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TENS, Standing EMG/NCV for Nerve Entrapment

Posted by Judy on 6/05/98 at 16:57 (000713)

I have been suffering from severe heel and arch pain with burning/tingling on the sole of my right foot, with lesser pain in the left, for several years.

About a year ago I was diagnosed with plantar fasciitis after a positive bone scan and have been through many of the treatments discussed on this site:
- heel cups, taping and orthotics
- injections in the heel, ultrasound with electrostimulation
- casts (one last fall, one this spring followed by a velcro boot for a total of almost 4 months)
- physical therapy with trigger point therapy and message
- bone scan (positive for PF)
- EMG (negative)

Last fall I also had an MRI which showed degeneration of the L4-L5 vertebrae. I underwent a series of three therapeutic epidural blocks (steroid injections in the spine) which seemed to help the burning in my foot some...but now the pain is back.

Because my symptoms are worse when I stand and/or walk for even a short amount of time my doctor (a foot and ankle specialist/professor at a major medical school) wants to repeat the EMG/NCV in a standing position while I am experiencing a flare of pain. He is trying to rule out Tarsal Tunnel, and/or see if the problems originate in my back. Has anyone been through a standing EMG after a negative 'standard' one while lying on the back? My orthopod says it is the only way to tell where the pain originates. I am not sure if I want to go through that test again...of all the procedures that I have had done, the EMG is by far much worse than anything (even the injections!)

Also, the physical therapist with whom I am working has recommended I try TENS (transcutaneous electronic nerve stimulation). She tells me that it will not cure the problem, just 'ratchet down' the pain from a 9.5/10 to 6/10 or so. Has anyone tried it? Was it worth it?

They are also talking about nerve suppressant drugs such as anti-depressants, anti-convulsants, etc. Sounds like scary stuff...

As many of the people who post to this site, my life has been dramatically altered by this affliction...I left the doctor's office today near tears when he said that I might just have to live with it.
I am too young to stop living an active life - have already had to give up tennis because of my back - and don't want to have to give up hiking if I can avoid it, but now I cannot even walk around the block without pain...

Thanks for providing a place to vent and share ideas!

Re: TENS, Standing EMG/NCV for Nerve Entrapment

Janet on 6/07/98 at 07:15 (000718)

Hi Melissa--Good Luck with the TENS--if you go for it. I have a few questions for you. What is EMG and NCV? Also, is a bone scan an x-ray, or something different?

Re: TENS, Standing EMG/NCV for Nerve Entrapment

Cindy on 6/07/98 at 19:15 (000722)

Hi, Judy. I had the weight bearing or standing up NCS/EMG after having a negative one a year ago while lying down. The second nerve conduction study last month also showed absolutely nothing, altho. two very good podiatrists tell me I have all the classic symptoms of Tarsal Tunnel syndrome. Also, both told me that the fact that neither study showed anything does not mean I don't have TTS. Also, had MRI's on my feet last week, with contrast, and that also failed to show any TT problem. But, the podiatrist told me before hand that it probably wouldn't. So...I don't know where that leaves us. My history is almost identical to yours. I haven't tried the TENS unit - maybe I should. Nobody has ever suggested it to me. As for the drugs, the drs. may be talking about neurontin - its really an epilepsy drug, but I have been taking it for almost 2 months for the burning in my feet. Finally, just in the last 10 days or so, the burning is better. The dr. told me it takes about 6 weeks to work. The drug makes me sleepy, but not so bad I can't function. I haven't noticed any other side effects. I did look at the web cite where all the people with severe epilepsy and seizures were discussing their use of the drug, and didn't learn a lot from it (nobody mentioned any side effects - some had a problem because the drug did not prevent their seizures). I am scheduled for surgery on my tarsal tunnel area on Wed. of this coming week. I don't know if this is the right thing to do, but I am desperate. Like you, I am too young and otherwise healthy to just live like this unless I have absolutely no other choice. I'll let you know how it goes. Frankly, the reports as to success are not that great - I just hope it doesn't make me worse

Re: TENS, Standing EMG/NCV for Nerve Entrapment

judy on 6/08/98 at 11:55 (000724)

EMG is electromyography and NCV is nerve conduction velocity.

With the EMG the doctor inserts fine needles in various muscles and then sends an electic current through them to see the response, i.e., does the foot jerk and if so how violently. The NCV tests how quickly the response in the target body part is recorded.

As I said in my initial message, it is very painful and costly...and often negative for tarsal tunnel even though all the symptoms point to TT.