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

CRPS of the lower leg and foot can be debilitating.

Complex Regional Pain Syndrome (CRPS) is a chronic neurological disorder that often affects the the lower leg or foot, but can also impact the arms and other parts of the body. Also called Reflex Sympathetic Dystrophy (RSD), the condition can cause excruciating acute pain. Unfortunately, CRPS is still poorly understood, and significant research is still underway to learn more about its causes, symptoms and how to treat it.

Your Guide To Recovery
What is CRPS?
CRPS causes
RSD and CRPS terminology
Common CRPS symptoms
Non-surgical pain management for CRPS
Surgical options for CRPS
Recovering with lower leg or foot CRPS
CRPS/RSD support resources

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What Is CRPS?

CRPS is a chronic neuro-inflammatory disorder that generally affects one or more limbs, though it can happen in any part of the body [1]. The condition causes the nervous and immune systems to malfunction in response to tissues damage, which causes nerves to misfire. A damaged neurological connection then becomes continuously more faulty and leaves the affected area in constant pain. CRPS also creates an abnormal immune system response that magnifies the pain in the affected area.

The levels of pain and outward visual CRPS symptoms can range dramatically from person to person, and although significant research is ongoing CRPS is still poorly understood.

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CRPS Causes

The majority of research on CRPS suggests that in 90 percent of cases an initial injury permanently damages pain receptors in the affected area, and that causes disrupted communication between the injury and the brain [2].

Common initial injuries may include: fractures, sprains or strains, soft tissue injuries (such as burns, cuts, or bruises), limb immobilization (such as being in a cast), surgical or medical procedures, heart disease, degenerative arthritis, stroke, nerve irritation, shingles, and breast cancer.

The list of possible CRPS causes is constantly growing, which reflects that the exact mechanism of how CRPS develops is not well understood.

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RSD and CRPS Terminology

As noted above, CRPS is also often referred to as Reflex Sympathetic Dystrophy syndrome (RSD). Though many consider the terms interchangeable, RSD is more accurately used to describe a specific condition: Type I CRPS.

The two forms of CRPS, Type I and Type II, have near-identical symptoms, but they’re differentiated by their causes [3].

  • Type I CRPS occurs from a tissue injury or situation where there is no underlying nerve injury. This form is also sometimes called sudeck’s atrophy.
  • Type II CRPS occurs from injuries caused by trauma or impacts that are clearly associated with a nerve injury. This form is also sometimes called cusalgia.

Despite these clear differences, RSD is still often used to describe the symptoms associated with either form of CRPS. When CRPS affects the upper limbs following a stroke, it is called shoulder-hand syndrome.

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Common CRPS Symptoms

CRPS symptoms often appear following an injury.CRPS symptoms vary widely in intensity [4]. Along with physical symptoms, nerve damage may correlate with an individual person’s emotional state, which affects the level of pain he or she feels. High levels of stress or anger, for example, can significantly increase many CRPS symptoms.

Common symptoms may include:

  • Moderate to severe pain that’s described as deep, aching, cold or burning,
  • Swelling and stiffness in the affected joints,
  • Decreased motor function in injured area,
  • Discoloration of the injured area,
  • Abnormal sweating patterns,
  • Changes in nail and hair growth,
  • Skin sensitivity,
  • Pain that’s more severe than normal for a given injury,
  • Pain that lasts longer than the average recovery period.

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Non-Surgical Pain Management for CRPS

In some cases, CRPS pain can be managed using a range of over-the-counter and prescription drugs [5]. These include but aren’t limited to: antidepressants, non-inflammatory steroid medications, muscle relaxers, narcotics, compound creams, medicated patches and diabetic neuropathy medications.

Before considering surgery, doctors may also attempt treatment using a sympathetic nerve block. This involves a spinal injection that’s intended to block pain transmission to the brain. All non-surgical pain management options must be executed under the close supervision of a doctor.

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CRPS Surgical Options

CRPS symptoms can be persistent and painful enough to require surgery.

If medications or nerve blocks don’t resolve CRPS symptoms, surgery may be required to alleviate the resulting pain. The least invasive option involves locating the exact nerve causing the issue and removing or detaching it [6].

The most invasive and life-altering procedure used to treat CRPS is amputation of the affected limb. Most doctors oppose the idea of removing a limb because of nerve damage, but there are cases for which amputation may be the best option [7].

Unfortunately, there have been multiple CRPS cases in which an amputation lead to poor results. Even after removing the affected limb patients sometimes still suffer the same pain via the phantom extremity.
Anyone suffering from CRPS should consult regularly with their doctor to determine which treatments are best suited to their needs..

Recovering with CRPS in the Lower Leg or Foot

CRPS recovery options depend on the affected limb or limbs. For example, recovery for an arm affected by CPRS involves immobilizing the arm to limit its use while keeping it safe and comfortable.

Recovering from CRPS on the lower leg or foot is more challenging. The CRPS patient must find ways to walk with only slight pressure on the affected area. There are only a handful of options for mobility when the lower leg or foot is damaged by CRPS:

  • Crutches,
  • Cane,
  • Wheelchair,
  • Knee scooter or knee walker,
  • iWALK hands-free crutch.

Canes and Crutches

Canes and crutches literally keep the hands full, which means a person using them has limited or no use of their hands while standing or walking. Because there is no direct cure for CRPS this means people using crutches will have their hands full for life. Struggling with crutches is not an option for anyone who has to care for themselves or others. Crutches hinder a person’s ability to do laundry, cook food, take out the trash, walk the dog or numerous other day-to-day tasks.

Wheelchairs

Wheelchairs are alternatives for those looking for long-term mobility options. Wheelchairs allow the CRPS patient to keep weight off the foot, but they’re bulky and difficult to maneuver. They may also require many additional modifications to your home and routine, such as ramps that go around or over stairs, to be useful.

Knee Scooters or Knee Walkers

Knee scooters give users more freedom and versatility compared with wheelchairs, but they are cumbersome and challenging to use in tight spaces. Knee scooters also have limitations because they require use of your hands to steer and balance, and because they can only be used on flat surfaces.

iWAlK Hands-Free Crutch

The last and most revolutionary lower leg and foot recovery device for CRPS patients is the iWALK hands-free crutch. The iWALK is strapped directly to the leg and takes weight off of the injured lower leg or foot. This makes the hands available for everyday tasks. The compact, lightweight design of the iWALK makes it easy to use in small spaces, for walking up and down stairs, and even in the shower.

CRPS/RSD Support Resources

Though CRPS affects only a small number of people, it doesn’t mean you have to suffer alone. Support groups for those with CRPS offer ways for patients to work through recovery and also help others dealing with the same kind of debilitating pain that’s caused by this troubling condition.

Find a CRPS Support Group Near You

The Reflex Sympathetic Dystrophy Syndrome Association (RSDSA) compiles extensive resources for those with CRPS. One of their members will contact you and help you find a local group suited to your specific situation.

RSD/CRPS Doesn’t Own Me

This site has complied numerous links to RSD and CRPS support groups in both North America and Europe.

CRPS/RSD Facebook Support Group

A support group for anyone suffering with CRPS/RSD. Members are encouraged to ask questions and share stories.

Burning Nights CRPS Support

Burning Nights is a site dedicated to helping CRPS sufferers. The site offers a number of support resources to help with the overwhelming aspects of this condition.

CRPS Summary

CRPS is a challenging-to-understand chronic disease that requires in-depth research and understanding to productively survive with its diagnosis. Surgical and non-surgical treatments are available for CRPS/RSD recovery, but each should be considered carefully with a doctor’s careful input. If your lower leg or foot is affected, it is important to find a mobility device that fits your lifestyle.

The information above is intended for informational purposes only and is not intended to prevent, treat, or diagnose any illness or disease. We aim to provide the highest quality information, so if you have any questions on the information above, we welcome your feedback!

References

  1. Complex Regional Pain Syndrome Fact Sheet. National Institute of Neurological Disorders and Stroke. 14 October 2020. https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Complex-Regional-Pain-Syndrome-Fact-Sheet
  2. Yvette Brazier. What is complex regional pain syndrome. Medical News Today. 18 February 2018. https://www.medicalnewstoday.com/articles/184338
  3. Complex Regional Pain Syndrome. National Organization for Rare Disorders. Accessed 13 July 2020. https://rarediseases.org/rare-diseases/reflex-sympathetic-dystrophy-syndrome/
  4. Telltale Signs and Symptoms of CRPS/RSD. Reflex Sympathetic Dystrophy Syndrome Association. Accessed 13 July 2020. https://rsds.org/telltale-signs-and-symptoms-of-crpsrsd/
  5. James C. Watson, M.D. Complex Regional Pain Syndrome (CRPS). MERCK MANUAL. February 2020. https://www.merckmanuals.com/professional/neurologic-disorders/pain/complex-regional-pain-syndrome-crps
  6. Satishchandra Kale, MD. Surgery for Reflex Sympathetic Dystrophy (Complex Regional Pain Syndrome Type 1). Medscape. 26 January 2021. https://emedicine.medscape.com/article/1269453-overview
  7. Kashy, B. K., Abd-Elsayed, A. A., Farag, E., Yared, M., Vakili, R., & Esa, W. A. (2015). Amputation as an Unusual Treatment for Therapy-Resistant Complex Regional Pain Syndrome, Type 1. The Ochsner journal, 15(4), 441–442. https://doi.org/10.1043/TOJ-14-0074
  8. Carol DerSarkissian, MD. Complex Regional Pain Syndrome. WebMD. 21 April 2021. https://www.webmd.com/pain-management/guide/complex-regional-pain-syndrome
  9. William C. Shiel Jr., MD, FACP, FACR. Reflex Sympathetic Dystrophy (RSD, Complex Regional Pain Syndrome Type 1, CRPS). MedicineNet. 16 November 2020. https://www.medicinenet.com/reflex_sympathetic_dystrophy_syndrome/article.htm