rypz79

Hello Dr. Corenman,

It’s now 3 months since my operation.
S1 is clear I confirmed that with the surgeon.
The remaining issue is numbness mainly in the balls of the foot and in dorsum of it, the same symptoms that led me to do the operation.

The problem with the balls of the foot is that you use them all the time standing, walking, running or doing heel raises. The more pressure there is on this area the more painful/irritated it becomes. There is also a loss of skin sensation (dermatome) in this area compared to the other sole.

Why do I have those symptoms in the terminal parts of the nerve and never in the path of it?

If we are talking about some axonal damage with the myelin sheath still intact does the distance (from l5) plays a role in this situation ?

Thank you very much Dr. Corenman

Hello Dr. Corenman

There are somethings that I’m not sure I’m fully understand from https://neckandback.com/conditions/peripheral-nerve-anatomy/ I’ll try to question as precise as I can:

1) It’s written

A nerve is really a collection of thousands of nerve cells in one bundle- something like a telephone cable with thousnds of individual wires within the cable

So when we are talking about a nerve root (cable) damage we can be talking about multiple injury types i.e each nerve cell (wire) can sustain a different type of injury?

2) In axonal regeneration its written that

The nerve ending may terminate in a muscle, a sensory organ (skin sensation) or a proprioceptive organ (coordination sensation…)

So in case of l5 or s1 nerve root damage as this, how can the lower leg/foot recover from paresthesia while it cannot recover from motor/muscle loss or it can’t recover from both? or does axonal regeneration is reserved only for muscle nerve cells?

3) In nerve sprouting it’s written

This sprouting activity can take from 12-16 weeks after the initial injury to occur

While the compression place, degree and time determines the type of nerve injury sustained are all the nerve recovery times written: Myelin injury: 8-14 weeks , Axonal regeneration: 12-18 weeks , Nerve Budding: 12-16 weeks, get restarted from the time of the decompression surgery?

Thank you very much Dr. Corenman

Dear Dr. Corenman

After further checking the physical condition of my foot using a video tutorial I did find wasting of the Extensor Digitorum Brevis i.e the muscle ball near the ankle of my right foot doesn’t feel as strong and is less visiable then of my left one I’ve also tried the test for weakness of the Extensor Hallucis Longus and passed it there is no differences with the toe power. SLR was always negative, there is no noticeable diminished sensation on dorsum of the foot.

From your tutorial https://neckandback.com/conditions/home-testing-for-leg-weakness/
On L5 I’ve passed the 20 feet duck walk test with ease but when I’ve tried the 20 straight tip toe check I immediately saw that there is a noticeable difference between the two legs I can do it with my right foot (not without sending a hand to stabilise myself) but it’s much easier to do with my left one. I will practice on that more depending on the pain produced but in general is this muscle power unrecoverable if we’re talking about axonal damage?

Is the pain I’m feeling after this exercise in the balls of my feet is meets your definition of “pain inhibition”? It gets worse when I push harder.

Is my “voluntary limping” (to minimize pain while walking normally) for several months prior to the surgery could also contribute to this muscle weakness?

Are those new weakness findings suggest anything about the type of injury I sustained and the time needed for recovery?

Thank you very much Dr. Corenman