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The response to the question below was authored by Marc Mitnick DPM

sciatica and swollen toes

by Michael
(Milwaukee WI)

I have had three back surgeries in the last 18months. Both anterior and posterior, l4-l5 initially and l3-l4 7 months ago. In the last 6 months I have had severe pain down radiating down my right leg and into my foot. I had this same problem on and off in between the 2nd and 3rd surgery. I recently had an mri to check l5-s1 and I am told that that disc looks fine. In the last few days, the pain in my foot is so severe that I can not walk on it. An x-ray was taken to rule out a foot injury. I was put on lyrica a week ago. Now, my middle three toes are swollen and painful. Could this be from the scar tissue from the surgeries. Any ideas what to do? I am 40 years old and cannot believe that I am still not better and actually worsening. I have been to orthopedic doctors and the last surgery was done by a neurosurgeon. Also, I do have a tear in my SI joint from the initially injury that started all of this. ( I was on my stomach pulling a heavy pump from a tank that slipped and I caught it)

Thanks for your help

RESPONSE

Hi Michael,

The assumption would be that you are having foot problems as a result of your back problems and subsequent surgery, as there is no history of injury to your foot per se.
The radiating pain down your leg into your foot appears to be sciatica and I would have to assume the pain is a result of the surgery. This happens

quite frequently from the standpoint that I see a lot of patients with foot issues after having back surgery, or for that matter patients who have back issues without having had any surgery.
What happens is nerves that are coming out of the spinal canal are being irritated and this irritation causes the symptoms that you are experiencing.
I certainly cannot speak on the actual surgery itself as I do not treat backs, nor do I operate on them.
There may be scar tissue or even just inflammation from the surgery itself that is causing your symptoms.
I would be curious to know if you had any physical therapy after the surgery and whether or not the Lyrica is helping you.
Speak to your doctors about the possibility of having physical therapy as this can be very beneficial in reducing the sciatica pain as well as reducing some of the scarring (if that is an issue), as well as some of the inflammation that may be present.
Lyrica is not a drug that you want to stay on indefinately so anything else you can do to relieve the pain would be helpful.
The thing about repeated surgeries in the same area of the body whether it is your back or your foot is that after each surgery there is some scarring as this is how the body heals itself, so having additional surgeries in the same area is not always the answer. Speak to your doctors about alternatives that may be available to you in an effort to relieve your back issues and the problems they are causing with your feet.

Marc Mitnick DPM
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Feb 16, 2012
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Response to swollen toes
by: Michael Johnson

Thank you for your response. Yes I am in physical therapy several times a week. I have been on several "nerve" medications, but non have helped. Looking at the ends of my toes, they look frost bitten, but of course they are not. They are swollen and spots of red on them giving them an appearance of being frost bitten. Do you think I should see a foot doctor or return to the neurosurgeon. I keep bouncing back and forth from doctor to physical therapy to mri to x-ray. I am getting worse not better and the pain in my leg and foot is becoming increasingly worse.

RESPONSE

Hi Michael,

I would recommend you have the foot evaluated by a podiatrist, particularly those swollen discolored toes.
I do not know what kind of climate you live in, but if it is a cold damp climate, there is certainly the possibility of a superficial frostbite but of course without actually examining you, I am only guessing.
The sciatica you seem to be experiencing will of course have to be treated by the neurosurgeon.

Marc Mitnick DPM
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Columbia University Department of Rehabilitation

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Illinois Bone and Joint Institute

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American Family Physician

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