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Dr. F
Dr. F, Board Certified MD
Category: Neurology
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Experience:  Neurosurgeon with more than 20 years experience in practice and teaching.
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Is it possible that and unresolved pinched nerve in the ankle

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Is it possible that and unresolved pinched nerve in the ankle achilles area could cause constant pain that becomes neuropathic and spread to other joints and even lead to migraines.

My very mature (now 5'8", 177lbs) 13 year old daughter presented with constant left ankle Achilles pain after running in Gym class 3 years ago when she was 10yrs. Although she did not have allydonia, swelling or color changes she was eventually diagnosed with CPRS perhaps for lack of a better explainantion for the constant pain she discribed as sharp in achilles and ankle ligaments and all over ache globally in ankle. She definately had constant pain even at rest which intensified with activity. It started in her Achilles area and pain spread to lateral ankle ligaments and then medeal ankle. At that point if she moved her good leg in a mirror the brain would send a pain signal to the bad foot. Her pain at rest could sometimes get down to a 7, w/ and after activity 10+. She underwent a 3 week pediatric pain rehab in another state. Worked miracles for others there but intensified her symptoms. She continued with home PT and resumed normal activities despite the constant pain. She does not move fast but she keeps moving. Pain started to spread to left knee then right that both hips and both hands. Now pain is never under an 8 on pain scale. Headaches began intermitent at first then true migraine (photo & phono fobic, increases w/body joint pain elsewhere or lack of sleep). Symptoms in hands are making it hard to write (now even having difficulty coordinating brain and hand to write). Migraines are making it hard to focus and read (words bounce off page) or computer screen (screen glare is excrusiating). Takes dance class 1x week and afterward shakey everywhere and trouble opening and stretching out fingers. Extremely sensitive to vibrations (like in car), sounds and palpations or bumping especially in ankle ,knees, hips and hands. One bump (in hall) or loud noise (fire drill) is reverberated all day long in her body and/or head. Prior to the pain program we had tried one sympathetic nerve block, botox in calf and cortizone injections for the ankle all of which caused symptoms to increase temporarily. EMG Normal. Bone scan showed decreased perfussion and lower tracer activity in left ankle as compared with right, however this was after a year of non weight bearing. Went to pain rehap program. Interdisiplinary approach with intensive PT & OT. Started on Cymbolta in Jan 2009 switched to amitryptiline just recently. Since 2009 have also tried a long successtion of other drugs in addition to the anti depressants that have made no change in pain level. Nuerontin, lidoderm patch, lyrica, topomax, flector patch, Arthrotec, terazonin(hytrin) Voltarin, Ultram, Propranonol, naprozen. In the beginning Motrin used to help marginally for about 2 hrs of a 6 hours dose the pain would be a little less sharp, but not any more. After the pain program when things did not resolve we tried acupuncture (temp increase in pain following treatments) and lazer accupuncture (turned pain into a cold ache for about 19 hours after treatments). Lazer acupuncture Pain Doctor (MD) performed a neuro scan ElectoDiagnostic Report states Both A-beta pain fibers and A-delta small pain fibers indicated impaired conduction- probable nerve entrapment and hyper conduction- probable irritation. Report also stated possibility of poly neuropathy at L5 S1. When lazer therapy results were unsutainable there was nothing more they could do for her. So we moved on again. A little over a year ago she got a TENS unit. Soon after noticed the headaches. Periodic at first and (if TENS on for 20 minutes there would ALWAYS 100% of the time be a headache.) The quick procession to other areas was soon after that. I am having a very hard time finding a pain doctor in the vacinity who will see and treat a pediatric chronic pain paitient. They won't take her until she is 17-18 but at this rate I don't know what state she will be in by then. She is remarkably resillient and determined to be possitive/productive and continue to be an A+ student but it is taking a herculean effort and she is in so much pain 24/7 never under a 8 and lately can only be acheived by using all of the relaxation, comfort measures and destraction techniques in her aresenal. Her primary has referred her to a peds neurologist for the head aches. I do not know if he will treat her yet. Ironically, w/ treatment RSD kids have better outcomes than adults but finding pain specialist in our area willing to take on a peds patient for long term is so hard. Q's: What should I ask him? Where do I go from here? I feel that if we can not get the pain under control and it has been 3 years she will never be able to be make progress and will continue to slip. It's a cycle of pain perpetuating pain. I’m worried about future auto immune issues with rsd. Is it possible she does not have CRPS afterall? Confused and concerned Mom
Submitted: 3 years ago.
Category: Neurology
Expert:  Dr. F replied 3 years ago.

Welcome to Just Answer

Your question is very complex, and may be more than can be answered in an on line forum

Is it possible that and unresolved pinched nerve in the ankle Achilles area could cause constant pain that becomes neuropathic and spread to other joints and even lead to migraines

 

That is very unlikely. while their are a few nerves in the area, they are very small by the time they have traveled that far, and do not have any ability to "spead" any thing upward except simple information about pain and temperature in foot, etc

 

Your daughter has had many complex and advanced interventions and medications. A pediatric neurologist will have some expertise in treating her headaches, and may have some help for the other pain.

 

If she has not had an MRI of her brain and spine, she should to be sure that there is no treatable problem. If she has not had a sleep study, that should also be done, as poor sleep can cause a multitude of problems.

 

Good Luck in your efforts. I hope this helps

Dr. F, Board Certified MD
Category: Neurology
Satisfied Customers: 266
Experience: Neurosurgeon with more than 20 years experience in practice and teaching.
Dr. F and other Neurology Specialists are ready to help you
Customer: replied 3 years ago.
Thank you. I am sorry it took me so long to accept your answer for some reason it was put in my spam file and I did not see it right away. We are going to see a peds neuro on Tuesday. In the meantime I have another question for you. Her pediatrician perscribed 3 days of Rizatriptam or maxalt which we started Friday to try to stop the daily headache cycle. The dosage is 10mg every 8 hrs for 3 days. She has had 3 so far and it is time for her 4th. No change in her headache yet. My question is if it was going to work would we have seen improvement by now?

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