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Thursday, January 15, 2015

Foot Nerve Pain: Email Advice regarding origin from back

Hi there Dr Blake, 

    I have watched your 'Foot nerve pain -can it come from your back?' video about 100 times !! Thank you for sharing it - it is very useful. I am writing because I would be extremely grateful for your advice. 

    ​ I have had severe, non stop excruciating, burning pain in my right foot ( sole and arch - but mainly sole and more recently on front of ankle) for 8 months.. I have no back pain or leg pain - just the foot. It is really getting me down, curtailing my work, making me grumpy etc.. There is no structural problem with the foot (numerous MRIs are all clear) but a lumbar MRI shows a disc herniation at L5/S1 level. I have tried nerve blocks into the nerve which relieved the pain for a couple of hours but then it came back. The physician said the fact that the pain went away, albeit briefly, is is a strong indicator that the origin of the pain is in my back  But the surgeon hesitates to do a microdisctectomy as says he cannot guarantee that the herniation is the cause as I have no other radicular pain and no neuropathic symptoms ( numbness, problem with movement etc) . He basically said he can offer a 70% chance of the MD fixing it as opposed to 95% ( that is a BIG) difference .. It could also make it worse esp as I have a small scoliosis at the top which may be disturbed ... What to do ? I am going to see him again tomorrow . What questions should I ask ? I cannot bear the pain ( and cannot take meds as feel too spacey) . The surgeon is one of the best in the UK so he knows what he is talking about. In my (unprofessional view) as all possibilities of a mechanical problem in the foot have been excluded, it seems a logical option that the pain is emanating from the spine. Is it possible to have foot pain (and JUST foot pain) with no other symptoms in back, down leg etc ?? I would sooo appreciate your opinion on this. 

Thank you so much for your time - i really appreciate it.
Very best wishes,

Dr Blake's response:

     Thank you so very much for the email. Definitely I see so many patients with only pain at the end of the nerve, and nothing in the back, and no classic sciatica radiation. The art of all this. One of my friends came in 5 years ago for excruciating pain from an ingrown toenail. The problem was when I examined him he had no ingrown toenail. I told him it was probably a bulging disc. He said he had no back pain, and he definitely had a negative straight leg test. The back doctor reluctantly agreed to a lumbar MRI, not sure if the back was involved. The patient called me after the MRI stating that I had been wrong (a guy thing!!). He said that he did not have a bulging disc as I had thought, but his foot pain was caused by Stage 4 Prostate Cancer with impingement on the nerves in the low back. He has done great, and I am happy to have been part of his cure. It is one of the best examples I have on back problems causing only foot pain and nothing else. 
     It is all about nerve irritation coming from somewhere (even the neck primarily)  to hit those nerves. And, it could be "double crush", so I am glad you are ruling out the foot part. Unfortunately, you probably have no choice but to work on the low back (surgically or conservatively). Many disc herniations do not need surgery. Mine did not, but I spent 8 months in PT getting stronger, more flexible, and calming the nervous system down. My symptoms were L2/L3 in the thigh above the knee. But, they sound like yours. I was blessed that I did not have to walk on the pain, but I joked that I wanted to be the podiatrist for a nudist colony since the pants leg would hit the front of my leg and send level 10 pain. What joy!! And, I never had back pain. 
    When you get neuropathic symptoms, it is 1/3rd of the time only numbness/tingling, 1/3rd of the time only pain (you I think!!), and 1/3rd of the time a combination of numbness and pain. 
    I wish I could tell you how to proceed, but my gut level is you have to address the back. The neuropathic pain you are dealing with unfortunately can be a devil to turn off, even if the disc herniation is surgically treated or resolves on its own. I am assuming you are doing neural flossing, applying compounding creams three times daily or Neuro-eze, oral medications like Lyrica or Neurontin at least in the evening (as soon as you get home for good), warm compresses should be used, and a good low back treatment including postural dos and donots that they teach in every low back class. Bend those knees, etc. Look into Calmare pain therapy if it is offered in the UK for the peripheral nerve part. Ice your low back 3 times daily minimum for 30 minutes. The epidural you had gets at the inflammatory part of the herniated disc, but most of your pain is neuropathic. A sympathetic block may be very important combined with epidural. For sympathetic blocks, they need to hit 3 ganglions/levels for the best results.
     I sure hope this helps you somewhat. Greetings from across the pond. Rich


  1. Thank you for the excellent post Dr. Blake. I am having foot pain only. It's from higher up. I feel it in my buttock too and some faint pain sometimes in my leg. I have a clean back MRI, though. Is it possible the L5 nerve impingement causing foot pain can be found in the hip/glute muscles instead?

    1. For sure, you should read about piriformis syndrome, but the sciatic nerve can also get hanged up in the hamstrings or behind the knee. Rich


Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.