Diagnosing and Treating Nerve Problems in Feet

Nerve-related pain in the feet and legs is on the rise in America today. Poor diet, lack of exercise, increasing rates of diabetes and metabolic syndrome, and even bad shoes are among the many culprits.

And that’s very bad news, for two pretty big reasons:

  • Nerves are the critical link between your brain and the rest of your body, responsible not only for transmitting sensory data (touch, smell, vision, etc.) but also controlling muscles and autonomic systems like digestion and respiration.
  • Significant nerve damage is difficult, and sometimes impossible, to fully reverse. So, you and your medical team need to act quickly if you want to maintain your quality of life.

Unfortunately, peripheral nerve specialists are in relatively short supply, and general practitioners aren’t always well trained on recognizing, diagnosing and treating nerve injuries. Entrapped or compressed nerves in particular often get misdiagnosed as plantar fasciitis or other inflammatory problems. This compounds the problem.

Here in Palm Desert, Harvey Danciger and his staff are well trained in diagnosing and treating common painful and problematic nerve issues of the lower extremities. Read on to learn more about some of the most common problems we see, and our comprehensive options for dealing with them.

doctor and patient

Common Peripheral Nerve Conditions
Peripheral Neuropathy

Peripheral neuropathy is an overarching term that describes systemic damage to the peripheral nerves, with symptoms usually concentrated in and around the hands and feet.

It’s strongly associated with diabetes, since high levels of blood sugar are toxic to the sensitive and delicate nerve fibers of the extremities. However, other causes are possible, including smoking, alcohol abuse, and various medical conditions.

The most common types of neuropathy affect sensory nerves, and symptoms tend to gradually progress from intermittent pain, tingling, and other “phantom” sensations. Over time, pain becomes more severe and constant, until the connection with your brain is so damaged that sensation stops, and total numbness takes over.

However, other forms of peripheral neuropathy affect motor nerves and/or autonomic nerves. As a result, you may gradually lose muscle strength and control, bladder control, temperature regulation, and other critical bodily functions.

Nerve Compression

Also known as “nerve entrapment,” compressed nerves are an extremely common (and under-diagnosed) problem that can lead to profound complications.

Nerves often have to travel through extremely tight spaces often called “tunnels” or “canals,” sandwiched between bones, tendons, and ligaments and sharing space with veins and arteries. The tunnel in your ankle (tarsal tunnel) and the area surrounding the knee are particularly common spots for compression, but certainly not the only ones.

As a result of this configuration, nerves can be physically pinched or compressed at these points (or others) for one of any number of reasons, including:

  • Swelling in the nerve or any of the surrounding structures, due to diabetes, thyroid dysfunction, high blood pressure, high blood sugar … the list goes on.
  • Repetitive motions or positions due to job duties or hobbies—office work, constant kneeling or crouching, etc.
  • Accidental injuries (including both traumatic injuries and chronic ones).
  • Complications from a previous surgery (not necessarily related to nerves), particularly to the ankle, knees, or back.
  • Structural defects or misalignments in your bones, tendons, or ligaments.
  • Tumors or cysts pressing on the nerve.
  • Obesity.

At first you might only notice pain, tingling, numbness, burning sensations or other odd and uncomfortable feelings. But left untreated, the damage may become permanent, and you may lose complete sensation, or the ability to raise your foot entirely.

Drop Foot

Drop foot is one of the most severe possible complications of nerve compression, especially of the common fibular nerve as it runs just below the knee. That said, drop foot may sometimes be caused by neurological or neuromuscular disorders or conditions that aren’t directly related to entrapment, including brain and spinal cord injuries.

If you have this condition, your ability to raise up your foot at the ankle (the medical term for this is dorsiflexion) becomes extremely weak and limited. The muscles responsible for this motion become paralyzed.

As a result, your toes may flop down and forward and drag along the ground when you walk. This greatly increases your risk of tripping and falling, and you may have to raise your feet especially high at the hips and thighs to avoid catching the ground with your toes, especially while navigating stairs.

foot nerve

Advanced Peripheral Nerve Care

Traditional remedies for injured or damaged nerves obviously depend on the specific diagnosis. They have included things like:

  • Medications and dietary supplements
  • Physical therapy and exercise
  • Activity modifications
  • Shoe gear modifications (including orthotics and braces)
  • Proper management of underlying conditions (for example diabetes)

Of course, we provide all of these treatments as well, as they continue to be valuable components of a comprehensive nerve treatment strategy.

However, our office also provides several more advanced therapies, including:

Laser Therapy

Therapeutic laser therapy, using the state-of-the-art MLS laser, is best known for treating inflammatory conditions—in other words, “itis” diagnoses like plantar fasciitis, bursitis, arthritis, tendinitis, etc.

However, it is also extremely useful in the treatment of peripheral neuropathy, and in many cases even nerve compression symptoms.

There are many reasons for this. One, the powerful and rapid anti-inflammatory effect of the laser reduces the size of swollen tissues, which in turn reduces pressure on the nerves themselves.

On top of that, the laser’s ability to improve local circulation draws more oxygen and nutrients to the area, and even stimulates the functional components of the nerve cells relieving pain, triggering regeneration and improving function of the nerve cells themselves.

In fact, research published in 2012 and 2017 found that laser therapy improved the outcomes of diabetic peripheral neuropathy patients, including reduced pain, improved nerve function, and improved sensation in feet.

Advanced Nerve Surgery

Dr. Danciger has received advanced training in peripheral nerve surgery, including nerve decompression surgery. We use minimal incision and microsurgical techniques to carefully “release” tendons and structures that are impairing or pinching the compressed nerve, allowing it to heal and regain function.

Probably the most well-known example of decompression surgery is performed for carpal tunnel syndrome in the wrist. However, fewer doctors are trained to perform lower extremity decompression surgeries.

We’re not kidding when we say there’s a critical shortage of peripheral nerve specialists. Dr. Danciger is one of just nine doctors in all of California who are either fellows of, or fellow qualified by, the Association of Extremity Nerve Surgeons.

This is a small but growing organization of podiatrists, MDs, and other medical specialists dedicated to advanced research and training in the diagnosis and treatment of extremity nerve conditions and disease, and all fellows must meet stringent requirements for advanced training and clinical experience.

If you’re currently suffering from nerve pain, nerve compression, drop foot, or any other painful or disconcerting condition in your lower limbs, please don’t wait for problems to get worse before deciding to get better! The more advanced your nerve injury is, the less likely we will be able to reverse the damage.

Instead, please call Dr. Danciger today and learn how we can help you reduce your pain and restore nerve function to the greatest extent possible. You can reach our Palm Desert office at (760) 568-0108.

 

Dr. Harvey Danciger
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Dr. Harvey Danciger is a podiatrist and foot surgeon in Palm Desert, CA specializing in the foot and ankle
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