Nerve damage, operative side to foot and to opposite leg

[Glen O]

Hello,

I am a 55 year old male, five days short of 3 months post op with a BHR right hip, Dr. Paul Dicesare with UC Davis Medical Group did the surgery. Dr. Dicesare is the head of Adult Orthopedics and one of the docs who pushed for FDA approval of resurfacing in the USA. I have had no hip pain at all since the surgery. Muscle pain and pain from swelling around the hip have diminished dramatically to almost non-existent. Recovery thus far allows me to walk several miles at a time, sit and stand for long periods w/o pain, lift heavy weight, carry heavy items, drive (which was the worst at first) moderate distances, motorcycle, even put on my pants, socks, shoes, etc. w/o pain... BUT I have a drop foot on the operative hip side and my opposite leg is numb on the front of my thigh from the knee cap to my pocket area, 3-4 inches wide all the way up.

I've read all the nerve damage postings I could find and most of the replies seem to say that time will improve the nerve damage.

The nerve damage on my operative side seems to have impacted the L5 Peroneal nerve (according to my chiropractor friend Jim). This nerve controls rotation of the foot outward and up from a 90 degree sitting position. Associated with this nerve issue is a complete atrophy of my shin muscle. Put together, when the heel hits the ground while taking a step, the ankle should begin to flex to less than 90 degrees with forward momentum, then roll onto the ball in a smooth, fluid motion. For me after the heel touches the ground my foot flops down causing a funny 'slap' sound and what looks like a limp. From what I've read about 'drop foot', my condition is more like 'slap foot'. I have some control of my ankle.

The numbness in my foot (behind my toes) from nerve damage and the numbness in my thigh on the other leg have not changed at all since the day after surgery. There is no pain associated with this and there has been no improvement either.

The operation has been no less than miraculous; eliminating all pain, and increasing my ROM. The slap foot changes all hope of my returning to racquetball/handball, backpacking in the Sierras, and the other activities I love.  

Will I have any indication that nerves are regenerating? Am I naive to think the nerves can regenerate? Is there anything I can do to stimulate nerve growth? How long might it take?

I would appreciate hearing from anyone who has experienced similar conditions and recovered from them. Thanks for reading and for responding.

I am very pleased with this procedure, I have no regrets at all for having the operation but I do hope for a full recovery.


Glen

[Ipock]

Glen,

Had a car accident and got Drop foot, have had it for 18 months now.  Slap foot is an indication for drop foot, the "test" you could say for foot drop is to walk on your heels, and you will find that near impossbile if you have drop foot.  As for nerve regeneration, they do grow back depending on the injury, there are compressions, nicks to the nerve, full seperation, injury to the nerve root, all different types of damage.  Nerves regenrate at an average of 1 cm a month so i've been told.  If you can press your foot down continue to strech it against stairs, standing calf raise, and strech the foot towards you with you leg staight and bent, keep as much possible range of motion in your ankle, it is real important.  You should consider sleeping in a night splint so your foot doesn't hang in that limp position and over time your achilles will tighten(shrink).  You should look at getting an AFO, which are various splints you can wear in your shoes to keep your foot up in the swing phase of the walk.  You can get one custom made, which are the best for maintaining proper foot mechanics(reduces pronation supination?)  I would find a prostetist for that, they might be expensive but worth it, after having worn several different types, custom made is the best.  The window for nerve regeneration is 12-15 months, and after that there will be no functional return.  Get a brace, and you will really increase your range of travel without having to walk funny and compensate.  You can have an EMG test from a physical medicine doctor where they stick neddles in you and shock you on the nerve paths to determine regeneration.  As for the thigh, i would as a doctor about femoral nerve damage on your other leg, that is a similar location for it, but what you descripe for the other leg is peroneal damage.  I am not a doctor but have been living and researching my conditions for coming on 2 years now.  I know guys at the hospital where sometimes it just comes back, keep a positive outlook thats always best.  brian

[Sam]

Dear Glen,
My wife had a BHR just over 3 years ago.  Immediately after the operation she had little movement in her toes.  The hip like yours has been very good, no pain and it has improved that side of her life.  But the nerve to her foot has not fully recovered yet.  It is a lot better that it was.  She had decided before the operation that she was probably be cautious and not run again, but we are keen walkers.  The foot has recovered enough that we have been to the Alps for the past two summers, and last summer ascended the Stralhorn at 4000m and the Ulrichshorn at 3940m.  The main problem is that she has not got the strength in her foot to stop it rolling sideways, so we have to tape it beforehand to stop her pulling the ligaments in her ankle.  Her problem has been compounded by also having RSD, reflex sympathetic dystrophy, as well as the damage to the sciatic nerve.  This caused her incredible pain for the first 12 months and she still has sensations from it.  The physio that she is going to at the moment has said not to give up on the nerve regenerating for at least 5 years.
She had certain sensations which she thought could be the nerve regenerating.  She also tried mirror therapy as used by stroke victims to try and stimulate nerve growth. You just have to continue to be positive and keep up the exercise, nerves can regenerate but it is slow and depends on the original damage.

[Debbie]

I am so glad you posted.  I had not heard of anyone else having nerve issues after surgery, and my doctor has never experienced it.  Several specialists at UC San Diego looked at me while I was in the hospital and none of them can tell exactly what happened.  My operated side was totally numb from my groin to several inches below my knee right when I woke up.  Their best guess was that I had pinched a nerve when they dislocated the hip.  Luckily, my feeling is coming back (slowly but surely).  I was told that it should come back a millimeter or so a day.  It is now only numb from about six inches above my knee to a little below my knee and my surgery was 6/5/09.  Just when I fear that it is not getting any better I get a tingling and notice improvement a week or so later. 
I hope your nerves are at work and you will notice more improvement of your own soon.  The pace feels glacial at times, but hang in there.

[EastOrlandoHippy]

Not sure if you are still around or what your result is, but I just had resurfacing done about 4 weeks ago and my symptoms -- on the opposite leg from the surgery -- are almost identical to yours.  How are you doing these days?  Did anything every change?

[badbone]

Sorry to hear of your numbness.
I have not had resurfacing yet, but I will tell you that I did suffer from those same symptoms.
Tingling, numbness  (couldn't stand for more than 10 seconds).  Sever pain in the buttocks, knee and all the way down to my toes.  Like a blow torch was directly on my foot.

The cause was a herniated disc (11mm herniation) at the L5/S1 junction.
The herniated disc was pressing on those two nerve roots.  The pain was debilitating.
Had a microdisectomy and it was gone the next day.  Getting old, isn't it fun??

Not sure why you have this pain now, unless the surgery:

1) Traction during your surgery affected your discs

2) Sitting for long periods of time while put pressure on your L5/S1

Please keep us posted.