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RSD question

Posted by elliott on 3/29/05 at 14:46 (172113)

It has been stated that having surgeries in close succession are a known cause of RSD. I was wondering: is that only of the foot, only of the same foot, only in the same place on the same foot?

So for example:

If you've had surgery on the medial side of your foot, and then soon after have surgery on the lateral side of the same foot, does that last surgery place you at a higher risk for RSD?

If yes, if you have surgery on one foot and then have surgery on the other foot, does that last surgery place you at a higher risk for RSD?

If yes, if you have, say, shoulder surgery soon after foot surgery, does that last surgery place you at a higher risk for RSD?

elliott

Re: RSD question

Geri on 3/29/05 at 18:31 (172127)

Great question Elliott!! I have wondered this myself. The only explanation I have found is 'multiple surgery's'. I never heard of this risk until this site which was after my tts. surgery. It was never diag. for me but I sure had many symptoms-mainly intense pain for so long and dark red foot if it was down at all. I hope one of the Doctors or RSD sufferers can enlighten us.

Re: RSD question

BrianG on 3/29/05 at 21:23 (172142)

Hi Elliott,

I can't answer your question, but I have read up some on RSD. One person I read about got RSD from a simple needle stick. Appaerently the needle hit a nerve in just the wrong way, and so began her life of pain. Aanother got it from a tooth being filled. And then for no apparent reason, it will travel from one extremity, to another. This is what the majority of patients end up with. The really unfortunate souls end up with full body RSD. And a few lucky people have gone into remission, but for most there is no such thing as a cure. This why the 'Coma Cure' (using Ketamine) has such wonderful potential.

BrianG

Re: RSD question

Julie on 3/30/05 at 01:14 (172149)

RSD is a systemic condition involving dysfunction of the central or peripheral nervous system. I don't believe it is limited to the area of surgery. One theory is that it may be caused by a triggering of the immune response.

Here's a link to a good description of symptoms, causes, treatment etc: http://www.ninds.nih.gov/disorders/reflex_sympathetic_dystrophy/detail_reflex_sympathetic_dystrophy.htm#What%20causes%20CRPS ?
.

Re: RSD question

elliott on 3/30/05 at 11:31 (172174)

I did a quick review of the literature on RSD/CRPS using both google and pubmed. It seems to me that it's not multiple surgeries or even ones in close succession setting it off, but rather a bad or unlucky one. The location of the surgery does play a role. The following abstract offers a very brief, but still helpful, insight into causes:

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15480404

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Re: RSD question

Julie on 3/30/05 at 14:01 (172188)

Interesting abstract, Elliott, this sentence in particular:

'The most common inciting surgical events were bunionectomy, tarsal tunnel release, and heel-spur surgery.'
.

Re: RSD question

messed up foot on 3/30/05 at 16:52 (172202)

I am 6 weeks post TTS/partial PF release (and 16 weeks post peroneal tendon repair). I have incredible ankle swelling despite a Jobst stocking so much so that it is causing my TTS scar to widen. I also have redness in my leg from toes to mid-thigh but it does resolve at times and looks normal. My surgeon said 'you don't want RSD' when I asked him about it (I guess that is a treatment?) and I most certainly do not have all of the symptoms listed in the NIH site. I have a strong aching pain but I am not sensitive to touch. In fact, I have numbness that isn't decreasing one bit. Considering that I've had a lot of ankle/foot trauma, I don't know how much of this is normal. Any ideas? I could do without the swelling and the advice of 'elevate your foot' just isn't always possible especially at work. The board of directors wouldn't find it at all amusing if I put my camcast up on their fancy oak table!

Re: RSD question

Dr. Z on 3/30/05 at 19:20 (172218)

I agree. You need to add neuroma.

Re: RSD question

Ed Davis. DPM on 4/03/05 at 11:06 (172487)

Julie and Elliott:
Some beleive that the proximity of the surgery to a sympathetic nerve trunk would be a factor but if bunionectomy is high on the list, that throws that theory out...
Ed

Re: RSD question

Ed Davis. DPM on 4/03/05 at 11:11 (172489)

It is important ot take action on RSD quickly. Considering what you have stated, if you were my patient, I would probably be moving toward starting empirical treatment of TTS NOW.
Ed

Re: RSD question

elliott on 4/08/05 at 08:55 (172823)

Dr. Ed, the dorsal cutaneous nerve can be deleteriously affected during bunion surgery; see the section titled 'How to Safeguard Against Incision Complications' in the article below:

http://www.podiatrytoday.com/podtd/displayArticleaa.cfm?articleID=article1854

So the proximity of the surgery to a sympathetic nerve trunk being a factor may well be a very valid theory.

elliott