Tell Me Where it Hurts
Sciatica
Q: I am a 31-year-old male. I fell 15 feet at work and broke my pelvis. My foot was weak and numb for a while. The weakness has improved, but the numbness is still there. Now my calf and foot burn like crazy. What could it be?
A: The nerves that travel to the lower extremity, such as the sciatic nerve, do so through the pelvis. Any injury to that area can potentially sever or injure these nerves. A completely severed nerve is unlikely to recover, leading to numbness, weakness and even pain. Partial damage allows a nerve to heal to a substantial degree, usually growing at a rate of one inch per month.
It is common for incomplete healing to occur, many times resulting in persistent pain as a result. If the sympathetic nerves get involved there may be burning, swelling and other skin changes as a result. These injuries are very seldom amenable to local surgical treatment, and cutting the nerve, which sounds like a simple solution, invariably makes the pain worse. Medications for neuralgia and injections around the nerves are your best bet. Physical therapy should be maintained, and, if depression develops, it needs to be addressed.
If conservative therapy fails, more invasive treatments are necessary. One option for severe nerve damage pain is a spinal cord stimulator. It is a battery-operated device similar in principle to a heart pacemaker, and it is attached to an electrode implanted in the spine, which stimulates the affected nerves with electricity, thereby blocking the pain.
© Dr. Moacir Schnapp and Dr. Kit Mays
