Right Foot Nerve Issues and Persistent Lower Body Tension

Abnormal nerve sensation in the right foot (toes) and overall tightness in the right lower extremity?

I underwent spinal scoliosis correction surgery at the age of 16 (in 2005).
Before the correction, I had an S-shaped curvature when viewed from the back, with an angle of approximately 50-60 degrees.
After the surgery, there remained about 15 degrees of curvature.
Everything was normal post-surgery, and I was able to engage in regular physical activities until the end of 2018.
Due to prolonged deadlifting training, I gradually began to feel soreness in my right lower back.
Subsequently, I had X-rays and an MRI, and the doctor found no abnormalities with the spinal screws; however, the MRI showed a slight protrusion of the L5-S1 intervertebral disc, which was not severe.
Therefore, I only underwent passive rest treatment, during which I stopped weight training.
I noticed gradual improvement in my lower back soreness, but by mid-2019, although the soreness had significantly improved, I began to experience occasional numbness in the sole of my right foot, with abnormal sensations in my toes.
Additionally, I felt tightness in my right lower back, groin, buttock, and the back of my right knee, especially noticeable when standing still or even during daily showers.
It felt as if my entire right leg was tight and constrained, causing discomfort 24 hours a day, except when sleeping.
The discomfort was ranked as follows: standing still > sitting > lying down > walking.

In 2020, I consulted many doctors, all of whom believed it was a disc and muscle issue.
I tried various treatments, including electrical stimulation, heat therapy, stretching, core exercises, and even changed my mattress, but there was still no improvement.
Eventually, I consulted an orthopedic surgeon who determined it was still a disc problem and, due to the severity of my symptoms affecting my daily life, I decided to undergo minimally invasive disc removal surgery in January 2021.
The surgery went smoothly, but tragically, four months post-surgery, I found that my symptoms persisted without any improvement, which has been incredibly frustrating.
I have sought opinions from various orthopedic and physical therapy specialists but have not received a clear diagnosis or explanation for my pain.

I would like to know if there are more detailed diagnostic methods available to accurately identify the root cause of my issues to avoid unnecessary treatments.
Is it possible that my symptoms are untreatable? Am I destined to coexist with this pain for the rest of my life?

Shen xin ju pi, 30~39 year old female. Ask Date: 2021/05/06

Dr. Chen Yongxue reply Orthopedics

Hello, based on what you described, the symptoms seem quite severe.
However, please consider whether it could simply be a case of myofascial inflammation.
The reasons are as follows: 1.
MRI shows only mild compression of the nerve (L5-S1).
2.
There has been no improvement after surgery.
3.
The S1 nerve does not affect the groin, buttocks, or the posterior aspect of the right knee.
If possible, please consult an orthopedic physician for a physical examination.
If it is not a nerve issue, undergoing more surgeries and rehabilitation may not be effective...

Reply Date: 2021/05/06

More Info

Understanding the complexities of nerve issues in the right foot, especially in the context of a history of scoliosis surgery and persistent lower body tension, requires a multifaceted approach. Your experience highlights a common challenge faced by many individuals with similar medical histories, particularly those who have undergone spinal surgeries.
Firstly, it is essential to recognize that the symptoms you are experiencing—numbness in the right foot, abnormal sensations in the toes, and tension in the lower body—could be attributed to several underlying factors. Given your history of scoliosis and the surgical correction performed, it is possible that the alignment of your spine and pelvis may still be contributing to nerve compression or irritation. The L5-S1 disc protrusion noted in your MRI could be a source of nerve root irritation, especially if it is affecting the S1 nerve root, which innervates parts of the lower limb.

The chronic denervation changes observed in your right tibialis anterior muscle, as indicated by your electromyography (EMG) results, suggest that there may be ongoing nerve damage or dysfunction. This could be due to a variety of reasons, including mechanical compression from surrounding structures, post-surgical changes, or even muscle imbalances that have developed over time. The fact that you have not experienced improvement post-surgery could indicate that the source of your symptoms was not adequately addressed during the procedure.

In terms of diagnostic approaches, it may be beneficial to consider a comprehensive evaluation by a multidisciplinary team, including a neurologist, orthopedic surgeon, and physical therapist. Advanced imaging techniques, such as a high-resolution MRI or a CT scan, might provide further insights into the structural integrity of your spine and surrounding tissues. Additionally, nerve conduction studies could help assess the function of the peripheral nerves more thoroughly.

Physical therapy focused on neuromuscular re-education may also be advantageous. This could involve exercises aimed at improving core stability, enhancing proprioception, and addressing any muscle imbalances that may have developed due to your scoliosis and compensatory movement patterns. Techniques such as myofascial release, dry needling, or even acupuncture could provide symptomatic relief and improve overall function.

Moreover, it is crucial to address the psychological aspects of chronic pain. The frustration and anxiety stemming from persistent symptoms can exacerbate the perception of pain. Cognitive-behavioral therapy (CBT) or mindfulness-based stress reduction (MBSR) techniques may help in managing the emotional toll of living with chronic discomfort.

Lastly, it is vital to maintain open communication with your healthcare providers. If you feel that your concerns are not being adequately addressed, seeking a second opinion or consulting with a specialist who has experience in treating complex pain syndromes may provide new perspectives and treatment options.

In conclusion, while the journey to finding relief from your symptoms may be challenging, it is essential to remain proactive in seeking comprehensive care. With the right combination of diagnostic evaluation, physical rehabilitation, and psychological support, there is potential for improvement in your condition. Remember, you are not alone in this journey, and with persistence, it is possible to find a path toward better health and well-being.

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