CRPS of the Lower Leg and Foot: Causes, Symptoms, Treatment and Recovery

CRPS, abbreviation for Complex Regional Pain Syndrome, is a condition that affects the foot and the legs. Also known as Reflex Sympathetic Dystrophy, it is a complex multi system and excruciating chronic disease of the central nervous system and the autonomic nervous system. This disease causes constant pain and is said to be as excruciating as conducting a finger amputation without anesthesia. It is often diagnosed too late to recover fully and is devastating for the patients.

 CRPS – An Overview

CRPS is a neuro-inflammatory disease of chronic nature. It can happen in any part of the body but affects one or both limbs in most of the cases. In CRPS, the immune and nervous system of the patient’s body malfunction to respond to tissue damage, caused from an injury or trauma. This causes the nerves to misfire, and the connections become faulty which leaves the affected areas in constant acute pain. In most of the cases, there is an abnormal response of the central nervous system and the immune system of the affected patient’s body which makes the injury even worse and causes severe pain.

The level of pain varies from person to person. It can cause physical and visual inconsistencies, and the amount of trauma caused to the body due to CRPS also varies from patient to patient. Unfortunately, not many people are aware of CRPS. A lot of research is still underway on the disease, its causes and how it can be treated.

 

Types of CRPS

CRPS is of two types. Both these types typically have the same signs and symptoms but have different causes.

• CRPS Type 1: It is also known as the reflex sympathetic dystrophy syndrome. It is the result of an injury, trauma or an illness that does not affect or damage the nerves in the affected limb directly. CRPS Type 1 accounts for about 90% of the cases of the diseases.
• CRPS Type 2: Also known as causalgia, this type of CRPS is caused as a result of a distinct nerve injury.

Most of the cases of CRPS occur as a result of a trauma to a leg or arm such as amputation, fracture or a crush injury in case of an accident. Other traumas such as heart attacks, surgeries and infections can also cause CRPS.

 

Causes of CRPS

While there is no single documented cause of complex regional pain syndrome, research suggests that it is caused mainly by an initial injury that causes nerve damage which damages the pain receptors in the brain. As many as 90% of the cases of CRPS are caused as a result of an injury or trauma. Here are some of the possible causes of CRPS.

• Sprains and strains
• Fractures
• Injuries to the soft tissues such as bruises, cuts and burns
• Medical or surgical procedures
• Limb immobilization such as staying in a cast for a long time
• Degenerative arthritis
• Heart diseases
• Nerve irritation
• Stroke
• Breast cancer
• Shingles

The list of possible causes of CRPS is growing constantly with research and new cases coming up every passing day. That being said, the exact mechanism of the development of CRPS is still poorly understood.

 

Common Signs and Symptoms of CRPS

The symptoms of CRPS vary from person to person. Most common symptoms are swelling and pain. There is also a noticeable redness and changes of hypersensitivity and temperature in the affected areas. The affected limb and foot can become pale and cold, undergo nail and skin changes,  and also experience muscle tightening and spasms. The condition is often irreversible once the changes take place.

These are the common signs and symptoms of CRPS:

• Continuous throbbing or burning pain in the legs, arms, foot or hand
• The area is sensitive to cold and touch
• Swelling in the painful area
• Changes of temperature of the skin near the affected area. The skin might be sweaty at some times and may be cold at others.
• Changes in the color of the skin. It can range from mottled and white to blue or red
• Changes in the texture of the skin. The skin becomes shiny, thin and tender in the affected area
• Stiffness, damage and swelling of joints
• Changes in the nail and hair growth
• Weakness in muscles, muscle spasms and atrophy
• Decline in the strength to move the affected part of the body

The symptoms of CRPS can spread from the affected area to other parts of the body, such as the other limb. The symptoms in some cases may go away on their own. In other cases, the signs and symptoms can persist for months and even years. The treatment is effective when it is started earlier in the course of the illness.

The treatment options for CRPS are both surgical and non-surgical.

 

Non-Surgical Treatment

The non-surgical treatment for CRPS basically takes care of the acute pain associated with the syndrome. Various medicines are available to take care of the pain which include but are not limited to:

• Non-inflammatory steroid medications
• Antidepressants
• Narcotics
• Compound creams
• Diabetic neuropathy medications
• Medicated patches
• Muscle relaxers

If these pain relievers do not work, the doctors can go for surgical procedures. However, before considering the surgical treatments, the option of sympathetic nerve block is also available to the doctors. It consists of an injection in the spine of the patient that intends to block the transmission of pain to the affected limb. All non-surgical options for pain management must be done under the supervision of a doctor.

 

Surgical Treatments for CRPS

If the non-surgical treatments don’t work, the doctors then resort to surgical treatments. It involves locating the nerve which is causing the issue and completely detaching it. It is an invasive surgery with risks associated with it as well.

The last option when nothing else works is amputation. The idea of amputation is opposed by a number of doctors as the damage is within a nerve; however, it is the best options available in some cases. Unfortunately, a number of cases of amputations due to CRPS are reported where there is no effective result even after the amputation, and the patient still suffers acute pain.

If you are suffering from CRPS, it is important to consult a well-versed and highly experienced doctor about the best surgical treatment option for your condition.

 

Recovery

Recovery options for the patients with lower leg and foot CRPS depends on the specific injured area. It is difficult recovering from the CRPS of the lower leg and foot. It is important for the patient to find ways to walk which put the least amount of pressure on the affected limb or foot. Here are some options you can choose from for mobility following a CRPS surgery or amputation.

• Cane
• Crutches
• Knee Scooter or Knee Walker

 

Canes and Crutches

Crutches and canes allow you to keep your weight off your injured leg. These might be readily available and inexpensive, yet there are many disadvantages associated with them that you should be aware of. The number one complaint from people using these crutches is pain in wrists, under their arms, elbows and hands. It becomes difficult to do every day work such as walking through a door, going to work, and even pushing a shopping cart. All this leads to occasional weight bearing on the affected leg which can cause the injury again or increase the recovery time.

 

Knee Walkers or Knee Scooters

These are becoming common to make the rehabilitation process easy. Knee scooters from KneeRover let the user bend their knee at an angle of 90-degrees and kneel on the platform on a frame attached to four wheels. It works like a bicycle and the user can steer it easily using the handles.

Knee scooters are a great option for long distance mobility and provide the user freedom to move as soon as the doctor advises after the surgery. They provide comfort and keep your weight off your affected lower limb and foot.

 

Complex regional pain syndrome is a painful, chronic and a progressive neurological condition that affects the bones, joints, muscles and skin of the affected individual. It can result from a major trauma, surgery or even small causes like sprain or infections. Pain begins in one area and then spreads to other parts of the body. It is characterized by severe pain, swelling, sweating and sensitivity to touch. It is important to consult a physician in case you are suffering from acute pain in the lower leg and/or foot. Timely diagnosis of CRPS can increase the chances of recovery.

 This is for informational purposes only, please remember to consult your doctor.  

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