Algodystrophy or “complex regional pain syndrome” is an unpredictable reaction that can affect one or more limbs following trauma, such as the foot. How to recognize and treat it? Advice.
Algodystrophy or “complex regional pain syndrome” is a unpredictable reaction that can affect one or more limbs following a trauma (sprain, fracture, etc.). How the recognize and the cure ? What to do against pain and stiffness? Answers with doctor Charles-Marie Dujardin, doctor generalist and algologist at the medical and cardiological clinic of Aressy, Pau.
What is algodystrophy of the foot?
Algodystrophy is the old name for “complex regional pain syndrome”. It’s about a complex and disproportionate reaction that develops on one or more limbs, after trauma or surgery. It can affect all limbs of the body, including the foot. The offending member “may develop a hypersensitivity reaction manifested by painful and inflammatory phenomena“explains Doctor Charles-Marie Dujardin, general practitioner and algologist at the Aressy clinic.
What causes algodystrophy of the foot?
“This is a dysfunction of a number of neurological pathways of the organization, whose pain pathways which are hypersensitizedand the autonomic nervous system with in particular the sympathetic system which regulates everything that is automatic and involuntary, such as thestate of vessel dilationsweating, muscle or skin tissue trophicity”, informs the doctor. Whether it is the foot or another limb, we raise two types of causes of algodystrophy, “those following a trauma such as a sprain or fracture for example, and those following a nerve trauma“.
What are the symptoms of algodystrophy of the foot?
Algodystrophy of the foot is detected “in the weeks or months after the trauma, when the inflammatory and painful phenomena are no longer correlated with the initial trauma. These phenomena are amplified, respond poorly to the usual treatments and persist over time when they should attenuate as in the course of a simple trauma”, explains Doctor Dujardin. After blood tests and an X-ray eliminating other complications, the diagnosis of complex regional pain syndrome can be considered. The syndrome includes three stages of development.
► During the hot phase, which typically varies between one and six months but can extend up to a year, “the syndrome is manifested by painful and inflammatory phenomena. The patient may develop a hypersensitivity reaction in the offending limb which may remain red, begin to sweat, inflate“ says the doctor.
► “Secondly, the inflammatory and painful phenomena decrease but the trophic disorders appear, he adds, the skin is weakened, the muscles lose tone, the stiffen joints and a loss of mobility can be observed as a result.. The foot moves less well, the patient may feel like a feeling of heaviness.
► Depending on the patient’s recovery, a sequel phase or the foot will stiffen and it will be more difficult to use it.
Restoration is necessary, but can be complicated.
Can you walk with algodystrophy of the foot?
“As far as it is possible to do”, answers the algologist. Weight-bearing is necessary, but can be complicated for the patient with algodystrophy who dare not set foot. “You have to fight against the fear of movement, the risk is apprehension, insists Charles-Marie Dujardin, the goal is to maintain mobilization in a gentle but active manner“. The walk is like this “absolutely” advised. The most important thing is to maintain movement, “even if it is a simple support or small steps at first, with possible technical aids such as a cane or a walker”.
What is a bone scan used for?
“Bone scintigraphy is not compulsory because the diagnosis is above all clinical”explains Doctor Dujardin. “It can participate in a diagnostic aid when the latter is not obvious. Thanks to bone scintigraphy we can observe the phenomena of demineralization which contribute to the diagnosis complex regional pain syndrome”. However, the bone scan may appear normal even though the syndrome is present.
“Anti-inflammatories should be avoided because inflammation brings the immune cells of tissue repair to the injured area”
What are the treatments for algodystrophy of the foot?
“It’s the rule of least painexplains the doctor, you have to maintain movement and work the painful limb gently with a physiotherapist”. It’s here regular mobilization which allows to maintain the good trophicity of the foot and avoid sequelae such as pain or stiffness. In addition to regular physiotherapy, “The doctor can offer a classic pain treatment based on usual analgesics such as paracetamol, or even tramadol or codeine, avoiding as much as possible to go as far as morphine. Avoid anti-inflammatories because it is precisely the inflammation that makes it possible to bring the immune cells of repair of the tissues to the level of the injured area”, recommends the algologist. In addition, the patient may also be offered non-drug treatments as “electrical therapy, local anesthetic patches to reduce the painful sensation in the skin or Scottish baths”. The mirror therapy can be considered, “it allows the brain to integrate the visualization of the healthy limb with the mobilization of the painful one”.
Should you take vitamin C to speed healing?
“It’s recommended” indicates Charles-Marie Dujardin, particularly in the case of a complex regional pain syndrome related to surgery. “The bone is constantly regenerating, but in the complex regional pain syndrome, there may be an increase in the osteoclastic system with a demineralization of the bone which will make it more fragile. Vitamin C would prevent this phenomenon.”
Can algodystrophy of the foot be cured? How long ?
“It is not because you have had this syndrome that you will have pain for life”, reassure the doctor. The Healing time is very variable from one person to another and depends on the preventive work put in place by the patient and the health professionals. “We don’t know how long the hot phase will last, our goal is to provide the best possible support, to improve the daily lives of patients and to avoid sequelae thanks to rehabilitation.” People who remain with trophic disorders will be brought to consult in a pain center.
Thanks to doctor Charles-Marie Dujardin, general practitioner and algologist at the Aressy clinic, Pau.