Get Relief From Lower Extremity Nerve Pain

Baltimore Peripheral Nerve Surgeon Eric H. Williams MD Provides Surgical Solutions for Patients With Lower Extremity Nerve Pain

knee pain | Baltimore peripheral nerve surgeonAs a peripheral nerve surgeon, Eric H. Williams MD, works to cure the causes for pain patients present with when it is possible, not just “manage” pain with medications. While pain medications can be a viable option for managing chronic neuropathic pain, this doesn’t mean you should assume your pain can only be managed with drug therapy, especially if you do not want to rely on those medications for relief. Oftentimes, there are other possible treatments that may provide a long-term solution. If nerve pain is keeping you from working, spending time with loved ones, or engaging in your favorite hobbies, Dr. Williams may be able to help you get relief.

Why Is it So Hard to Find an Answer to What’s Causing Your Pain?

In general, the overall medical community simply does not have adequate training in the treatment of lower extremity neuropathic pain. Consider the following:

  • Most orthopedic surgeons are concerned with bones and joints.
  • Podiatrists are often focused on structural problems of the feet (along with biomechanics). 
  • Typically, most plastic and reconstructive surgeons who are trained to treat nerves focus on the upper extremities, as hand surgery is part of every plastic surgeon’s training.  
  • Most neurosurgeons tend to concentrate their practice on the spine and brain; very few seem to venture beyond an occasional carpal tunnel procedure
  • Pain management teams seek to “manage” pain in the patients that they have been sent as a “last resort” to help them.   They obviously use the tools that they have which include medications, stimulators, and physical therapy, and these tools are important.  

We are very glad there are so many talented doctors who perform all of the aforementioned procedures. They all contribute to an age of unprecedented specialization in medicine and surgery and provide positive outcomes for their patients.

Unfortunately, this specialization has a downside for patients with peripheral nerve problems in the lower extremities. These issues are underappreciated, undertaught, and undertreated in many parts of the country. It is not uncommon for patients visiting our office to have seen multiple doctors without obtaining a clear diagnosis or being offered effective treatment options. 

If you’ve been searching for effective solutions to your pain, do not give up hope. As a specialist in peripheral nerve surgery, Dr. Williams focuses on the following procedures in hopes of providing permanent treatment for peripheral nerve dysfunction:

  • Nerve decompression. This surgical procedure relieves pressure on a compressed nerve by removing or cutting through structures like tendons, ligaments, muscle, fascia, or scar tissue that are cutting off blood supply to the nerve, thus causing irritation and compression, and pain, numbness, weakness, and loss of function. 
  • Nerve repair. When a nerve has been severed due to injury or trauma, carefully rejoining the two ends of the nerve through suturing can restore continuity and function.
  • Nerve resection. When a nerve is irreparably damaged or dysfunctional, a nerve resection involves surgically removing a segment or portion of the nerve and treating the end of that nerve to try to prevent recurrent pain.

Refer to the patient testimonials section of our site to learn more about the results we’ve been able to achieve for people struggling with chronic neuropathic pain. 

What Does Lower Extremity Nerve Pain Feel Like? 

Neuropathic (nerve-related) symptoms typically cause certain types of pain. Common descriptions of pain due to nerve injuries or nerve entrapments include:

  • Intense burning. Imagine a fire that rages beneath your skin, making every step feel like you’re treading on hot coals. This burning sensation can flare up unexpectedly, leaving you grasping for relief.
  • Tingling. Nerve issues can cause a buzzing sensation that never seems to go away.
  • “Pins and needles” pain. This sharp, prickling sensation can make the affected area feel like it's being jabbed with countless tiny needles. 
  • Distorted or “creepy” physical sensations. Your leg or foot might feel strange, almost alien, as though it's not quite part of your body. Sensations of bugs crawling on the skin or water dripping down the leg are also common. 
  • Hypersensitivity. The affected area can become so sensitive that even the slightest touch can trigger severe pain. Even the gentle caress of a breeze or bedsheet across your skin can be excruciating.
  • Feeling as though you are walking on nails, tacks, or rocks.  If you have nerve pain in the soles of your feet, each step feels like you are walking on sharp objects—making even a short walk across the room an unbearable ordeal.
  • Numbness. Alongside these painful sensations, you might also experience numbness. This lack of feeling can be just as troubling, as it robs you of the ability to sense the ground beneath your feet, leading to instability, loss of balance, falls, and wounds.

Dr. Williams will ask for a detailed description of your pain, including when it started and what activities aggravate your symptoms, before your visit. (Get the information you need to prepare for your first visit.)

How Is Nerve Damage Diagnosed?

Physical examination is very important to document and examine the function of the nerve in question, and compare it to the other nerves. 

Testing for a Tinel's sign (“funny bone feeling”) involves tapping over the path of a nerve to elicit a tingling, electrical, or radiating sensation in the distribution of that nerve. A positive Tinel's sign indicates some degree of nerve irritation, compression, inflammation, or injury. You can test for a positive Tinel sign from the comfort of your home, but it’s important to remember that is just one diagnostic tool and not a substitute for an in-person visit.

Diagnostic nerve blocks or therapeutic nerve blocks are one of the most common tools we use in our office to pinpoint whether a specific nerve is responsible for your pain. 

EMG nerve conduction studies and imaging studies such as ultrasound and MRI are also very helpful. Sensory testing can be beneficial to determine the severity of injury to cutaneous sensory nerves.

What Lower Extremity Conditions Does Dr. Williams Treat?

Neuropathic pain in a lower extremity may be caused by nerve entrapment or direct nerve injury. Compression may damage a nerve or prevent it from working properly due to squeezing or direct pressure on a nerve, cutting its blood supply off which leads to loss of normal function.  A direct nerve injury may include anything ranging from a “bruised nerve” up to a nerve that has been cut or ripped in half. 

Numerous nerves in the lower limbs can become injured. Fortunately, Dr. Williams has extensive experience identifying damaged nerves and then surgically addressing the problem.

Chronic Regional Pain Syndrome 

Chronic regional pain syndrome (CRPS) is characterized by severe, persistent pain that typically affects a limb after an injury or surgery. The pain is often disproportionate to the initial trauma and can be accompanied by changes in skin color, temperature, and swelling in the affected area. 

Peripheral nerve surgeons like Dr. Williams can play a vital role in managing CRPS by addressing potential underlying nerve issues. They may investigate for nerve compression, entrapment, or injury that could be contributing to the condition. They can also take a multidisciplinary approach, combining surgical options with pain management strategies, physical therapy, and psychological support,

Common Peroneal Nerve Compression

A branch of the sciatic nerve, the common peroneal nerve innervates the muscles and provides sensation to the front and top of your lower leg and foot. Also known as peroneal neuropathy, peroneal nerve entrapment, or common fibular nerve compression, common peroneal nerve compression is characterized by damage or compression associated with numbness, tingling, burning, hyperesthesia, paraesthesia, and loss of function from the knee to the top of the foot.

The common peroneal nerve only affects the top of your foot. If you have symptoms affecting more than one part of your foot, you may have multiple nerve compressions. Dr. Williams will work with you to determine the best course of treatment. 

Meralgia Paresthetica

Meralgia paresthetica is caused by a compressed lateral femoral cutaneous nerve, which is trapped under the inguinal ligament that spans the gap from the outside of the hip to the pubic bone. The compression causes pain and numbness in the outside half of the thigh from the hip to the knee. Symptoms are often intermittent in the early stages but become more constant as the compression progresses. As time passes, the pain may start to radiate downwards—feeling like a severe sunburn or searing burning and electrical pain.

Meralgia paresthetica patients don’t have low back pain. If you have low back pain, a spinal lesion may be the more likely culprit. However, because there are always exceptions to every rule and it’s possible to have both conditions, a thorough medical workup is needed.

Neuroma

There are two main types of neuromas affecting the lower extremities: a traumatic or stump neuroma, and a Morton’s neuroma.

A traumatic or stump neuroma develops after amputation or nerve injury, where the severed nerve end forms a tangled mass of disorganized nerve tissue.  These can be extremely painful, and often, the patient can put a fingertip right on the area that seems to be the “mother of my pain.”  These can occur anywhere a nerve can be injured.  Anywhere a nerve exists, a traumatic or stump neuroma can form.   

A Morton's neuroma is a benign enlargement of the interdigital nerve between the toes, typically occurring between the third and fourth toes.   This neuroma does not form the same way as the stump or traumatic neuroma.  

Surgical treatments for neuromas can include neurolysis to free the nerve from surrounding scar tissue, nerve repair, or neuroma excision. In some cases, Dr. Williams may relocate the nerve ending to a less sensitive area or perform other procedures designed to prevent the neuroma from reforming and causing similar pain. 

Piriformis Syndrome

Typically caused by the irritation or compression of the sciatic nerve as it passes through or beneath the piriformis muscle in the buttocks, piriformis syndrome leads to persistent chronic pain deep within your buttocks that radiates down your leg and makes it hard to sit, stand, and walk. Many people with this condition also report muscle weakness in the lower leg.

Piriformis syndrome is often misdiagnosed as a herniated disc or superior cluneal nerve entrapment due to an overlap in symptoms. Patients with radiating pain down the back of the leg may have a medical workup of the spine due to suspected sciatica. However, if the patient has piriformis syndrome, the spine will typically be normal, unless the patient has both problems. 

Post-Surgical Pain

If you have burning, tingling, searing, sharp-shooting pain, numbness, or weakness in a lower extremity six months after an operation, you may have a peripheral nerve entrapment or injury that is not being recognized, and the pain may be caused by a traumatic or post-surgical neuroma.   Examples of these events include:

You may also have a nerve entrapment or injury if your treating physician is telling you things like:

  • “Your hardware looks great.”
  • “The fracture has healed well.”
  • “All you did was sprain your ankle. Looks fine to me.”
  • “I don’t know why it still hurts – your [fill in the blank] looks better than mine.”

Please keep in mind that many complaints of lower extremity pain may have more than one cause—they could be both orthopedic and nerve-related in nature. Dr. Williams will work with you, your orthopedic surgeon, podiatric specialist, pain management team, or other doctors to determine the top priorities and the best treatment strategies to provide the relief you want.  

Proximal Tibial Nerve Compression

Proximal tibial nerve compression is a type of peripheral neuropathy caused by damage to the tibial nerve, which is a distal or downstream branch off of the sciatic nerve that runs down the leg to the back of the calf and sole of the foot. This nerve plays a crucial role in controlling movement and providing sensation to the muscles in the calf and foot. 

The proximal tibial nerve is an area championed by Dr. Williams, as he has published several papers in medical literature regarding this procedure, and has been instrumental in bringing this underdiagnosed compression to greater awareness. 

Saphenous Nerve Compression

The saphenous nerve, the largest cutaneous branch of the femoral nerve, runs down the inner aspect of the thigh and lower leg to provide sensation to the skin on the inner knee, lower leg, and ankle. Compression can occur at various points along its course, but common sites include the adductor canal in the thigh and near the medial knee. This can lead to pain, numbness, or tingling along the inner calf and knee that sometimes extends down to the inner ankle and foot.

If conservative treatments fail to provide the desired level of pain relief, a peripheral nerve surgeon like Dr. Williams may consider surgical decompression of the nerve. This procedure aims to release the nerve from surrounding tissues that may be compressing it—potentially alleviating symptoms and restoring normal nerve function.

Superior Cluneal Nerve Entrapment

Many people are surprised to learn that lower back pain isn’t always the result of an issue with the spine. Superior cluneal nerve entrapment can cause severe lower back that is off to the side rather than directly over the spine. Sometimes, the pain radiates into the hip or buttocks. Standing or sitting for extended periods is painful, and lying on your back or bending over often intensifies the pain.

Superior cluneal nerve entrapment can be related to failed back surgery syndrome, piriformis syndrome, sciatica, and sacroiliac joint disease. A diagnostic nerve block is one tool Dr. Williams will recommend to ensure that your condition is accurately diagnosed. 

Tarsal Tunnel Syndrome

Tarsal tunnel syndrome occurs when the posterior tibial nerve and its branches become compressed or irritated. This can lead to pain, tingling, numbness, and weakness in the feet. Dr. Williams takes an aggressive and well-proven surgical approach to treat this condition because he releases not just the tibial nerve but all four downstream branches of the medial plantar, lateral plantar, inferior calcaneal, and medial calcaneal nerves. 

Dr. Lee Dellon, Dr. Williams’s mentor and previous partner, likes to refer to this disease as tarsal “tunnels” syndrome to emphasize that there are multiple tunnels that need to be released to try to ensure a favorable outcome from decompression surgery.    

Dr. Williams also takes a more aggressive approach to mobilize patients after this nerve decompression, often allowing patients to partially weight bear as tolerated on foot as soon as 24-48 hours after surgery and move the foot regularly so these nerves do not get “re-entrapped” by scar tissue.  

Traumatic Nerve Injuries

Traumatic nerve injuries can be caused by car accidents, on-the-job accidents, or athletic injuries, or a simple fall. Believe it or not, chronic severe pain after an ankle sprain is one of the most common problems that presents to our office.  

Treatment approaches for traumatic nerve injuries depend on the severity and location of the damage. Mild cases may respond to conservative management including rest, physical therapy, and pain management. 

Severe traumatic nerve injuries often require surgical intervention, which is where peripheral nerve surgeons play a crucial role. Dr. Williams can perform procedures such as nerve decompression, direct repair, grafting, or nerve transfers to relieve pain and restore function. 

Other Peripheral Nerve Entrapments and Injuries

There are many other nerve entrapments in the lower extremities, and the upper extremities, torso, and head and neck that Dr. Williams treats as well. An incomplete list includes: 

  • Occipital neuralgia
  • Migraine headaches
  • Chest wall pain from intercostal nerve injuries
  • Abdominal wall pain from anterior cutaneous entrapment syndrome (ACNES)
  • Injury of the ilioinguinal and iliohypogastric nerves after surgery like hernia repairs or C-section
  • Knee pain after total knee or partial knee replacement surgery
  • Radial tunnel syndrome
  • Radial sensory nerve entrapment
  • Carpal tunnel syndrome
  • Cubital tunnel syndrome
  • Benign nerve sheath tumors

You Don't Have to Live With Pain Any Longer

Your journey to a pain-free future may include a visit to see Dr. Eric H. Williams with The Dellon Institute for Peripheral Nerve Surgery.  If you would like more information or want to request your appointment with Dr. Eric H. Williams, simply call our office at (410) 709-3868 or fill out a contact form here. 
Eric H. Williams MD
Eric H. Williams MD
Specializing in reconstructive surgery and pain relief in the Greater Baltimore area.