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Dr. Zuckerman, or anyone else, can you answer this?

Posted by Irene m on 2/22/00 at 00:00 (016199)

I had a posterior tibial nerve block a couple of months ago. The block made the bottom of my foot numb, but it did not affect the pain that I have in my arches when I stand or walk.

The doc who performed the block interpreted this result to mean that the source of my pain was higher up in my body, perhaps in the spine. Thus, he said, that any treatment directed at the foot itself, such as orthotics or surgery, would likely have no effect.

Assuming the nerve block was correctly performed, is this the only possible interpretation?

Thanks,
Irene


Re: Dr. Zuckerman, or anyone else, can you answer this?

john h on 2/22/00 at 00:00 (016216)

dr zukerman can probably answer that but there are nerves other than the tibial nerve that serve the bottom of the feet. if he indeed just block the tibial nerve that would not seem to be an accurate statement or conclusion.

Re: Dr. Zuckerman, or anyone else, can you answer this?

Dr. Zuckerman on 2/22/00 at 00:00 (016223)

The purpose of the Posterior Tibial nerve blocked is to produce a sympathetic nerve response. That is to increase blood flow to the foot. In a very small percentage of patients the block will produce numbness but not the sympathetic response. I like to wait and add additional local anesthetic to make sure that the increase temp takes place. The patient must stay in the office until the doc feels the increase in temp. It is possible that our block didn't produce this sympathetic effect. When you mean the arch are you talking about the medial band of the Pf. Are you talking about the Tib Ant. or Tib Post
insertion at the navicular bone. I am not trying to be doctor small but this is important. Alot of time you will have two or more problems going on with pf. This isn't necessary just pf. There are alot of tendons and muscles etc that support the foot in function and
locomotion. So the pf may have been treated but not the PT or the AT
tendons.

I hope I answered this. Oh! I don't understand how the foot doctor came to the conclusion that it was in your back just because the arch pain didn't get better. That was the question


Re: Dr. Zuckerman, or anyone else, can you answer this?

Irene m on 2/23/00 at 00:00 (016260)

Thank you so much, Dr. Z, and John too.

To answer your question about the location of the pain, it is all across the entire arches of both feet when I stand or walk, front to back and side to side. There is no pain in the heel or toward the toes. The pain is a little worse on the lateral rims than the medial sides. It isn't worse in the mornings. There is no pain on the tops of the feet, just the soles.

I have had this foot pain for 30 years, all my adult life, and it's been getting worse with time. I need to use a wheelchair most of the time. I have seen so many doctors and gotten so many treatments and diagnoses that I am at my wit's end.

When I had the posterior tibial nerve block, my foot did get hot. The bottom of my foot got numb, but when I got up to walk, the pain was still there, exactly the same as always.

Dr. Zuckerman, when you say that the purpose of this type of nerve block is to get a sympathetic nerve response and increase the blood flow -- I do believe my nerve block accomplished that. So, would you say that the result indicates that my pain originates not from my plantar fascia but one of these other structures of the foot?

Thank you so much for helping me understand this.
Irene


Re: Dr. Zuckerman, or anyone else, can you answer this?

john h on 2/22/00 at 00:00 (016216)

dr zukerman can probably answer that but there are nerves other than the tibial nerve that serve the bottom of the feet. if he indeed just block the tibial nerve that would not seem to be an accurate statement or conclusion.

Re: Dr. Zuckerman, or anyone else, can you answer this?

Dr. Zuckerman on 2/22/00 at 00:00 (016223)

The purpose of the Posterior Tibial nerve blocked is to produce a sympathetic nerve response. That is to increase blood flow to the foot. In a very small percentage of patients the block will produce numbness but not the sympathetic response. I like to wait and add additional local anesthetic to make sure that the increase temp takes place. The patient must stay in the office until the doc feels the increase in temp. It is possible that our block didn't produce this sympathetic effect. When you mean the arch are you talking about the medial band of the Pf. Are you talking about the Tib Ant. or Tib Post
insertion at the navicular bone. I am not trying to be doctor small but this is important. Alot of time you will have two or more problems going on with pf. This isn't necessary just pf. There are alot of tendons and muscles etc that support the foot in function and
locomotion. So the pf may have been treated but not the PT or the AT
tendons.

I hope I answered this. Oh! I don't understand how the foot doctor came to the conclusion that it was in your back just because the arch pain didn't get better. That was the question


Re: Dr. Zuckerman, or anyone else, can you answer this?

Irene m on 2/23/00 at 00:00 (016260)

Thank you so much, Dr. Z, and John too.

To answer your question about the location of the pain, it is all across the entire arches of both feet when I stand or walk, front to back and side to side. There is no pain in the heel or toward the toes. The pain is a little worse on the lateral rims than the medial sides. It isn't worse in the mornings. There is no pain on the tops of the feet, just the soles.

I have had this foot pain for 30 years, all my adult life, and it's been getting worse with time. I need to use a wheelchair most of the time. I have seen so many doctors and gotten so many treatments and diagnoses that I am at my wit's end.

When I had the posterior tibial nerve block, my foot did get hot. The bottom of my foot got numb, but when I got up to walk, the pain was still there, exactly the same as always.

Dr. Zuckerman, when you say that the purpose of this type of nerve block is to get a sympathetic nerve response and increase the blood flow -- I do believe my nerve block accomplished that. So, would you say that the result indicates that my pain originates not from my plantar fascia but one of these other structures of the foot?

Thank you so much for helping me understand this.
Irene