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Forum Name: Neurology Topics

Question: Severed nerve on accdnt during foot surgery


 Rhianan72 - Mon Nov 03, 2008 5:33 pm

I had a fairly simple procedure done 6 weeks ago to remove an implant out of my right ankle, while my Dr. was performing the surgery he severed my Intermediate dorsal cutaneous nerve on accident. He informed my husband and myself right after the surgery was completed. He does not seem optimistic at all and, I hate talking to him about it cause I feel bad for him (I know crazy huh) he always looks so sad and guilty feeling. I feel good talking on a forum cause here I can speak the truth and not make anyone feel bad. I really like my doctor and I have to say it happens no ones perfect. I live in an extremely small town so I don't have many options on who to talk to, cause I don't want any troubles for my Dr.

In March I had a tear in my flexor digitorum longus tendon and another one on my posterior tibial tendons, they were repaired and attached to each other to make it one strong tendon instead of 2 weak ones, that is also when the implant was put in.


I have had pain since the 2nd surgery 6 weeks ago, and I think the nerve section that's still attached is inside my scare tissue from the incision site, it hurts if I extend my foot forward, and when I lay down in bed the sheets even cause pain. I have tried amatriptoline and it did not help at all. I sometimes have an extreme itch on the portion of my foot that I can not feel but, scratching it does nothing, very annoying and mentally frustrating. I can not feel a large portion of the top of my foot or my 3 smallest toes, I can feel half of my middle toe.


I work in Law Enforcement and am on our SWAT team, I return to work on Nov. 5th and I'm scared as hell, I don't think I will ever be able to do our SWAT drills like this cause I fear the pain I will suffer that night. I have to be able to respond to emergencies very quickly and that involves running...

I also have 2 horses that I have only ridden 3 times in 6 weeks, and I have to just watch other people enjoy them :( do the the pain I might have to go through that night, and one I had just started breaking :(

When I know I'm going to stand for longer periods of time I notice I keep my bad foot on top of my good foot I guess kinda like how a horse rests one foot at times, but I do it always. I am surprised I still have a good foot with all the stuff my left foot has been through since March trying to keep weight off the right one.


My questions are :

What is the worse possible thing it could lead to? I have read some scary stuff online about ulcers and stuff.

What are some options I might have to help with the pain?

How long will this pain be present?


Thanks in advance,
Rhianan
 John Kenyon, CNA - Tue Dec 16, 2008 10:54 pm

User avatar Hi Rhianan -

You've inheritied something of a challenge. I'm no neurologist (nor even an MD), but I have a lot of training and experience, mostly in emergency medicine, but have had occasion to follow a lot of certain types of cases. This is one of those which, while it's very difficult to predict improvement by timeline, at least allow us some idea of if it will resolve at all, and how much, based on statistics alone.

First, the nerve pain, which is something best appreciated by someone who's experienced it, may, in your case, indicate something positive. Since the nerve clearly can be irritated by direct stimulation or contact (even movement or contact with bedsheets), while awfully uncomfortable, tells us the irritated nerve is still functional. This is good, because if the irritation can be relieved or corrected either medically or surgically, some of the function should return, and maybe even some of the superficial sensation. That itch where you can't feel the surface is probably indicative of a permanent superficial injury, but the itch at least should slowly go away. The area may actually become sensitive (as though suburned) for a while.

Since you can cause the pain by extending your foot, it probably is due, at least in part, to scar tissue, which might be correctable by another surgery (some people are more inclined than others to develop more or less scar tissue). Because this seems to be direct irritation rather than muscular strain, working with the foot shouldn't (hopefully, at least) cause residual pain after use. It may well hurt while you're using the foot, but shouldn't continue to hurt afterward. If it hurts too much while using it, this is a different story and may constitute a disability issue. Maybe.

I don't see any reason, with reasonable care, that you should suffer ulcers. People with diabetic neuropathy of the feet have this happen because their neuropathy is, at least in great part, caused by diminished blood supply. That's very different from other sorts of neuropathy.

There are other, better nerve pain blockers available now, than amytriptiline, such as gabapentin (Neurontin) and pregabalin (Lyrica). You might ask for a trial of one of these. As to how long the pain may be present, this is impossible to predict, either absolutely or in terms of time. It may go away completely, with or without medication, or it may become more tolerable. It may become intermittent. It may be totally resolved by time or possibly by surgery to remove scar tissue. It is really difficult to know with any certainty what it will do, except that it is unlikely to become worse, and is unlikely to become aggravated by use of the foot after the fact.. That's about the best I can give you on that. Medication may make it very manageable, but there are no guarantees. However, newer meds that I've mentioned above are often more effective than what you've tried so far.

I hope all this is helpful to you and that you've been able to return to work without any significant difficulty. You are to be commended for your dedication to your very important duty and for your consideration of your doctor. Best of luck to you, and please keep us updated.

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