- CRPS is a chronic pain disorder where the nervous system gets stuck in an inflammatory pain loop after an injury or surgery.
- Symptoms include burning pain, sensitivity to touch, color and temperature changes, swelling, and stiffness.
- It is more common than people realize — and it is often missed for months because clinicians don't expect the diagnosis.
- Treatment is multidisciplinary: physical therapy, nerve pain medication, sympathetic blocks, and sometimes spinal cord stimulation.
- Early diagnosis dramatically improves outcomes. Late diagnosis means a much harder recovery.
What is Complex Regional Pain Syndrome?
Complex Regional Pain Syndrome (CRPS) — formerly called reflex sympathetic dystrophy (RSD) — is a chronic pain disorder where the body's pain processing system becomes dysregulated after an injury, surgery, or fracture. The original injury heals, but the pain doesn't — and in fact often gets worse. Patients describe burning, electrical, or crushing pain in the affected limb that is dramatically out of proportion to the original injury.
CRPS has two types. Type 1 (the more common form) develops without a definable nerve injury — just an inciting event like a fracture, sprain, or surgery. Type 2 develops after a confirmed nerve injury. Both behave similarly clinically. The earlier it's diagnosed and treated, the better the chance of full recovery.
At NES, foot and ankle CRPS is something we screen for in any patient whose pain after an injury or surgery is not following an expected recovery curve. Treatment is coordinated with pain medicine, physical therapy, and sometimes neurology. We do not manage CRPS in isolation — the best outcomes come from team-based care started early.
See it in motion
Animations licensed from ViewMedica · Swarm Interactive
What it feels like
CRPS has a characteristic pattern of symptoms that affect skin, bone, and nerves together:
- Burning, throbbing, or electrical pain in the affected limb — out of proportion to the original injury
- Skin sensitivity — even light touch or air movement is painful (allodynia)
- Color changes — the affected area looks redder, bluer, or mottled compared to the other side
- Temperature changes — the affected limb is warmer or cooler than the other
- Swelling that doesn't go away
- Stiffness and progressive loss of motion
- Hair and nail growth changes on the affected side
- Bone loss visible on X-ray over time
- Reluctance to use the limb, leading to disuse atrophy
Why it develops
CRPS is triggered by an inciting event — but why some patients develop it and others don't is not fully understood:
- Fractures, especially distal extremity fractures (ankle, wrist)
- Foot and ankle surgery — including elective procedures
- Sprains and soft-tissue injuries
- Immobilization in a cast for a prolonged period
- Female sex (CRPS is more common in women)
How we diagnose Complex Regional Pain Syndrome
CRPS is diagnosed clinically using the Budapest criteria — a structured set of symptom and sign categories that must be present. There is no single laboratory or imaging test that confirms CRPS. We rule out competing diagnoses (infection, DVT, missed fracture, complex sprain) with appropriate workup, then look for the characteristic symptom pattern.
Non-surgical care
CRPS treatment is multidisciplinary and aggressive — early intervention is crucial:
- Physical therapy, often desensitization, mirror therapy, and gradual functional restoration
- Nerve-pain medication (gabapentin, pregabalin, amitriptyline, duloxetine)
- NSAIDs and short courses of corticosteroids in early CRPS
- Topical agents (lidocaine, capsaicin) for skin sensitivity
- Sympathetic nerve blocks (lumbar sympathetic block for foot/ankle CRPS) — coordinated with pain medicine
- Spinal cord stimulation in resistant cases
- Cognitive behavioral therapy for the chronic pain component
- Avoid casting or immobilization where possible — disuse worsens CRPS
When to see a specialist
- Pain that's lasted weeks longer than expected after an injury or surgery
- Burning or electrical pain in a foot or ankle that's out of proportion to a recent injury
- Color or temperature changes in a limb after injury or immobilization
- A foot that you can't bear to have touched — even by socks or sheets
CRPS is co-managed at NES — your podiatrist coordinates with pain medicine, physical therapy, and (when appropriate) neurology. Dr. Yama Dehqanzada and Dr. Thomas Melillo, who handle a high volume of post-surgical patients, are particularly attuned to CRPS recognition.