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Same savage right heel pain

HighwaymanHHighwayman Posts: 47
Hello, I had nerve surgery March 25 by a plastic surgeon Doc who specializes in nerve entrapment issues trained at Dellon institute. Three different areas were addressed. Just below the right knee for numbness on right calf, at the middle toe to check for mortons neuroma and the right ankle for tarsel tunnel for right heel pain. I thought recovering from my L5-S1 PLIF was rough, this has been much harder. I was on a walker for two weeks, then on and off for another week. the Doc did find much compression at the ankle but did not say any thing else. For the first two and a half weeks my right heel was fine and then it came alive and with a vengeance. No amount of pain meds could stop it. Saw the Doc two days later. He said during the surgery at the ankle he found a neuroma one of the nerves ( I do not recall the specific nerve name ) that descends into the heel. It was not what he expected to find but it explains the savage heel pain. He decompressed the nerve but it appears the damage has already be done. He gave me a steroid shot just above the incision at the ankle, after four days it finally calmed down to pre-surgical pain. Needless to say I was so disheartened. But the Doc did give two options, one, let it be or totally remove the offending nerve. Yea baby, I'm for taking that darn nerve out right now with a hand saw if I could!!! O.K. most days are like that but the Doc wants to wait at least 10 weeks post-op before going there. I go back to work May 10th and have some other obligation in May so I will put if off until the first of June. There has not been an injury to my right ankle that would explain the neuroma, it just is. When I see my Doc again we will cover the side effects of removing the nerve. I know there will be numbness but what else I do not know. I do care but then again the pain can be so bad at any time I do not care about side effects. Luckily it is relatively small area effected I think?
With that said has anyone had a nerve removed?
If so, how did it turn out?
Presently there is still swelling at all surgery sites, especially the ball of the foot.
The good news is I am off the MS Contin just because. Still on percocet and lots of Neurontin but nothing else. I did try Cymbalta for the nerve pain after the surgery, but had urinary side effect issues with it and had to stop taking it.
I will post again after I meet with the Doc to discuss the nerve removal.
God Bless,


  • Hi,

    Unfortunately I don't have experience.
    Just curious on why you selected a Plastic surgeon to do the work vs. a neurosurgeon who specifically trains in nervous system?

    Do you know if their training is different or geared toward different issues? I guess I hadn't heard of a plastic surgeon who specializes in nerve entrapment so I'm just interested.

    Hopefully others can help you with your dilemna.

  • I have had what's called a C2 Ganglionectomy, which is basically where the dorsal root ganglion at C2 is removed. Don't know how close it can relate to the nerve that your doc is talking about but I figured I'd share my experience.

    In a nutshell, while the thought of numbness over pain is a no brainer, the surgery is a different story. The body is a tremendously complex mechanism and although the docs understand A LOT of it, there's still much that they don't.

    After undergoing numerous procedures, years of medications and a lot of wishful thinking, the decision was made to do the ganglionectomy. In a nutshell the procedure was a success. I no longer have the bolts of pain shooting through my head, and my scalp on one side and part of my neck are permanently numb. Good deal right?

    Well as far as can be determined, there was more being done from the dorsal root ganglion than thought or expected and 2 muscles in my neck and head were permanently denervated and have atrophied to nothing.

    DNice brings up a good question, as to the specialization of the surgeon. You certainly don't want to lose more than the pain and feeling in your leg. Have you the opportunity to consult with a neurosurgeon on this?

    Best of luck with your decision.


  • I think the thing you need to worry about would be causing foot drop. Are you convinced that part of the nerve problem and pain in the ankle is not stemming from residual nerve compression at L5-S1? I would want to know the answers to those two questions before proceeding with surgery. Believe it or not, you could end up worse off than you are now.

    The peripheral nerves are a highly complex system. Removing one may result in that type of pain, I forget the name of it, that people who have amputation suffer from.

    It is my understanding that when a nerve is removed, the severed end tries to reconnect. It keeps firing but makes no connection, but the brain continues to interpret the signal as pain.

    I would get a number of opinions on this, if I were you...before proceeding.

    Good luck.
  • Hey highwayman,

    I was so hoping this was the answer for you as I am supposed to in my near future have that same procedure as you. Now as far as cutting the nerve the question I have is how do they know which nerve it is causing the issue and is the offender. Something I didn't know exist but do know now is they can block out nerves in the leg. I am wondering if before you do this procedure that is permanent and can't be undone if they shouldn't isolate out the nerve and block it out to see if it is the problem? If it is pain coming from higher up being radicular in nature won't the pain just be as bad where they cut the nerve? My concern is just the nature if it don't help and is coming of something else you have lost that nerve ending. Keep me posted I am really interested on how you get along. Take care.
  • Good Morning,
    Thanks for the great replies.
    DNice, the neurosurgeon referred me the the plastic surgeon after he determined that it was not my back causing the heel pain. This plastic surgeon specializes if peripheral nerve issues. He has quite a resume in nerve issue training, along with much surgery training. But I may return to the neurosurgeon with questions before I agree to the nerve removal.
    Gwennie, I've been following your saga with the insurance company, and pray the right thing happens in your case. I believe the nerve issue your thinking of is called phantom pain. I am missing most of one digit of a finger. At times it feels like there is something under my fingernail which of course is not there. It can be very annoying. But it is nothing compared to missing a whole limb.
    The MRI and CT scans show no issues at L5-S1 since the PLIF but sometimes I wonder if there is not an issue yet. Just a gut feeling.
    "C" You give me much to think about. It is some fix to be in to have nerves cut to get out of pain, but then the side effects. I know this is a hard question but would you do it again knowing what you know now? When I see the Doc this Friday I will have questions written down to ask, for sure about atrophy. I don't know about y'all but my mind seems to go blank when I get in a doctors office.
    Tamtam, That is a good question. Can that nerve be blocked? The Doc knows exactly the nerve on which he found the neuroma. I am sure he said it descended into the heel and is the offending nerve. I need to get a copy of his report to get the facts straight. If he can block the nerve, that would give a good indication of what might happen if the nerve was removed??????
    I return to work Monday. It has been six weeks since the surgery and if I am up on my foot half a day the pain meds do no good for the heel. I hate to think I need to gut it out the rest of my life. This type of pain is the pits. It is going on three years of dealing with this. I still have three kids to get through college. It sure is a pickle now to cut the nerve or not. Thank You for your replies. I feel better prepared to question the Doc Friday.
    God Bless,
  • Good Morning all,
    I went back to work last Monday the 10th. By Wednesday noon the pain was so bad I hid in the back. I could not even drive home for two hours. So Thursday I went back out on short term disability. It hurts financially but I am grateful for the coverage. I will attempt to return in two more weeks. Yesterday (Monday) I was able to get a second steroid shot in the ankle. Today it is much improved. I spoke with my surgeon about removing the damaged nerve. He said the minimum time to do the procedure would be three months post-op from the first surgery. He would cut the nerve above the neuroma then reroute the nerve into a muscle above the heel. At that point there would be no pressure pain at the heel, but nerves have memory. So if you were to touch the area where the nerve was relocated you may have heel pain again. What a catch twenty two. The doc put me on Valium for the spasms in my foot. That really does help but he is cautious about me just stopping using it. He said it not like stopping lortab or percocet. Does any one have experience with this?
    Do to my PLIF at L5-S1 and the hardware removal, I can now sit much more at work but sitting only involves about 20% of the time. Wearing steel toe boots and walking on concrete most of the day is the issue. I have a closet full of boots but have yet to find a pair that causes less pain than another. I have mats to stand on but must be about more than on the mats. I do love my work, so it is hard not being there and am praying for a good resolution to this situation. The biggest thing I am doing is keeping my month shut about this issue. I need to be speaking about how good life is and how good God has been to me. It seems that right focue is as important as proper treatment. So with that have a great day and count your blessings.
    God Bless,
  • I love your attitude. We often need to find the compromises that make our lives livable and enjoyable to the best of our abilities. But that doesn't mean we should just accept where we are and not look for better. God gave us voices to ask questions and ears to hear the answers. When we use all he/she gave us then we can be truly happy. :)
  • Highwayman said:
    "C" You give me much to think about. It is some fix to be in to have nerves cut to get out of pain, but then the side effects. I know this is a hard question but would you do it again knowing what you know now?
    That is a tough question to answer. Since my SCS is so helpful to the pain in my neck,shoulders,arms and hands and I was offered an SCS to control the pain that the ganglionectomy was for ... if I knew what I know now, I would have most likely tried the occipital SCS first. At the time they weren't having as much success as they are with them now, so who knows if it would have worked to control the pain as well as the ganglionectomy does. It's one of those things, where it was supposed to be near fool proof and work great, but ...

    I have found with the nerves that have been cut or ablated, it is very easy to get "phantom pain" from them. Also the development CRPS from the same procedures is a big risk as well. So I have now become far more hesitant and leery of any procedure that involves messing with the nerves themselves other than to free them from impingement.

    Do I regret having the surgery? No. It has helped tremendously

    Would I do it again knowing what I know now? Probably not without trying neurostimulation first.

    Hope this helps.

  • Highwayman said:
    The doc put me on Valium for the spasms in my foot. That really does help but he is cautious about me just stopping using it. He said it not like stopping lortab or percocet. Does any one have experience with this?

    I agree with the doc that it is not good to stop Valium cold turkey. I was taking 20-25mgs three times a day and stopped it cold turkey. Had nasty experience with withdrawl from it. Got mad and wanted to see if I really needed it anymore and so I just let the prescription run out. Big mistake!

  • HI "C"
    I have been offered the SCS by my PM Doc for quite some time. I have been very leery of this option as I have read on the SCS board about poor foot coverage. I do know that there is a trial first but with the permanent implant life changes and I do not know if I want to go there. I have read about phantom pain and have some minor experience with it so that is a serious consideration. So what a pickle life can be at times, but I like pickles, yes bad joke but I need to laugh. Like my surgeon said please give time time and maybe the nerve will calm down. I though am like the vulture that said patience my butt I want to kill something!
    Count your blessing and God Bless,
    P.S. love your pic, they do not make great cartoons like that anymore.
  • Hi all,
    I am back to work after another 2.5 weeks on disability for a total of nine since tarsal tunnel surgery. Evidently the damage to the nerve from the neuroma is permanent. It’s been OK but at the end of the day the heel is still the same, CUT IT OFF!!!! I am at the point of decision. Do I go for the SCS or removal of the nerve? If I go SCS route it is just a trail to see if I can get coverage in the foot. If it works and an implant is done and then stops working it is reversible. If I go the nerve removal avenue it is permanent. I am so tired of this nerve pain. My PM is pushing the SCS hard. Most pain meds are of little to no use any more. I am taking Neurontin 800 4x but the side affects of that are getting worse, mostly just CRS and blurry vision. I am leaning to nerve removal because then the issues of the SCS are not there. But in researching nerve removal phantom pain is the biggest issue. Despite the nerve removal my heel could still hurt because nerves remember though there would be no real pain in the heel. I just really do not want to be tied to the SCS. Am I making the SCS more of an issue than necessary or is it real? I have pushed off the next PM appointment until mid July. I just hate being in a pickle like this. I have researched this to death and still cannot find much on nerve removal and side effects. I am grateful my back (PLIF) did work well. Sometimes though I think that there is still an issue at S1 to the heel, you know a gut feeling, but it is difficult to articulate to the Doc. All MRI’s & CT scans are showing no compression. Any way it is nice to be working because it is a good distraction from the pain. The PM doc said that Medtronic has a new paddle lead out that can cover the whole foot. What to do, what to do. I just keep asking questions and praying for guidance. Thanks for listening to my rambling in doing such I can answer my own questions, sometimes.
    God Bless,
  • Good Morning,
    Well after much research, talking with different docs, my wife, and prayer I have decided to have the nerve (calcaneal) removed from my heel. That nerve is a sensory nerve only. It is not for muscle control. It seems clear that the damage from the neuroma is done. The doc will cut it above the neuroma (at the tarsal tunnel) then put the end of the nerve up in the calf muscle where there is less chance of stimulation than left down in the tarsal tunnel. The area that would be left numb is not that big, the inside of the heel going under to about half way across the bottom of the heel and maybe a small part of the arch. The doc put a steroid shot right into the offending nerve on Tuesday; I just about came unglued until the numbing agent took effect. Since Wednesday the heel pain is down to about a 3 which is great. I do not know long it will be this way but I am grateful for the relief. The SCS will be my last option if the nerve removal does not work. My job involves being around RF radiation and I do not know how this would effect the SCS. It would be a bummer to have it put in me and not be able to turn it on at work where I need it the most. Now whether phantom pain will be an issue or not we will see. I hope it does not turn into a catch 22.
    The healing process from the decompression of the nerves between the long bones in the foot is very slow. Though I did not have Morton’s neuroma the nerves where compressed. The testing of that area on Tuesday showed an improvement of feeling which I can tell. The swelling though of the ball and pad of the foot is slow to go away and painful still. Unforchantly(sp) I am on my feet on concrete 90% of the day at work.
    My pain doc has changed me to nucynta 100 4x a day and neurontin 800 4x a day. This has done me better that Percocet. The surgery is scheduled for late August due to summer activities. Now if that shot will last until then I would be a happy camper.
    I am done rambling now, have a great 4th July holiday,
    God Bless,
  • Thanks for the update. I really hope that this all goes well for you and you get some much needed relief. Sounds like you have a top notch doc who wants to do right by you. I completely understand your decision to try the surgery first. That's what I did and I could not be convinced otherwise at the time either. That's okay, because it's our body and our decision and we are the ones that have to make the hard choices. If cutting the nerve works, then you are free! Oh what a wonderful thing that will be for you.

    Best of luck!

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