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Have chronic fibromyalgia and multilevel disc compression. Having pain above ankle. Foot instantly turns purple. Remedy?

DOCTOR OF THE MONTH - Nov 2013
Nov 2013
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hi my name is XXXXXXX um having a little trouble with this I've never done this before I don't know if you received my query but I got a chat request and the chat box never came up um have you received my question and can we chat now? I've already paid.

I have chronic fibromyalgia and multilevel disc compressions as well as tarlov cysts and meningoceles. The cysts have been there a long time and so has one of the meningoceles, but one meningocele is new and happened when I was in an assault in December 2012. I was hit with a bat on my rear, behind my knee, on the outside of my knee and outside of my ankle, I laid unconscious in my house for3 or 4ndays before my husband found me. I still have visible scars at each place. I contracted rrhabdomyelytis and ARF and awoke with a paralyzed foot and most of the lateral leg numb. I went to XXXXXXX and they did an MRN and found a lesion at the ischeal tuberosity. My surgeon up there (400 miles fdom my house) is going to explore the lesion as well as do a peroneal decompression at the lateral knee. The worst pain I'm having is from slightly above my ankle throughout my whole foot ex ept for some sensation in the medial ankle and foot. I have about 4 positive tinels from the lesion down and there is still visible scarring on my hip/glute level as well as the lateral aspects of my thigh (actually thigh is more posterior) but the knee and ankle hurt and numb laterally all the way down. I cannot bear weight at all. I can't control the leg. I can't flex or dorsiflex the foot but I can move it side to side although it is very painful. The foot instantly turns purple and gives me excruciating pain as soon as I bring it below heart level. I tried shaving my leg and just touching the area slightly above my ankle all the way around forces a scream and tears and I have to fight not to pass out. I told my surgeon about these symptoms and he said he didn't want to deal with my foot until he saw how the first surgery (ischeal tuberosity and peroneal) came out but meanwhile I'm scared of what the compression may be doing to my foot and he doesn't want to give me a straight answer about it. Can you help me to understand his thinking?

Current Medications : Pristiq, Lexapro, xanax, flexeril, keppra, oxycontin, oxycodone 5 for breakthrough
Gender : Female
Age : 43
Posted Sat, 13 Jul 2013 in Brain and Spine
 
 
Answered by Dr. Sudhir Kumar 1 hour later
Hi,
Thank you for posting your query.

I have read your detailed description, and it is unfortunate that you have such uncomfortable symptoms. These symptoms are suggestive of neuropathic pain (pain of nerve origin). It is possible that the nerves in the skin got injured, when you got hit near the knee and ankle, and that is resulting in this neuropathic pain.

Sometimes, a nerve recovering from a previous injury can also give rise to similar symptoms.

At this point, neuropathic pain medications such as pregabalin or gabapentin or duloxetine may be helpful, in relieving the symptoms.

Your surgeon may be expecting an improvement after the surgery, so, he does not want to investigate this now. However, nerve conduction studies (NCV test) may be helpful in quantifying the nerve damage/injury.

I hope it helps.
Please get back if you require any additional information.

Best wishes,

Dr Sudhir Kumar MD (Internal Medicine), DM (Neurology) XXXXXXX Consultant Neurologist
Apollo Hospitals, Hyderabad,
My personal URL on this website: http://bit.ly/Dr-Sudhir-kumar
My email: YYYY@YYYY
My blog: http://bestneurodoctor.blogspot.com/
Above answer was peer-reviewed by
 
Follow-up: Have chronic fibromyalgia and multilevel disc compression. Having pain above ankle. Foot instantly turns purple. Remedy? 34 minutes later
sorry screen froze. still there? I have had 2 EMGs. Still no recovery from ischeal tuberosity since last test in January.
 
 
Answered by Dr. Sudhir Kumar 2 minutes later
Thank you for getting back.

Neurological recovery in nerve injury can be slow, and sometimes, may take upto 12-18 months for good recovery.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by
 
Follow-up: Have chronic fibromyalgia and multilevel disc compression. Having pain above ankle. Foot instantly turns purple. Remedy? 1 minute later
So there is no risk to my foot by letting it stay compressed?
 
 
Answered by Dr. Sudhir Kumar 2 minutes later
There is generally no risk. However, if the nerve is entrapped (as can be assessed with clinical examination and EMG test), then, a surgical decompression of the nerve can be done.
Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by
 
Follow-up: Have chronic fibromyalgia and multilevel disc compression. Having pain above ankle. Foot instantly turns purple. Remedy? 8 minutes later
The doctor says I could very likely have tarsal tunnel entrapment to lateral and plantar nerves. He just doesn't want to deal with that until he knows 1. If the lesion at the buttock is scar tissue, hamstring tendons or dead and needs a graft. 2. How well the surgery is going to go. He says we are in "a race against time" to get the nerve healed to the knee in time to save the knee below the knee. So my question is, why can't he decompress or at least explore the tarsal tu nel at the same time he decompresses the knee and buttock?
 
 
Answered by Dr. Sudhir Kumar 4 minutes later
Thank you for getting back.

For your clarification, the nerves near the foot (plantar nerves) are the extension of the nerves in the buttock and knee. So, unless the proximal (nearer) nerves are healed/cured, it does not make sense to do surgery for the distal (farther) nerves. So, your surgeon is planning to salvage the nerves near the buttocks and knee. If they heal, then, probably, he would work near the ankle and foot.

Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by
 
Follow-up: Have chronic fibromyalgia and multilevel disc compression. Having pain above ankle. Foot instantly turns purple. Remedy? 0 minute later
I meant save the leg below the knee not the knee below the knee lol...
 
 
Answered by Dr. Sudhir Kumar 0 minute later
I understood that...
Above answer was peer-reviewed by
 
Follow-up: Have chronic fibromyalgia and multilevel disc compression. Having pain above ankle. Foot instantly turns purple. Remedy? 1 minute later
So you are saying that if he decompresses the ankle entrapment the nerve won't heal upwards only down from the spine?
 
 
Answered by Dr. Sudhir Kumar 3 minutes later
You are 100% correct!

This is because the nerves start in the lower back and proceed downwards via the buttocks, thighs, knees, ankles and then foot. Nutrition for the nerves come from top and then goes down. Healing of the nerve also happens from top to bottom fashion.

Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by
 
Follow-up: Have chronic fibromyalgia and multilevel disc compression. Having pain above ankle. Foot instantly turns purple. Remedy? 3 minutes later
Ahhhh ok I get it now. Thank you so much for your time Dr. XXXXXXX I understand now. So I'll just have to gut out the pain until we see what happens. Again thank you and have a blessed day. Sincerely, XXXXX
 
 
Answered by Dr. Sudhir Kumar 1 minute later
Thank you and best wishes!!
Above answer was peer-reviewed by
 
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