Bottom Line – for podiatric patients who fall into any of the categories listed above, the most likely cause of the pain is a difficult or unrecognized peripheral nerve problem. Rather than banishing these patients to the pain management realm, a referral for a comprehensive peripheral nerve evaluation will usually result in a definitive diagnosis and surgical plan that eliminates the pain rather than consigning the patient to a lifetime of narcotic use.
Peripheral nerves live in close association with bones, ligaments, tendons, and muscles. The trauma which produces injury to these types of structures and the surgery necessary to repair it carry with them a high risk of concomitant injury to peripheral nerves. The overriding feature of peripheral nerve damage is severe, unrelenting pain. Due to a general lack of experience and detailed knowledge of peripheral nerve anatomy, most lower extremity surgeons do not feel comfortable diagnosing or treating complex peripheral nerve problems. Incorrect diagnoses or poor surgical planning or execution can lead to failure or even make the original problem significantly worse. In some cases, symptoms in the lower leg and foot may be due in whole or in part to peripheral nerve lesions which are located more proximal than podiatrists typically operate.