Why am I Still Dealing With Foot Pain Months After Treatment or Surgery?

It’s worth noting that a certain amount of lingering, residual discomfort and swelling after a foot surgery is a normal part of the healing process. This process may be as short as a few weeks or as long as several months, depending on the severity of the initial pain, the extensiveness of the surgery or treatment, and how well you follow up with home care.

However, with pain that is “zinging” or distant—especially if it continues to linger—a damaged nerve is a more likely culprit. There are a couple of reasons this can happen.

• Misdiagnosis of the original condition. When it comes to foot and heel pain, a wide range of very different underlying conditions can produce extremely similar or overlapping symptoms. Unfortunately, due to a relative lack of physician training in this area, nerve problems in the feet that produce zinging or distant pain are especially likely to be misdiagnosed as more common (or at least more well-known) condition such as plantar fasciitis, tendon pain, muscle pain, and others.
• Botched surgery. Sadly, this is also a fairly common outcome. It may be that, in fixing an unrelated problem such as a bunion or hammertoes, the surgeon accidentally strikes a nerve or forces it into a pinched or compressed position. Your original condition may have been fixed, but now you’re left with an entirely new problem.

If words like “zinging,” “prickling,” “shocking,” “burning,” “distant,” or other related terms come to mind when you try to describe your pain, that’s a pretty good sign you should seek out a nerve specialist for a consultation and nerve test.

A trained foot and ankle nerve surgeon, such as Dr. Craig Thomajan, should have access to several useful diagnostic tools:

• Nerve conduction studies, electromyography (EMG), and/or nerve conduction velocities (NCV) tests to evaluate a nerve’s ability to transmit and receive electrical signals.
• Imaging tests, particularly magnetic resonance imaging (MRI), to provide a clear picture of both the nerve and the surrounding structures.
• Nerve biopsies, which allow the surgeon to remove a small section of nerve tissue and examine it for any abnormalities or irregularities.

Without a correct diagnosis, any further treatment you receive will only cost you more money and increase your frustration with no tangible results.

Fortunately, through these tests, a trained nerve specialist will be able to positively identify any nerve-related pain conditions in your feet and prescribe an appropriate treatment course.

Feet are highly complex. They contain fully a quarter of all the bones in your entire body, along with dozens of joints, tendons, ligaments, muscles, and other structures. In order to reach the toes, nerves often have to pass through narrow tunnels and tight spaces between and around joints and other tissues.

Repetitive stresses, injuries, surgical mistakes, and even poor diet or disease can collapse these tunnels and press on the nerves, which is what causes the zinging sensation.

Some of the most common compressed nerve conditions include:

• Tarsal Tunnel Syndrome. The tarsal tunnel crosses behind the ankle along the inside of the foot, through the medial malleolus (which you might know better as the “bump” on the inside of your ankle). Pressure here can affect the heels, arches, balls of your feet, toes—essentially, anywhere along your entire foot.
• Common Fibular Nerve Compression. The common fibular nerve is quite thick (about the width of a pen) and runs through a tunnel between the fibula (sometimes known as the “calf bone”) and surrounding muscles. Compression here frequently results from ankle or knee injuries, and can cause a condition called drop foot, which prevents raising of the foot.
• Deep Fibular Nerve Compression. This nerve is responsible for bending your foot upward at the ankle. The most common point of compression is located at the peak of the arch, known as the metatarsal cuneiform joint, and pain is most likely to occur around the largest few toes.

A more general term for any kind of localized inflammation of nerve tissues is neuritis. Direct damage to a specific nerve may be caused by injury or surgical error, arise as a side effect of other treatments (such as chemotherapy or radiation), or emerge as the result of a medical condition or lifestyle choice (such as autoimmune disease, cancer, diabetes, or alcohol abuse).

Treatment Options for Lingering, Zinging Foot Pain

The best treatment method will be selected by your foot and ankle nerve specialist based on the specific facts of your case.

Conservative Care Options

In some cases, tight nerve tunnels and pinched nerves can be relieved through non-invasive care, such as rest, icing, or anti-inflammatory medications. If the compression in the nerve is related to a problem with your foot structure, orthotics may be an effective treatment method.

Unfortunately, for botched surgeries or for nerve pain that has been misdiagnosed by an earlier physician, conservative options are less likely to be effective, especially if you’ve already been using them to treat what you originally thought was plantar fasciitis.

Nerve Decompression Surgery

Over the last several decades, organizations such as the Association for Extremity Nerve Surgeons (AENS) have pioneered new surgical approaches and techniques for relieving pressure on nerves in the lower limbs, training a new generation of surgeons to recognize common nerve conditions and correct them.

The AENS maintains a list of fellows and associates on its website who have the necessary training and experience to perform nerve decompression surgery safely and effectively. Since nerve decompression can be difficult and risky for an inexperienced surgeon, this list is a very valuable resource when choosing a surgeon.

Dr. Thomajan is one of just a few hundred surgeons nationwide, and currently the only one practicing in Austin, who is an AENS fellow and highly trained in these techniques.