Any Peroneal Nerve recovery stories?

[missmyknee]

Hi Cris

Dr Dellon is an excellent peripheral nerve surgeon and works a lot on those with foot drop. I used him for a different nerve problem. He usually responds fairly quickly to emails. However , he is a cash only doctor.

Pam

[cris]

Pam,
Hi, I did hear that about Dr Dellon, but if he can help I would pay.
Thanks
Cris

[cris]

can anyone tell me what the first signs of nerve recover are and how long it took for them to get?  Did it keep going slowly or stop for awhile then recover? I am 2.5 months post surgery and still not seeing a whole lot of improvement.
Thanks
Cris

[BIGEL]

Hey Cris,

       The first observation I noticed was very slight dorsiflexion at the 8th month prior to surgery.  After the surgery, slow progression then a brief pause.  Presently continued progression at almost 19mo.  I have been told to remain active.  If you haven't get a good afo.  I also visited the gym to keep the achilles loose and built up my anterior tib.  Don't limit yourself!

[cris]

Thanks Bigel,
I go to PT 2 times a week and do home excercises.  What excercises to you do to build up the anterior tib?

I have 2 afo's but is it better to go around without it to try to get the nerve going, or does it not matter?

Reason I am so down is I got the results from the EMG last week and showed the nerve in conductivity but damage was severe.  I don't know what that means.  The doctors approach has been to wait and see.  It has only been 3 months since the injury but when do you stop waiting and do something? or is their anything to do.

Just really down thinking about living with drop foot the rest of my life.  I try to stay positive but then get down again when I think about it.

Thanks for all your help,
Cris

[BIGEL]

Hey Cris,

Common symptoms of foot drop is muscle atrophy.  I personally lost a couple of cms of my anterior tib. muscle and its definition.  You can slow down the effects of atrophy by being active.  Some of the exercises I do are: 

The one leg stand (the goal is to stand on one leg for 1 full min, however don't push it in the begining.  do what you can and build up to the 1 min)  This exercise builds the tib. and uses your ankle and foot muscles while balancing.

The pro stretch this device stretches the calf and the anterior tib to keep it from stiffing up. 

http://www.bing.com/shopping/prostretch/p/10D15E7FC5732A635020?q=prostretch&lpf=0&lpq=prostretch&FORM=CMSMEE

The Quads can also be a problem from lack of use.  The quads can become weak and suffer from atrophy too.  You may notice that you are having trouble getting up from the seated or kneeling positions.  The quad muscle is used to get you up from these positions.

  One Quad exercise I do is having my back to the wall and bend my knees (basically a seated position, but your back is to the wall, while bouncing a large ball to keep your mind off the exercise.  Start with 3 mins and add more time to this exercise if you wish 

Get a tens unit to help stimulate the nerves.

I too have 2- afos and working on a third one.  The third will allow me to run and play sports.  I can walk with out an afo but I can't run nor pivot.  The one I'm trying to obtain will allow me to do just that.  Its really state of the art.

Don't worry about those EMG tests.  I was disappointed too when I didn't see any improvements.  After its determined that the nerve is in continuity you'll be one your way to recovery.  My PT, OS and I saw improvement before I went for my 4th EMG.  So remain active and do strenghten exercises.  ITS A LONG ROAD! 
                                                                                                                                  Bigel

[cris]

Bigel,

Thank you so much for your reply!

Sounds like I am doing the right things.  I do the one leg stands with moving the other leg in various directions and now have progressed to trying do them with my eyes closed, but this is extremely hard.

I have the pro stretch and do 3 sets of ten seconds each 2 times daily (and whenever I am not doing anything in front of the tv)

I am going to try your quad exercises. What I have been doing is getting up from a seated position on one leg. I try to do 30 of those a day, but they are hard.

I also have returned to the gym and am starting again using weights, real easy and low weights now at first.  Also introduced to using the treadmill walking backwards and frontwards on incline.

I have an empi e-stim and use it 2 times a day for 15 minutes each.  I use it but don't see any muscle contraction.

My emg showed the nerve in continuity but I just have not seen much improvement in the last 2 months. But I
had a significant stretch, although my doctor couldn't say how much.  He say we need to wait and see as it could take 1 years or more.  I am going to wait a few more months before I see a neurosurgeon and see what they have to say.

Also I notice tingling in my feet and toes when I tap the injured nerve area.  I am hoping this is a tinel sign and
will diminish over time as the nerve regenerates.  My therapist said to stop doing that because it is causing micro
 trauma to the nerve, so I have stopped.

What is that new afo that will allow you to play sports?  Is that a SAFO? I like the SAFO but they are expensive.

Good luck with your recovery and getting back to playing sports and again thanks for all your encouragement.

Cris

[BIGEL]

Hey Cris,

Apparently you are doing the all of the right things!  I'm going to try the walking backwards on the treadmill and the one leg stand with my eyes close.  My PT has me standing on an air filled pad with both feet with my eyes close.  He saids this will have your muscles work harder because your not using your sense of vision.

My nerve was significantly stretched as well.  Be aware that 9 mos. is the mark not a year to for the wait & see approach.  I was told this by my OS, PT and I read this on several online searches.  In my case I had to wait about 9.5 months before exploratory nerve decompression surgery was performed.  My OS during the surgery found that the nerve was being strangled by scar tissue (from blowing out my knee).  He removed the scar tissue and the next day I noticed slight dorsiflexion movements.  Today I can see my tib. contract along the shin bone for the first time in over a year!

I'm just excited with this afo because its extremely light weight and high flexable.  With the toe lift no body can tell if I'm wearing it and my gait has improved.  No limping.  This is what it looks like:

http://www.orthoticshop.com/blog/wp-content/uploads/2009/06/royceafolight.jpg

I'm not sure of the price, my insurance is covering it.  I'll let you know what they paid for it.

Thanks for the above mentioned excerises!  And good luck with your recovery too!  Time will go by at its own pace, just keep up with the excerises and stay active.  Believe me I have been there and I know what your feeling.

                                                                                                             Bigel

[cris]

Bigel,

Nice looking AFO.  Be careful with those eyes closed one legged stands, make sure you have something close to brace yourself.  I can hold it for about 5 seconds.

I think around the 6 month point if no more improvemnets I will look at decompression surgery, but hopefully by then I will see some more improvements.

I try to do 1 hour a day at home of PT and then see my therapist 2x a week.

It is better to walk around without the afo if you can to try and activate the muscles?

thanks
Cris

[Shumster]

Hey cris and Bigel,

I'm really glad you guys have kept this thread going.

Bigel, it's so great to hear you're making great progress. How much ankle dorsiflexion do you have now?

Cris, I'm really sorry that you've joined the dropped foot club. I'd like to assure you though that no matter what happens it really does get better. I'm 17 and am 5 months post nerve graft surgery. I'm also dealing with a knee that has only progressed to 115 degrees in the last 11 months. It has taken a lot of time to fully understand my injury but I would like to say that you eventually do figure out how to live with it. I know this is totally not what you want to hear as you are very focused on getting back to 100%. I was the same way but I am realizing that I can still find a way to live the life I want to despite my injury. Anyway i'm not saying you should give up or anything. I'm saying that you should put everything you have into your recovery but still have the mindset that no matter what happens you'll find a way.

Anyway i'm sure it's sort of weird getting life advice from a teenager but I just thought I would try to help cause I know it is a tough journey.

Ok, on to some more technical stuff. You were asking if walking around without the brace on is a good idea. I have a really wise orthopeadic trauma surgeon who is now an ortho massage therapist that I consult with and he has said that is a good idea to walk around without the brace on once in awhile. I personally walk around the house without it on. The reasoning behind it is that it helps with proprioception. Something to do with your body recognizing where your foot is in space or something and knowing that your tib ant is supposed to be fired. Something else I also do is before I go to bed for about 10 minutes I just lay there and focus on pulling my foot up. That apparently helps the brain direct your axons or whatever to connect to the right receptors. Sorry im not a doctor and am really poor at explaining this stuff. Hopefully some of that stuff helps. oh, last thing, This ortho therapist I see also does this thing called friction massage right over my fibular head to try and break up any scar tissue around the nerve. Might be helpful to consult with an ortho massage therapist in your area?

In terms of me I am still waiting to see if my nerve graft takes. Honestly I am fairly certain it will not. That hasn't stopped me from doing everything I possibly can to try and help it work though. I just have a feeling that a posterior tibial tendon transfer is down the road. I am not looking forward to more surgery...

Anyway sorry about the formatting of this post, I am aware that it is poor. I'm just trying to reply quickly cause I have to work tomorrow.

Take it easy,
Lachlan

[cris]

Shum,

Thanks for the reply.

I am still focused and praying hard for my recovery.  I do have some tendon activation at my ankle and am able to clear my foot when I walk but I do get foot slapping when I place my foot.  I have small amount of anterior tib activation but I have not seen much improvement in the last 2 months.

I do everything told to me to try to strengthen that anterior tib,  but it is so hard.

Thanks for answering my question about walking around with no afo.  I do the same thing as you and around home I do not wear it.  I can go short distances slow without the afo but fatigue easily.

At 6 months I will consult with a neurosurgeon about nerve decompression.

Again thanks for the reply and I will pray for your recovery as well  as Bigel and others.

Let's keep the thread going.

Cris

[BIGEL]

Hey Cris & Shum,

Cris,

Thanks for the heads up on the one leg stand!  I tried and it was heart pounding!  Lol!  If you can lift your foot up slightly and are ok with ankle weights, purchase a pair of 2.5 lbs. weights.  Start out slowly.  Do what you can.  I started out with 3 reps. 10x ea of dorsiflexion and 3 reps. 10 sec hold of dorsiflexion.  It was a struggle.  I since moved up to 10 reps. 30x each and 3 reps. 30 sec hold of dorisflexion with a pair of 5 lbs. weights. Wrap the weights around the ball of your ball of your foot.  I do walk without a brace in public to the gym, market, etc., some days are better than others.  Got to get those nerves fired up to do its job.  I use the Ossur soft brace when the need arises. You connect and disconnect at will.  I mentioned how I didn't like it before in a previous post, but its better than wearing the bulky one I use to wear and its more flexable!  Slapping noise still exists.  http://www.amazon.com/Ossur-Foot-up-Brace-Large-Black/dp/B00302N4P8/ref=sr_1_2?s=hpc&ie=UTF8&qid=1340971704&sr=1-2&keywords=ossur+afo

Shum,

I've been told I have recovered 50% presently.  I can dorseflex, perform eversion, move my toes, but my big toe has been very slow to recover. I can move that up slightly.  The big toe movement involves a larger muscle and is the last part of recovery.  However, my movements have been more crisp and sharp.  Then, its all about strengthening.  I wish I new about the importance of the massage sooner.  I was getting the massage about every 2 weeks by my PT and boy was it painful.     

I too wish for everyone to have a successful recovery!
                                                                                               Bigel

[cris]

just wanted to update and keep the thread going.

No big improvements here but have been swimming allot over the past few days which hasn't done much for my dropped foot but has helped loosen up my knee.

I don't have much nerve pain and the numbness is subsiding, but I still have this ankle tightness.  It feels like a clamp is on the top of my ankle,  it is more annoying then painful.  Does anyone know what this is and how to cure it?  Also my ankle gets sore if I walk on it too much, bought a good pair of orthodics that help but doesnt eliminate it.

I have always had feeling in my foot and ankle and I can wiggle my toes pretty good now, just can't dorsiflex.

that's the latest, keep in touch,
Cris

[BIGEL]

Cris,

I actually swam better with the drop foot. lol! 

I haven't tried walking backwards on the threadmill yet, but I walked backwards on the track.  Quads were burning and I'm now sore.  Good workout!  I started it on the track and 3 other walkers followed!  It was pretty funny to see that. 

My big toe is flickering left to right more pronounced with some upward movements and the tendon is improving.

Finally, got approval by my insurance for the new afo, but now the othro co. is closed for vacation for a week.

Keep pushing, stay active!
                                                                                                           Bigel

[xneumanx]

Yes.  I had foot drop.  Left leg, terrible weakness on left side, etc.  I thought I had a mini stroke, MS, or nerve damage.  Went through all the tests, mri, emg, blood tests, etc.  Started doing exercises that I saw on UTube.  Then bought Clark Wave Shoes as reccomended on a MS blog site.  Started taking B complex vitamins.  About one month in my outer toes started to move, the numbness on the top of my foot and my shin was less pronounced. My large started to respond.  This is all before I started PT.  Now, I am getting electric stims and new exercises.  I feel that I have already recovered 75%.  Yes there is hope!