
We will extensively review any potential complications from an initial surgery and discuss with you whether further action may be recommended. This may include dealing with neuromas, or revision or full removal of a nerve.
If a nerve is removed, an area of numbness is typically experienced. This will usually shrink over time following the surgery, but almost never fully comes back. A patient should expect permanent numbness to a small degree, but it is often greatly preferred over the pain.
It is best to be honest about potential complications with surgery. Any type of surgical procedure may involve complications such as bleeding, infection, injury to other structures and wound healing complications. However, these risks tend to be small in appropriate surgical candidates, and few people develop worsening pain. Unfortunately, a small number of patients can develop worsening pain.
Surgical Help for Chronic Ankle Pain
If you have suffered from chronic foot, ankle, or leg pain after an injury, and other specialists have “found nothing wrong,” we would be happy to evaluate you for the possibility of a neuropathic cause. Dr. Williams has helped many patients find relief from nerve damage and pain.
All circumstances are not the same, however. If we cannot help you, we are happy to work with your other physicians to find other options.
Contact our office by calling (410) 709-3868 to schedule an appointment. If you prefer to contact us electronically, fill out our contact form and a member of our office will reach out to you.
Also, don’t forget our free guide on Chronic Pain After an Ankle Injury. It’s full of more information and tips that may be of assistance!