Tarsal Tunnel Syndrome as source of RSD after Brostrom?

On Dec 22, I had OCD lesion of talus repaired with microfracture, ATFL Brostrom and peroneal tendons synovectomies/debridement from a fall in Feb 2010. Was plaster splinted after surgery and nwb with crutches. Also, left the hospital (outpatient) with two indwelling catheters for nerve blocks (saphenous & popliteal). First 3 days were easy. When medicine for catheters ran out, life became not so fun to say the least. Immediately fell too much electricity, tingling, incision site was horrible. Returned in two weeks (minus 2 days bc I was going crazy) and md wanted to cast me but I high objected and promised to wear boot as if it were a cast x 4 weeks, was told not to invert or evert ankle at all. I obeyed orders. Same symptoms, numbness, tingling, fire, incision horribly painful,etc. Feb 1st , 2011 got boot off and permission to begin PT. At that MD appt, I told him all 5 of my toes were numb, ball of foot was numb. I had no ROM bc I had been in a boot. He said it would all be better and in 8 weeks(where we are now) I would be healed....NOT.... Since then, I have been dx with CRPS, not by him bc I can't even get an appt with him until I recently raised a big ruckus. Will see him this Thursday.

Have been reading a lot. how likely is it that the ATFL repair was an "over-correction" and now the source of CRPS is actually Tarsal Tunnel? I have a positive Tinsel sign. I have watched my foot many timesgo from normal appearance to bright red and it starts at the incision (lateral ankle), then my pinky toe goes red, then ball of foot, then toes then entire foot. There is no doubt I have nerve damage....I am wondering where the nerve damage originates. I am lucky that my foot is only red for 4-6 hrs per day but it happens every night. A physiatrist put me on topamax, cymbalta, zanaflex, lidoderm patches or cream.
Whatever is going on, I definitely DID NOT have this prior to surgery. It is horrible. Any advice would be appreciated. Thanks.
Or any questions to ask MD on Thursday would be appreciated (actually appt is with his PA and if I am lucky I will be able to get the doctor in the room with me.) Current complaint is burning pain ball of foot, all 5 toes are numb with 4th and 5th toes being the most numb,yes they can still burn with electricity. Scar still burns, then entire foot will feel like someone turned on a light switch at night!

Hi,
Thank you for submitting your case. I am responding without actually having the opportunity to examine you (obviously). Based on your photos and your history RSD seems a likely diagnosis. This problem can come about from injury and surgery is considered a physician induced "injury" as the surgical site is traumatized. Additionally wearing a cast or other form of immobilization can also exacerbate the condition particularly if the cast is too tight.
Once the diagnosis is made, aggressive therapy and treatment is mandatory as this condition can become a downward spiral and continue to worsen.
I do not have any questions for you to ask your surgeon but I do have one you need to ask your physiatrist, and that is how much experience has he or she had treating RSD?
This problem needs to be treated by someone who is experienced, otherwise in many cases the condition ends up being under treated and no improvement is noted.
You do not mention having any physical therapy. This is generally a necessary part of the healing process as well as the oral medications you are presently taking. (for this you would have to ask your surgeon if your foot is ready).
I do not believe that your foot looks and feel the way it does due to tarsal tunnel syndrome. Tarsal tunnel will not cause the vascular discoloration that you exhibit. It is not to say that you do not have some tarsal tunnel symptoms but I do not think that is your main problem.
Because of the potential damage RSD can cause, do not be afraid to get a second or even third opinion in order to get the most aggressive therapy possible.
Good luck.
Marc Mitnick DPM

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