Ankle surgery is supposed to make you feel better. So what’s with all this chronic tingling, burning, and discomfort that doesn’t seem to be improving even months or years after the original operation?
Unfortunately, you may be dealing with post-surgical nerve pain.
Although most ankle surgeries are highly successful and precede a full recovery with few (if any) long-term complications, a minority of cases (5-10 percent) may produce chronic pain long after the operation date.
This can happen for a variety of reasons, but the most common involve peripheral nerves that have been damaged or impaired in some way.
Signs of Post-Surgical Nerve Pain
The first order of business is to determine whether it is, in fact, a nerve problem that you are experiencing. Remember that a certain amount of pain and swelling after surgery is normal for up to 3-6 months or more, depending on the procedure.
Although you’ll need to see a doctor to be sure, these are some of the most identifying signs of nerve pain after an ankle surgery:
- Pain persists long beyond the normal recovery window for the type of surgery you had.
- Pain tends to be described more as a burning, tingling, or electrical shocking sensation that may shoot up or down the leg. (More “normal” throbbing or aching pain tends to indicate a muscle problem rather than a nerve problem.)
- Hypersensitivity to hot, cold, or touch.
- Occasional numbness, especially near the toes.
- Muscle weakness in the legs and feet.
Once you come to our office and describe your symptoms for us, there are a number of tests we can run (diagnostic nerve blocks, biopsies, imaging tests, etc.) to confirm the diagnosis.
Why Am I Suffering from Post-Surgical Nerve Pain?
Again, there could be a few possible explanations, but it’s important to start with a short anatomy lesson.
The ankle joint is a lot more complicated that it looks. In addition to the convergence of bones, the ligaments that hold them together, and the muscles and tendons that allow them to move, you also need to fit a bundle of nerves and blood vessels through some very tight spaces.
Just to use one example, let’s look at the tarsal tunnel. The “tunnel” is essentially a narrow passageway sandwiched between the bony bump on the inside of the ankle (medial malleolus) and the tendon that holds it to the heel bone (flexor retinaculum). And this tiny gap must accommodate the tibial nerve, an artery, a vein, and a bundle of flexor tendons!
Because there isn’t a lot of wiggle room, issues can arise after a serious injury or an invasive procedure like surgery. For example:
- Accidental surgical damage. A surgeon may accidentally nick the nerve during the operation, damaging it. Alternatively, the repair may alter the shape of joint slightly, leading to compression.
- Post-surgical entrapment. Even if the surgery is conducted flawlessly, the formation of scar tissue around the ankle joint may encroach into the space reserved for nerves. Essentially it creates a “choke point” that leads to pinching and pain.
There’s also another possibility in some situations, which is that nerve pain was your original problem, you were misdiagnosed, and the surgery did not correct it. However, this is less common with ankle pain and surgery than with heel pain.
What Can I Do About It?
The good news is that, once properly diagnosed, there is an excellent chance we will be able to help you.
Sometimes we don’t even need surgery! In certain circumstances, a combination of non-invasive therapies like laser therapy, physical therapy, and custom orthotics can reduce pain, promote nerve healing, break up scar tissue, and/or reposition feet so that the nerves are no longer being pinched.
That all being said, most cases of post-surgical nerve pain do require another surgery to repair the damage.
The good news is that Dr. Harvey Danciger is a member of the Association of Extremity Nerve Surgeons and one of fewer than 200 physicians nationwide fellow-qualified by the organization to perform advanced peripheral nerve decompression techniques.
When compression or pinching is the source of the pain, a decompression surgery can often bring rapid and radical pain relief in a relatively short timeframe. The earlier you seek treatment, however, the better your odds of a complete restoration of nerve function.
Surgical mistakes are the least likely scenario to be fully correctable, but that doesn’t mean all hope is lost. There may still be a chance the damage can be repaired and reversed to some extent—or at least be managed in such a way that you are controlling the pain, rather than having the pain control you.
Once again, the most important thing is that you seek out a peripheral nerve specialist as soon as you suspect there may be a lingering nerve issue after your ankle surgery. And if you happen to live in or around the Coachella Valley, that means calling Dr. Harvey Danciger.
To schedule an appointment with us at our office in Palm Desert, CA, please dial (760) 568-0108 today. You can also request an appointment online.