Leg pain and nerve pain in the feet post lumbar surgery

by Joel Howard
(Webb City, MO)

Neck problems can cause pain and weakness in the legs.

Neck problems can cause pain and weakness in the legs.

Leg pain and nerve pain in the feet post lumbar surgery are a difficult complication.

Hi, you were kind enough to respond to my questions about an issue that I am having in my cervical spine, so I am hopeful you will answer some questions I have about a lumbar condition. I guess you can tell that I have neck and lower back issues, much to my delight! :)

Anyway, 7 months ago I had a microdiscectomy at L5-S1 with very limited success. My back and leg pain did go away for a while. I was able to walk long distances almost immediately after the surgery without much pain or irritation in the legs. However, within days of the surgery I developed odd spasms in the arches of my feet and nerve pain in my ankles. Especially on the inside. After 6 or 8 weeks post surgery the pain started coming back in my legs. Mostly my right leg, but some in my left too. Don't get me wrong, I hate that pain, but there is something else that bothers me more. For the past few months if I do much of anything physical (like rebounding basketballs for my son), my right leg will (in the upper thigh) will get a heavy, dead sort of feeling. Like I might be unable to move it. In fact, if I attempt to raise my knee up actually feels heavier than the other leg. This feeling is very unsettling and concerns me about my long term future.

My surgeon is very conservative and not quick to overreact to something but he did order another lumbar and thoracic MRI. I have not had one in almost 6 months. I don't have the results back yet, but will soon.

I guess my real question after all that explanation is...can all of that be caused by nerve compression in the lumbar region? Am I in danger of permanent nerve damage? I have been very active and athletic all my life until this surgery. Now just walking a significant distance puts me in pain.

I know it is a lot to ask for some sort of diagnosis based on what I have said, but any thoughts would be appreciated.

I very much appreciated your feedback on my neck situation. You have a great website, that is very helpful.

Thanks for your time.

Joel

Hello again Joel,
The answer is yes, the dead feeling in your right thigh, and difficulty raising your knee can certainly be caused by nerve compression in the lumbar spine. But higher, affecting the femoral nerve.

Have your knee jerk reflexes tested, and bounce on each leg; does the right leg tend to give at the knee? The femoral nerve stretch is difficult for you to do at home, but the surgeon will have done it; find out if it was positive.

Frankly, in my opinion, you went back to long distance walking far too soon. After major surgery a period of rehabilitation, with gentle exercise and perhaps swimming was the way to go. You were badly advised; or did it against orders?! But that's water under the bridge and there's no going back.

Now something far more difficult; very occasionally and it's unlikely in your age group, a problem in the neck, or surgical complication can affect not just the nerve roots passing to the arm, but the spinal cord itself. Then pressure in the neck can cause these difficulties in your leg. It's unlikely, but needs to be considered.

I wish I were nearer Joel, but South Africa is some distance from Missouri! But there are plenty of good chiropractors in your neck of the wood. I'm not sure that you're a chiropractic case, though. Not now. But you might start looking around for a very experienced and thorough chiropractor in your neck of the woods.

Dr B



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Nov 30, 2016
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Sciatic issues getting worse
by: Joel Howard

Hello Doctor!

I wanted to respond to some of the questions you raised in our last correspondence and also give you an update.

You had asked me to go to the leg muscle testing page and perform those tests. For the most part I passed them. I would say there is some slight more weakness in the right leg, but nothing dramatic.

As far as the slump test, I think I would answer the same way. There is a difference from one leg to the other, but nothing remarkable.
I have probably mentioned this, but both legs hurt. However the right one is much worse.

Yesterday I had an ok day with my legs during the day, but not great. I had physical therapy last night where I did some significant leg strengthening exercises (with almost no added weight) followed by some dry needling of the hamstring area of the right leg. Which does give significant relief, but it is very temporary.

I was able to attend 2 basketball games of my son after I left there, but today my legs barely feel that they can support me. The right one has a frequent cramping, painful feeling.

I am growing more and more concerned that I have some type of irreversible condition. Or even that I have a neurologic or muscular disorder that has yet to be diagnosed.

I am normally a very calm and logical person, but I really am very worried. Not to mention I am in a lot of pain.


So any thoughts or encouragement you can give would be very welcome.

You mentioned morning exercises. There are some that I do, but I doubt they are what you suggest. Could you make some suggestions.

Thanks as always for you help and patience!

Hello Joel,
It is depressing, and it's good that you are facing these things squarely. It's possible you are developing arachnoiditis, a post surgical inflammation and I'm afraid I have no suggestions, except to avoid having any more needles stuck into the area.

Yes, I think some daily back exercises done every morning before getting out of bed are important; vital in fact. Done gently they can only help; remember you're not aiming to make the US team to the Winter Olympics!

Sorry to be facetious, but one does need to try and see the lighter sides of life.

You'll find them in the navigation bar on the left at Chiropractic Help. Really you should probably have professional help choosing the right ones for you. I do them myself.

Some thoughts on an anti inflammatory diet may be helpful too; it's a huge subject, but start by reducing the omega-6 in your diet by changing to olive oil. And increase the omega-3 by enjoying fatty fish like salmon regularly. A high ratio of 6 to 3 is very inflammatory.

A swimming pool? Backstroke to begin with.

Dr B

Nov 18, 2016
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Still have leg weakness
by: Joel Howard

Hello Doctor! I haven't checked in for many moons, so I thought I would give an update and maybe ask a few questions.

As always, I very much appreciate your site, your advice and your willingness to help people. Having seen countless doctors that don't seem to take the time to get to know me or really listen, even though you are across the world it is nice to be able to converse with you.

Anyway, I wish I had great news to report, but I am still struggling with leg weakness and pain. My ankle pain and crazy spasms in my feet have reduce in severity and are sometimes not present at all. So there is something positive to report.

My legs (especially the right) still have some pretty significant pain that is mostly from the behind down to the knee. The pain is definitely exacerbated by activity. So unfortunately when it is really flared up even walking makes things worse. Not only is it painful, but both legs (right is worse) feel extremely weak. In fact, they feel as if they will give out from under me. Hello Joel, it's difficult to measure less than 10% of power loss; these are powerful muscles and often all that is detected clinically is a "sponginess" on testing. But do go to our leg pain muscle testing page, and see if you can provoke any weakness: http://www.chiropractic-help.com/Leg-pain-muscle-testing.html

In particularly, can you raise your heel off the ground, and hold it steady in space?



So, I really have a few questions:

1. Over the last few years I have developed fairly significant varicose veins in the lower part of my right leg. Is it possible that the pain in thigh area is actually a vascular issue? Yes it certainly is, but the posterior thigh area is a prime target area for sciatica. Do the Slump test for sciatica at Chiropractic Help. Is the posterior thigh much tighter? If you bend slowly forwards, is that thigh much tighter than the other? But if it is vascular, then I would avoid any deep sciatic work nerve. If unsure, have a vascular test.

2. Is the weakness I feel in my legs possibly more of a perception than a reality? I always pass the basic strength tests administered by a PT or doctor. Can "angry" nerves give a feeling of weakness as some sort of protective mechanism. certainly, like I said, marginal weakness is difficult to elucidate.

As you can imagine my legs have never actually given out, but it is very unpleasant feeling and makes it very difficult to enjoy life. I understand that, because if it did give out, you would fall, for example on the stairs, and then have other issues!

I would love to hear your thoughts, but I know you get many, many requests. So if you don't have time I understand. Sometimes it helps just to be able to tell someone.

Thank you for your time!

Joel

Are you doing lower back exercises faithfully every day before getting out of bed? Nothing with a situp action, could adversely affect your neck.

Fijn weekend,

Dr B

Aug 03, 2016
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Post Surgery update
by: Joel

Hello, I have not posted anything in quite a while, but I always enjoy reading the issues I receive via email in the form of a link.

Anyway, I wanted to give you update on my current condition and ask a bit of advice.

In the past 6 months I have opted to have both a cervical fusion (C5-C6) and a lumbar fusion (L5-S1). The disc at L5-S1 turned out to be in pretty bad shape, so I don't think I had any other option but surgery. Sometimes one reaches the end of one's tether and, for better or for worse, it's inevitable that one makes decisions like these. Spines can be bastards!

The disc and C5-C6 was herniated and pushing on the nerve root and my spinal cord as well.

If you read back through previous updates you will see that I have been through the ringer trying to avoid either surgery, but without any relief.

So surgery seem the right way to go.

The cervical surgery so far (about 10 weeks ago) has been very good. Pain & numbness down my are is gone, pain in my shoulders and neck is almost completely gone. They only flare up when I have done something I shouldn't. Plus the headaches at the base of my skull are gone too. So for the most part I am happy with that surgery. Certainly it would seem you are on the road to recovery. Don't make the same mistake you did with your back! Give it a chance to heal before playing silly buggers!

The lumbar has been a bit more of a challenge. AS I mentioned earlier once they did the surgery the surgeon said the disc was in very bad shape and nothing short of a fusion or disc replacement would have helped.

The recovery has been such a roller coaster. There are have been so many ups and downs. The good news is that over the last few months the major sciatic pain I had down my right leg is much better. That's fantastic. However on many days I still have significant pain in my behind or in my hips. I understand that the hip pain may be due to a change in my gait or some other post surgical change. I have been in physical therapy which does help some. I treat patients on a daily basis with similar issues after chiropractic treatment. The buttock and hip region are in an interplay with the lumbar spine.

I do feel my legs get tired and weak feeling much quicker than they did prior to surgery. This is of quite serious concern, but a subjective feeling that may not be entirely accurate.

Last but not least, I continue to have "nerve" pain my ankles. Sometimes this is much better, but most of the time the pain is still there. Prior to surgery I also had nerve pain and nearly constant muscle spasms in my feet. These have also diminished greatly. I wonder if these aren't quite independent issues in the feet, with little to do with the lumbar spine.

So all of that babbling on to ask a few questions.

Is the nerve pain in my ankles consistent with L5-S1 issues? Certainly, but that doesn't mean that it isn't a foot issue.

If so do you foresee this continuing to heal and possibly going away? I don't know.

If it isn't L5-S1 causing it, what could be? Certainly an examination by someone who works with feet on a daily basis would be an option. A chiropractor with a FICS qualification, a podiatrist...

Are the issues of "tired legs" and the pain in my behind also consistent with L5-S1. Very definitely. Are you also taking statins?

Same question, do you see these resolving with time? I'm afraid I have no idea, but it is early days. You need to give the surgery at least a year to know whether you are going forwards or not. Are you doing lower back exercises at home on a daily basis?

I am about 4 1/2 months post lumbar surgery.

I know you are not a surgeon, but I assume you see many post surgical patients in your practice!

I am frequently told by my surgeon, PA's, etc. that I need to be more patient and this could talk 12-18 months to fully heal. I agree.

I am just looking for some advice from someone who knows what they are talking about and doesn't have any "skin in the game" so to speak. Other than you just seem like a caring doctor that wants to help everyone feel better!

Any advice or response you can give would be most appreciated.

My apologies for the novel.

My comments I'm afraid are vague because this is complex stuff and I haven't had a chance to examine you or see your scans. Even a severe cord impingement in the neck after surgery can cause many of these symptoms you mention in the legs.

In conclusion, be sensible, do lower back and neck exercises, no silly buggers, walk and perhaps swim daily and now time a chance. I hope it goes well.



Jan 22, 2016
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Leg Pain/Foot pain
by: Joel Howard

Where are you from in the states? How long have you been in South Africa?

I will take a look at the exercises on the site and discuss with my doctor. He is pretty open to ideas. Kind of anything that will help.

He looked at my most recent MRI just yesterday and agrees there is serious degeneration at L5-S1 and at some point I will probably need surgical intervention. I see him again on Monday and he is going to give me a free trial of Spinal Decompression just to see if I can help with the pain. Even if it is temporary. I will let you know how it goes.

Thanks as always for your responses.

Hello Joel,
Actually Mayflower descendents, my father from Maine followed a lovely lady to Eastern seaboard of SA where we still live. Three brothers back in the States. They met in chiropractic college and practised their whole lives here.

What's odd with backs is how some have dreadful degenerative changes, yet minimal trouble, but others almost nothing to be seen, but in severe pain.

Give your chiro a solid chance.

Dr b



Jan 21, 2016
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Feedback on leg pain after surgery
by: Joel Howard

As always, thanks for your feedback. I have found what I hope to be a good chiropractor. He is helping me with my neck, but it is slow going. He has also worked on my lower back, mainly to mobilize the SI joint on my right side which he said was not moving at all. This seems to have helped with movement of my right side and helped with some constant pain I was having in my hip. But he has been very honest and feels that there is only so much he can do for my lower back. Unfortunately he even thinks I may be headed for another surgery.

Post my last surgery I was encouraged to walk daily, which is what I did. However I felt so good I am sure I overdid it. In fact, I had surgery on Thursday afternoon and Friday morning I attended my son's basketball tournament. I know, I am not the sharpest knife in the drawer.

So the pain in the feet and ankles can be caused by nerve compression in the back?

I also wish you were closer to Missouri! Thanks again for responding. I love your site and look at it nearly everyday. I can tell you genuinely care about the health of your patients.

No doubt I will have more questions in the future!!

It is snowing here in case your wondered.

Hello Joel,
I am actually of American stock, so have plenty of family. Been wondering if winter was going to reach the USA this year, of if we are well on our way to global warming and catastrophe!

It's great that you've found someone with whom, as we say, you've "clicked". Be patient; Achen and Cologne weren't built in a day. Nor was Rome.

The si is central to the health of the lower back, so it's great he's found and is dealing with the problem there.

Then, perhaps you could suggest that my thoughts were the upper lumbar spine and the femoral nerve needs evaluation.

This time don't overdo it; one step at a time.

There's always the question whether ankle pain, for example, is a local problem, or referred nerve pain. Your chiro will know how to examine for that.

We have an exercise programme for the sacroiliac joint perhaps ask him to check it out and see if it's suitable for you.

Dr B



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Interesting challenges of the day

1. Mr S is a 76 year old man with neck pain of some 9 months duration. Luckily, most of the discomfort is upper cervical which is only rarely arthritic; his lower cervical spine is a degenerative mess that I've left alone. After seven treatments his pain and stiffness is 50 percent better, and he's happy in the circumstances. He can sleep through the night now and that makes a huge difference.

2. Mr P is 32 year old man with very severe lower back pain radiating to the big toe which is 30 percent numb. He had an episode three weeks ago, took anti inflammatories and was soon better as is typical of the medial disc herniation. But before it healed, after a trivia it came roaring back, much worse. The characteristic crossed sign was evident; sitting in a chair, straightening the right leg provoked severe left back pain and tingling in the leg. He's doing well.

3. Severe lower back pain is scary; just ask Mrs P. Just watching her get out of the car I she was in trouble; she had a slipped disc at L4 making her lean towards the opposite side; luckily she had no pain in the leg. Despite family pressure that this was far too severe for a chiropractor, she persevered. Within five days she was standing upright, and after two weeks almost painfree. 

Despite a hectic job, she wisely took my advice and stayed home for what I call exercising bed rest.

4. Mr S has had lower back, groin and back of thigh and calf pain for fourth months.

He has a pincer deformity in the hip causing the stabs in the groin, and a degenerative facet causing the sciatica. Both are responding well to chiropractic and he's well pleased; sixty five percent better after three treatments.

5. Mr T is a wise man; he's taken a warning TIA seriously and has lost 15 pounds, and has at least as much again to lose. A change to a low starch diet and half hour daily walk has made the difference; but the walking is making his foot and back miserable. The expensive orthotic is hopeless; luckily his hips and back are fine, but he needs a simple heel lift.

6. I too have had serious lower back issues, luckily fixed by my own chiropractor; so I too have to do my exercises, take care when lifting supers full of honey, gardening and using the chainsaw. Regaining the function of your spine is just as important as the pain.

7. My own granddaughter, only 7 is hypermobile giving her pelvic, knee and ankle issues. Xrays show a mildly dysplastic hip. Years ago we would have called it growing pains. She too regularly needs chiropractic care and luckily responds well. Increased range of motion is more difficult than too stiff in my opinion. Our care is for kids too.

8. This 65 year old lady is a serious gardener; every day she is bending, lifting and digging for 2 to 3 hours a day. It regularly catches her in the sacroiliac joint, so she has a treatment once a month that sorts it out. She does her lower back exercises faithfully.

9. This 88 year old lady is an inspiration; every day she is busy in the community. With a nasty scoliosis she manages very well with a chiropractic adjustment every six weeks and exercises faithfully done.  

10. Mr X is a 71 year old retired man who wants to continue with maintenance care every six to eight weeks; he had suffered from two years of lower back pain when he first came a year ago. He has no discomfort now after 8 chiropractic treatments, but is aware that danger lurks.

11. Mrs C has been having severe headaches, and taking a lot of analgesics. It's a non complicated upper cervical facet syndrome, and she's doing well.

12. Mr D is a 38 old year man with chronic shoulder pain after a rotator cuff tear playing cricket. It responded well to treatment, but he knows he must do his exercises every day; for two years he couldn't sleep on that shoulder.

13. Mr D, a 71 year old man, has a severe ache in the shoulder and midback since working above his head. Trapped nerve tests are negative but he has advanced degenerative joints of Luschka; after just two treatments he is 50 percent better. Can we reach 90?

And so the day goes; chiropractors shouldn't be treating the elderly most medical sites state but that's so much bunkum.



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