Nerve pain after surgery or injury

How injuries and operations can affect nerves

Sensory nerves run just beneath the skin around the ankle and foot, close to where injuries happen and where incisions are often made. A nerve can be affected in several ways:^[2,4]

• Stretched or bruised — for example during an ankle sprain or fracture. These injuries often recover over weeks to months.
• Compressed — by swelling, a cast, splint or tight boot, or later by scar tissue that tethers the nerve.
• Partly or completely cut — the nerve tries to regrow, and a tangle of nerve fibres called a neuroma can form at the injured end. Some neuromas are painless; others become very sensitive.

The nerves most often involved after ankle procedures are the superficial peroneal nerve at the front of the ankle and the sural nerve on the outer side.^[1] Digital nerves in the toes, the saphenous nerve on the inner ankle and small branches around the heel can also be affected.

Symptoms

• burning, electric or shooting pain near or beyond a scar
• numbness or tingling in the area a nerve supplies
• a tender spot that sends a “zing” into the foot when tapped
• sensitivity to light touch, socks, bed sheets or shoe pressure
• pain that seems out of proportion to how the wound looks

Pain accompanied by changes in skin colour or temperature, swelling, sweating, or changes in hair or nail growth can be a sign of complex regional pain syndrome (CRPS), which benefits from early recognition and treatment.^[5,6]

What’s expected after surgery — and what isn’t

Some numbness around an incision is common and often improves over months as small nerve fibres recover. Symptoms that deserve an evaluation include pain that is increasing rather than settling, electric or shooting pain, sensitivity that stops you from wearing shoes, or numbness that spreads.

Recovery after a nerve injury can take longer than people expect. In the ankle arthroscopy study above, symptoms usually began within the first two days, and people with more intense pain or stronger nerve-pain features were less likely to recover on their own.^[1]

How it’s evaluated

• Your story: the original injury or operation, when symptoms started and how they have changed.
• Records: operative reports, imaging and previous test results are very helpful. Please bring them or have them faxed.
• Examination: mapping of numbness and sensitivity, tapping along the nerve’s course, the scar, circulation, skin and joints.
• Other causes to rule out: infection, problems with hardware or bone healing, tendon injury, CRPS, and nerve problems in the lower back.
• Tests: ultrasound or MRI can sometimes show the nerve and surrounding scar. Nerve studies may help for larger nerves, but they don’t always capture small sensory nerves; when needed, they are arranged with another specialist.

We will communicate with your original surgeon and other clinicians where that helps your care.

Treatment options

Non-surgical care

• Time and protection: many nerve injuries improve gradually.
• Desensitization: a structured programme, often with a physical or occupational therapist, to calm an over-sensitive area.
• Footwear and padding to keep pressure off sensitive spots.
• Medication for nerve pain, including topical treatments, coordinated with your primary care physician or pain specialist.
• Injection in selected cases.
• Early, coordinated care for CRPS when it is suspected.^[6]

Surgery for a painful neuroma

When pain persists despite well-tried non-surgical care and a specific injured nerve has been clearly identified, surgery may be considered. Described approaches include removing the neuroma and relocating the nerve end into muscle or bone, freeing a nerve from scar tissue, and reconstructing the nerve with a repair, graft or conduit. Newer techniques aim to give the regrowing nerve a “target” so that a painful neuroma is less likely to re-form.^[4]

No single technique has been shown to be best. A meta-analysis of published studies found that surgery led to a meaningful reduction in pain in about three-quarters of patients overall, but the quality of the studies varied.^[3] If surgery might help, Dr. Ozturk will explain which options suit your situation. Learn more about nerve repair and reconstruction and revision nerve surgery.

Second opinions

If you have been told your pain “should have settled by now,” or you still have nerve symptoms after a previous operation, a second opinion can help clarify what is going on — see revision nerve surgery. Bringing your operative reports, imaging and previous test results makes that visit more useful.

Realistic expectations

Nerve recovery is slow and often incomplete. The goal of treatment is meaningful improvement in pain and function; complete resolution is not always possible. Your plan should be built around what matters most to you — walking, work, sleep, shoes you can wear — and reviewed as things change.

When to seek care

Consider an evaluation if burning, electric or shooting pain after an injury or operation lasts more than a few weeks, is getting worse, or keeps you from wearing shoes or sleeping.