What are the treatment options for radiculopathy (nerve root disorder) affecting the feet?

From the Guidelines

Radiculopathy in the feet is typically treated with a combination of conservative measures, including rest, activity modification, and over-the-counter pain medications, as well as more invasive interventions such as epidural steroid injections or surgery in severe cases. The treatment approach should prioritize reducing nerve irritation and managing pain and inflammation. Initially, over-the-counter pain medications such as NSAIDs (ibuprofen 400-800mg three times daily or naproxen 500mg twice daily) can be used to manage pain and inflammation 1.

Conservative Measures

• Rest and activity modification to reduce nerve irritation
• Over-the-counter pain medications such as NSAIDs
• Physical therapy focusing on gentle stretching, strengthening exercises, and proper body mechanics, typically 2-3 sessions weekly for 4-6 weeks

Prescription Medications

• Gabapentin (starting at 300mg daily, gradually increasing to 300-600mg three times daily) or pregabalin (75-150mg twice daily) for neuropathic pain, as combination therapies have been shown to be effective in managing neuropathic pain 1
• Muscle relaxants like cyclobenzaprine (5-10mg three times daily) can help with associated muscle spasms

Invasive Interventions

• Epidural steroid injections may provide temporary relief if conservative treatments fail after 6-8 weeks
• Surgery is typically reserved for cases with progressive neurological deficits, severe pain unresponsive to conservative measures, or when there is an identifiable structural cause that requires correction, as most cases of acute cervical neck pain with radicular symptoms resolve spontaneously or with conservative treatment measures 1

Prevention

• Maintaining proper posture, ergonomics, and weight management are important for preventing recurrence, as degenerative changes on lumbar imaging are usually considered nonspecific and correlate poorly with symptoms 1

From the Research

Treatment Options for Radiculopathy Affecting the Feet

• Medications:
  • Gabapentin monotherapy has been shown to be effective in alleviating pain and improving quality of life in patients with chronic radiculopathy 2
  • Pregabalin and gabapentin can be equally used to reduce pain in lumbar radiculopathy patients who underwent transforaminal epidural steroid injection 3
• Injections:
  • Transforaminal epidural steroid injections (TFESIs) have been found to be an effective treatment with satisfactory results in about 80% of patients for a period of 2 years 4
  • Periradicular injections of ACS or PRP can be used as a biological treatment approach for cervical radiculopathy 5
• Physical Therapy:
  • Spinal manipulative therapy, specific exercises, and sustained pain-relieving positions can be used in the acute stage of cervical radiculopathy 6
  • Increasing individualized physical activity, supervised motor control, specific exercises, and/or neurodynamic mobilization can be added in the subacute stage 6
  • General aerobic exercise and focused strength training can be used in the chronic stage of cervical radiculopathy 6
• Other Treatments:
  • Laser therapy or collagen magnetophoresis can be used as a physical treatment approach for cervical radiculopathy, but may have limited effectiveness during the follow-up period 5
  • Manual therapy or traction therapy can be used as a mechanical treatment approach, but caution should be paid when using traction therapy in the acute period of root oedema due to possible signs of intolerance and exacerbation of discomfort 5