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bracer 07-04-2011 11:53 AM

Foot Drop After Fusion?
 
I had a L4-S1 fusion on June 21. Though I had problems immediately following surgery (aspiration pnuemonia, for one) and, like most others, have issues after going home, I am more bothered by one thing more than the others right now. And, after all that build-up, I realize the title of this thread gives it all away, doesn't it?

Anyway, I'd like to discuss common experiences or hear opinions about the weakness in my left leg. It wasn't there before surgery, but now I have what seems like a minor foot drop. When standing flat-footed, I can't lift the toes on my left foot nearly as high as those on my right. In addition, when I'm walking my right foot moves in a relatively normal fashion (disregarding the pain and numbness), while my left seems to want to go straight from heel to toes -- kind of slapping the ground if I don't really do my best to control it. Could this be due to swelling from my fusion or is it likely that there has been damage to the nerves in my left leg? There is no numbness in my left thigh. That being said, I have noticed some minor differences in the muscle movement on the outside of the left thigh as opposed to my right, quite a bit of numbness on the left side of my left calf, and a lot of numbness across the top of my foot and first two toes. I don't drag my foot -- taking a step just feels and looks different.

I had balance problems that seemed to involve my left leg immediately after surgery, but those resolved quite a bit within a week or so after surgery. I'd appreciate any thoughts, advice, or comments you might have. I know that a fellow fusioner (fusionee?) whose wife posts here had foot drop after surgery, but I think it was much more serious than mine. Anyone else had similar experiences?

linjack 07-04-2011 01:33 PM

Re: Foot Drop After Fusion?
 
Hi Bracer,

Thanks for starting this thread. Hopefully, if anyone else has had foot drop, they will post.

My husband noticed a difference in his right foot right after surgery, more numbness than before surgery. Dr. just said it was normal. At his two week check-up, he could lift his foot off the floor, slightly, and wiggle his toes somewhat. Dr. said that was good and it will come back. Go home, go walking and come back in four weeks. I asked the dr. if there were any restrictions on distance...none.

He went home and walked that evening and his foot felt worse. Of course, we just thought maybe too much too soon. Waited a day or so and he walked again. After the second walk, his foot began to swell and pain increased.

His foot got so bad, that he had to go back to the dr. in two weeks instead of four weeks. Dr. seem quite surprised when he saw his foot. He couldn't raise it off the floor at all or move his toes. No strength at all when pushing against the dr's hand. Gave him a medrol pack. Also wrote a prescription for an AFO foot brace. Come back in two weeks. Also gave him more percocet. The pain in his foot is so bad, he can't even stand the bed sheet to touch it.

The swelling increased along with the pain, so back to the dr in a week. He asked why he didn't have the foot brace on and we told him there was a mix-up with insurance. Dr. straightened that out and said the brace would really help. See you on July 5th. Also said "cut back on that percocet."

So, he got his foot brace and has tried it several times. He can't stand it for more than 15 minutes because it hurts too much to put his foot in a shoe. Neither the pain nor the swelling has subsided. This has been going on for 5 weeks.

I forgot to mention the dr. said he thinks this is a reaction to the bone growth hormone that was used in the fusion. Only seen 2 or 3 cases like this in 6 years. I don't know how long BMP has been used, but his dr. has been practicing for 30 years. I don't buy it, but would be interested to know if anyone else has heard of that.

Of interest, the specialist who fit his foot brace said they see foot drop quite often after fusion surgery. Most of it transient. Of course, she also said severe pain isn't usually associated with foot drop.

My husband's fusion was at L5 S1 and I believe the L5 affects the big toe and possibly the second.

That's where he is right now, lots of pain and swelling. We have a lot of questions for the dr. tomorrow.

If you don't have pain in your foot, Bracer, I would think that you would have a faster recuperation.

We have quite a few questions for the dr. tomorrow.

Linda

bracer 07-04-2011 03:00 PM

Re: Foot Drop After Fusion?
 
Linda:

I'm distressed to hear that your husband's problem has become worse. Hopefully, the doctor can offer some answers as well as solutions at your appointment.

I believe you are correct that L4L5 controls the big and second toe. When I had my second discectomy back in 2005, it was on that very area on my spine to deal with pain on that part of my right foot.

Due to my pneumonia and other issues in the hospital, I really didn't notice the difference in strength between my left and right feet until the day before I was discharged. When the PA for my group came around to check on me the next morning, I asked him what he thought. After giving my question the four or five seconds he thought it deserved, he let me know that he didn't find anything for me to worry about., Unfortunately, I didn't see a surgeon before my discharge, so I was unable to express my concern to another physician in that group.

Anyway, in the almost two weeks since, I've shown my wife the various symptoms I've had relating to this foot drop -- most of them I mentioned in my original post to this thread. My case does sound different than yours. I've had no noticeable swelling, no great decrease in strength and the increase in pain I've had has not been related to my foot drop (at least, I don't think so). It feels sometimes like it is tingling more than usual or has become slightly more weak, but nothing like you describe. I've walked as I was told, which has led to what I assume to be normal recovery aches and pains. I think I read before where you posted that your doctor had mentioned foot drop as a common side effect. Mine never mentioned the issue. I see him in exactly one week, so you can be sure I'll bring it up and, since he won't be waking me up in a hospital bed very early in the morning, I'll be a little more ready to ensure that my questions are taken seriously, unlike the day his quite unprofessional and uncaring PA came by to pay a cursory visit as he moved on to something he felt more important than patient care.

Nevertheless, please let me know what your surgeon says tomorrow. I have an appointment with my GP and I have some questions he may not know how to answer. I figure there's no harm in trying, though. I'll let you know what he says.

Please take care. As always, your family is in our thoughts.

teteri66 07-04-2011 07:56 PM

Re: Foot Drop After Fusion?
 
The L4 nerve innervates the great toe. The three middle toes are L5 and the little toe is S1.

Linda ~ Most of the problems in lumbar fusions come from the bone product continuing to grow and "overgrowing" the boundaries where it was placed. If it grows outside the cage and begins to push out into the foraminal space where the nerves are trying to exit that segment, it could result in nerve compression just as the same as would a disc herniation, etc. There have also been problems with the bone product growing around a nerve, to the point where the nerve was encased in bone. This is from the manufacturer's website:

"Although not seen in these studies performed by the manufacturer, there is a possibility that too much bone may form at the implantation site (exuberant bone formation), bone may form at a location away from the implantation site (ectopic bone formation), or the bone that is formed may be abnormal."

BMP has been used in spinal fusion patients since 2007, and possibly earlier. I had it in Jan of 2008 for a L4-5 fusion with no complications.

james079 07-04-2011 11:35 PM

Re: Foot Drop After Fusion?
 
[QUOTE=bracer;4792421]I had a L4-S1 fusion on June 21. Though I had problems immediately following surgery (aspiration pnuemonia, for one) and, like most others, have issues after going home, I am more bothered by one thing more than the others right now. And, after all that build-up, I realize the title of this thread gives it all away, doesn't it?

Anyway, I'd like to discuss common experiences or hear opinions about the weakness in my left leg. It wasn't there before surgery, but now I have what seems like a minor foot drop. When standing flat-footed, I can't lift the toes on my left foot nearly as high as those on my right. In addition, when I'm walking my right foot moves in a relatively normal fashion (disregarding the pain and numbness), while my left seems to want to go straight from heel to toes -- kind of slapping the ground if I don't really do my best to control it. Could this be due to swelling from my fusion or is it likely that there has been damage to the nerves in my left leg? There is no numbness in my left thigh. That being said, I have noticed some minor differences in the muscle movement on the outside of the left thigh as opposed to my right, quite a bit of numbness on the left side of my left calf, and a lot of numbness across the top of my foot and first two toes. I don't drag my foot -- taking a step just feels and looks different.

I had balance problems that seemed to involve my left leg immediately after surgery, but those resolved quite a bit within a week or so after surgery. I'd appreciate any thoughts, advice, or comments you might have. I know that a fellow fusioner (fusionee?) whose wife posts here had foot drop after surgery, but I think it was much more serious than mine. Anyone else had similar experiences?[/QUOTE]

A drop foot can be caused by a bit of compression in and around the area of the surgery. Also it can be caused by the leg being rotated outwards during or after the surgery when in bed. The nerve runs round the outer side of the knee and if some pressure it put upon it it will conduct less. The good news is that the description you give would suggest that it should resolve quickly.
If anyone ever watched "Morse" the british detective series you may have noticed he had a permanent drop foot, from what I do not know.
James

bracer 07-05-2011 04:35 PM

Re: Foot Drop After Fusion?
 
[QUOTE=james079;4792732]A drop foot can be caused by a bit of compression in and around the area of the surgery. Also it can be caused by the leg being rotated outwards during or after the surgery when in bed. The nerve runs round the outer side of the knee and if some pressure it put upon it it will conduct less. The good news is that the description you give would suggest that it should resolve quickly.
If anyone ever watched "Morse" the british detective series you may have noticed he had a permanent drop foot, from what I do not know.
James[/QUOTE]

James:

Thanks for the encouraging words. Just reading that this "should resolve quickly" brings a smile to my face. Even though I've never met you outside this one tiny bit of contact on the internet, you've lifted my spirits. Thanks!:wave:

Linda:

I met with my GP today and he said essentially the same thing that James did. How did the visit with your husband's surgeon go?

linjack 07-05-2011 06:27 PM

Re: Foot Drop After Fusion?
 
Hi Bracer,

Good news for you. It really does sound like your foot drop will resolve quickly and it doesn't sound like my husband's at all.

Went to the surgeon this morning and he took an x-ray of my husband's back. That was fine, everything looks good.

He just can't figure out why he has a problem with his foot. Probably not the bone growth hormone. Told him to buy some TED hose and wear those during the day to try to get the swelling down. Changed his medication from Lyrica to Neurontin and gave him Vicodin. He also told him to make an appointment with GP to see if he can get the swelling down. We do that tomorrow.

I finally asked the doctor if there was a possibility that this is reflex sympathetic dystrophy. He said it's a cousin of it. We didn't quite get what a cousin of it means, so he said he has a lot of the same symptoms and left it at that.

I've done some reading on RSD and from all I've read, you need to act quickly because it can progress. So we asked about physical therapy and he said yes, that might help. Next week PT starts three times a week. He also cannot go back to work for four more weeks.

Hopefully tomorrow the GP will explain this "cousin" better and take a little more time with us.

My husband said he's not really too worried about having foot drop, he would just like the pain to stop. Maybe the new medication and PT will help...our fingers are crossed.

Other than your foot, Bracer, how are you feeling? Pneumonia gone?

Take care,

Linda

linjack 07-06-2011 02:25 PM

Re: Foot Drop After Fusion?
 
Hi Bracer,

Just dropping a quick note to let you know my husband went to the PCP today and was diagnosed with RSD.

He was sent for a doppler study of his leg right away just to be sure that it was not a DVT. It came back fine.

Was put on strong steroids and they are trying to get him in to see a specialist right away. Dr. also wants to see if we can get him into physical therapy faster than next Tuesday.

We're both a little distressed right now.

Linda

teteri66 07-06-2011 02:26 PM

Re: Foot Drop After Fusion?
 
It's good it was caught fairly early and that treatment has started...but, I don't blame you for being distressed. I hope their treatments will help your husband's pain soon.

linjack 07-06-2011 02:43 PM

Re: Foot Drop After Fusion?
 
Tetonteri,

Thanks so much for your well wishes. This board has been so helpful in more ways than one.

Linda

bracer 07-07-2011 09:12 AM

Re: Foot Drop After Fusion?
 
Hi, Linda:

I think the pneumonia is gone -- I finished the last of the oral antibiotics and went for a follow-up CXR yesterday. I had a lumbar CT taken, too. I think I'll find out the results at Monday's appointment.

Though I'm sad about the RSD, I'm glad that a diagnosis has been reached so treatment can start right away. I share Teri's optimism and her hopes that things will be better soon. That Teri is one great person, isn't she?

Please keep in touch. There are many wonderful things about this message board, one of which is the positive atmosphere of hope and caring.

Jeff

linjack 07-07-2011 06:40 PM

Re: Foot Drop After Fusion?
 
Hi Jeff,

I agree Teri is great! Great info and very encouraging. I am so glad I found this board, it has helped tremendously.

Sounds like you're doing much better and bet you'll get good news Monday.

We went to one of the doctors our PCP recommended just to make an appointment. The nurse talked to us in the waiting room and came back and said the doctor is going to see you today. The dr. was wonderful. She spent a lot of time with us and showed me how to massage my husband's foot to help with the swelling. She also has a physical therapist in her office so he has an appt with her on Wednesday and he has to see the doctor again on Monday.

She said the foot drop was a complication from the surgery and it is definitely RSD, but we've caught it early and hopefully it won't spread up his leg.

My husband was really pleased with the doctor and felt much better after the visit. He was really impressed that we just walked in and she decided to see him.

So, things are a little cheerier around here this evening.

Let us know how you make out Monday, Jeff.

Linda

bracer 07-08-2011 12:25 PM

Re: Foot Drop After Fusion?
 
Linda:

I sure hope you're right. The more reading I do about post-op foot drop, the more discouraged I get. It's tough sitting around waiting in this fusion to heal, but I thought I was prepared for that. Hoping that I'll wake up one morning and realize that the foot drop -- or any of the pre-surgery symptoms -- simply leads to one disappointment after another. I convinced myself that if I had the fusion with no improvement, I'd be able to come to terms with that. But the possibility of being worse off afterwards is a nightmare, as my pre-op posts here make clear. Looking back at what I wrote prior to my operation makes me wish I could slap my "back-then" self and tell him to be satisifed with things the way they were. Today is one of those depressing days, I guess. Maybe I'll feel less sorry for myself tomorrow.

Thanks for listening.

Jeff

linjack 07-08-2011 12:43 PM

Re: Foot Drop After Fusion?
 
Hi Jeff,

I know you mentioned your foot not feeling right, but do you have foot drop for sure or are you just worried about getting it?

Linda

bracer 07-08-2011 03:29 PM

Re: Foot Drop After Fusion?
 
[QUOTE=linjack;4795374]Hi Jeff,

I know you mentioned your foot not feeling right, but do you have foot drop for sure or are you just worried about getting it?

Linda[/QUOTE]

I do sound kind of paranoid or some kind of internet self-diagnoser, don't I?
:) However, at my initial PT meeting and an appointment with my GP, both of them agreed that it looked like foot drop. I also have the following symptoms:

Numbness of big and second toe of left foot, can't lift the front part (esp. big toe) of left foot nearly as high as right, can't walk on heel of left foot, and I slap the front part of my left foot down onto the floor or sidewalk when I walk. I know there are more severe symptoms associated with foot drop, but this has been going on since after surgery (when my surgeon's PA dismissed it as me "not giving it enough effort" and then leaving the room).

Am I driving myself crazy for nothing? Is there another explanation and is there a chance that this could disappear quickly? I see my surgeon on Monday for a my regular post-up check (he's been out of town). My GP thought enough of the symptoms after he examined me to call my surgeon, who promptly called me at 7:30 this morning to let me know my latest CT was perfect and that I should come in for an EMG on Wednesday. Maybe that will lead to good news, but I don't think so.

Jeff


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