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Old 12-05-2007, 03:41 PM   #1
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Foot drop due to traumatic compartment syndrome

Thank you for reading and giving advice.

I had a fracture in my tibial plateau on July 8 2007, which lead anterior compartment syndrome. Unfortunately, it was not diagnozed until two days after the initial compression and foot drop was noticed before a fasciotomy was performed.

The factured bone has now almost been healed but my foot is still dropped. EMG and nerve conduction tests were done 2 times with 3 months apart, which indicated peroneal nerve damage and no sign of recovering in almost 6 months.

My doctor has ordered MRI on my leg to see if the nerve can be repaired. If not, I was told the only choice left is tendon transfer.

Has anybody experienced the same and ended with a good outcome?

I like to hear your story and your advice.

Thank you!

 
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Old 12-30-2007, 01:12 AM   #2
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Re: Foot drop due to traumatic compartment syndrome

I also have foot drop but mine is a result of right total hip replacement surgery on 9/11/07. I've had no improvement and my surgeon told me that we'll have a nerve conduction study and EMG done at the 6-month mark but I just found the website of a surgeon in Houston and after reading that, I'm wondering if waiting will cause more problems. He does a nerve transfer rather than tendon transfer and he states that doing it more than 6 months after the injury lowers the chances of good results. I'm so confused about this but I'm thinking that I would rather have a nerve transfer than a tendon transfer. However, I'd have to move pretty fast on that and that scares me. I'm hoping that someone with knowledge on this posts here because I need information too.

I wish you the best jiasent and if I find answers, I'll let you know here.

 
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Old 12-30-2007, 08:06 PM   #3
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Re: Foot drop due to traumatic compartment syndrome

i am just wondering if you were ever referred for any type of possible PT totry and improve the overall nerve flow in there?when my fine motor was knocked out of commission in my left hand(among other significant damage) due to a surgery done on my spinal cord that severely damaged the nerve that went to my fine motor functions,i was actually able to get back alot of nerve flow just doing PT.it helped alot with gaining back the muscle that was still possible to actually gain(some was permanently lost,8 of the intrinsic muscles in my hand actually)and rather amazingly,at this point after four years of living with this,i have gained back even more over those four years just typing everyday.my post op(two months after)EMG was a nightmare with that left hand,but the one i actually has just a few months ago,i actually gained new nerve function over that time.these were some areas where i had n0thing there with the first EMG that was done.now THAT shocked me.but it just goes to show you that with the right type of actual therepy,things can improve on their own,you know what i mean?i just never thought my nerve flow would possibly improve where there was really nothing there two months post op.i would seriously speak with your dpc about at least trying some level of PT just to see if it could help with that foot drop.i was also able to regain my ability to walk with the left leg just by ALOT of acute rehab.the leg was just 'not there' post op and i had to kind of 'rebuild' it up just to be able to even put wieght on it then finally walk again and actually be able to go up the three stairs which was a huge goal for me in rehab.some types of PT and the right therepist can really do some very amazing things,you know what i mean?i never thought,just given how bad my hand and leg were that things would ever get even remotely somewhat normal again for me,but they really did surpass what i actually believed at that time was even possible for me.you just never really know til you try.just something to contemplate before diving into that surgery.i wish you luck with this.please keep me posted.Marcia
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3-22-01,herniated C-6-7
11-20-01,placement of hardware for failed fusion
9-22-03,removal of cavernous hemangioma that was inside spinal cord. Neuro damage to L hand L leg and R leg.

 
Old 12-31-2007, 02:44 PM   #4
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Re: Foot drop due to traumatic compartment syndrome

I had PT but with focus on regaining flexibility of my left knee and ankle after the surgery. The doctor (an orthopaedist) who performed the surgery told me that both my deep peroneal nerve and the muscle in the anterior compartment are damaged and it is very unlikely the nerve would come back. Later I had two EMG and nerve conduction tests (4 months apart) which did not show any improvement.

I have searched the internet about compartment syndorme regarding nerve damage. My understanding is that irreversible nerve damage occurs after 12 hours after compartment compression. I had the compression for about 48 hours before the surgery.

I am not aware of any PT specific to nerve recovery. I will check around.

I have also consulted with Dr. Nath in Houston who is the inventor of nerve transfer procedure. But my case is not suitable for it because of the muscle damage.

I have also consulted with a foot/ankle specialist (podiatrist). His suggestion is to have tendon transfer after at least 1 year, which my orthopaedic doctor sort of agreed when I talked with him. My orthopaeidic doctor recommended me to have an AFO, which I had but hate it.

Jiasent

 
Old 01-02-2008, 06:48 AM   #5
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Re: Foot drop due to traumatic compartment syndrome

it really sounds like you are coveraing all your bases here and that is really good for you.you need to find this stuff out before consenting to any type of surgery,ya know?any surgical intervention,espescially at the level you are contemplating ahould always be kind of the last resort and not a quick first choice.if there is no possible way that any PT would help at all in your situation,well at least it sounds like you are in some good hands and they are basically recommending the very same type of thing to you.just make certain that all other non sugical options have been tried or simply would not be possible before going ahead with any surgey on any area of your body since sometimes,surgery for some people can actually make things worse,ya know?you just always need to know that you did all that you could do.hope things go well for you with this.please let me know how things go,K?marcia
__________________
3-22-01,herniated C-6-7
11-20-01,placement of hardware for failed fusion
9-22-03,removal of cavernous hemangioma that was inside spinal cord. Neuro damage to L hand L leg and R leg.

 
Old 01-03-2008, 03:49 PM   #6
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Re: Foot drop due to traumatic compartment syndrome

Thank you for the advice: tendon transfer should be the last resort.

I have started PT with focus on recovering the peroneal nerve. It basically involves moving the toes/foot upwards passively and building the muscle strength. I am also given electric stimulations.

I am also waiting to see a nurosurgeon in two weeks and possibly will have a MRI on the nerve to understand how bad/good the nerve is. I will post results. Jiasent

 
Old 01-08-2008, 04:11 PM   #7
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Re: Foot drop due to traumatic compartment syndrome

Quote:
Originally Posted by jiasent View Post
Thank you for the advice: tendon transfer should be the last resort.

I have started PT with focus on recovering the peroneal nerve. It basically involves moving the toes/foot upwards passively and building the muscle strength. I am also given electric stimulations.

I am also waiting to see a nurosurgeon in two weeks and possibly will have a MRI on the nerve to understand how bad/good the nerve is. I will post results. Jiasent
Hello,

I wish you all the best of luck.

I have been monitoring various message boards about foot drop because my four year old daughter has it due to an unexplained injury. She had nerve surgery one and a half years ago and has shown questionable improvement.

We also do not want to have to resort to tendon transfer, especially because of her age.

I'm curious about the peroneal nerve therapy you are doing. May I ask you to be more specific? Did you find a therapist who understands this problem and has some specific exercises to do? We have had mixed luck with PT in our own town. We did find an out of town therapist who uses biofeedback and it involves, maybe similar to your method, trying to exercise the other muscles in the leg

Also, we do threshold electrical stimulation at night. Some still call it an experimental therapy but it has been shown to possibly stop muscle atrophy.

Best of luck to you.

 
Old 03-01-2008, 07:19 AM   #8
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Re: Foot drop due to traumatic compartment syndrome

Hello,
I'm new to this forum but thought my case may later offer some suggestions to those suffering from foot drop, compartment sydrome, and peroneal nerve damage.
About 4 years ago I had a champagne bottle explode when it hit the ground near my leg. It cut a fairly good size hole in my shin muscle. I went the emergency room and had it stitched up and it healed without any loss of function to any nerve or my leg. The only draw back was I was left with a muscle hernia in my shin area. In January I went to a plastic surgeon for something totally unrelated to my leg and asked him to just look at the spot on my leg. He assured me he could fix it and everything would be fine. Well, needless to say I'm writing here so everything wasn't ok.
The day of the surgery I came home with extreme pain in my ankle area and the top part of my foot. Since that day I have not been able to dorsiflex my foot and have a numbing feeling between my two first toes. My cosmetic surgern kept assuring me it was due to the stitches he put in being too tight. Finally after 3 weeks he went in and took the stitches out but improvement has not happened. I had an EMG and Nerve test done on 2/27 and found out the results just yesterday. The peroneal nerve is basically dead between the place on my shin and my toes. There was no activity at all. My orthopedic surgeon delivered the terrible news to me and was very helpful in helping me to understand what my options were. Basically, he wants to do "exploratory" surgery in hopes of finding what caused the nerve to stop functioning and to relieve the pressure that is still on the nerve. He has given me a 10% chance of improvement with the surgery. Basically, no percent chance without. My surgery is scheduled for this Thursday. Although the process started a month ago, the journey for healing and prayerfully getting to walk normally again will begin Thursday after the surgery.
If anyone out there has had a similar situation please let me know how you are doing and what I can expect. Does the fasciotomy leave hideous scars? Do you feel like you have a constant sprained ankle? The thought of never walking normally again is almost unbareable to think about.

 
Old 03-13-2008, 03:33 PM   #9
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Re: Foot drop due to traumatic compartment syndrome

Quote:
Originally Posted by Alli1002 View Post
Hello,
I'm new to this forum but thought my case may later offer some suggestions to those suffering from foot drop, compartment sydrome, and peroneal nerve damage.
About 4 years ago I had a champagne bottle explode when it hit the ground near my leg. It cut a fairly good size hole in my shin muscle. I went the emergency room and had it stitched up and it healed without any loss of function to any nerve or my leg. The only draw back was I was left with a muscle hernia in my shin area. In January I went to a plastic surgeon for something totally unrelated to my leg and asked him to just look at the spot on my leg. He assured me he could fix it and everything would be fine. Well, needless to say I'm writing here so everything wasn't ok.
The day of the surgery I came home with extreme pain in my ankle area and the top part of my foot. Since that day I have not been able to dorsiflex my foot and have a numbing feeling between my two first toes. My cosmetic surgern kept assuring me it was due to the stitches he put in being too tight. Finally after 3 weeks he went in and took the stitches out but improvement has not happened. I had an EMG and Nerve test done on 2/27 and found out the results just yesterday. The peroneal nerve is basically dead between the place on my shin and my toes. There was no activity at all. My orthopedic surgeon delivered the terrible news to me and was very helpful in helping me to understand what my options were. Basically, he wants to do "exploratory" surgery in hopes of finding what caused the nerve to stop functioning and to relieve the pressure that is still on the nerve. He has given me a 10% chance of improvement with the surgery. Basically, no percent chance without. My surgery is scheduled for this Thursday. Although the process started a month ago, the journey for healing and prayerfully getting to walk normally again will begin Thursday after the surgery.
If anyone out there has had a similar situation please let me know how you are doing and what I can expect. Does the fasciotomy leave hideous scars? Do you feel like you have a constant sprained ankle? The thought of never walking normally again is almost unbareable to think about.

I am sorry to hear your story. I guess your peroneal nerve was squeezed (compartment syndrom) for too long and most likely the damage to it is irresversible. A fasciotomy, if performed within 24 hours from start of the compression, is possibly to save the nerve by releasing the pressure inside the compartment. The key is when the compartment syndrom is diagosed and when the surgery is performed. I had a compartment syndrom on July 9 last year and a fasciotomy surgery was done at 24 hours after the compression. I was not able to move up my toes before the surgery and my situation has not improved at all as of today.

Although I cannot move up my anke/toes, my foot does not drop either. It is at near neutral position. I feel I have an interal AFO while I never had a anke fusion.

 
Old 03-16-2008, 10:03 PM   #10
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Re: Foot drop due to traumatic compartment syndrome

Update - I had surgery to repair what they said was a dead perineal nerve. Well . . . when they got in there they think the nerve is not dead because it was hard and not "mushy" like dead nerves are. Instead they found that my muscle in my leg was dead causing the nerve to not send pulses down to my foot. They removed the dead muscle. That was about 8 days ago. I still can not move my foot or feel between my 1st two toes. How could the EMG and nerve test have been completely wrong about the nerve?? Now what?? I swear I can't find a positive story on the internet about this situation. Does anyone know anyone with a complete recovery from foot drop or nerve damage. Literally my doctor told me I was a "medical Mystery". What a life. . .

 
Old 03-18-2008, 02:43 PM   #11
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Re: Foot drop due to traumatic compartment syndrome

Did the doctor check the nerve in the ankle area where you had a lot of pain? In any case, you need to see a neurologist or even a different doctor. The last, prepare to collect all medical records as you may be able to sue the responsible doctor for malpractice.

 
Old 08-18-2008, 07:03 PM   #12
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Re: Foot drop due to traumatic compartment syndrome

April 20th, 2008 and only 20 yrs old, I had a severe dirt bike wreck and had an extremely severe tibial plateu fracture. Many of the bone fragments got shoved up into my knee doing more damage. After six hours of surgery, a plate, and fourteen screws i was finally put back together. The next evening, i had to have emergency surgery from compartment syndrome as well and lost part of my calf muscle from the damage. Four days later i had my final surgery to getmy leg closed up ending with skin grafts. A few days later I began to notice the numbness and immobility. I realize it has only been 4 months, but so far the only motion i have in my foot is extension(downward motion). Most of my foot, and most of the right side of my leg is completely numb. I have had severe neuropathy which was the most acute pain i've ever experienced! My orthopedic surgeon also has recommended me for a tendon transfer as well, but i'm really doubtful i'm going to allow it. I'm not gonna risk losing my extension. I have read your post hoping i woud find some useful information, because i would love to trash my AFO and walk without looking like an idot!! Like many of you, i have had two nerve conduction tests and both were non responsive unfortunately. And now i'm having kidney problems among other things that were discovered because of my surgeries. So yea, we all have problems and some of you should stop feeling sorry for yourself and be thankful you're alive!! You're only hurting yourself. Not talking about you "jiasent"!

 
Old 09-03-2008, 10:19 AM   #13
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Re: Foot drop due to traumatic compartment syndrome

i have a tendon transfer. i had a bad football accident 4 years ago. life is nearly normal. i can jog, run, jump and do alot of things i havnt been able to since the injury. man thing is, walking is nearly back to normal so it doesnt look like you have a "gimp" anymore.

 
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