Complex Regional Pain Syndrome (CRPS) is a condition that primarily affects the lower leg and foot. Discussed below are the causes, common symptoms, pain management/surgical treatments, and recovery options, as well as helpful information about mobility device options. By the end of this section, you’ll better understand all the implications of CRPS as well as treatment options.
What Is CRPS?
Also known as Reflex Sympathetic Dystrophy (RSD), CRPS is a chronic neuro-inflammatory disorder that generally affects one or more of the limbs, though it can happen in any part of the body. That means the nervous system and the immune system malfunction in a response to tissues damage–normally from trauma or injury–causing nerves to misfire. The connection then becomes continuously faulty, leaving the affected area in constant pain. CRPS also creates an abnormal response that magnifies the affected injury, making it much more severe.
The levels of pain and outward visual signs of CRPS can range dramatically from person to person. Along with the visual and physical inconsistencies, the amount of trauma to the body that causes CRPS can vary greatly Unfortunately, CRPS is widely unknown, though information on the subject is constantly being studied and uncovered.
Causes of CRPS
There are no documented direct causes of CRPS. The majority of research on the condition has suggested that the initial injury permanently damages the pain receptors, which then causes disrupted communication between the affected area and the brain. Research shows that in 90% of all CRPS cases the condition is caused by significant trauma or injury, such as:
- Soft tissue injury (such as burns, cuts, or bruises)
- Limb immobilization (such as being in a cast)
- Surgical or medical procedures
- Heart Disease
- Degenerative Arthritis
- Nerve Irritation
- Breast Cancer
The list of possible CRPS causes is constantly growing, reflecting the fact that the exact mechanism of how CRPS develops is poorly understood.
RSD and Other CRPS Terminology
In many circles, CRPS is also referred to by another name: Reflex Sympathetic Dystrophy Syndrome or RSD. Many consider RSD an older term for describing CRPS, though it’s still often used in the medical community.
Though many consider RSD and CRPS interchangeable, RSD is more often used to describe a more specific condition: Type 1 CRPS.
Type 1 CRPS and its counterpart, Type 2 CRPS, have near identical symptoms but they’re differentiated by their causes:
- Type 1 CRPS occurs from tissue injury or situations where there is no underlying nerve injury
- Type II CRPS occurs from injuries caused by trauma or impact that is clearly associated with nerve injury
Despite minor differences, RSD is still commonly used for describing the symptoms associated with CRPS. Along with RSD, there are several other terms occasionally used to describe this condition, such as:
- Shoulder-hand Syndrome
- Sudeck’s Atrophy
Common Symptoms of CRPS
CRPS symptoms vary depending on levels of severity and the length of suffering. Because the majority of CRPS are caused by injury, common symptoms include:
- Pain (moderate-to-severe) described as deep, aching, cold, burning
- Swelling and Stiffness in affected joints
- Decreased motor function in injured area
- Discoloration of area
- Abnormal sweating patterns
- Changes in nail and hair growth
- Skin Sensitivity
- Pain more severe than normal for the injury
- Pain lasting longer than the average recovery period
CRPS symptoms can vary in intensity. Along with the physical symptoms, the nerve damage may correlate with the individual’s emotional state and affect the levels of pain he or she feels. In fact, high levels of stress or anger have been known to significantly increase many of the symptoms related to CRPS. With each CRPS sufferer presenting their own unique symptoms, each case can differ dramatically.
Non- Surgical Pain Management for CRPS
Initially being diagnosed with CRPS can lead to a long road full of discussions and decisions with the doctor. Most immediately, the doctor should help the sufferer find a physical therapist and established a strategy for maintaining muscle function in the injured area. Physical therapy will generally cause pain, but it is crucial for recovery. Often, therapists will implement treatments that involve alternating heat and cold in an attempt to relieve pain. They can also try a device called a TENS Unit, which sends pulses through to the muscle attempting to reset the damaged nerves.
There is also a large range of pharmaceuticals including but not limited to
- non-inflammatory steroid medications
- muscle relaxers
- compound creams
- medicated patches
- diabetic neuropathy medications
Before surgical treatments are considered, doctors may want to explore another option: A sympathetic nerve block. This consists of an injection into the spine intended to block the pain transmission. All medical non-surgical pain management options must be done under the supervision of a doctor.
Surgical Options for CRPS
If the symptoms associated with CRPS can’t be allieviated with non-surgical treatments, doctors may then consider the internal alternatives. There are three primary options: A spinal cord simulator, removing the damaged nerve, or amputation. The spinal cord stimulator is a device that connects to the spinal cord. Using a hand-held device, the wearer controls electrical stimulations that affect the nerve in the same way the TENS Unit does.
The second options, removing the damaged nerve, involves a surgeon locating the exact nerve causing the issue and completely detaches it. Much like the other options, this one involves invasive surgery and the risks that come along with it.
Finally, the most extreme option is amputation. Most doctors oppose the idea of removing a limb because of nerve damage, but there are special cases where amputation may be the best option. Unfortunately, there have been multiple CRPS cases where an amputation of the nerve damaged area lead to poor results. Even after removing the affected limb they still suffer the same pain via the phantom extremity.
It’s advised that anyone suffering from CRPS consults regularly with their medical professionals to determine which surgical options—if any– are best suited to the patient’s specific needs and previous reactions to the non-surgical procedures.
Recovering with Lower Leg or Foot CRPS
Recovery options for CRPS depend somewhat on the specific injured area. For example, the revocery for an arm affected by CPRS involves not using the arm while keeping the injured area as safe and as comfortable as possible. Recovering from CRPS on the lower leg or foot is a bit more difficult. The sufferer must find ways to walk with the least amount of pressure on the affected area. There are only a few options for mobility when the lower leg or foot is damaged:
Canes and crutches literally keep the hands full, which means the user has limited or no use of their hands while standing or walking. This poses a problem for most suffers as there is no direct cure for CRPS and many sufferers live with the condition for life. Having to struggle with crutches is not an option for anyone that has to care for themselves or others as it hinders the ability to do laundry, cook food, or almost any other day-to-day life duties.
Wheelchairs and knee scooters are alternatives for those looking for more long-term mobility options. Wheelchairs allow the sufferer to sit and keep weight off the foot, but they’re bulky and difficult to maneuver. They may also require many other modifications, such as ramps to be useful in your home. The knee scooter gives the user more freedom and more versatility in comparison to the wheelchair, but they are cumbersome and hard to use in tight spaces. Scooters also have some serious limitations, as they can only traverse flat surfaces.
The last and most revolutionary lower leg and foot recovery device for CRPS patients is the iWALK2.0. The iWALK2.0 is a hands-free crutch that straps directly to the leg. This takes weight off of the injured lower leg or foot and leaves the hands free and available for everyday life. The compact, lightweight design of the iWALK2.0 makes it easy to use in small spaces, up and down stairs, and even in the shower! To learn more about the iWALK2.0, click here.
For sufferers, CRPS is a very misunderstood chronic disease that requires in-depth research and understanding to productively survive with its diagnosis. Surgical and non-surgical treatments are available, but each should be considered very carefully with a doctor’s supervision. If your lower leg is affected, it is important to find the mobility device that best fits your lifestyle and gives you back your freedom while you are in recovery.