By B. Forrest Burke, MD

B. Forrest Burke, MD B. Forrest Burke, MD, is a physiatrist, a physician specializing in physical rehabilitation medicine, with Silver State Spinecare. The practice offers EMG nerve testing and X-ray guided injections. For more information or an appointment, please call 331-2600 or go to silverstate spine.com.

I recently saw a patient who had developed foot and ankle pain while moving from one house to another. Initially, it was felt to be a sprained ankle. An ankle splint did not help, and a bone scan was negative, so the patient was referred to me.

On exam, she had a loss of the Achilles reflex, numbness in the lateral foot and a positive straight leg-raise test in which symptoms in her foot and ankle worsened as she raised her leg. I ordered an MRI to evaluate the soft tissues, specifically, the disks and nerve roots. The MRI showed damage to the disk between the L5 and S1 bones of the lower spine -- the L5-S1 disk.

A nerve test showed damage to the nerve root that goes to the outside of her foot, the S1 nerve root that travels past the L5-S1 disk. This is known as an S1 radiculopathy.

To address the nerve root damage, we performed an X-ray guided injection along the S1 nerve root. This is known as a transforaminal epidural or selective nerve block. After the inflammation was addressed, the patient was helped by physical therapy.

I recently saw her at the mall where she reported that her symptoms have not returned, and she loves her new house.

Is it a foot or back problem?

• Unusual symptoms in the legs and feet can be a sign of a back problem.
• Referred pain can be due to inflammation of nerve roots exiting the spine and going into the legs and feet.
• An MRI can show soft tissue changes to disks and nerve roots.
• Electromyogram (EMG) nerve testing isolates which nerve root is affected. This is a test using a special in-office machine that can reveal whether any nerve damage exists, which nerve is damaged and how badly the nerve is damaged.
• X-ray guided injections in the back can help resolve inflammation and pain into the legs and feet.