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lots of pain but tests are normal

Posted by Janet on 8/11/99 at 14:00 (009637)

I'm interested in talking to persons who have significant pain but whose test results--EMG/Ultrasound/Rheumatology bloodwork/x-rays--are normal. I've had all the above tests and they all came back 'unremarkable'. My ortho thinks I might have a nerve problem (over-stretched)which is causing the pain. My weight is 107, so that's not a problem, but my pain is so severe that I have to ride a scooter. I'm seeing Dr. Galea this week but it will only be for a second opinion. He won't give you lithotripsy unless your PF measures 7+. Mine were 3.2 and 2.5--exceptionally normal.

In particular, I'm interested in talking to anyone who has been diagnosed with any kind of neurologic problem--entrapment etc. I'd like to know what diagnostic tests you had and what treatments were recommended. Scott, maybe you can help me out too. What other neuro tests are recommended beyond the EMG for foot pain? Also, can an MRI reveal neurologic involvement?

Thanks everyone. Hang in there.


Re: lots of pain but tests are normal

andrea on 8/11/99 at 18:03 (009643)

Have they ruled out plantar fascitis or is that still the diagnosis. Is the pain you are having in your heel/heels? I have had all the above tests except the EMG which I am having next Friday. All of my tests are normal too. Because I have pain in both feet that I classify as a 'burning ache' they believe I also have a nerve problem that could have originated with PF but they also think it is nerve problem and not TTS since it is in both feet (which I guess is common with nerve problems). My symptoms are also kind of strange in that my pain begins after STANDING still and gets better as I move around or walk. Almost like it takes the pressure off a nerve.

We didn't discuss what we would do next if the EMG came back negative nor what would occur if it came back positive either.

Sorry I am not much help but I know when I have posted here I appreciate any feedback that I can get. It gets lonely in my painful world as I am sure my family and friends get real sick of hearing about my pain.


Re: lots of pain but tests are normal

wendy2 on 8/12/99 at 01:07 (009653)

I have had blood work, xrays, and a bone scan - all have been normal. I am having the nerve conduction testing done on Friday - but I have been cautioned that it may or may not reveal an underlying problem. Two doctors have told me that TTS may or may not show up on the test, and just because it's normal - doesn't mean that I don't have nerve entrapment. I have been (at least for now) diagnosed with TTS a.k.a. nerve entrapment or compartment syndrome. Other than the drugs the doctor suggested (elavil and/or voltaren) and cortisone - all of which I refused - no one has suggested a real course of treatment. Thankfully, with rest, ice, new orthotics and A LOT of patience, my pain has subsided at least temporarily. I am now able to stand for a reasonable length of time, and I can sleep and work without constant pain.



Re: lots of pain but tests are normal

john on 8/12/99 at 09:18 (009658)

i recently had the standard 'nerve conduction test' on both feet to check for nerve entrapment. test indicated mild nerve entrapment in both feet which the doctor said could be causing my pain. make sure someone highly qualified does the test not a doctors assistant as some do.

Re: lots of pain but tests are normal

janet on 8/12/99 at 11:00 (009664)

At this point, based on my most recent test--ultrasound--they have ruled out PF. My pain is in both heels and longitudinally through the arches into the metatarsal heads. I think I have metatarsalgia with some kind of nerve involvement. I wonder whether I've ever really had PF, as my pain has been atypical for that diagnosis. Like lots of folks who post here, my pain gets worse the more I'm on my feet and I don't have the typical pain on first steps in the morning etc.

I'll post after I see Dr. Galea. Hopefully he'll have some valuable input.

Thanks everyone for your responses.


Re: lots of pain but tests are normal

TTS on 8/12/99 at 14:53 (009673)

I am still waiting for my doctor to come back from vacation to give me his opinion of the nerve conduction test done a week ago. the doctor who did the test indicated i did have some degree of tarsal tunnel syndrome in both feet and that it could indeed cause the pain i am experiencing. the doctor said it was not uncommom to have it in both feet. a burning type pain is usually indicative of some problem with the nerve (so i am told). my pain can also be describe a a burning/aching pain. i can tap on the inside of my foot just below the ankle bone and create a sensation in my foot (tingling) which is one of the doctors routine test for TTS. can anyone else produce this tingling sensation by taping in this area?

Re: lots of pain but tests are normal

Jenn on 8/13/99 at 09:18 (009698)

He told me that anyone over 5mm, he would do it to. Mine was 6 on the right and 5 on the left. My right is 1000x's worse than the left. Anyways, my test also came back 'unremarkable'. I had x-rays(which showed the bone spurs), bone scan, nerve test, blood test for gout and rhuematoid arthritis. All were normal.

Re: lots of pain but tests are normal

john on 8/13/99 at 09:22 (009699)

janet: can they really rule out pf with ultrasound? none of my doctors (5-6) ever even suggested it.

Re: lots of pain but tests are normal

janet on 8/14/99 at 18:24 (009753)

hi john,
scar tissue is obvious on an ultrasound. I had a doc show me a comparison of normal and scarred tissue on an ultrasound of his knee. He had tendonitis. The normal tissue fibers all run parallel. The scar tissue fibers go every which way and look like a can of worms. I've also been told that inflamation is readily apparent on an ultrasound but I'm not sure what it looks like. Anyway, in my ultrasound, my fibers all look normal.

Re: lots of pain but tests are normal

andrea on 8/11/99 at 18:03 (009643)

Have they ruled out plantar fascitis or is that still the diagnosis. Is the pain you are having in your heel/heels? I have had all the above tests except the EMG which I am having next Friday. All of my tests are normal too. Because I have pain in both feet that I classify as a 'burning ache' they believe I also have a nerve problem that could have originated with PF but they also think it is nerve problem and not TTS since it is in both feet (which I guess is common with nerve problems). My symptoms are also kind of strange in that my pain begins after STANDING still and gets better as I move around or walk. Almost like it takes the pressure off a nerve.

We didn't discuss what we would do next if the EMG came back negative nor what would occur if it came back positive either.

Sorry I am not much help but I know when I have posted here I appreciate any feedback that I can get. It gets lonely in my painful world as I am sure my family and friends get real sick of hearing about my pain.


Re: lots of pain but tests are normal

wendy2 on 8/12/99 at 01:07 (009653)

I have had blood work, xrays, and a bone scan - all have been normal. I am having the nerve conduction testing done on Friday - but I have been cautioned that it may or may not reveal an underlying problem. Two doctors have told me that TTS may or may not show up on the test, and just because it's normal - doesn't mean that I don't have nerve entrapment. I have been (at least for now) diagnosed with TTS a.k.a. nerve entrapment or compartment syndrome. Other than the drugs the doctor suggested (elavil and/or voltaren) and cortisone - all of which I refused - no one has suggested a real course of treatment. Thankfully, with rest, ice, new orthotics and A LOT of patience, my pain has subsided at least temporarily. I am now able to stand for a reasonable length of time, and I can sleep and work without constant pain.



Re: lots of pain but tests are normal

john on 8/12/99 at 09:18 (009658)

i recently had the standard 'nerve conduction test' on both feet to check for nerve entrapment. test indicated mild nerve entrapment in both feet which the doctor said could be causing my pain. make sure someone highly qualified does the test not a doctors assistant as some do.

Re: lots of pain but tests are normal

janet on 8/12/99 at 11:00 (009664)

At this point, based on my most recent test--ultrasound--they have ruled out PF. My pain is in both heels and longitudinally through the arches into the metatarsal heads. I think I have metatarsalgia with some kind of nerve involvement. I wonder whether I've ever really had PF, as my pain has been atypical for that diagnosis. Like lots of folks who post here, my pain gets worse the more I'm on my feet and I don't have the typical pain on first steps in the morning etc.

I'll post after I see Dr. Galea. Hopefully he'll have some valuable input.

Thanks everyone for your responses.


Re: lots of pain but tests are normal

TTS on 8/12/99 at 14:53 (009673)

I am still waiting for my doctor to come back from vacation to give me his opinion of the nerve conduction test done a week ago. the doctor who did the test indicated i did have some degree of tarsal tunnel syndrome in both feet and that it could indeed cause the pain i am experiencing. the doctor said it was not uncommom to have it in both feet. a burning type pain is usually indicative of some problem with the nerve (so i am told). my pain can also be describe a a burning/aching pain. i can tap on the inside of my foot just below the ankle bone and create a sensation in my foot (tingling) which is one of the doctors routine test for TTS. can anyone else produce this tingling sensation by taping in this area?

Re: lots of pain but tests are normal

Jenn on 8/13/99 at 09:18 (009698)

He told me that anyone over 5mm, he would do it to. Mine was 6 on the right and 5 on the left. My right is 1000x's worse than the left. Anyways, my test also came back 'unremarkable'. I had x-rays(which showed the bone spurs), bone scan, nerve test, blood test for gout and rhuematoid arthritis. All were normal.

Re: lots of pain but tests are normal

john on 8/13/99 at 09:22 (009699)

janet: can they really rule out pf with ultrasound? none of my doctors (5-6) ever even suggested it.

Re: lots of pain but tests are normal

janet on 8/14/99 at 18:24 (009753)

hi john,
scar tissue is obvious on an ultrasound. I had a doc show me a comparison of normal and scarred tissue on an ultrasound of his knee. He had tendonitis. The normal tissue fibers all run parallel. The scar tissue fibers go every which way and look like a can of worms. I've also been told that inflamation is readily apparent on an ultrasound but I'm not sure what it looks like. Anyway, in my ultrasound, my fibers all look normal.