Expert: Dr. Victor Dolan, DC, DACBSP - 9/30/2009

Question
QUESTION: Hi there,
I am 36 years and 4 days old(still getting used to the 36 bit :-) )
I had a full ceramic hip replacement in Feb 08. I was born with dislocated hips & knees and had surgery on both hips and my left knee when I was a baby. My leg was shorter by inches, I knew it was shorter but hadn't realised it was as short so the team equalised my leg lengths. When I tried to wiggle my toes the night after surgery, I couldn't feel my leg and was told the next morning I had a dropped foot or 'drop foot' I couldn't feel anything from my knee down and my foot was just like a lump of jelly.
I was told it could take 6 weeks to 6 months to get better by my consultant and up to 2 years by another.. if it came back at all.. Nerve pain started immediately and got progressively worse.. stabbing, burning, electric shocks, tightness, crawling feeling, extreme coldness etc
After approximately 2 months I had slight movement as in I could lift my foot up ever so slightly.. a year and 7 months on I have allot more movement back, thank god but still have loss of sensation in my foot and muscle weakness around the top/front of my foot. Toes are still quite weak. My question is, do you think I should make a full recovery due to the fact that I have improved so much so slow.. although extremely slow!! I reckon some people may think I'm milking it at this stage but I tell you, i wouldn't wish nerve pain on anyone!
I thought maybe the spinal anaesthetic was something to do with it as I got a terible shock through my left leg when getting that which terrified me!

Looking forward to hearing from,

Kind regards
Susanne

ANSWER: Hello Susanne,


I am sorry to hear of your complicated, painful story.

"....I am 36 years and 4 days old(still getting used to the 36 bit :-) )....",  at one point, I thought 36 was OLD!, then I thought 36 was 'Jussssst right'!, NOW , I think - 36,,,, wow I wish I was that young again !!!, what a baby!!!

You got a Lonnnnng way to go.  As long as we breathe our body can be growing healthier, or growing more debilitated.  As long as we breathe, there is hope.  The body heals itself, water it, give it a little sunlight, the right fertilizer, kind words and thoughts- and the body will heal itself!

"....I had a full ceramic hip replacement in Feb 08. I was born with dislocated hips & knees and had surgery on both hips and my left knee when I was a baby.....", my- you certainly present a complicated picture.

"....When I tried to wiggle my toes the night after surgery, I couldn't feel my leg and was told the next morning I had a dropped foot or 'drop foot' I couldn't feel anything from my knee down and my foot was just like a lump of jelly.
I was told it could take 6 weeks to 6 months to get better by my consultant and up to 2 years by another.. if it came back at all.....",  you have had extensive, complicated surgery.  For people with 'easy', or 'simple' procedures recovery can take months, sometimes years.  You have had problems since birth, you will spend many years trying to maximize your physical potential.
No one (on earth) knows your limits.  Will your foot/ leg come all the way back and be 'normal'?-
who knows?, probably not,,, but are you happy where it is?, where you are?, if you are happy--- stop therapy, stop exercising, stop taking supplements, stop doing 'the right thing'.

If you want to progress- if you want to move ahead, improve, get the leg to be all that it can be, , , ,  well, , , ,  you have to keep on working- therapy, exercise, supplements, acupuncture, yoga, chiropractic, positive thinking, prayer, --- all of the positive things, doing all the health building things, doing 'the right things'!

"....I thought maybe the spinal anaesthetic was something to do with it as I got a terible shock through my left leg when getting that which terrified me!...",  you know what, this could contribute to your condition.  As a Doctor of Chiropractic I have treated many patients who have / had back complaints after a spinal anesthetic.  Usually a couple of weeks to several weeks of chiropractic adjustment will erase the pain/ condition caused by the injection.  You have had extensive surgery, while the shot may have temporarily aggravated your leg, I would think the major cause of your leg complaints, nerve condition is the totality of the surgery.

"....My question is, do you think I should make a full recovery due to the fact that I have improved so much so slow.. although extremely slow!! I reckon some people may think I'm milking it at this stage but I tell you, i wouldn't wish nerve pain on anyone!...", Thank you for NOT wishing this on anyone!- nerve pain is terrible and you have my sympathy!- I know you are not milking this.  Several things come to mind listening to your symptoms, history, surgery:  You can search on the internet:  ' causalgia ' , ' RSD = reflex sympathetic dystrophy ' , CRPS = chronic regional pain syndrome '.

http://en.wikipedia.org/wiki/Complex_regional_pain_syndrome
http://emedicine.medscape.com/article/793370-overview

Keep working.  I really do not think anyone can tell you how much better the leg will get.  As long as you work appropriately upon the leg, it will get better or at least stay the same.  If you give up on it, it will give up on you and possibly stay the same, or retreat.

I will include an information sheet that I give to my patients on 'pinched nerves' that includes nutritional supplement advice.


“Pinched  Nerve”   

( Also Known As-  neuritis, neuralgia, brachial-neuritis, sciatica )

“pinched nerve” – is only ½ a diagnosis,  WHAT is causing the ‘pinch’? Your Doctor of Chiropractic will examine and evaluate you to make sure you are not showing signs of neurological damage or disease, tumors, cancers,  severe pathology, perhaps a Herniated Disc, or a Vertebral Subluxation Complex.

Sometimes  we  can  wake  up  with  a  ‘pinched nerve’,  or  a  muscle spasm.... sometimes a slip, trip, fall, heavy lift, or even a motor vehicle accident can cause a ‘pinched nerve’.  Very often -  the true    c a u s e   of  the pinched nerve, painor numbness  in the:    neck and/ or  shoulder  and/ or  arm  and/ or  hand;   pain in the back and/ or   buttock/ hip/ leg/ knee/ foot -  is a misalignment,  a  ‘kink’ in the neck or back - more properly termed a Vertebral Subluxation.

         Vertebral   Subluxation   Complex    (a.k.a.  ‘subluxation’)
The vertebral subluxation complex is the underlying cause of many healthcare problems.
A subluxation interferes with the proper functioning of the nervous system (the master system which controls and coordinates all function within the body) and may cause various other conditions, symptoms and problems.


This is a serious condition identified by its five parts:

      Spinal Kinesiopathology:
         This is fancy way of saying the bones of the spine have lost their normal motion and position. It restricts your ability to turn and bend. It sets in motion the other four components.

      Neuropathophysiology:
         Improper spinal function can choke, stretch, or irritate delicate nerve tissue. The resulting nerve system dysfunction can cause symptoms elsewhere in the body.

      Myopathology:
         Muscles supporting the spine can weaken, atrophy, or become tight and go into spasm. The resulting scar tissue changes muscle tone, requiring repeated spinal adjustments.

      Histopathology:
         A rise in temperature from an increase in blood and lymph supplies result in swelling and inflammation. Discs can bulge, herniate, tear, or degenerate. Other soft tissues may suffer permanent damage.

      Pathophysiology:
         The VSC contributes to OsteoArthritic degeneration.  Bone spurs and other abnormal bony growths attempt to fuse malfunctioning spinal joints. This spinal decay, scar tissue, and long-term nerve dysfunction can cause other systems of the body to malfunction.



The Vertebral Subluxation Complex describes what happens when spinal bones lose their normal movement patterns and position.
         Automobile accidents, improper lifting, improper posture, alcohol, emotional stress, chemical imbalances, and long periods of sitting can cause the Vertebral Subluxation Complex.
         Vertebral  Subluxation  cannot be corrected through chemicals (medicine), stretching, yoga, vitamins or physical therapy alone.  Subluxation- a neuro/skeletal/muscular- mechanical- problem requires a mechanical correction-  -  -    a manipulation,     best performed with the chiropractic adjustment.    For good health-
Treat   the   Cause,  not just the Symptoms.


“Pinched  Nerve”   ( Also Known As-  neuritis, neuralgia, brachial-neuritis, sciatica )
“pinched nerve” – is only ½ a diagnosis,  WHAT is causing the ‘pinch’? – That “pinch” has to be taken care of FIRST!

As the “pinch” – the MECHANICAL component of the problem, the CAUSE of the problem is being taken care of  through Chiropractic treatment,   perhaps additional help would speed your return to health:

Nerve Health Support:
-----B complex containing thiamine, folic acid, B-12 and niacin is highly suggested for nerve support.  High dose
B-vitamins should only be taken at the advice of a licensed healthcare professional.
-----B-6 is lower in patients with neuropathy.  Vitamin B-6 reduces the glycosylation that can cause nerve damage.  Amounts greater than 200mg/day can cause neuropathy symptoms.
-----Calcium and magnesium are important for nerve conduction and as muscle relaxants.
-----A multi-vitamin/mineral supplement is suggested for comprehensive support.
-----Essential fatty acids are necessary for nerve health.  Essential fatty acids include omega-3 fatty acids (fish and flax oil) and omega-6 fatty acids (black currant seed oil, borage oil and evening primrose oil).
-----Proteolytic enzymes may be beneficial in neuritis for the inflammation.
-----Lecithin aids in nerve support.
-----Natural herbal remedies including passion flower, valerian, chamomile, scullcap and white willow bark may be helpful.
-----Eat a healthy diet.  Avoid foods that stimulate the nervous system such as caffeine, chocolate, refined sugars, soda pop and cigarettes.
-----Drink plenty of filtered water.
-----Chiropractic care is imperative to remove nerve irritation.
Joint Support:
-----Glucosamine sulfate helps strengthen joint integrity.  Glucosamine is effective in relieving joint pain associated with osteoarthritis.  Glucosamine's pain-relieving effects may be due to its cartilage-rebuilding properties.  These disease-modifying effects are not seen with simple analgesics and are of particular benefit.
-----MSM is known for its pain-relieving properties in such conditions as fibromyalgia, osteoarthritis, bursitis, tendonitis, back pain and muscle soreness.  Not many clinical trials have been done using MSM, but clinical observations support the theory that MSM is beneficial in pain managment.
-----White willow is an antiinflammatory and analgesic agent.  White willow was used as far back as the Middle Ages to reduce pain and fevers.  The salicylates found in the white willow bark are responsible for the anti-inflammatory and anti-fever effects.  Acetylsalicylic acid, otherwise known as aspirin, is chemically similar to the salicylates.
-----Boswellia and turmeric (curcumin) are potent antiinflammatory herbs.  Curcumin may have similar action to aspirin.


Dr. Victor E. Dolan,   Doctor of Chiropractic;   Diplomate, American Chiropractic Board of Sport Physicians; Diplomate, American Academy of Pain Management; Certified Clinical Nutritionist (IAACN); FIRST  Chief of Chiropractic  in  a  Hospital  in  New York State (DHSI);  As  Seen  in  PREVENTION  Magazine

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Be cautious of pain medications:



PAIN          

Pain  is a  ‘red light on the dashboard’.

Pain is your body telling you that something is wrong.

That RED LIGHT on the dashboard of your car-
-- do you ignore it until the car breaks down,
or do you get it checked and correct the problem?  

Pain,
pain in your body-
-- do you ignore it until your body breaks down,
or do you get it checked and correct the problem?   

Pain,  
do you cover up the pain by taking a painkiller?  
Take a painkiller,
mask the pain,
and allow a problem to progress in your body?



         NOTICE  ON  PAIN  RELIEVERS:
 
Label changes ORDERED by FDA;  the FDA announced proposed label changes for OTC over-the-counter pain relievers to  include the potential for stomach bleeding and liver damage (FDA news  206- 207;  12-9-06) ;

The  American Heart Association issued a scientific statement   recommending medical doctors change the way they prescribe OTC pain relievers from a first choice    to an alternate of recommending non-pharmacologic treatment (AHA statement  2-26-07).

NSAID Acceleration of ARTHRITIS; an important side effect of Aspirin and other NSAIDS is that it will inhibit cartilage repair and accelerate cartilage  destruction ( Journal of Rheumatology, 1982; 9: 3- 5 ).   Many times people take NSAIDS  for  the pain of Arthritis,  not realizing these drugs may make the underlying condition worse.   These medications  cover  up  the  pain,  and  cause  the  problem  to   worsen.


Pain  can  often  be  the  result  of  the  Vertebral  Subluxation  Complex.

Vertebral  Subluxation          (  ‘VSC’ ,    ‘subluxation’   )
Vertebral Subluxation  is  actually  a  quite  common  condition.   Doctors of Chiropractic look for pathological conditions which may require referral to other specialties,   and also look for ‘Subluxation’. Other disciplines look for pathology, but overlook the importance of alignment and movement in the spine which affects our nervous system  (the master control system- ALL health disciplines learn this).  VSC- ‘Subluxation’ – can be the cause of many symptoms and conditions.

Only  a  Doctor of Chiropractic  will  evaluate  and  treat  for  VSC,   as  well  as  other  pathology.

The course of VSC is highly variable.   Some patients with VSC literally cannot walk, yet other patients with similar test findings may be able to run marathons or lift heavy weights.    Some patients immediately develop symptoms related to the VSC,  some patients take years to develop symptoms.  Some people suffer for only a few days with pain and symptoms, some people suffer for months.  Some people recover in days, some take months or years, depending upon severity of the condition.

A subluxation interferes with the proper functioning of the nervous system (the master system which controls and coordinates all function within the body) and may cause various other conditions, symptoms and problems.


The Vertebral Subluxation Complex describes what happens when spinal bones lose their normal movement patterns and position.  When subluxated, joints are in a stressed, vulnerable, compromised condition.  Subluxation may cause Arthritis, Disk Herniation, or aggravate such conditions.
       Vertebral  Subluxation   cannot   be corrected through chemicals (medicine), stretching,  yoga,  vitamins  or  physical  therapy  alone.       Subluxation- a neuro/skeletal/muscular-    mechanical-    problem  requires  a    mechanical correction-  -  -    a manipulation,         best  performed  with  the  chiropractic  adjustment.

Dr. Victor E. Dolan,   Doctor of Chiropractic;   Diplomate, American Chiropractic Board of Sport Physicians; Diplomate, American Academy of Pain Management; Certified Clinical Nutritionist (IAACN); FIRST  Chief of Chiropractic  in  a  Hospital  in  New York State (DHSI);  As  Seen  in  PREVENTION  Magazine

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I cannot answer your question about how much better your leg will get, nor how long it will take to get there.    I do want to be as encouraging as possible to say- keep with it!

I would recommend a nutritional adjunct to whatever steps you are taking- see above for some advice, see a local nutritional doctor for further help!

I would recommend a Doctor of Chiropractic to help maximize your healing potential.  I have an old schoolmate who is either in Ireland or England (as I read your question info, it says you are in Ireland,,,, ) ,  perhaps he could be of help to you:  Dr. Scott White @ dr4all@mac.com ,
just let him know I recommended you to contact him.



I hope this information helps you.


If you need further information, please do not hesitate to re-contact me here at
AllExperts.com
http://allexperts.com/ep/965-100794/Chiropractors/Victor-Dolan-DC-DACBSP.htm

Thank you for the question. Good luck in returning to full, Good Health!
KEEP  ON  'DOING  THE  RIGHT  THING' = building health, NO one knows your potential.

Your Staten Island Chiropractic Expert,

Dr. Victor Dolan, DC
Email newsletter: . . . . http://drvictordolan.chiroweb.com




---------- FOLLOW-UP ----------

QUESTION: Firstly, thank you very much for your speedy response!!

Just another question please. I have started doing aquafit mainly to stengthen up my leg due to muscle loss, do you think this is beneficial to my foot? Are there any particular exercise you would recommend?

I still have some nerve pain/discomfort and I am hoping that is a sign that the nerves are still regenerating. I am constantly massaging my leg / foot %26 have not given up as I believe I am continuing to recover. I don't see  the recovery on a day to day basis, not even week to week, more like month to month or even longer..
I am also constantly trying to move my foot%26 do small amounts of exercise to try keep it in action. It wasn't until about 2 or 3 months ago that I could curl or wiggle my toes..

Again, thank you very kindly for getting back to me so soon %26 for all the information. It is very much appreciated!!

Kind regards,
Susanne

ANSWER: drop foot, staten island drop foot, dropped foot




Hello Susanne,

Thank you for your kind words and further information/ inquiry.

Upon review of my answer, I would like to continue- and add more.

I should have also described/ explained 'drop foot' or 'dropped foot' or 'foot drop'.
Foot Drop is a symptom, not a real diagnosis.  Foot drop, as you have experienced is some
degree of inability to control the foot properly.  For instance- when we walk we instinctively
raise our toes to clear the ground as we move forward.  If we let our toes point down (foot- drop) , we will trip over our own toes, our own foot.  Foot drop does not usually occur due to a muscle problem, but usually occurs due to a nerve problem.  Some people have a complete foot drop- absolutely NO control over the foot.  some people have some degree of foot drop- sometimes tripping over the foot, sometimes not.  Often this symptom receives symptomatic treatment of wearing a brace, aiming the toes up, allowing the person to walk a little more normally.

This foot drop comes from a nerve problem.  In a chiropractic office, foot drop can come from a 'pinched nerve'.  The pinched nerve, in turn, can come from many different things: a vertebral subluxation (joint not positioned/ moving properly= irritating a nerve), herniated disc, a bruise to the sciatic nerve, nicking the nerve with a needle injection, even possibly a space taking lesion (ie: tumor) compressing or irritating or 'pinching' a nerve.

Your foot drop comes from your poor nerve being moved about, stretched, irritated during your surgical procedure(s).

Foot drop heals as the NERVE heals.  We may mistakenly look at the foot and think the problem is the foot, or in the foot--- but it can be much higher along the route of the nerve.  The nerve can have damage in the foot, ankle, knee, thigh, hip, buttock, or lower back (working upwards).
Heal your NERVE and your leg and foot will work better.

Another thing I forgot to mention in my previous answer, talking about 'building health', helping the nerve repair, regrow, regenerate: certainly good nutrition, targeted nutrition, chiropractic, perhaps acupuncture, perhaps massage---- massage by a LICENSED or CERTIFIED massage therapist, so that appropriate work is done.

"...I have started doing aquafit mainly to stengthen up my leg due to muscle loss, do you think this is beneficial to my foot? Are there any particular exercise you would recommend?...."
Aquafit is WONDERFUL.  You will be able to do more in the water.  You can PROGRESSIVELY do more intense/ more strenuous exercise OVER TIME.

You seem to be taking a mature, intelligent approach--- I love your remark:  "....I don't see  the recovery on a day to day basis, not even week to week, more like month to month or even longer....." YES.  YES.  YES.  Be patient. KEEP working. It takes time.
         And NOT day - to - day time,,, not even week to week,, but YES- it may even take month to month changes.  But the longest journey starts with the first step!  Monthly evaluations, monthly re-evaluations should be performed by your therapist/ doctor/ health practitioner to chart your progress.  Never get discouraged.  You are doing the 'right things'.

Exercise/ therapy should be slowly progressive.  For example, waist deep, nipple deep in water,,,
just do some toe raises= standing, just raise up on your toes; stand on your toes; walk on your toes; raise up on one foot, raise up on the other.  Then- the opposite: heel walking= more difficult!;, raise up ON YOUR HEELS; both feet, one foot- the other foot, then walk around the swimming pool- on your HEELS. Progressively more and more.  Stand on one foot, Kick your other foot towards the sky, toes pointed up (foot raised rather then foot dropped).  These are initial exercises, yet they may be all you can do at this time.  I am sure your therapist can lead you in more.

Good Luck.  You seem to be on the right track, the right road, even though you come from a difficult past path!

I hope my answer has helped and encouraged you.

Again, good luck.

Do not hesitate to re-contact me if I could be of help (whether now or in the future).

Remember: KEEP  ON  'DOING  THE  RIGHT  THING' = building health, NO one knows your potential.



Your Staten Island Chiropractic Expert,


Dr. Victor Dolan, DC
Email newsletter: . . . . http://drvictordolan.chiroweb.com




---------- FOLLOW-UP ----------

QUESTION: Sorry Doctor, I am back again!
You have suggested maybe I try massage---- massage by a LICENSED or CERTIFIED massage therapist, so that appropriate work is done.
I told you I have been massaging my leg & foot. Do you think maybe I am doing more harm than good with this. I do tend to massage quite hard as it gives me a weird sensation, as in when I rub the back of my leg, I can feel it in the sole of my foot & I kind of thought that was a good thing and presumed it was the nerve endings..



Also, I can try do these exercises "For example, waist deep, nipple deep in water,,,
just do some toe raises= standing, just raise up on your toes; stand on your toes; walk on your toes; raise up on one foot, raise up on the other.  Then- the opposite: heel walking= more difficult!;, raise up ON YOUR HEELS; both feet, one foot- the other foot, then walk around the swimming pool- on your HEELS. Progressively more and more.  Stand on one foot, Kick your other foot towards the sky, toes pointed up (foot raised rather then foot dropped).  These are initial exercises, yet they may be all you can do at this time.  I am sure your therapist can lead you in more"
In relation to the above, I find it uncomfortable standing on my toes of the dropped foot as the sensation is weird & it feels like its just bone against skin, no padding.. if you know what I mean..
Also, my physio therapist seems to think she has done all she can for me at the moment, I can give her a call anytime I want to ask her anything though( it was a physio in the hospital as a public patient )
And my local doctor only assesses me by askin me questions, doesn't really check me that much.
Also, I have been back for a number of hospital appointments since my op & for the last few, it is someone different everytime so they are not fully aware of my initial condition..

Anyway, I think I have taken up quite enough of your time. I thank you again for all the information & time you have provided me with.

You are very good :-)

Answer
Drop foot, Dropped foot, Foot Drop, nerve palsy, nerve weakness, pinched nerve, exercise,



Hello again Susanne,

"Sorry Doctor, I am back again!...."- NO PROBLEM.  I hope my long winded answers help you.

"....You have suggested maybe I try massage---- massage by a LICENSED or CERTIFIED massage therapist, so that appropriate work is done. ...", in New York State we have LICENSED massage therapists; these health practitioners have gone through schooling AND taken a test to receive a LICENSE to practice massage.  Other states have certification to practice.  Some type of credentialing (plus a good reputation) will assure the best type of care is given to you.
         Massage will be good for you.  But improper, too strenuous, wrong direction,,, whatever-- massage, like anything can do good or bad!  If you are massaging yourself, make sure you pull towards the heart!  Since you do not have good sensation, maybe you are too hard or too soft!

If raising up on your toes gives you a 'weird feeling', only you can decide if you want to tolerate this feeling.  Raising up on your toes is NOT as important as rising upon your heels anyway!  Point those toes up and walk about the pool TOES UP (against the 'foot drop').

Again, good luck!, do not hesitate to REcontact me with a question - or in the future with a progress report!

Dr. Vic