Much of podiatric training centers on the structure and mechanics of the foot and ankle. Many peripheral nerve problems don’t seem to be emphasized as often — and complex peripheral nerve complaints may be the reason patients keep coming back. If this resonates with you, a peripheral nerve evaluation from peripheral nerve surgeon Dr. Eric H. Williams may be a logical next step:

  • Pain after a technically good surgery (or even a frustratingly difficult one). The bunion repair, ankle reconstruction, or fusion looks great on imaging, the hardware is fine — and the patient still has burning, shooting, or hypersensitive pain months later. That pattern points toward a nerve injury or a post-surgical neuroma.
  • Recurrent or "failed" Morton's neuroma. Pain that returns after an interdigital neuroma excision usually means a stump neuroma has formed at the cut nerve end. These respond to a different surgical approach than a first-time excision.
  • Numbness, weakness, or foot drop. Motor and sensory loss from the knee to the top of the foot can be traced to common peroneal nerve compression — a decompression most podiatrists don't perform.
  • Burning feet that outlast the workup. When a patient with diabetes or persistent tarsal tunnel symptoms has exhausted conservative care, a compressed nerve may still be treatable surgically. Not every case qualifies, but many are never evaluated for it.
  • Failed tarsal tunnel syndrome.  An operation was performed, but the patient and the doctor did not see the response that they were hoping for. Is it a problem of incomplete release, secondary entrapment downstream or upstream, or something else altogether? 
  • Chronic pain after an ankle sprain or trauma. Severe, lasting pain after what should have been a routine sprain is one of the most common presentations here — often an injured cutaneous nerve rather than the ligament.  The MRIs look benign, the X-rays are normal, the ankle is stable, but they still can’t run, walk, or even touch their leg. They have been given a diagnosis of CRPS, but 95% of these patients with persistent pain will have a number of nerve entrapments from a stretch traction injury.   
  • Pain that the imaging can't explain. When the X-ray, MRI, and mechanics all look normal, but the pain is real, a diagnostic nerve block can confirm whether a specific nerve is the source before anyone commits to more surgery.