Question: Hi - I have just had steroid facet joint injections 1 week ago. I am distressed and worried, since the numbness on my top R foot and lateral lower R leg, were numb following my fusion/decompression surgery 3 yrs ago. This is permanent, and I have had to live with this side effect, along with a weakened ankle.
Following the surgery, by some 36 hrs, the tightening/numbness top of R foot, has sinificantly worsened, and now my toes are also numb. The ankle, on walking, is now even more unstable and gives way (6 times on 5 min walk, on level ground). Have used the same boots to walk in safely, over the last 3 months, but the ankle was stable, only weakened if I wore the wrong footwear.

Is this ? permanent side effect, a result of the steroid facet joint injcetions? If so, what can i do other than try to strengthen the ankle with exercises at home? The initial numbness and weakness has never resolved from the post operative complication. I am insulin dependent diabetic (50 yrs). I can ill afford to suffer more numb damage. I do have minimal peripheral neuropathy, but I had a normal ankle strength & good sensation, before the surgery.

I am now very worried at this horrible increased tightening, muscle spasm, and weakness in my R foot/ankle. I am afraid that the surgeon who administered the steroid injections, may not wish to conclude/admit that there is any connection between the procedure and this recent complication. Even though this damage may be permanent (as was my initial numbness/weak ankle, following surgery 3 yrs ago), I really need to know, if possible, the likely cause of my increased disability.
error - beginning of my 2nd paragraph : SHOULD READ "36 hours POST FACET JOINT INJECTIONS on 9 Feb 2013", rather than 'following my initial fusion surgery L 4/5 + decompression (Jan 2010)

Please can you help?
Many thanks
XXXXXXX

Thank you Dr Chaudhari
In answer to your queries:

No, I was not conscious for the facet joint procedure
yes, it was at same level L4/5. I have facet joint degeneration, I believe the steroid injections will just reduce some of the inflammation within.

The surgeon injected only HALF dose of steroids to 3 injection sites, since I suffer really bad facial flushing, with headache, which lasts up to 4/5 days. My blood glucose levels increase, 24 hrs post steroids, to between 18-28 mmol/L! I know what to do, and I inject multiple doses of Novorapid insulin, but with little effect. The blood glucose levels do return to 'normal'. after 6-7 days.

If as you say, any root canal damage post facet joint injections would last only 36 hrs to a few days, WHY WOULD i STILL BE HAVING THIS INCREASED NUMBNESS & ANKLE WEAKNESS AFETR 10 DAYS NOW? These symptoms were only felt 36 hrs post facet joint injections, and felt initially as foot 'muscle tightening', as the increased numbness set in. This now reaches my toes, whereas prior to the injections 10 days ago, the numbness was just the central TOP of R foot.

My last query is that I had a nasty FALL 2 days after the injections (tripped over some crates left in the wrong place at work)!!

COULD THE FALL BE THE CAUSE OF THIS ROOT NERVE DAMAGE, or is this very unlikely?

I would be very grateful for your opinion, since I may wish to pursue a claim against my work, IF this is a likely cause of my increased foot/ankle numbness & ankle weakness now? If it is NOT, then I would not pursue any claim.

I am as you suggest, doing some simple ankle strengthening exercises at home, but with little, if any real benefit. Electromyostimulation may not be an option for me, if this is not avaialble on the NHS

Many thanks again XXXXXXX

Thank you very much, Dr Chaudhari. Very helpful to read your opinion...I did not damage the R ankle when I fell. However, the ankle did feel stiff and slightly tender on rotation, in the days that followed the injection's, after the numbness set in. Toes are now numb, whereas before they were NOT.

The post surgery root nerve damage (2010) was most likely due to the R metal screw was placed very close to the spinal column (as apposed to the L screw, which was a good safe distance away). This was shown up on CT scan, 3 weeks post surgery. This resulting numbness and ankle weakness has not changed over the 3 years post op, but with the right (limited)footwear, I was stable, even on uneven ground.

With the increase in numbness now, along with worsened ankle strength, will obviously cause me greater disability.

Just to inform you, I did gat a call this morning from the spinal nurse practitioner, to say that she willl be organising for me to have repeat MRI scan + X rays, possibly next week. I will then be informed of these results by phone, or consultation.

I am still much afraid that this damage is now permanent, (just as it was post surgery 3 yrs ago). However, I am really trying to exercise the ankle area, as you suggested.

I may not be entitiled to any further communication from yourself, with my particuler payment plan?

I would like to update you with results of scans etc, IF YOU WOUL LIKE TO BE INFORMED? You have been very helpful and informative, over a rather complicated senario!

With many thanks, as before XXXXXXX

ps I am a health professional myself, having worked mainly in Primary Care, but also with cancer services(upper GI/Specialist Nurse).