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Originally Posted by toepain2013
Such great advice. Thanks Zookster.
I've been suffering for 15 months. My pain started after an assault wherein an individual broke into my house and I was forced to defend myself and fight him out of the house in nothing but my underwear. The fight progressed outside onto the street in front of our house, where my feet sustained a lot of damage as I grappled with / restrained the individual until the cops arrived.
The pain started about a month after in my right foot, but has now progressed to my left (it did so after about a month of pain in the right foot).
I've been diagnosed with sympathetically mediated pain by a pain specialist who sees a number of patients with CRPS. I also had the diagnosis confirmed by a podiatrist. I've had three sympathetic blocks in my lower lumbar on the right side, all of which eliminated the pain completely in my right foot for about 24 hours.
It was the podiatrist, however, that suggested the peroneal nerve injury, given the EMGs I had had previously didn't test that nerve + the MRIs I had were only of the foot, not the ankle. Furthermore, my symptoms started with pain on the top of my foot -- but progressed to involve the bottom as time went on. Also, my symptoms are much worse on my right foot, where I'm positive for "tinels" sign (parathesia when tapping the nerve).
Next up is diagnostic injections to see if we can knock the pain out by blocking that nerve specifically. If it works, I believe they'll then be looking into imaging / other diagnostic methods to determine where exactly the nerve is injured. Hopefully then they can find some sort of entrapment / scar tissue / something to fix up -- gosh that'd just be amazing.
Let me know if there's any other info you need. I have my first peroneal nerve block in two weeks (doc is going on vacation so I have to wait -- ugh!) -- here's hoping it helps.
In the meantime I'm stopping all exercise that involves ankle plantar flexion and just focusing on mellower stuff (walking,c cycling etc). I'm an athelete and have forced myself to keep exercising through all of this. It helps me control the symptoms, but they're now worried that I could be continuouslly aggravating a stretched nerve (I love to run and do crossfit -- yes, a CRPSer who does xfit -- I know, I'm crazy).
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Gosh, I am so sorry that this was caused by an intruder - that must have been extremely scary! You are brave to have fought him/her off.
So just to clarify regarding MRI's - MRI's don't really show nerves well enough to the untrained eye. MRNeurography use a different machine and the physician viewing the study are trained specifically for lesions involving even the smallest of peripheral nerves. Most doctors won't order an MRN but, it is worth getting if you are contemplating surgery.
It is said in numerous studies that there is 'spread' and then there is referred pain which can be confusing to both the patient and the physician in CRPS. I wonder if perhaps your left foot is experiencing referred pain rather than true spread? If that is the case then perhaps you may benefit from surgical decompression but only you can make that decision. It is such a difficult call to make.. Once you get the nerve block specifically to that nerve I am sure you and your doctor have more information to base that decision on.
Personally, I wouldn't stop your exercise routine as long as it isn't causing you a large increase in pain, that won't settle after resting. Figuring out your baseline will be helpful in determining how much you can push yourself. Movement is good for mobility, mind, spirit and pain coping. So much of fighting CRPS is mental so if you are able to continue to do what you already love then why stop? You will aggravate the symptoms but you won't cause further injury to the nerve by doing so. The reason people caution being aggressive with PT is that the PT itself will not 'cure' the problem and if it is miserable or agonizing for the patient then why torture them with continuous therapy that isn't going to cure it? However, in your situation if it is making you feel better while doing it and you can get a handle on your pain afterwards then by all means don't stop - in the long run it surely will help you mentally and physically. The added bonus is that this will help you sleep better, which is greatly needed for healing and recovery and something that is almost always affected with chronic pain.
Since you love crossfit/athletics and seem to be a determined type of person - determine yourself not to become a CRPS statistic, but instead be one of the small percentage of people who can continue as much of their normal life as possible for as long as possible. Having that king of attitude will carry you through many challenging days.
A great book to get your hands on is "Holistic Pain Relief' by Heather Tick, MD.
Take good care and let us know how your block goes,
Tessa