How Foot Surgery Can Lead to Chronic Pain—and How a Peripheral Nerve Surgeon Can Help

Baltimore Peripheral Nerve Surgeon Eric H. Williams MD Helps Patients With Chronic Pain After Foot Surgery Regain Their Mobility

chronic pain after foot surgeryIt’s normal to experience some degree of discomfort after foot surgery, but if you’re still in pain six months or more after your operation, you may have a peripheral nerve injury that may have been present before the operation or could have occurred during the procedure. Baltimore peripheral nerve surgeon Dr. Eric H. Williams has extensive experience helping people with nerve damage from foot surgery and foot injuries find relief from chronic neuropathic pain—and he may be able to do the same for you. 

What Types of Surgeries Can Lead to Nerve Damage in the Foot? 

In case you were not aware, surgery is a full-contact sport.  No surgical procedure is without risk. Any surgical procedure on your foot and ankle, or anywhere else on your body for that matter, can potentially lead to nerve damage, including:

What Nerves Can Be Damaged During Foot Surgery?

Foot surgery can potentially affect multiple nerves depending on the specific procedure being performed. Here are some nerves that can be at risk during foot surgery:

  • Common peroneal nerve. The common peroneal nerve can be at risk during surgeries on the lateral side of the foot, such as those addressing fractures or injuries to the outer part of the ankle, procedures requiring traction on the leg, or procedures around the outside of the knee. This nerve travels from the outside of the knee to the top of the foot as it branches into two daughter branches. 
  • Deep peroneal nerve. This branch of the common peroneal nerve can be at risk during surgeries on the top part of the foot. This nerve travels down the top of the foot and goes to the muscles that lift the foot, lift the toes, and provide sensation to the webspace between the great toe and second toe. 
  • Superficial peroneal nerve. This branch of the common peroneal nerve may be affected during procedures involving the lateral side and the top of the foot or front of the ankle. This nerve travels down the side of the leg and across the front and outside corner of the ankle, helps the foot move outward to provide stability, and provides most of the sensation to the top of the foot. 
  • Sural nerve. This nerve runs along the back of the calf and the outer side of the foot. Operations involving the Achilles tendon, the peroneal tendons, or the lateral aspect of the foot may pose a risk to the sural nerve. This nerve provides sensation to the outside of the heel.   
  • Saphenous nerve. This nerve runs down the inside of the thigh past the inner knee into the medial shin down past the ankle and provides only sensation to this area. Operations on the inside of the calf can injure this nerve.  
  • Tibial nerve. This nerve runs down the back of the leg, around the inside of the ankle, and into the sole of the foot. Procedures involving the heel, Achilles tendon, inside of the ankle, arch of the foot, or posterior tibial and toe flexor tendons of the foot may pose a risk to the tibial nerve.
  • Medial plantar nerve. The medial plantar nerve, which provides sensation in the inner sole of the foot (first several toes), may be at risk during surgical procedures that involve the medial or inner aspect of the foot or sole of the foot.
  • Lateral plantar nerve. This nerve innervates the outside half of the sole of the foot and toe flexors in the bottom of the foot, and it can be affected during surgeries that involve the plantar aspect of the foot and heel.  

In some cases, it’s possible that more than one nerve can be damaged during the same surgical procedure. This can lead to pain in multiple parts of your foot. It is also possible that the surgical procedure itself was not what caused damage, but it could have happened from a nerve block that is commonly performed to provide pain relief for up to 24 hours after surgery.   

Why a Nerve Injury Doesn’t Necessarily Mean a Surgeon Has Been Negligent

Let me make sure I am clear on one thing. If you have suffered from a nerve injury that you did not have before surgery, this does not mean that someone has done something maliciously wrong. As we said, every operation has risks. Every nerve injury does not mean a lawsuit should be considered. 

Even surgeons who follow every gold standard technique can experience complications. Again, this is part of the consent to operate. It is also a reason why we as physicians  “practice” medicine.  

There will be some flagrant mistakes out there, but far and away, injury or entrapment of nerves from a surgical procedure occurs without flagrant disregard for patient safety by very well-meaning physicians with good training. Why? Because surgery is a “full contact” sport. We are literally invading the body with a knife, scissors, drill, retractor, needle, etc.  Nerves are soft and fragile, but instruments are hard or sharp. This is the proverbial “two-edged sword.”  We always aim to use our techniques to heal.   

Also, it is important to understand that many of these nerves may have been injured or at least partly dysfunctional prior to surgery.  This may be the reason why some patients continue to have pain after a procedure that was supposed to help them—perhaps they had two problems: an orthopedic one and a peripheral nerve one.  

Some of these nerve injuries can be overlooked under some circumstances—such as when a patient’s ankle bone is sticking out of their skin and they need to emergently have their ankle fracture repaired or if they have had persistent pain after an ankle sprain for a few months. The nerve-related part of a patient’s pain can be under-appreciated when there are dramatic findings that can be physically seen in the patient’s imaging studies.   

How Do I Know If I Have Nerve Damage in My Foot?

Some degree of numbness, tingling, or discomfort is common immediately following surgery due to the effects of anesthesia, swelling, and the healing process. However, persistent or worsening symptoms may indicate nerve damage. 

Nerves are like electrical wires. They bring information to tell us about sensation and pain as well as provide signals to help muscles move and function. They go to very specific areas of the body, just like wires in a house go to specific rooms in that house. An experienced electrician will likely have a good idea of what wiring to fix in a building, depending on what rooms or appliances are not functioning correctly.  

With this in mind, here are some signs that you may have nerve damage after foot surgery: 

  • Numbness or tingling. Persistent numbness or tingling in the foot or toes can be a sign of nerve damage. This sensation may be localized or extend along a nerve pathway. What nerve is injured will determine where the sensations are felt.  
  • Burning or shooting pain. This type of pain is often described as feeling like an electrical shock or as if your foot is on fire; some may describe more of a very bad “sunburn” sensation. 
  • Altered sensation and/or painful sensations. Changes in sensation may suggest nerve damage. Often, normal actions such as wearing socks, putting on shoes, or having bedsheets draped over your feet become incredibly painful. A “pins and needles” feeling may also be present.
  • Weakness. Difficulty moving or controlling the foot and toes could indicate nerve impairment. Weakness may also affect the muscles controlled by the damaged nerve.
  • Difficulty with balance or coordination. Nerve damage can affect proprioception (your sense of body position) and coordination, leading to difficulty walking and performing everyday activities. 
  • Color and temperature changes. Severe nerve injury can lead to changes in the autonomic nervous system to the injured extremity causing color changes and temperature changes to the skin. Patients can complain of a “hot limb” or a very cold limb,” and often a deep violaceous color can occur in extremities.  

When Is It Time to See a Peripheral Nerve Surgeon?

X-rays, CT scans, and MRIs can easily be used to diagnose orthopedic pain, but nerve pain can be harder to identify. If it’s been six months or more since your foot surgery and your pain or function isn’t getting better, you’ll want to consult a peripheral nerve surgeon. If you have hypersensitivity, painful sensitivity, numbness, or loss of function that is not returning, these are all good reasons to see a peripheral nerve surgeon. 

Often, people with nerve pain after surgery will be sent to pain management and physical therapy as a first course of action. These are important steps for sure. Medication can temporarily relieve symptoms, and many patient’s symptoms will improve on their own or with the help of a physical therapist. However, if the pain is out of proportion to what it should be, not improving at all, or associated with unusual numbness, tingling, burning, hypersensitivity, or dysfunction, medication that is meant to block the pain signals is not really treating the underlying cause of the problem. It may be covering the pain, but it is not treating the cause.  

If you have nerve pain due to a nerve that is badly compressed, caught in scar tissue, or otherwise injured, you will often need to treat the nerve causing the problem. For instance, if a nerve is “pinched” then the best way to put a stop to your pain is to surgically “unpinch” it! We call that a nerve “decompression.”    

Our goal as a peripheral nerve practice is to determine what may be causing the problem, create a plan to help that problem, and then execute that plan to improve the patient’s health, quality of life, and function.  

What Can I Expect After Surgery?

Dr. Williams will explain the recovery process and answer any questions that you might have about what to expect after surgery. Every person’s recovery experience is unique.  

Peripheral nerve surgery may include nerve decompression surgery, nerve reconstruction, or nerve resection. Results can lead to dramatic improvements in your overall quality of life. Consider these examples: 

  • Relief from chronic pain. After having the toes in his right foot amputated due to complications from diabetes, our patient began to experience severe pain while walking, which persisted for about a year before our operation. He has improved tremendously since the operation and is now pain-free. 
  • Walking without crutches. After a failed bunion repair, our patient had been only able to walk with crutches and wasn't able to put weight on her foot for more than a year when we first saw her. She described her pain as a sharp, stabbing, burning, terrible hypersensitivity pain. Air blowing across the skin was described as raking hot coals over her foot, and she described an electrocution-type pain in the great toe. Now, she’s getting back to her daily activities without pain. 
  • Back to wearing normal shoes. This patient had been unable to wear normal shoes for several years. She could only use an open-toed slip-on type sandal.  She experienced shocking pain in the top of her foot that was diagnosed with a nerve block performed in our office. The deep peroneal nerve was subsequently removed and implanted into the lower leg in a much more protected environment deep within the muscle of the leg. This stopped her pain and allowed her to wear normal shoes once again.

To learn more about the results Dr. Williams has been able to achieve with his patients, refer to the testimonials section of our website.