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TTS - FAQ - MRI and follow up on me

Posted by wendyn on 8/07/00 at 21:43 (024867)

Alan and John et al. I just went through my pile of notes, and MRI is mentioned quite often as a dignostic tool. Even though (as you both point out) it can't be used to necessarily confirm TTS - it can show the cause of the compression along with whatever else may be going on in the foot. One site says it can show tumors, ruptured tendons etc (things that maybe the doctor doesn't know about from examination.)

A different reference said point blank that MRI is not useful for diagnosis of TTS. Since the comments were about 15 to 1 for MRI, I guess it needs to stay in.

As I said before, please feel free to offer any feedback. The more people that contribute - the more likely it is that we'll get things right. Or as right as we understand it to be. I think some of the comments on some of these medical sites are out to lunch. One describes TTS as a 'vague' pain. Hmmm...I would think that 'vague' would have been the last word I'd use to describe searing hot poker pain stabbing me in the foot. Very definate pain - not vague.
On a personal note...as I read all of my notes and this work on TTS - I am amazed at how few symptoms I have any more. A few months ago I pretty much had every symptom listed, now I have almost none. I don't have any numbness or tingling. The burning is isolated to incidents when I foolishly stand or walk too long. As I compare my situation now to 6 months ago, I consider this recover to be nothing short of a miracle.

That's not to say that I don't have pain, and my activities are still restricted....but I'm consistently amazed at how things seem to be improving.

Ouch - kay, I just checked to see if I still have Tinels's ouch - I do...but it's not nearly as bad as before....and I really had to whack around to find it. Also the pain shot only into my foot instead of going up my leg. That has to be a good sign doesn't it?


Re: TTS - FAQ - MRI and follow up on me

Dr. Zuckerman on 8/08/00 at 06:35 (024876)

Most of TTS is caused from trauma oralot of repetitive stress injury to the foot and ankle. The foot is placed in an inverted position for example in an ankle sprain and or fracture whether it be slight or great there is trauma to the entire ankle and foot including the tarsal tunnel compartment. The reason that I feel that an MRI is needed is not for the TTS but to rule out any injury to the ligaments and tendon to the foot and ankle. The TTS could be a symtoms of another problem just like plantar fasciitis can be caused from posterior tendonitis tear. So in summary there needed to be a complete hands of examination of the foot and ankle and the use of an mri to rule out injury to the ligaments, tendons and joint surfaces of the foot and ankle. I hope this is helpful.

Re: TTS - FAQ - MRI and follow up on me

alan k on 8/08/00 at 07:31 (024879)

Hi wendy,

glad to see you are doing better. I too had many of the symptoms, like tingling and a pressure-like feeling in the toes along with generalized pain in the foot. My tingling went away through foot exercises and some cycling, but as I posted at the time exercise also made it worse at times so it was a constant struggle to stay patient and not push it.

I still have the general pain which I have to say is 'vague,' except when on my feet for a long time. Still, it is a general pain and I can't quite say where it comes from except the general heel area. So, I guess vague pain is a possibility with tts, actually, but perhaps shouldn't be the only definition of the pain of course.

I got MRI results yesterday which showed a perfectly good spine. That's good news I guess. I didn't ask for an MRI on the foot yet but I will eventually. Of course with the MRI and tts I was only pointing out that may not be a definitive test, not that tts patients shouldn't get one. This is because some tts sufferers, like my wife and I, probably don't have any traces of trauma or injury that would show up there, yet still have the condition, which my doctor who told me tts release is %99 effective would call 'ideopathic' with this tone of profundity as though I didn't understand that ideopathic means 'I have no idea.'

take care,
alan


Re: TTS - FAQ - MRI and follow up on me

john h on 8/08/00 at 10:05 (024888)

wendy: i yield to your research as you have done a lot more research than me. my only thought is why my surgeon who is a foot and ankle fellowship trained doctor did not order one for me? i did have the electrical studies which the doctor said that regardless of what they showed were a subjective test. He said in the final analysis the surgery for tts was my call. i concluded what the h--- i am having surgery on my toe and pf so i will just add another scar. at least i would be able to rule out tts as the source of my pain. he did say there was a large vericose vein near the nerve which he moved but i am left with the opinion in 'most cases' it will be a shot in the dark for a tts release. i never really experienced much pain from the surgery but have about a 5' scar. for a while i had swelling and funny sensations but they all abated after about 3 months. after having a cortisone shot into the area of my pf pain and the pain going away for 3 weeks it sort of indicates to me that the pain generator is where the cortisone was injected-at the site where the band of fascia from the great toe attaches to the heel. if this is a wrong assumption i need someone to explain it to me.

Re: TTS - FAQ - MRI and follow up on me

Dr. Zuckerman on 8/08/00 at 12:48 (024901)

The board certified fellowship trained doctors (four years of additional training,) in my office will do ankle repair and tendon repair of the foot and ankle at the same time that they do a release. For example lateral ankle stabilization with a TTS release . I never ordered MRI's until I hired these docs to do all of my ankle and major tendon surgery. These guys have found posterior tendon tear in addition to TTS. The point that I am making is that TTS can be a part of other foot and ankle pathology and not just TTS.

Re: TTS - FAQ - MRI and follow up on me

Dr. Zuckerman on 8/08/00 at 12:52 (024903)

This isn't a wrong assumption however. If the patient has pain or weakness in the lateral aspect of his or her ankle i would point this out to the patient and ask if they sprain the ankle alot. I would check out rom in the ankle and foot and muscle strength. There are other tendons in the area of the tarsal tunnel especially the posterior tibial tendon and this could be the cause of TTS and or pf.

Re: TTS - FAQ - MRI and follow up on me

Dr. Zuckerman on 8/08/00 at 06:35 (024876)

Most of TTS is caused from trauma oralot of repetitive stress injury to the foot and ankle. The foot is placed in an inverted position for example in an ankle sprain and or fracture whether it be slight or great there is trauma to the entire ankle and foot including the tarsal tunnel compartment. The reason that I feel that an MRI is needed is not for the TTS but to rule out any injury to the ligaments and tendon to the foot and ankle. The TTS could be a symtoms of another problem just like plantar fasciitis can be caused from posterior tendonitis tear. So in summary there needed to be a complete hands of examination of the foot and ankle and the use of an mri to rule out injury to the ligaments, tendons and joint surfaces of the foot and ankle. I hope this is helpful.

Re: TTS - FAQ - MRI and follow up on me

alan k on 8/08/00 at 07:31 (024879)

Hi wendy,

glad to see you are doing better. I too had many of the symptoms, like tingling and a pressure-like feeling in the toes along with generalized pain in the foot. My tingling went away through foot exercises and some cycling, but as I posted at the time exercise also made it worse at times so it was a constant struggle to stay patient and not push it.

I still have the general pain which I have to say is 'vague,' except when on my feet for a long time. Still, it is a general pain and I can't quite say where it comes from except the general heel area. So, I guess vague pain is a possibility with tts, actually, but perhaps shouldn't be the only definition of the pain of course.

I got MRI results yesterday which showed a perfectly good spine. That's good news I guess. I didn't ask for an MRI on the foot yet but I will eventually. Of course with the MRI and tts I was only pointing out that may not be a definitive test, not that tts patients shouldn't get one. This is because some tts sufferers, like my wife and I, probably don't have any traces of trauma or injury that would show up there, yet still have the condition, which my doctor who told me tts release is %99 effective would call 'ideopathic' with this tone of profundity as though I didn't understand that ideopathic means 'I have no idea.'

take care,
alan


Re: TTS - FAQ - MRI and follow up on me

john h on 8/08/00 at 10:05 (024888)

wendy: i yield to your research as you have done a lot more research than me. my only thought is why my surgeon who is a foot and ankle fellowship trained doctor did not order one for me? i did have the electrical studies which the doctor said that regardless of what they showed were a subjective test. He said in the final analysis the surgery for tts was my call. i concluded what the h--- i am having surgery on my toe and pf so i will just add another scar. at least i would be able to rule out tts as the source of my pain. he did say there was a large vericose vein near the nerve which he moved but i am left with the opinion in 'most cases' it will be a shot in the dark for a tts release. i never really experienced much pain from the surgery but have about a 5' scar. for a while i had swelling and funny sensations but they all abated after about 3 months. after having a cortisone shot into the area of my pf pain and the pain going away for 3 weeks it sort of indicates to me that the pain generator is where the cortisone was injected-at the site where the band of fascia from the great toe attaches to the heel. if this is a wrong assumption i need someone to explain it to me.

Re: TTS - FAQ - MRI and follow up on me

Dr. Zuckerman on 8/08/00 at 12:48 (024901)

The board certified fellowship trained doctors (four years of additional training,) in my office will do ankle repair and tendon repair of the foot and ankle at the same time that they do a release. For example lateral ankle stabilization with a TTS release . I never ordered MRI's until I hired these docs to do all of my ankle and major tendon surgery. These guys have found posterior tendon tear in addition to TTS. The point that I am making is that TTS can be a part of other foot and ankle pathology and not just TTS.

Re: TTS - FAQ - MRI and follow up on me

Dr. Zuckerman on 8/08/00 at 12:52 (024903)

This isn't a wrong assumption however. If the patient has pain or weakness in the lateral aspect of his or her ankle i would point this out to the patient and ask if they sprain the ankle alot. I would check out rom in the ankle and foot and muscle strength. There are other tendons in the area of the tarsal tunnel especially the posterior tibial tendon and this could be the cause of TTS and or pf.