Nerve Decompression Frequent Questions

Baltimore Peripheral Nerve Surgeon Dr. Eric H. Williams Shares How Nerve Compression Can Be Mistaken for Plantar Fasciitis

If you’ve been treated for plantar fasciitis for six months or more and are still struggling with chronic heel pain, it’s time to look for an alternative diagnosis. You may be suffering from Baxter’s nerve entrapment or tarsal tunnel syndrome. If so, Baltimore peripheral nerve surgeon Dr. Eric H. Williams can surgically decompress the pinched nerves in your foot to relieve your pain. 

How Nerve Compression Can Be Mistaken for Plantar Fasciitis 

Baxter’s nerve entrapment and tarsal tunnel syndrome are two types of compression neuropathy that share symptoms with plantar fasciitis. Understanding how these conditions differ is crucial to finding a solution for your chronic heel pain. 

Plantar fasciitis involves inflammation of the plantar fascia, a thick band of tissue that runs across the bottom of the foot and connects the heel bone to the toes. The primary symptom is pain in the heel, especially with your first steps in the morning or after you have been sitting for a long time. 

Baxter's nerve entrapment, also known as Baxter’s nerve compression, Baxter’s neuropathy, or inferior calcaneal nerve entrapment, involves the entrapment or compression of the first branch of the lateral plantar nerve (the inferior calcaneal nerve or Baxter's nerve). It can cause severe refractory heel pain similar to plantar fasciitis, but the pain is typically more localized around the inside of the heel and may involve numbness or tingling. In addition, if severe, the patient may notice that they can not spread or fan out their fifth toe.  

Tarsal tunnel syndrome occurs when the posterior tibial nerve and its branches become compressed or irritated. It is sometimes known as posterior tibial neuralgia or compression of the posterior tibial nerve. The pain associated with tarsal tunnel syndrome is typically located along the inside of the ankle and the bottom of the foot.  Because the tibial nerve is upstream of Baxter’s nerve, compression of the tibial nerve is likely to present with more symptoms than just the localized heel pain. It can affect all of the branches of the nerves that travel to the sole of the foot, not just the calcaneal nerves. This means that the medial plantar and lateral plantar nerves are often compressed, which is why tarsal tunnel syndrome most often causes numbness, tingling, buzzing, burning, and painful sensations to the sole of the foot from the arch to the toes. In some isolated cases, it may only affect the inside half of the sole of the foot or the outside half of the sole of the foot.   

Distinguishing between nerve compression and plantar fasciitis can be complicated due to the overlap in symptoms, so don’t be afraid to seek a second opinion if your plantar fasciitis treatment isn’t producing the desired result after six months. You may have been misdiagnosed or discover that you’re suffering from both plantar fasciitis and compression neuropathy. Because plantar fasciitis is so common, and most podiatrists and foot and ankle teams treat this so often, it is easy to fall through the cracks if your “heel pain” is not improving over time with treatment. Don’t be afraid to ask about these other possible diagnoses. 

Symptoms of a Pinched Nerve in the Foot

The symptoms of a pinched nerve in the foot can include: 

• Heel pain. The pain is often described as a sharp, shooting, or burning sensation.  
• Pain that worsens with activity. Pain from nerve compression typically increases with activities such as standing, walking, or running and may improve with rest. However, unlike plantar fasciitis, the pain may not be as severe in the morning or after long periods of inactivity.
• Tingling or numbness. There might be tingling, burning, or numbness in the area of the heel or along the path of the nerve.  It is very important to know that plantar fasciitis alone does not cause a change in sensation.  It is the nerve that is being pinched that causes the buzzing and tingling sensations.  
• Radiating pain. The pain might radiate from the heel into the arch of the foot or towards the toes, following the path of the compressed nerve.
• Weakness in the foot muscles. This is an important clue that your heel pain is NOT just plantar fasciitis. If you can not spread all of your toes apart on the foot that is hurting (especially your fifth toe), but you can on the normal foot – your heel pain almost for sure involves a nerve as well.  All of the muscle weakness in the bottom of the foot itself is innervated by the affected tibial nerve and its branches.  Patients with severe nerve compression may have atrophy or wasting away of these muscles that may also cause clawing of the toes.    

Checking for a Positive Tinel Sign to Determine if Nerve Compression Might Be the Cause of Your Heel Pain

If your plantar fasciitis treatment doesn’t seem to be working, one step in determining if nerve compression might be the culprit is to look for a positive Tinel sign. The Tinel sign is a clinical diagnostic technique used in the evaluation of peripheral nerve injuries and entrapment syndromes. The test is named after Jules Tinel, a French neurologist who first described it.

Here’s how to check for a positive Tinel sign from the comfort of your own home:

1. Get comfortable. Sit in a chair where you can easily reach your foot. Ensure your foot is relaxed and in a neutral position, resting on a stool or the floor.
2. Identify the area you want to test. Focus on the inside of your ankle and heel, just behind the ankle bone. This is where the nerve likely to be compressed is located within the tarsal tunnel.
3. Using the tip of your finger, gently tap over this area. The tapping should be firm but not too hard. Think of it as tapping on a door to get someone’s attention. (We are not talking about your teenage children or someone with headphones on here; we are talking about tapping enough force to make a light “thumping noise.”)
4. Pay attention to any sensations you feel as you tap. A positive Tinel sign is indicated by a tingling sensation or a feeling similar to a mild electric shock that radiates from the tapping site. This is often described as a "pins and needles" sensation or a sensation just like a “funny bone.”  The only problem is that it is rarely very funny.  Sometimes, it can be downright uncomfortable.   
5. Test both feet. It's a good idea to do this test on both feet, even if one foot is not bothering you. This can help you understand if the sensation is normal for you.
6. Note your findings. Was there tingling, numbness, or no reaction at all? Was there a difference between both feet? Was there significant pain and soreness but no tingling?  Did it feel “different” in any way from the other side? This information can help your doctor make an accurate diagnosis.

We also have a video on our website that demonstrates the steps to look for a Tinel sign. 

If you have a positive Tinel sign, this is a strong indication you may be suffering from nerve compression. However, if you can’t find a positive sign and you have symptoms that could indicate nerve compression, you should still schedule an appointment. Dr. Williams may be able to find a positive sign while performing the test in his office, as he has checked for this sign in many patients. Dr. Williams may also recommend additional diagnostic tests, including EMG nerve conduction studies or imaging tests like an MRI, to confirm the diagnosis and the exact location of the nerve entrapment.

How Nerve Decompression Surgery Can Put a Stop to Your Heel Pain

Nerve decompression surgery relieves the pressure or compression on a pinched nerve in your foot. Dr. Williams will make an incision near the heel, often on the side of the foot, to access the area where the affected nerve is located. Then, he’ll carefully release any structures compressing it. This may involve removing or cutting through tight ligaments or fibrous bands that are pressing on the nerve. After the nerve is decompressed, the incision is closed with sutures.

After surgery, you’ll need to limit your walking and weight bearing on the affected foot by using crutches. Physical therapy may be recommended to restore strength and flexibility, but many do not need extra therapy.  How much time you’ll need to take off work will depend on your specific work duties.

Individual results can vary, but you should see an immediate reduction in pain that continues as your body heals from the procedure. For example:

• Before seeing Dr. Williams, one patient had numbness, pain, and burning in her foot for more than one year. Three months out from a left-side tarsal tunnel release with decompression of the medial plantar, lateral plantar, and calcaneal nerves with a simultaneous plantar fascia release and lengthening of her gastrocnemius muscle, she reported a 90% to 95% decrease in pain. She was able to walk, stand, and exercise once more. 
• One patient suffered for more than 18 months with unsuccessful yet aggressive therapy for her suspected plantar fasciitis. Her referring podiatrist suspected tarsal tunnel syndrome with compression of the calcaneal nerve and plantar nerves. Six to seven weeks after nerve decompression surgery with Dr. Williams, she was completely pain-free.
• One patient had severe refractory heel pain and numbness in the foot accompanied by a loss of the ability to spread or fan out his toes. Treatment of the plantar fascia alone did not relieve his symptoms, but decompression of the tibial nerve, the lateral plantar, medial plantar, and calcaneal nerves resulted in complete resolution of the tingling, numbness, and burning pain in his foot, as well as the ability to once again move his toes.

If you are a candidate for nerve decompression surgery, Dr. Williams will answer any questions you have about the procedure and what to expect during the recovery process. You can learn more about the results he has been able to achieve with his patients on the testimonials section of our website.

Diabetic peripheral neuropathy (DPN) is a type of nerve damage that affects the extremities in people with diabetes. It is caused by high blood sugar levels that damage the nerves over time. The condition can affect people in different ways but is often described as: 

• Tingling in the feet and hands
• Intense burning
• Severe pins and needles
• Feeling like your feet are covered in ants
• Feeling like you’re walking on barbed wire
• An overall feeling of numbness that makes it hard to keep your balance

Until recently, it was felt that DPN was an incurable disease that was irreversible and would progressively worsen over time. Treatments typically focus on managing symptoms and preventing further damage. This often includes diet, exercise, and medication. We agree with aggressive control of blood sugar levels as the mainstay of trying to slow or halt the progression of symptoms. We are also thankful that there are some medications that can improve painful symptoms of neuropathy symptoms, but treatment doesn’t need to stop here. 

Over the past 15 years, there has been a growing level of evidence from different physicians and countries that surgical decompression of the affected nerves can have a profound effect on the health of the nerves badly affected by changes associated with DPN. It has been shown that diabetes causes sugar to move into the nerves itself. This sugar then can not get out and it brings water with it. Imagine how your fingers swell after eating a bunch of salty food.  How hard is it to get a ring off the finger? Why is that? Well, the finger swells but the ring around it does not change size. This is exactly what happens when the nerve swells, but the tunnel that the nerve travels through does not get bigger. The blood supply to the nerve gets cut off.  

It is not rocket science to determine what can happen next. Less blood flow equals less function.   Nerves start dying. When nerves start dying, they start talking to you to let you know it—they burn, they tingle, they send shocks, they lose feeling, and the muscles stop working.  

There are entire textbooks on all the other changes that occur in a nerve due to diabetes. Surgeons are not able to help many changes that can occur, but the work done by Dr. Dellon and others in the past 15 years has reinforced the idea that many of the symptoms that well-controlled diabetic patients complain about can improve by taking pressure off the nerves as they travel through tight tunnels in the hands and feet. Therefore, if your blood sugar is stable, nerve decompression surgery may be a part of your recommended treatment plan. 

Although surgery can’t completely reverse the nerve damage caused by DPN, it can help to alleviate pain and improve function in your feet and hands. Allowing the nerve to recover significantly can lead to improved sensation, better balance, prevention of ulcers, and less pain.   

Now these procedures are not a panacea, and they are not a “get out of jail free” card.  If a patient allows their diabetes to spiral out of control, if a patient chooses to continue to smoke after it has been recommended to stop, or if a patient fails to take their health seriously, these procedures will have a high failure rate.   

Remember, the surgery addresses one problem of the entire complex picture of DPN: we focus on the swollen nerve in the tight tunnel. We also know that the longer the nerve has been affected and the more severe the disease has been, the less likely it becomes that the surgery will work—as the nerves have just been injured too long. It is hard to bring a nerve back from the dead. However, we can help a nerve that is dying if we get there soon enough.

If you’ve been unable to enjoy your favorite activities and spend time with loved ones because of pain from diabetic peripheral neuropathy, contact our office to see if nerve decompression might be an appropriate treatment option. Since 2007, Dr. Eric H. Williams has focused his medical practice on the surgical care and rehabilitation of lower extremity and upper extremity complex peripheral nerve syndromes, emphasizing nerve injury, entrapment, and diabetic peripheral neuropathy.  

How Does Nerve Decompression Surgery Help Diabetic Neuropathy?

Nerve decompression surgery may be used to treat the symptoms of diabetic neuropathy by relieving pressure on compressed nerves in the extremities. This pressure can be caused by a variety of factors, such as swelling of the nerve in a very tight tunnel, scar tissue, or trauma.

The goal of nerve decompression surgery is to identify and release the compressed nerve or nerves, allowing them to function normally again. This may involve making incisions in the affected area to access the nerve or nerves, followed by the removal of any sources of pressure or irritation, including tight fibrous tissue, and in some cases extra muscles. 

After nerve decompression surgery, you will likely need to limit your activity and wear a protective device or dressing to help protect the surgical site as it heals. Your surgeon may also recommend physical therapy or other rehabilitation exercises to help restore normal function to the affected nerve.

Research has shown that nerve decompression surgery can effectively reduce pain and improve sensation in people with symptoms from diabetic neuropathy, particularly in those with compression of the tibial or common peroneal and lateral femoral cutaneous nerves in the legs and the median and ulnar nerves in the legs or arms. 

However, not all cases of diabetic neuropathy can be improved with nerve decompression, and the effectiveness of nerve decompression surgery may vary depending on the individual case. 

Our Results Speak for Themselves

Our Baltimore surgical practice provides comprehensive care for those who suffer from peripheral nerve injuries, entrapments, and chronic pain or dysfunction. This includes people with nerve pain related to diabetic peripheral neuropathy. If you’d like to learn more about how we’ve helped others like you alleviate the painful symptoms of diabetic neuropathy and get back to making the most of each day, we encourage you to review our patient testimonials. 

For example, Dr. Williams helped a man with a history of diabetic peripheral neuropathy with entrapment of the tibial nerve at the tarsal tunnel as well as the proximal tibial nerve in the calf. The patient had diabetes for three years and struggled with numbness and pain for approximately 10 years. After nerve decompression surgery, he saw substantially reduced numbness, tingling, buzzing, and pain in his toes. Watch this testimonial video to learn more about this patient’s nerve decompression experience. 

Another one of our patients was similarly thrilled with her results just one week out from a tarsal tunnel release and decompression of the medial plantar, lateral plantar, and calcaneal nerves. Her previous care providers told her she had irreversible diabetic neuropathy, so she wondered if she’d simply be expected to live with numbness and pain forever. Then, after seeing Dr. Williams, she found hope for a brighter future. Even though it takes several weeks to see maximum results, she noticed substantial improvement in sensation just one week after her nerve decompression surgery. Watch this testimonial video to learn how nerve decompression helped improve her quality of life. 

 

Diabetic neuropathy is a type of nerve damage that occurs in people with both type 1 and type 2 diabetes. Diabetic neuropathy can affect many organ systems, but this article refers to patients who have tingling, numbness, and pain in the feet and hands. Their symptoms are typically worse in the feet and have been described by some as intense burning, severe pins and needles, feet covered in ants, or walking on barbed wire. Some will complain of numbness and loss of balance. 

Patients tend to ignore these symptoms for long periods of time. Only when their condition is severely affecting their quality of life do they seek out medical attention. 

There are many different medications that have been tried to treat these painful symptoms, and some will be successful. However, research over the past 10 years performed and confirmed by several different teams in several countries has demonstrated that many patients diagnosed with diabetic peripheral neuropathy and treated only with medications also have nerve compressions in the feet and hands. This nerve compression may be the chief cause of their painful symptoms as well as the numbness that occurs. 

We know that decompressing a nerve that is pinched is the best way to treat a compressed nerve. Therefore, one solution for relief for patients suffering from symptoms of diabetic neuropathy might be adding nerve decompression treatment to the other standard treatment measures. However, finding the right physician is vital. You need to work with an experienced peripheral nerve surgeon to create an effective treatment plan to manage your condition and improve your quality of life.

Tips for Finding the Best Doctor for Diabetic Neuropathy

Take the following suggestions into account. Then, you can rest assured that you have the information you need to research professionals capable of providing quality care tailored to your needs.

Ask Your Primary Care Physician for a Referral 

After assessing your condition, your primary care physician can refer you to a specialist with experience in treating diabetic neuropathy pain.  This should include a referral to a peripheral nerve surgeon for evaluation. You may have to ask specifically for this referral as the published research on surgical management is still not widely circulated in the primary care fields, despite 15 years of pioneering research and publications of physicians like Dr. A. Lee Dellon, MD Ph.D.  

Talk to Friends and Family

If you know someone who suffers from pain due to diabetic neuropathy, ask them for a referral, along with what treatment methods were used and the type of results they achieved.

Do Thorough Research

You can search online for doctors in your area who specialize in treating diabetic neuropathy. You can look for peripheral nerve surgeons in your area. Look for physicians who have experience with this condition and positive patient reviews and testimonials. You may even consider watching videos on the doctor’s website to learn how nerve decompression helped other patients manage their neuropathy pain.

Look for Education and Experience

While some physicians might generally treat diabetes for daily management, others provide solutions that require more experience. Dr. Williams is a board-certified plastic surgeon with additional fellowship training in peripheral nerve surgery. He specializes in nerve compression surgery in diabetic patients as well as non-diabetic patients.  

What to Ask Potential Doctors

Once you narrow down the options, schedule in-person appointments with doctors who specialize in treating diabetic neuropathy. At your consultation, here are some key questions to ask: 

• What specific qualifications do you have to treat diabetic neuropathy pain? 
• How long have you been treating patients like me?
• What makes your practice unique and different from others in the area?
• What tests will be done to diagnose my diabetic neuropathy?
• What are the different treatment options for diabetic neuropathy, and which do you recommend for me?
• Who’s an ideal candidate for nerve decompression surgery?
• How successful have treatments such as nerve decompression been for other patients with diabetic neuropathy pain?
• What lifestyle changes can I make to manage my diabetic neuropathy symptoms?
• What are the potential complications of diabetic neuropathy, and how can I prevent them?
• How often should I schedule follow-up appointments to monitor my condition?

The answers each doctor provides and the level of comfort you experience help determine if they’re a good match for you. Remember, to ensure you receive the best possible care, arrive prepared for each appointment with your concerns and ask for specific treatment solutions. Dr. Williams will take the time necessary to address all issues and, after evaluating your individual symptoms and needs, determine the proper course of treatment.

Don’t Deal With Chronic Pain Any Longer

If you’re looking for a doctor to treat diabetic neuropathy, contact Dr. Eric H. Williams today. He’s a peripheral nerve expert who specializes in pain relief and reconstructive surgery, and will thoroughly assess your condition to determine if nerve decompression or another service can provide the relief you need. Find out more by calling our Baltimore office at (410) 709-3868 or by filling out our convenient online contact form.

Diabetic neuropathy is a severe diabetic complication that can cause pain and numbness in your extremities as well as other uncomfortable side effects. There are several different types of the condition, and if left untreated, they might lead to more grave health issues such as organ damage and even amputation. 

Pay attention to the signs of diabetic neuropathy and take action if you suspect you’re affected. The earlier you identify symptoms, the easier it is to address the condition and protect yourself from further complications. For example, to reduce the pain and symptoms associated with different types of diabetic neuropathy, Dr. Williams might recommend nerve decompression to relieve pressure on the affected nerve so you can return to enjoying the activities you once did.

Four Types of Diabetic Neuropathy

Diabetic neuropathy occurs in various parts of the body, and it’s also possible to have more than one affected area and various symptoms. Additionally, for some patients, neuropathy happens gradually over time and isn’t noticeable until nerve damage has occurred.

The four types of diabetic neuropathy are:

• Peripheral. This is the most common condition, which affects the feet and legs first, and then the hands and arms. Symptoms include tingling, numbness, and burning sensations.
• Autonomic. This impacts the autonomic nervous system, which controls involuntary bodily functions such as heart rate, digestion, and bladder control. Symptoms include but aren’t limited to changes in blood pressure, heart rate, and digestive function.
• Proximal. This form of neuropathy occurs primarily in the hips, buttocks, and thighs, presenting symptoms such as pain, weakness, and difficulty moving.
• Mononeuropathy. This type affects a single nerve, most commonly in the face, torso, or leg, with symptoms like sudden weakness or pain in the affected area.

It's important to note that not everyone with diabetes develops neuropathy, and symptoms and severity of the condition vary widely among individuals. But if you’ve had a persistent problem with any of the symptoms outlined above, talk with your primary care provider to determine the underlying cause so the right treatment plan can be developed based on your specific needs. You might also need to consult with another medical specialist to rule out other non-peripheral nerve-related conditions.

Diabetic Neuropathy Treatment Options

If you’re suffering from diabetic nerve pain or other symptoms of neuropathy, such as burning or tingling, nerve decompression surgery may be a potential solution. By undergoing nerve decompression surgery, it’s possible to find relief from these painful symptoms. 

The surgery works by improving blood flow to damaged nerves throughout the body. By increasing circulation and reducing pressure on the nerves, surgeons can successfully reduce pain associated with diabetic neuropathy. Patients often report significant improvements in their quality of life after the surgery. 

Unfortunately, if left untreated, diabetic neuropathy can cause serious problems such as foot ulcers, infection, and amputation. Don’t wait to seek treatment until it’s too late. Dr. Williams can determine if nerve decompression surgery is the right option for you. However, not every person is a candidate for the procedure. Here are some of the key factors that determine your eligibility: 

• Your A1C level must be less than 8.5, and your diabetes must be well-controlled
• A weight of under 350 pounds
• No uncontrolled swelling or restricted blood flow in your feet
• No open or unhealed wounds
• The severity of the nerve damage

Contact Our Baltimore Office Today For Diabetic Neuropathy Questions

If you’re concerned that diabetic neuropathy is affecting your quality of life, contact Dr. Williams today. He specializes in diabetic nerve decompression treatments to help reduce symptoms and increase mobility over time. Find out more by calling our office at 410-709-3868 or filling out our convenient online contact form.

Why does the tarsal tunnel syndrome cause so much pain?

Tarsal tunnel syndrome occurs when the tibial nerve and its branches of the medial plantar, lateral plantar, and calcaneal nerves get compressed or pinched.    Essentially the compression of nerve can occur from structural changes, trauma, extra muscles that you are born with, an enlarged nerve, and a variety of other cause.   Essentially there is just not enough room in a very tight space for the nerve to continue to function properly.   This leads to decreased blood flow or decreased ability for the nerve to get the appropriate nutrients and supplies it needs to function properly, and then it does the same thing that all nerves do when they stop working well…..  It talks to you!   Numbness, burning pain, tingling, buzzing, “creepy crawlies” can occur, or weakness, and muscle atrophy, loss of balance can also eventually set in.   Why some patients experience some of these symptoms while others do not is a bit of a mystery.

What is a typical recovery like after release of the tarsal tunnel and the medial plantar, lateral plantar, and calcaneal nerves?   

Most patients report that they actually do quite well after tarsal tunnel surgery, but some will struggle more than others. Because there is an incision on the inside of the ankle, and because the ankle does move, this is usually the source of most of the discomfort. Some physicians prefer to splint the foot after surgery to all the skin to rest and in an effort to improve the pain.   This is in general a good idea for orthopedic type procedures where the surgeon wants the foot to remain still so that bones heal, and that ligaments and tendons that were operated on or sutured together heal in with scar tissue like glue.  But when we consider nerve surgery we DON’T WANT SCAR TISSUE TO FORM AROUND NERVES, so it is very important to get the foot moving quickly.  Think of this as steel reinforced concrete.   The nerve is the rebar and the scar is the concrete.   We DON’T want steel reinforced concrete, we don’t want the nerve getting stuck in the scar tissue, so it won’t move or glide back and forth. We want to start making a tract for that nerve to move almost from the first day that we are done operating.  But we don’t want the skin to break down either.   So we have to play a delicate balancing act.   Ask the patient to move the ankle, but not use the ankle too much.  Ask the patient to move the foot, which may be uncomfortable, but allow the patient enough support, so they are not miserable.    We wrap the foot after tarsal tunnel release with a large cotton dressing that looks kind of like a giant cotton ball.   This bulky dressing is soft and moves with the patient but is sturdy enough not to fall apart.  It allows the patient to weight bear with some force, but it is annoying enough to keep them from running around the house.   It is soft enough that it won’t bother the person next to you in bed, but it is firm enough to be supportive and protect the incision.    

Will I need crutches after surgery? 

Yes. As we age, however, crutches can get a bit unwieldy, and so frequently, we will recommend a walker for those who have a bit more difficulty getting around.  Nearly all folks will need crutches at least until the dressing comes off after one week. Remember, we don’t want the patient to break the incision open because they are walking too much. About half the patients will no longer be using crutches at three weeks after the surgery when they come to have their incision evaluated and the sutures removed. A few stragglers will need crutches for about a month. If you need them longer than this, you are really struggling, and we will need to re-evaluate and make sure that everything is okay and determine if physical therapy would be beneficial for you.   

May I shower after surgery? 

I do expect patients to shower after surgery.  Patients will typically have to use a protective “cast bag” or large plastic bag around their leg to protect the giant water-absorptive cotton ball that is wrapped around their leg.  It is not fun when this gets wet – so don’t get it wet.  Have a plastic dressing placed over the incision that will allow them to shower.  But we do not allow patients to take a bath for about two weeks.

Can I wash my tarsal tunnel incision after my dressing comes off?  

Yes. You may wash the suture line with hibaclens soap (antibacterial soap) daily.  We then ask the patient to paint the incision with Betadine or Iodine to keep it clean and cover it with a large bandaid to protect it.  Putting an ace bandage on the foot at this time can also help keep the post-op swelling down. 

Do I need physical therapy after surgery after Tarsal tunnel release?  

This is a very personalized answer.  Some patients have had a wonderful experience with physical therapy while others have not.  Some patients will prefer to “do it on my own.”  While other patients will really like to have someone “helping them along.”  We are happy to recommend physical therapy when patients feel that this will be a major benefit for them.  I do think there is an advantage to this.  However, we also acknowledge that some patients will be able to control their own recovery well with a graded gentle return to activities.  We discourage any strenuous activities for about six weeks, but walking on even ground, walking on a treadmill, or elliptical trainer can be very helpful in increasing one’s activity AFTER the sutures have come out three weeks after surgery.   We generally will not start physical therapy until this time.    We strongly encourage walking on land and in a pool starting 3.5 weeks after surgery to help you recover well.  REMEMBER:  we don’t want patients busting open their incisions, so we ask patients to “walk for the needs, and not their wants” for the first three weeks.  

Can I drive after my tarsal tunnel release? 

Eventually you can return to driving.  But let’s use some common sense. 

1.  If we operate on the right foot and you have sutures in the ankle, then you are going to be moving that ankle a lot.   That is great for getting the nerve to move back and forth, but that is NOT great for the incision, which has sutures that can cut through the skin.  So if you have surgery on the RIGHT foot, it will be a bit longer before you can drive.  

2.  Common sense helps here as well.  If you are stoned on drugs – NO, you cannot drive.  3.  If your pain is more than you can tolerate and you are distracted by it – NO, you can not drive.  Most people who have their LEFT FOOT operated on can start to drive somewhere between 10-14 days after surgery. RIGHT FOOT is a bit longer.   BUT Everyone is different.  

The MOST IMPORTANT thing to remember is SAFETY!   Do not put yourself or others around you in danger.  Please use common sense.  If your spouse or family member won’t get in the car with you when you want to drive — then you should not be driving!   However, if they won’t ride with you PRIOR to surgery –  I can’t help you there…  You are on your own.      

When will I know if I am better after tarsal tunnel release?  

This is a complicated question. As one can imagine, there is NOT one correct answer here, and believe it or not – you will be telling your doctor when you are better!  However, in our experience, some patients will see relief from the minute they wake up. Others will get relief slowly over time.  Still, others may not get the relief that they were hoping for at all.   However, our experience is that most patients (85%) will eventually get improvements within weeks to months.   It is also common to continue to see improvements over time. We encourage patience, as those who have had symptoms for many years may take longer to improve.  We encourage patients to wait 6-12 months before trying to find and search out “other” causes for their pain because it can take time to see improvements, especially in particularly challenging situations.  

When can I return to work after tarsal tunnel release surgery? 

Again, this is a very individualized question.   If you are a sedentary worker and do mostly desk work, and you can work from home, then most patients may feel up to returning to work after about a week.   If the home option is not available, then it may take anywhere from 1-3 weeks.  If you have a heavy manual labor type position and are in significantly dangerous situations, then it may take up to 2-3 months.  If you have a position where you are expected to walk around for an extended period every day but are not in a particularly dangerous environment, you will probably be looking at about 3-4 weeks, but again everyone is different. The main point here is to make sure that you are SAFE to return to your work, and to be kind to yourself, while not taking advantage of your employer.    Your safety and your recovery are our priority, but we also want to be socially responsible as well.  

Will I be able to return to sports or activities like hiking, yoga, running, etc.?    

Well, it helps if you were active in these areas BEFORE the operation! But in general we do expect patients to get back to many if not all of the activities that they enjoyed prior to surgery. We strongly encourage walking on land and in a pool for several weeks after surgery to help you recover well.  It may take up to three months before you can be expected to have unrestricted activities.   

What kind of pain can I expect after a Tarsal Tunnel release surgery?

The pain after tarsal tunnel release seems to be very reasonable for nearly all patients. There are always the two ends of the spectrum. There are the patients that do have a very high pain threshold, as well as those with a very low pain threshold. But most patients do very well with a mixture of several medications. We encourage a cocktail of medications, both over the counter as well as prescription medications. We typically start with extra strength Tylenol and motrin alternating these throughout the day.  Then we add to this Gabapentin or lyrica for their treatment of nerve pain. We encourage ice on the surgical site intermittently, and then finally patients are given a prescription for a stronger narcotic medication that they may take if they are still experiencing pain that is not well controlled.  Some of our patients never take a pill of the narcotic, but most will take a few tablets. 

What will I need after my Tarsal Tunnel surgery?  

You will need crutches or a cane or walker for a few days to steady your gait. Some people who want to return to work early or who have long distances to walk may want to use a rolling scooter for some of the time they are up and about. You will need to pick up your medications for postop discomfort.  You will need a nice ice bag or two – (nothing wrong with a ziplock freezer bag.) You will need a protective cover to place over your dressing while you shower.  You will want to try to set up a place to recover that is on one floor if you can, but this is not required, but it is much easier. You will need someone to help drive and do many of your normal daily chores while you are recovering.  

When can I travel after my tarsal tunnel release?  

We do see many patients from out of town. If patients live less than two hours away from Baltimore, then they may go home after the procedure. They will need a ride as they will not be able to drive themselves. If they are driving distance, but further than two hours away, we typically ask them to spend the night in one of our local hotels. The reason we do this is in case of a complication such as bleeding, the patient can contact us and be seen quickly. Otherwise, they might be hours away and have a hard time trying to get into an emergency room with physicians that they do not know. If you are flying from out of town, we typically encourage patients not to make plans for a minimum of 24-36 hours. Again safety is our primary concern here. We want to make sure that there are no acute complications, that your pain is well controlled, and that you have plenty of time not to rush through the airport.   

Nerve decompression is a surgical procedure used to relieve pain caused by a compressed nerve in the body. It can be an effective treatment for some people with Type 1 and Type 2 diabetes, but it is important to understand that not everyone will benefit from the surgery. In order to make an informed decision about whether or not nerve decompression is right for you, it is important to discuss your options with your doctor.

Success of Nerve Decompression for Those With Diabetes

Even though nerve decompression can work effectively for some people with Type 1 or Type 2 diabetes, it is not an option for everyone. Those who are ideal candidates for the procedure have symptoms of numbness and tingling, either with or without the presence of pain due to peripheral neuropathy. If there is only pain without numbness or tingling, they may not be a candidate for nerve decompression.

Determining if nerve decompression surgery will be a successful option for you depends on individual factors such as:

• The severity of your nerve damage
• Whether your diabetes is well-controlled and your HgbA1c is less than 8.5
• Weighing under 350 pounds
• Not having uncontrolled swelling or restricted blood flow in your feet or any current open wounds

What to Discuss With Your Doctor Before Diabetic Neuropathy Surgery

Before deciding if nerve decompression surgery is right for you, there are certain things you should discuss with your doctor. These include:

• Your medical history, including any past surgeries
• Any medications you are currently taking, including over-the-counter drugs and prescription medications
• Your current level of physical activity and lifestyle habits
• Risk factors associated with nerve compression surgery, such as anesthesia risks
• Recovery time frame and post-surgical care instructions 
• Potential complications or side effects 

If you are considering nerve decompression surgery, schedule an appointment with Dr. Williams. He can determine if you will benefit from surgery and create a treatment plan to fit your needs. Find out more by contacting our Baltimore office at (410) 709-3868 or by filling out our contact form online.

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Diabetic nerve pain can be a debilitating condition, causing severe discomfort and making everyday activities like walking or even standing difficult. While medication is often the first course of treatment for diabetic peripheral neuropathy pain, the drugs can have undesirable side effects, such as weight gain and fatigue. If you are suffering from diabetic nerve pain, Dr. Williams can evaluate your condition to determine what treatments other than medication, such as nerve decompression surgery, may be an option for you to consider.

Nerve Decompression for Diabetic Nerve Pain

Nerve decompression is a surgical procedure to free compressed sections of nerves in the body to increase blood flow, allow the nerves to move more freely, and reduce pain caused by compression. This procedure has been shown to be effective for many people suffering from peripheral neuropathy by helping to relieve symptoms of nerve pain and restore mobility and function. If you are looking for an alternative to medication for diabetic nerve pain, speak with Dr. Williams about the possibility of undergoing a nerve decompression procedure.

With the proper treatment, you can regain control over your condition and live a more comfortable, pain-free life. In addition to having Dr. Williams perform nerve decompression surgery, you can do the following to manage symptoms of diabetic peripheral neuropathy:

• Monitoring your blood sugar levels to keep them under control
• Increasing exercise and eating a healthy diet
• Quitting smoking
• Taking good care of your feet

Are You Looking for a Diabetic Nerve Pain Specialist?

If you suffer from diabetic nerve pain and are looking for treatment options other than medication, contact our office for an evaluation. Dr. Williams can determine if nerve decompression surgery is an option for you and will create a treatment plan to help ease your pain and get you back to living pain-free as soon as possible. To schedule an appointment in the Baltimore office, contact us at (410) 709-3868 or fill out our contact form online.

Related Links: Baltimore Diabetic Peripheral Neuropathy Nerve Compression Relief Is peripheral nerve surgery safe? Peripheral Neuropathy and Trauma

Piriformis syndrome is a condition that causes gluteal pain and numbness. The condition can worsen with activity and is often caused by overuse or trauma. If it is left untreated, it may turn into a painful chronic condition that leaves you with restrictions or other issues such as sciatica. Dr. Williams explains how he can treat piriformis syndrome with nerve compression services so you can return to living pain-free.

Diagnosing and Treating Piriformis Syndrome

There are other conditions that can present symptoms that are similar to piriformis syndrome, such as a herniated disc, cluneal nerve entrapment, or sciatica. There is not a single test to diagnose piriformis syndrome, so diagnosis is made by ruling out other conditions and diagnosing based on symptoms and pain.

To treat piriformis syndrome, avoiding activities that cause pain is first recommended, along with rest. Other treatment options include:

• Physical therapy that includes stretching exercises
• Medication such as anti-inflammatories or muscle relaxants
• Nerve release surgery to release the sciatic nerve from the piriformis muscle

Untreated Piriformis Syndrome Complications

Piriformis syndrome can lead to serious complications if left untreated or undiagnosed. For some patients, the pain may be misdiagnosed as a lower back issue, so treatment is based on that type of condition rather than piriformis syndrome.

If the symptoms are thought to be from another condition other than piriformis syndrome, the patient may have unnecessary surgery or injections that increase their risk for complications and lead to chronic pain. Not treating piriformis syndrome can also make the person unable to train or continue an exercise routine.

Contact a Baltimore Peripheral Nerve Specialist

If you have piriformis syndrome and need treatment, contact our office for an evaluation. Dr. Williams can accurately diagnose the condition, answer any questions you may have, create a treatment plan to prevent possible complications, and get you back to living pain-free as soon as possible. To schedule an appointment in the Baltimore office, contact us at (410) 709-3868 or fill out our contact form online.

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The lateral femoral cutaneous nerve, located in the outer thigh, can become compressed and cause symptoms such as burning, tingling, or numbness in the leg. However, other conditions can also cause similar symptoms. Consulting with our Baltimore peripheral nerve specialist can determine if you have lateral femoral cutaneous entrapment, also known as meralgia paresthetica, or another condition. Learn more here.

Symptoms of Lateral Femoral Cutaneous Nerve Entrapment

Lateral nerve entrapment can cause a range of symptoms in the outer part of the thigh. Symptoms typically affect one side of the body and may worsen after standing or walking. Some common symptoms of lateral femoral cutaneous nerve entrapment may include the following:

• Burning
• Numbness
• Tingling
• Sensitivity

Meralgia paresthetica is not the only condition that causes these symptoms. If you are experiencing pain and numbness in your thigh, you could also have a muscle tear, overuse injury, or a sprain. A herniated disc in the back, chronic appendicitis, uterine fibroids, or a problem with the hip joint can also produce similar symptoms. It’s important to see a doctor to find out what is causing your symptoms.

Meralgia paresthetica can be caused by trauma or from a condition such as diabetes. Some other causes include:

• Wearing tight clothing or something heavy such as a tool belt
• Being obese
• Gaining weight
• Wearing something heavy such as a tool belt
• Pregnancy
• Past surgery or injury near the inguinal ligament
• Increase in abdominal pressure due to fluid accumulating

Meralgia Paresthetica Diagnosis and Treatment Options

If you are experiencing discomfort in your outer thigh and have symptoms of meralgia paresthetica, it is essential to see a doctor who can diagnose your condition. The diagnosis and severity of symptoms can determine the proper type of treatment and provide relief from meralgia paresthetica or another condition.

Meralgia paresthetica can be diagnosed through a physical exam and medical history. For some patients, imaging tests or nerve studies may be required to exclude other conditions. Once a diagnosis is made, conservative treatments are first recommended. Conservative measures that can help ease discomfort from lateral femoral cutaneous nerve entrapment include:

• Losing weight or maintaining a healthy weight
• Wearing clothes that are loose
• Medication such as over-the-counter pain relievers

In more severe cases that do not respond to conservative measures, nerve decompression surgery may be needed.

Contact Our Maryland Peripheral Nerve Specialist Today

Dr. Williams can help ease your lateral femoral cutaneous nerve symptoms and get you back to living pain-free as soon as possible. To schedule an appointment in the Baltimore office, contact us at (410) 709-3868 or fill out our contact form online.

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Piriformis syndrome and superior cluneal nerve entrapment can have similar symptoms, such as deep pain in the hip or buttock, but the two conditions also have major differences as well, including the type of treatment used to provide relief. Dr. Williams explains the similarities and differences between the two conditions and how he can treat either so you can get back to enjoying your regular activities without pain.

Similarities and Differences Between Superior Cluneal Nerve Entrapment and Piriformis Syndrome

Piriformis syndrome can mirror the symptoms of entrapment of the superior cluneal nerve since both conditions cause pain in the buttock or hip. The main difference between the two conditions is that with piriformis syndrome, sitting causes severe pain and discomfort, whereas with superior cluneal nerve entrapment, the pain subsides during periods of rest.

In addition to deep pain in the buttock, piriformis syndrome can cause spasms or cramps in the buttock and other symptoms such as:

• Numbness in the foot, leg, or buttock
• A sensation of pins and needles in the leg
• Increase in pain when doing activities such as running, squatting, or climbing stairs

Superior cluneal nerve entrapment can cause pain in the buttocks and lower back and symptoms such as:

• Burning sensation in the buttock
• Pain that is to one side rather than concentrated in the middle
• Pain that worsens with activity but reduces with rest

Diagnosis and Treatment Options

Since treatment options are different for piriformis syndrome and superior cluneal nerve entrapment, it is important to get an accurate diagnosis in order to find relief. Both conditions can be difficult to diagnose and are often misdiagnosed. To determine if the cause of your pain is due to superior cluneal nerve entrapment, a nerve block may be injected into the area. If the pain disappears, the diagnosis would likely be confirmed.

Diagnosing piriformis syndrome can be a challenge since there is not a single test to determine a diagnosis. Because other conditions such as superior cluneal nerve entrapment can cause similar symptoms, the two conditions can get misdiagnosed. To diagnose piriformis syndrome, a specialist will evaluate the pain and symptoms.

To treat piriformis syndrome, a doctor will recommend rest and physical therapy. In addition, steroids or muscle relaxants may be used to relieve pain. When conservative treatments do not provide relief, a nerve specialist can perform nerve release surgery to release the sciatic nerve from the piriformis muscle. To treat superior cluneal nerve entrapment, a specialist will likely recommend decompression surgery of the cluneal nerve. 

Since the treatment for piriformis syndrome and superior cluneal nerve entrapment are different, it is important to get the correct diagnosis and to see a peripheral nerve specialist such as Dr. Williams.

Contact Our Office

Dr. Williams has the expertise to treat both piriformis syndrome and superior cluneal nerve entrapment and can give the best advice to get you back to living pain-free. To schedule an appointment in the Baltimore office, contact us at (410) 709-3868 or fill out our contact form online.

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