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Question on TTS

Posted by Janet on 1/04/00 at 00:00 (014378)

Does the tarsal tunnel get tighter somehow and compress on the nerve? Or, does the nerve, tendons...get bigger and take up more room in the tunnel? Or does the tunnel somehow adhere to the nerve or visa versa? If the tunnel gets tighter how does that occur and how can PT help loosen it up? Thanks Wendyn. I always find your posts veeeerrryy informative. You could write a heel pain syndrome book.
I'm starting to wonder if I might not have some TTS. I'm going for a second EMG this month. Last one was negative. I had my MRI last week. The test showed several areas with a 'high signal' specifically one spot on the heel right at the insertion of the PF. I'm taking the film up to Galea this Thursday to see what he recommends. Will keep you posted.



Re: Question on TTS

wendyn on 1/04/00 at 00:00 (014388)

The tunnel is formed by bone on the inside and a tough band on the outside (the flexor retinaculum...see what words I know for Scrabble now?). Nothing happens to the bone, or the band - but there's little room to expand so anything extra in the tunnel will eventually cause compression of the nerve.

There is a tendon that goes through the tunnel (the posterior tibial tendon), and I gather that if it because swollen - it could cause compression. So could something like a varicose vein.

I'm not sure of how exactly PT can help TTS, but perhaps just with inflammation in general? If you listen to John H, just having a really good looking Physio therapist will make you feel better on its own..he likes his acupuncturist (I can also attest to the medical benefits of being attended to by attractive members of the opposite sex!).

As long as you go to someone reputable, PT is worth a shot and not likely to hurt you!

Good luck...



Re: Question on TTS: Has anyone ever been cured?

alan k on 1/05/00 at 00:00 (014394)

I was wondering if anyone knows anything in particular that pt can do for tts. I suppose it's not simply stretching, but perhaps there is something that can be done?

In general I wonder whether anyone on the board has been cured of tts. I am doing the conservative treatments but as I understand it, and experience it, they are just ways to deal with it, not cure it. Some of the things I read say the natural course is for the condition to steadily worsen.

I've been thinking about shots lately...

alan k


Re: Question on TTS: Has anyone ever been cured?

wendyn on 1/05/00 at 00:00 (014399)

Alan, I have an appointment with my PT next week. Last year we just kind of gave up on my feet and he worked mainly on some lower back problems (resulting mostly from my compensating walk). I am going to ask him next week what he thinks we can do for my foot (if anything). Although he is an experienced PT, specializing in lower extremities and he works in a major sports facility - he had never seen a diagnosed case of TTS until me.

This is one of the difficulties - finding someone with real experience in dealing with this.

I have had a set back yesterday and today. Never can figure out why, but it scares me when this happens - makes me worried that I will be in pain forever. I will have to take it easy and ice for a few days.

I've read that the normal course of TTS is for it to steadily worsen, but I've also read that it can just go away....especially if it's from an unknown cause.

One of the biggest reasons I've decided against the shots (for me) is because I do have structural problems with my feet. I think that if the way I walk is the cause of the problem, a shot will only be a temporary fix. A lot of research I've done says that a maximum of 3 shots (not sure of the time in between) is worth a try before resorting to surgery. The injection is done right into the Tarsal tunnel (make sure you have someone experienced and qualified doing this!). The risks would be infection, further nerve irritation, and potential rupture of the tendon (this would require surgery to correct). These are the risks my doctor identified, but he didn't really say how likely they were to occur...we didn't get that far.

My own experience has been that my TTS has not gotten steadily worse. It gets worse, then it gets a bit better, then it gets worse. But it's still not as bad as it was 6 months ago.

I have this current plan of attack ...

1. To try to get rid of my complacent attitude towards this problem...lately I've just been accepting it and not looking towards how to get rid of it. Tired of doctors, and tests etc.

2. Talk to the PT next week and see what he thinks we can do

3. Try the acupucture

4. Have the NCV testing re-done next month sometime

5. Go and get the blood work done that my doctor ordered for my wrists (no I haven't bothered to go yet..have to go this week.).

Let me know what you decide about the shots.



Re: Question on TTS

janet on 1/05/00 at 00:00 (014402)

Thanks Wendyn. My MRI report says my Flexor Hallicus tendons have fluid around them. I believe these tendons also run thru the TT? Maybe this is the source of my nerve compression (if I have it).

Re: Question on TTS

john h on 1/06/00 at 00:00 (014418)

janet i had a tarsal tunnel release and there can be numerous things that could press on a nerve. in my case the doctor said i had a large vericose vein deep in the ankle that was touching the nerve. having said that i am still very skeptical about TTS surgery. diagonsis is difficult and even if positive may not be the cause of your pain. i have sort of ruled this surgery out on my other foot which was also diagoned with tts.

Re: Question on TTS

wendyn on 1/04/00 at 00:00 (014388)

The tunnel is formed by bone on the inside and a tough band on the outside (the flexor retinaculum...see what words I know for Scrabble now?). Nothing happens to the bone, or the band - but there's little room to expand so anything extra in the tunnel will eventually cause compression of the nerve.

There is a tendon that goes through the tunnel (the posterior tibial tendon), and I gather that if it because swollen - it could cause compression. So could something like a varicose vein.

I'm not sure of how exactly PT can help TTS, but perhaps just with inflammation in general? If you listen to John H, just having a really good looking Physio therapist will make you feel better on its own..he likes his acupuncturist (I can also attest to the medical benefits of being attended to by attractive members of the opposite sex!).

As long as you go to someone reputable, PT is worth a shot and not likely to hurt you!

Good luck...



Re: Question on TTS: Has anyone ever been cured?

alan k on 1/05/00 at 00:00 (014394)

I was wondering if anyone knows anything in particular that pt can do for tts. I suppose it's not simply stretching, but perhaps there is something that can be done?

In general I wonder whether anyone on the board has been cured of tts. I am doing the conservative treatments but as I understand it, and experience it, they are just ways to deal with it, not cure it. Some of the things I read say the natural course is for the condition to steadily worsen.

I've been thinking about shots lately...

alan k


Re: Question on TTS: Has anyone ever been cured?

wendyn on 1/05/00 at 00:00 (014399)

Alan, I have an appointment with my PT next week. Last year we just kind of gave up on my feet and he worked mainly on some lower back problems (resulting mostly from my compensating walk). I am going to ask him next week what he thinks we can do for my foot (if anything). Although he is an experienced PT, specializing in lower extremities and he works in a major sports facility - he had never seen a diagnosed case of TTS until me.

This is one of the difficulties - finding someone with real experience in dealing with this.

I have had a set back yesterday and today. Never can figure out why, but it scares me when this happens - makes me worried that I will be in pain forever. I will have to take it easy and ice for a few days.

I've read that the normal course of TTS is for it to steadily worsen, but I've also read that it can just go away....especially if it's from an unknown cause.

One of the biggest reasons I've decided against the shots (for me) is because I do have structural problems with my feet. I think that if the way I walk is the cause of the problem, a shot will only be a temporary fix. A lot of research I've done says that a maximum of 3 shots (not sure of the time in between) is worth a try before resorting to surgery. The injection is done right into the Tarsal tunnel (make sure you have someone experienced and qualified doing this!). The risks would be infection, further nerve irritation, and potential rupture of the tendon (this would require surgery to correct). These are the risks my doctor identified, but he didn't really say how likely they were to occur...we didn't get that far.

My own experience has been that my TTS has not gotten steadily worse. It gets worse, then it gets a bit better, then it gets worse. But it's still not as bad as it was 6 months ago.

I have this current plan of attack ...

1. To try to get rid of my complacent attitude towards this problem...lately I've just been accepting it and not looking towards how to get rid of it. Tired of doctors, and tests etc.

2. Talk to the PT next week and see what he thinks we can do

3. Try the acupucture

4. Have the NCV testing re-done next month sometime

5. Go and get the blood work done that my doctor ordered for my wrists (no I haven't bothered to go yet..have to go this week.).

Let me know what you decide about the shots.



Re: Question on TTS

janet on 1/05/00 at 00:00 (014402)

Thanks Wendyn. My MRI report says my Flexor Hallicus tendons have fluid around them. I believe these tendons also run thru the TT? Maybe this is the source of my nerve compression (if I have it).

Re: Question on TTS

john h on 1/06/00 at 00:00 (014418)

janet i had a tarsal tunnel release and there can be numerous things that could press on a nerve. in my case the doctor said i had a large vericose vein deep in the ankle that was touching the nerve. having said that i am still very skeptical about TTS surgery. diagonsis is difficult and even if positive may not be the cause of your pain. i have sort of ruled this surgery out on my other foot which was also diagoned with tts.