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Back Problems Message Board


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I don't know of a way you would "know" there is no inflammation. Also the two (inflammation and nerve damage) are not an either/or thing. The inflammation may be causing nerve damage. Or the nerve may have been cut, knicked, stretched, or is just plain unhappy from being disturbed.

The EMG MAY indicate that one particular nerve is damaged, but I don't think that automatically rules out that something else may be going on, too. (such as inflammation). I think you just have to try to be patient until you get the results back from the guy who did the test, or from your surgeon if he is the one relaying the results to you. But I still do not believe those results will necessarily tell you what you want to know. Perhaps when your complaint is something as specific as drop foot, the EMG will provide more information than my limited knowledge is aware of. I hope so.

I just know in my case, the EMG showed that I had chronic radiculopathy at S1, right side worse than left. But it didn't provide any further information as to what was causing the radiculopathy, why I had such intense sciatic pain when there did not appear to be any compression on the nerve, etc.

[B]Perhaps I'm getting way ahead of myself, but If I go see the surgeon and he says time is going to tell the tale and come back to see him in 6 weeks, it's going to be tough not to feel like I'm being tossed aside as an unfortunate statistic. [/B]

You can feel this way but it wouldn't be fair to your surgeon. He'll tell you what he can...beyond that it would be like fortune telling or trying to predict the future. He won't be able to justify having you come back more often, because, other than offering you an option of PT or prescribing steroids or ESIs, there isn't anything more he can do for you.

Most people that have a more complete foot drop than you deal with it by prescribed exercises, stretching, perhaps wearing an AFO, and praying that time will heal the problem. If it appears that the damage is permanent and the nerve is not responding to treatment, they might look into tendon surgery, if the type of nerve damage supports that possible remedy. I believe it would have to be pereneal nerve damage for that to have any effect on the foot. From what you have described earlier, your situation doesn't seem to be severe enough to warrant a complex tendon surgery that might or might not "work"

Muscles do not need to atrophy while you are waiting to see if the nerve regenerates. You should be continuing to walk several times each day. Your PT should give you plenty of exercises to keep you busy, just as a one-footed calf-raise, etc. When your fusion is further along, I would think you could swim or ride a bike, etc. which would help keep the muscles exercised.

I know what you're going through is not what you'd planned on or hoped for, but tormenting yourself over what-ifs and what may happens are not helping you maintain the positive attitude you need for optimal healing. I think you'd be better off accepting this is where you are right now, and doing what you can to keep the foot stretched and active, walking as much as your surgeon suggests, keeping your food and liquid intake adequate and nutritious, and just trying to be as positive as you can muster. I realize it sounds kind of Pollyanna-ish but a positive attitude really does have an effect on healing.

[B]I see no reason that another EMG can't be done at the six week post-op mark to check for progress or an MRI be ordered to look for areas of damage. Is that being unreasonable? [/B] These things can be done if one of your doctors thinks it would reveal anything. There would be no point in repeating the EMG in six weeks...at least, I can't think what it would be. If the CT scan you had done post surgery didn't reveal anything, I doubt there would be any new information from a new MRI.

There is a new type of MRI you could have that might tell you if a nerve is damaged...it was developed by Dr. Aaron Filler, who has licensed a number of facilities around the U.S. to perform the MR neurography. But again, even if it were to reveal the exact cause of your drop foot, what could be done about it?? I think you would still end up in a waiting game.

I know you very much want some answers, and I apologize for being less than encouraging in that regard. I really hope I am completely wrong about what the EMG can reveal, and that the surgeon will be able to tell you what you want to hear when you see him. Then I will apologize again to you and learn from what you have to tell me about the whole process.

When do you see him?
Teri:

If it's not too late to give you this message, I'd love to know what I can do to prevent damage from occurring to my left foot (the infamous drop foot) while I am sleeping. From what I've read, it's easy for the toes and/or foot to begin the drooping process while we sleep. I'm willing to buy any brace or such to stop this from happening. Also, are there any exercises or other things that will help me to be ready when my foot returns to normal? My foot drop, regardless of cause, had lead to four muscles in my leg not receiving nerve signals. This is why my foot doesn't work properly and "drops". These muscles are the ones which are getting weaker and will eventually atrophy. Is there anything I can do to delay or stop this process? Finally, does foot drop get worse when caused by something that happens during surgery? This is not a progressive disease, so will my 4/5 get worse as time goes by and the unused muscles continue to atrophy? Here is how the scale works: 0=complete paralysis, 1=flicker of contraction, 2=contraction with gravity eliminated alone, 3=contraction against gravity alone, 4=contraction against gravity and some resistance, and 5=contraction against powerful resistance (normal power). If it takes a year or two to return to some type of proper function, will I find myself getting worse (maybe dropping to a 3 or 2) until the nerves reach a point where the muscles can start to recover? Apparently, this is a one-by-one muscle recovery process that is very slow. I'm going to try to track them as times goes by, but there's not been any recovery of any type yet.

Thanks, Teri!
Coincidentally, I had PT this morning, too. I talked to my therapist and he suggested several exercises, incuding a couple using the stretchy material common to such places. He gave me a good amount of the stuff, so I'll get started using it today.

I don't use a walker or a cane. I used the walker in the hospital and thought about using it at home, but didn't think I needed it at home for long. I graduated to a cane and used it for outside walking, but after a few days felt that it was making me walk funny. My back seemed to hurt more on one side, so I tried walking without it and have been moving without it ever since. It's been three weeks since I used it and tomorrow will be four weeks since my surgery. I have reasonably good results walking and tryto go four or five times a day for about 20 minutes each. I'd go longer, but the drop foot starts to really become apparent after about 15 minutes.

I get a strange feeling in the drop foot, too. It's kind of nerve pain, but not the shock-type. It's more a funnybone type of feeling that goes from my knee to my toes. It usually makes an appearance during and after exercise and subsides anywhere from a few minutes to several hours later. I'm lying in bed right now and can barely feel the sensation in my foot. Maybe that's the nerve doing something or other muscles protesting at being used in a different fashion -- I don't know.

I do feel like if I didn't have this drop foot that I could easily walk an hour, even with the feeling of numbness in all the toes, right side, and the ball of my right fiit.
The numbness also extends up the outside of my right calf. I figure it has something to do with L4 and hopefully will subside with time. It gives me balance troubles every now and then. It also drives me nuts to have anything (like a sock or sheet) touch the ends of the toes, especially when the foot is tired. I had this trouble in the big and second toe prior to surgery and had hoped for some relief, not a spreading of the problem. I suppose it's a result of the surgeon doing his work and will subside after awhile. Maybe I'll find out during my EMG results. If not, it's on my list of questions for the surgeon. I've been so concerned with the drop foot that it has garnered most of my attention. I've mentioned this numbness and parathesia to my surgeon before, but he thought it was a temporary thing. Of course, that seems to be his opinion about just about every problem I have.

I think you're absolutely right about the dorsiflexion. I have no trouble standing on tiptoe with either foot, so that's something I can easily do during the day. I don't see how it could hurt anything, either.

Speaking of hurting things, just how do you know when you've exercised enough or too much following back surgery? I think I'll start a new thread on that. Please let me know what your aunt's therapists had to say, Teri.
Unfortunately, my aunt had a different PT today. I didn't feel comfortable asking him much and I didn't trust his answers anyway...so I'm afraid I didn't learn anything useful.

One exercise he did with my aunt today which was useful is to take the theraband (that's the rubbery, stretchy stuff you were given), have your wife or someone stand on a length about 2 feet long. Face her, with you sitting on a chair. Put your foot underneath the theraband, so the band comes across the ball of your foot, and just flex your foot up and down --maybe 20 times. The bands come in different tensions...I don't know what color you were given, or if you have several, use one that isn't too hard for your foot to lift. The point of it is to increase the resistance just a bit more than normally flexing your foot.

The thing you want to be careful about is working it "enough" without causing a flare with the nerve. This can be a very fine line. If anything you're doing on your own causes more pain or numbness the following day, stop or cut back.

If you can walk OK without having to use a cane, your foot drop is not very bad. I know it isn't "normal" but I have high hopes that it will resolve in the near future. Just keep walking as you are doing. More frequent short walks are much better for your recovery than one long walk. The main idea is to keep those spinal nerves stretched out so that scar tissue doesn't have an opportunity to attach to one of them. It will also challenge the nerve that is damaged, get more freshly oxygenated blood flowing, rid the body of waste build-up, etc.

Whenever you are watching TV, lying in bed, etc. you can continue to work that dorsi-flex action. Do ankle pumps, slide the leg out so the leg is straight, and then back up so the knee is bent. cross the weak leg over the knee when sitting, and point and flex that foot, make ankle circles if you can...just anything that moves that foot. You can massage it any time...massage each toe individually and GENTLY pull it from the tip outward...so the toe is perfectly straight 9Not slightly curled under), etc.

If you have stairs, stand on the step, hang on to the railing so you don't lose your balance, and let your heels fall off the back of the step, so that you get a nice stretch in the Achilles tendon. And any time you think of it, raise up and down on tiptoe. (I guess this is called "heel raises." ) You can also try balancing on one leg for a minute with eyes open, and if you can do that, try it with eyes closed.

You can go online and find exercises for drop foot or exercises for foot drop...also look for exercises or stretches for plantar fasciitis and the ankle. Another good exercise is knee extensions. Sit on a sturdy table or desk so that your legs can dangle free. Swing your leg out from the knee until the foot is in a straight line with the knee. You can try it with the toes pointed or with the foot flexed...each exercises different muscles of the foot and ankle.

I'm sure there are more...but this should get you going.

If you can stand on tiptoe, can you walk on your heels??
I was given the yellow material. I'm finding it really hard to do the dorsiflexion exercise. I think the stuff is just too resistant, but I'm going to keep trying. I'm glad I have the summer off. I can't imagine havin g to go back to work like this. If things aren't better by the middle of August, getting my classroom ready will be an ordeal.

I can't walk on my heels at all. Well, I can walk on my right heel just fine, but the left heel is shot. I can lift my left foot that way about 1/4 inch off the ground when it's not tired. Even then, the heel is not firmly on the ground and there's no chance of even attemting to take a step. This has been unchanged since I first discovered the foot drop. I don't know what's more discouraging -- the lack of progress or the fact that my doctors had no inkling of the condition. I guess the post-op exams were less than perfect. Nevertheless, I'm going to keep up the exercises and hope for thr best. Teri, you've become an important part of my support system during this time. Thanks for doing more than you can know to help me make it through what has turned into a really depressing event. Your encouragement and positivity are greatly needed and appreciated.





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