A Common Occurrence
Complications after a surgery are common and no one should worry when they develop discomfort, numbness or soreness.
In fact, a recent study shows that 10% of the general population will encounter pain in their heels at some point in their lifetime.
This pain occurs in both patients with successful surgical outcomes and the minority who will endure persistent and recurrent pain.
Nerve pain in feet is mostly defined by a range of symptoms such as tingling, numbness, cramping, and burning.
Common causes include infection, bleeding or delayed healing process of a wound, which was the primary surgical site. Scar tissue may also cause pain in the foot but since it is part of the normal healing process, it should not be a reason for any alarm.
A research conducted by Chan and Peng showed that nerve entrapments may also cause pain or foot dysfunction or tarsal tunnel syndrome at the ankle.
Nerve complications occur mostly when nerves are pressed in confined spaces. The injuries may result in muscle complications and loss of sensations but mostly pain in most of the general population.
The type of treatment of injuries on nerves depends on the nature of the injury. They are classified as; first, second, and third-degree injuries.
While a first-degree injury, also called neurapraxia, may heal as early as a week or 3 months, a second-degree injury, also called axonotmesis, takes a long time for complete recovery. Only partial recovery occurs in a third-degree injury.
In the United States alone, approximately 200,000 lumbar laminectomy and discectomy surgeries are performed annually according to Andres and Buyten’s 2016 research.
From these, at least 90% of the patients experience good outcomes while the rest end up with complications such as heel pain among other problems.
The symptoms mostly appear between 6 to 12 weeks after an operation preceded by a period of relief. Although some may experience the pain immediately after a surgery, the recovery process depends on the type and extent of the injury on the nerves.
According to Dr. Thomas, discomfort in the feet due to nerve entrapment often at the initial branch of the lateral plantar affects the entire heel.
Plantar fasciitis, which is an inflammation of the thick strands of tissue linking the heel to the toes, is the most likely cause of pain.
This intense pain in the mornings especially when taking the initial steps, accounts for 80% of cases according to Dr. Long and Dr. Filtzer.
A Morning Problem
The initial discoverable symptom is a tender medial tubercle that can be determined during the examination. Diagnosing Plantar Fasciitis mainly relies on a patient’s medical history.
It often graduates with time beginning early in the morning when the patient first sets foot to walk and progresses with the intensity of activity such as prolonged standing.
Towards the end of the day most patients complain of worsening of the discomfort. On the brighter side, the pain barely radiates and is unassociated with paraesthesias, which is an irritating sensation characterized by a tingling or prickling feeling such as of pins and needles.
Stubborn persistent leg Pain
In some cases, patients endure consistent pain even without evidence of neural compression. Such stubborn cases do not respond to conventional medication and may result in functional disability.
Patients with such intolerable continuous leg pain may develop psychological disturbances that lead to depression and insomnia. It is, therefore, inaccurate to conclude a surgery incorrectly done is the sole cause of leg pain after surgery.
Since not every instance of neuropathic pain is associated with back surgery, changes in the pain modulation process in a body may account for intolerable leg pain.
There have been many attempts to explain and solve failed back surgery syndrome (FBSS) as the sole cause of leg pain.
Although there have been numerous advancements and improvements to such treatments across heterogeneous populations, none has completely resolved neuropathic pain after spinal surgery
Clinical Outcomes
1. Medication
Currently, Gabapentin taken daily with a maximal dose of 1,800 mg, is the most effective solution compared to Naproxen and other equivalents.
According to Dr. Thomas and Dr. Jacques, oral Gabapentin plus an epidural steroid injection yields better results than the injection alone.
Nonsteroidal anti-inflammatory drugs show little impact on FBSS while oral opioid frequently used on severe pain has not proven effective in patients with neuropathic pain.
2. Exercise and Physiotherapy
There are significantly few studies that support the efficiency of exercise and manipulation on healing neuropathic pain among FBSS patients.
One recent study, however, revealed that isokinetic lumbar stabilization exercises proved more effective than home work-outs.
3. Spinal cord stimulation
Spinal cord stimulation (SCS) has for a long time been examined as an option for chronic neuropathic pain in FBSS patients.
Not only does the treatment help relieve chronic pain in legs but also amend physical function and sleep quality. A study that followed up on the patients indicated that SCS was 48% effective compared to conventional medication’s 9%.
4. Surgical treatment
There are many studies that have demonstrated the role of surgery as an effective solution for leg pain. A variety of surgical treatments including instrumented fusion, the release of adhesion, repetitive decompression, or total disk replacement are commonly used.
It is nonetheless, crucial to making long-term follow-ups to confirm complete recovery after these surgeries.
5. Radiofrequency therapy
Although rarely used, Radiofrequency therapy has been used to control neuropathic pain. In the few cases it was used, the results were completely effective for a short-term period.
Cost-effectiveness
It is crucial to evaluate the details of any medical option before making a decision. For example, one should take note of the insurance policy recommendations as well as the general cost per unit.
Most studies suggest SCS as the most appropriate option considering its cost-effectiveness. Cost of a medical option varies widely with individuals, especially with different workers’ compensation details.
Conclusion
Nerve pain in feet after back surgery is not only a problem for patients but doctors as well because of its’ defiance to conventional medication.
Even though most studies suggest SCS as the most appropriate and cost-effective option, it is crucial to limit its routine because it is considered invasive.
A multi-disciplinary treatment design is, therefore, the most reasonable option for patients with complex leg pain after back surgery.
There is still an urgent need for further research on etiology, diagnosis, treatment to explore the most effective method of treatment of this complex disease entity.
Reference
For more graphical information to help you grasp the connection between leg pains after back surgery, Watch this YouTube video. The video contributes crucial information on the link between post back surgery and subsequent leg pain.
