Diagnosed CRPS help!!!!
 

I am a 43 yr old female. I had surgery for my cuboid bone that was not healing from a stress fracture and it got worst. Surgery 6-24-2015. I am a little over 2 months post op. No pins or screws just smoothed out bone and removed bone fragments broken off from bone. I have been going to ortho for post op every 2-3 weeks. Right after surgery for a while I suffered with a burning sensation if anything touched my foot. That is not as bad. I still can not walk long distances without crutches. Ortho sent me to pain dr on Friday. He diagnosed me CRPS. All he did was look and touch my foot (ouch) and my symptoms are. Numbness especially along outside of right foot, pins and needles when touched or when standing or walking. Swell throughout day and bad at night. Very stiff and sensitive to touch ( not severe like pain when sheets touch). Foot feels cold at times but no discoloration. He is doing a nerve block next week and put me on morphine and Lyrica. Does this all sound like a correct diagnosis of CRPS. To me from what I have read it doesn't. All information is welcomed!!!

Hi Julie,

I am so sorry you had to come and find us but you will find good support here. I hope that the meds and nerve block give you some relief. Foot surgery is a challenge to recover from even without CRPS. Whether that is what you have or not I can't say. It does sound suspicious but then again, foot surgery is a bear itself and often takes longer than the docs think it will. You aren't that far out from surgery. If it is CRPS there is hope, the majority of people, 80% according to Cleveland Clinic, recover over time. It takes time and dedication to your rehab and determination to keep trying things until you find what works for you. Compounded topicals or lidocaine may help with the cutaneous pain. Keeping your foot elevated since it's post-op is still important at 8 weeks out. Watch for swelling at the end of the day and maybe look at epsom salt soaks in cool water for that. It's great the burning pain is reducing and you at able to walk some without crutches.

Many of us benefit from the pool. After 3 foot surgeries, the last started the CRPS, I pretty much lived in there and it is where I began to walk again. Going 2+ miles on land now! Keep that foot moving with gentle range of motion and swishing around in the pool even on days you can't do anything else. You WILL make improvements. Ignore the doomsday info on the internet. It is not accurate and wont help your recovery.

I always recommend Dr. Pradeep Chopra's video "CRPS Diagnosis and Management". at 2 hours long it has loads of practical tips on therapies, treatment and supplements. He is highly regarded and a reliable source of info.
www.youtube.com/watch?v=s3LKhOZ8mAM

Be kind to yourself and come when you have questions, to share, vent or get a virtual hug.
Sending healing love,
:hug:

Thanks so much for the information. I appreciate it

The signs and symptoms you have described don't meet the criteria for a diagnosis of CRPS. Its a difficult condition to correctly diagnose and it should have taken a lot longer with a far more detailed history taken and more detailed examination done to make such a positive CRPS diagnosis, especially since none of your signs and symptoms are particularly remarkable and you are barely over the surgery itself.

You are only 2 months out from your surgery. That is nothing at all. Pain at this stage wouldn't technically even be diagnosed as chronic pain. All or virtually all of the things you are experiencing could be entirely explained by the normal post-operative healing process or even by a delayed post-operative healing process. Even a delayed healing process doesn't necessarily mean anything is wrong - some people are naturally slower to heal and fully recover than others. Sometimes the body will take longer than expected to settle down after the disruption from surgery. In those circumstances, a diagnosis of CRPS is not correct as there must be no other possible reason which could account for the signs and symptoms you have. One issue with CRPS is that all of the individual signs and symptoms it produces are also generated by many other conditions or processes in the body. One of the issues with all of the awareness raising that has gone on even in the time I have had the condition (8 years) is that whilst genuine cases are still being missed, there seems to be an increase in incorrect diagnoses being made.

A cynic might ask whether the diagnosing doctor realises that he can perform additional procedures on you and rake in easy extra cash. If he has diagnosed a post-operative chronic 'condition' with a name this gives him an insurance code to allocate costs to whilst generating himself some nice easy profits. It will be virtually impossible for anyone to ever challenge him because the signs and symptoms of CRPS typically change over time.

You may well want to take the medication as there is no point in suffering neuropathic type pain unnecessarily and it is thought that poor post-operative pain control can contributes to the existence of chronic pain. Do your research on the block and consider the risks v rewards of the block - if nothing goes wrong you will be fine in a few days but there are always risks, however small, with these procedures. The very best thing you can do is to be as normally active as possible - subject to your physio's instructions of course but the worst thing you can do is not to use a limb or to guard it because it is painful. Crack on and do the physio and then get straight back to plenty of normal activity to minimise the risks of future problems.

According to the Budapest Criteria you need 3 of the 4 main Symptoms for a diagnosis of CRPS

**

If you don't make progress in the coming weeks, be sure they do adequate work up to rule out any surgical mishaps. I wonder about the numbness you describe. Could that be CRPS, nerves pressed on by post op swelling or a nerve that got nicked or smooshed by scar tissue etc.? it is important to find and address any pain contributors so you can heal whether this is CRPS or ticked off foot. Morphine at 8 weeks out sounds heavy to me for any remotely typical healing spectrum. Obviously your foot hurts like hell for whatever reason.

I am very thankful for all of yall responses. My ortho sent me to pain management because he says I should not be in this much pain eight weeks out following this surgery. Also I forgot to mention he said that it took him twice as long to do the surgery because a nerve was in the way. He was hoping that he did not hurt the nerve in any way but he thinks he did that's why he sent me to have a nerve block done.

Poop. I am sorry to hear it. I sadly know too much about nerve injury from ortho procedures.

Nerves can handle being stretched and tugged on during procedures. If he just had to gently move it out of the way the nerve should tolerate that but maybe be ticked off. What nerves can't handle is being scarred down, cut/torn or worse yet, partially cut/torn. Mine partially tore from a retractor which is pretty extreme.

If you are in or near a major metropolitan area, and I mean MAJOR, Austin at 850k people didn't have the specialists for what I am proposing and I had to go to Houston. If you don't get better and your doc thinks he damaged the nerve it is possible to get a peripheral nerve ultrasound by a Physical Medicine and rehab specialist with ultrasound certifications. These guys can visualize nerves that can't be seen on MRI, Especially something major like you are probably talking about (Sural or superficial peroneal depending on where they went in). They can look at it and tell if it was transected, has a neuroma or is just scarred down. They can treat scarring with a hydrodissection.

hopefully it won't come to this and you will get all better soon. But if you don't , this is a little known imaging and potential treatment option to address nerve injury.
:hug:

Good morning. UPDATE
 

I went to a different pain dr yesterday for a second opinion. This was such an extreme difference from the last dr. This dr was in the room with me explaining and showing me things that the other dr didn't. By the way the first dr walked in looked at my foot and said you have CRPS "I'm not going to explain it just google it". I was like wow really? After thinking about it if I did let him do the nerve block would he have to google it? Needless to say I fired him
So the new dr explained and showed me that I have all four symptoms. With one of them being minor which is good. But I do have discoloration, temperature difference and I forgot the last one lol. The one where it is painful to touch is only in a small part of my foot but extremely painful to walk.
He gave me a choice to try intense physical therapy for four weeks or nerve block. I chose the physical therapy and we will see what happens there. He wants me to move my foot more and walk more without crutches. He also said that the liryca the other dr gave me was not enough so he upped that. He then gave me quick release morphine to take as needed along with the extended release morphine twice daily.
The the nice person who asked about me living in a rural area. I am in Louisiana in between New Orleans and Baton Rouge so I am seeing a dr in Baton Rouge
Thanks again everyone for all of your input. I look forward to hearing from yall more. I will let yall know how pt goes. My appointment is tomorrow

Hi Juliek~I'm a new member too and just wanted to say hello. Glad you found a pm doc that you like. I have an appt. with a new one on 9/8. My first one seemed to only do procedures (nerve blocks, did 3; SCS no way right now.) I want someone that will discuss other options. I am in PT since June (pool and land) and I wish you as much success with it as I have had. Not easy, but I'm so much stronger now. Good luck!