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Tarsal tunnel syndrome/flexor hallicus tenosynovitis/release surgery

Posted by dfeet on 9/03/00 at 14:00 (027052)

Hi,Docs. I'm at a crossroads with my treatment options which have been very limited due to the duration of the TTS affliction(8mos). I've been dx'd with bilateral TTS-emg confirmation,MRI indicating both PF(right only) and bilateral tenosynovitis. The diagnosis was made after initial symptoms of Only right foot PF pain, then after subsequent tx with rigid orthotics, later developing lower back pain and the TTS signs and symptoms bilaterally. I had to beg my pod to send me to a neurologist! The orthotics were then changed to semi-rigid and I switched docs. My sacral and lumbar spine were shown to be normal-no herniations,bulges,etc. All my bloodwork has come back unremarkable.
I have asked my orthopod what might be the cause of the TTS and its resilience. He has no definitive answers for me. I am managing my pain primarily with PT(very expensive) and self monitoring, limiting my physical activity and IB. The orthopod has no further options but to offer me release surgery. The PT suggested a back specialist and an epidural injection. My family physician says the the nerves will eventually 'burn themselves out'. My take on the whole matter is that if the cause is not evident then how can you correct it with surgery? Isn't the inflamation the major culprit in entrapping the nerve bundle? My profession requires a lot of time spent on my feet,and I'm the sole source of income, so disability is not an option. I have discussed 'nerve' meds also, but both my family physician and orthopod both agreed(I also agree), that that is not the best course. Any suggestions?? Thoughts? Comments? I'm in the chronic pain category and am approaching my last thread. Sincere thanks-dfeet

Re: Tarsal tunnel syndrome/flexor hallicus tenosynovitis/release surgery

Dr. Zuckerman on 9/03/00 at 21:59 (027088)

True tts is due to entrapement just like carpal tunnel syndrome, secondary to repetitive injury.. or even overt trauma. Since this is both feet then there has to be a cause and efect . You may have to see a pain specialist who could offer an epidural, even a posterior tibial nerve block could be helpful and diagnostic. Bilateral TTS is very rare . I have never heard of Bilateral TTS. So see a board certified pain specialist who does epidural blocks. Or see a podiatrist who does posterior sympathetic nerve blocks. That would be my next course of help.

Re: Tarsal tunnel syndrome/flexor hallicus tenosynovitis/release surgery

Dr. Zuckerman on 9/03/00 at 21:59 (027088)

True tts is due to entrapement just like carpal tunnel syndrome, secondary to repetitive injury.. or even overt trauma. Since this is both feet then there has to be a cause and efect . You may have to see a pain specialist who could offer an epidural, even a posterior tibial nerve block could be helpful and diagnostic. Bilateral TTS is very rare . I have never heard of Bilateral TTS. So see a board certified pain specialist who does epidural blocks. Or see a podiatrist who does posterior sympathetic nerve blocks. That would be my next course of help.