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tarsal tunnel syndrome signs ?

Posted by gilbert on 9/06/00 at 23:48 (027438)

please write if you have similar symptoms to what I have been having:

- I have tingling and numbness at the bottom of both feet equally within 20 minutes after sitting down.
- I have throbbing in my feet while sitting
- standing for more than 10-15 minutes on my feet will cause fatigue and discomfort in feet, and I'll have to sit down.
- my feet feel fatigue and tired after 15minutes of walking
- positive tinel's sign

following is a list of tests i did:

- An MRI of the back was negative. (I have no back problems)
- 3 EMG and NCV tests on the feet and lower back, of which one showed positive tts on one foot; second showed lower back problem, third showed no problem anywhere.

I am inclined to think that what I have is a Tarsal tunnel syndrome and will probably do that surgery soon.

I would like to see if others on this board have some similar things
to my symptoms. or if they have had that surgery.

Gilbert

Re: Response to gilbert

wendyn on 9/07/00 at 08:43 (027456)

Hi Gilbert - I responded to your message but it ended up above your post. Please see response there.

Re: Response to gilbert

john h on 9/07/00 at 14:31 (027487)

i wonder if poor blood circulation could not produce some of these same symptoms? have you given support stockings a try which might help with circulation. there are some test to check for circulation in the feet. if you had internal vericose veins when you stand they would of course swell and perhaps touch a nerve creating tts and perhaps some other sensations. how about it dr z what kind of test for blood flow in the feet. i read about one somewhere.

Re: Response to gilbert

gilbert on 9/07/00 at 22:15 (027527)

I have no circulation problems, I still excercise sometimes four times a week. I did a complete blood test, it came back okay.

what is strange about the situation I have is following:

- after sitting for even 10-15minutes the throbbing, numbness and tingling will begin at the bottom of the foot and go up to around the ankles and I will even feel the numbness as well in the knees (no swelling visible, both feet equal)

- after standing still for 20 minutes my feet will be very tired and fatigued and will have to sit down.

- after a walking for a mile the feet will be very tired and will have to sit down.

A good night sleep will ease any tingling and numbness, and throbbing in the feet. in other words when I wake up in the morning, I have no problems. just maybe some sensitivity and little burning sensation at the bottom of my feet.

Wendyn, John h. do you know anyone who has had the TTS done?

Re: Response to gilbert

wendyn on 9/07/00 at 22:51 (027534)

John has had the release done. It did not change the situation with his foot either way. I will let him respond with details.

I also correspond with another woman who was diagnosed with TTS. She had the release done at the one year point in August 99. It did not change her symptoms either. She was later diagnosed with idiopathic neuropathy. I followed both their situations carefully because all three of us were diagnosed around the same time.

A complete blood work up (blood count etc) does not necessarily mean they looked for all those things. You may want to ask to be sure -especially about the B12 (low b12 is an easily reversible cause of neuropathy).

If you research statistics on TTS release, you will find that the positive results don't seem to be nearly has high as patients would like them to be (I really wish that wasn't the case). I have some stats here I can dig out if you like - I can probably get you website addresses as well.

The problem with the release is this... (and this is also the Gospel according to my foot and ankle surgeon).

In comparison - carpal tunnel releases are where there is compression in the carpal tunnel from repetitive strain causing increased pressure and swelling. By going in and releasing the tough band of fibre - the pressure is released and the pain gone. Theoretically.

In Tarsal Tunnel Syndrome - there may be compression of the nerve in the tarsal tunnel. There is bone in the inside and a tough band on the outside called the flexor retinaculum. In a release - they go in and free up the nerve, theoretically releasing the pressure.

The problem is - according to my research and the doctors I've talked to- often TTS is not caused by compression that can be released with this band. In my case - the symptoms are caused by the nerve being stretched. A release can't fix this. With many cases of neuropathy - the nerve itself is not well, and a release can't fix that either.

On the other hand, if a varicose vein is causing the compression - it can be removed. If there's a nerve ganglion pushing on the nerve - it could be removed and the problem would be solved. So you see, it all depends on what's wrong in the first place. The surgery stats are much better if the surgery is done to fix a previously identified problem like a tumor.

I am having an MRI done next month, my doctor told me that the only way he will go in and do a release is if they can see a tumor or mass compressing the nerve in the tunnel. Otherwise, it is unlikely to help me and it may make my condition worse. Depending on the MRI, I may be having reconstructive surgery to correct the structural problems in my feet.

Dr's Z and B- do you have any comments on this??? Any insight would be helpful...

Re: tarsal tunnel syndrome signs ?

Bob Ray on 9/08/00 at 16:55 (027599)

Hi Gilbert;
Look at the success stats on TTS surgery you'll see they are less than 50%. I had TTS release and can't say it helped much. I would suggest trying ESWT first, before surgery. If you do elect surgery tell your surgion to check out the article by Dr Michihiro Kohno 'Neurovascular Decompression for idiopathic tarsal Tunnel Syndrome' 2000;69:87-90 July at JNNP on line. His email is mkouno-nsu@umin.ac.jc
It involves transplanting your own fat to insulate the nerve from scar tissue build up as a result of surgery. He is having over 90% success with this technique.
Good luck,
Bob

Re: Response to gilbert

sandy h. on 9/08/00 at 21:11 (027633)

just a comment as i have had 2 tts releases. in jan of this year with good success, not pain free, i went in with the expectation of having a liveable level of pain which it is on most days, unfortunately the other foot decided to follow suit and i had that surgery 3 weeks ago and am hoping for the same. i think 2 things to consider before deciding on surgery are what it going on anatomically,(is it fixable) and probably more importantly pick your surgeon carefully, i had been warned that it wasnt a very successful surgery, i did some exploring and talking to quite a few docs. luckily i found one 3 hours away with a better than average success rate. i was anti-surgery for many years, but so far im glad i did it. imhoping im one of the 'lucky' ones, good luck to all

Re: Response to gilbert

gilbert on 9/10/00 at 20:10 (027852)

Sandy, Bob,

From what I hear is that depending on the patient's condition, and diagnosis, the surgery can be successfull. I am not sure about the success numbers and stats, they can be a bit discouraging.

At this time, I am still trying to find out is if TTS is really what I have and not something else.

I have had my tingling and numbeness for over three years now. it does not seem to get a lot worse but I can't stand it anymore. The tingling and numbeness and throbbing starts in my feet after about
10-15minutes of sitting or if I am standing still. It will begin at the bottom of the foot and the tingling will go up to around the ankles, and I will even feel it around the knees on both feet.
Also, if I am walking for a while, my feet will be very tired and I'll have to sit down.

just a few questions:

- since you mentioned pain, what kind of pain did you have
before the surgery?
- any tingling, numbness while sitting?
- did you experience throbbing in the feet?
- How long did you have those sensations and symptoms before you decided on the surgery?
- What city did you have your TTS surgery done and how did you decide on your doctor. was he an orthopaedic? Did he have a lot of TTS experience?
- does anyone know the risks of this surgery?

Thank you for any answers on these questions. It has been really hard not being able to find ANYONE who understands what is going on with my feet.

Re: Response to gilbert

wendyn on 9/10/00 at 22:21 (027853)

The feeling of being alone is awful - don't worry...you've found a lot of new friends here. No matter what you decide, we'll be here with you.

I have spent an absolutely obscene amount of time researching TTS over the last almost 2 years.

I will share some stats with you as I dig them out of this pile of 'stuff' I have accumulated.

According to Springer Internation Orthopaedics
'The tasrsal tunnel syndrome: evaluation of surgical results using multivariate analysis.'

I will summarize.

34 patients w/TTS treated by decompression of post tib nerve. Bilateral in 3 cases...9 men 25 women average age 41 yr. Avg follow up 3.8 years. Outcome is influenced in order of importance by fibrosis around the nerve, the preoperative severity of the condition, history of sprained ankle, workers compensation, long history and heavy work. The results were favorable when the was a short history, prescence of a ganglion, no spains and light work. Precise cause of syndrome and its effect on treatment should be considered before operation.

According to MEDLINE on the web
Database med98-99
Clinical and electrophysiological findings and follow up in tarsal tunnel syndrome.
Azienda Sanitaria Locale 7, Institute of Neurological Sciences

59 patients w/TTS follow up in 23. Entrapment prevalent in females, bilateral 6 patients...23 were idopathic, 13 had history of local trauma, 3 had systemic disease others had external or intrinsic compresions...6 feet underwent surgery with excellent or good results in 5, 4 showed improvement of distal conduction of the plantar nerves. 9 were treated with local steroid injections with good results shown in 6 patients. 9 other patients who did not receive any therapy showed a disapperance of symptoms or good outcome in 6 cases. Subjects with poor theraapeutic results had S1 radiculopathy or systemic diseases. Note that surgical release should be limited to cases with space occupying lesions and when conservative treatments fail.

Wheeless' Textbook of Orthopaedics
Clinical Results after Taral Tunnel Decompression.

...32 feet avg follow up 31 months mostly female avg age 47 years. Overall 44% benefited markedly from the operative procedure (a good or excelleng result). Of 5 patients who were completly satisfied 3 had a ganglion cyst, accessory naviculor bone or medial talocalcaneal coalition in or near the tarsal tunnel that had been treated at the same time. 11 patients (38%) were clearly dissatisfied with the result and had no long term relief of the pain. Pain was decreased in 19% but the patients still had some pain and disability. 13% complications - 3 wound infections and 1 delay in wound healing.....Our findings suggest that, unless there is an associated lesion near or within the tarsal tunnel preoperatively, deompression of the posterior tibial nerve should be considered with caution.

I have other stats somewhere.

Doctors seem to often give about a 50/50 chance that you'll be better off with surgery. One patient here - was it Alan, had a doctor that originally told him it was 90% succesful, then 75% and then I think even lower.

Like I said before, it really seems to depend on what's causing the problem in the first place.

Re: tarsal tunnel syndrome signs ?

Dr. Zuckerman on 9/10/00 at 22:41 (027859)

I would in addition check out your blood flow to the lower extremity and feet. This is done by clinical evaluation and good history. If there is any doubt lower extremity doppler ultrasound will tell you alot. I find it difficult to believe that you have TTS caused by local trauma due to the condition being both feet. There are alot of other causes for TTS symptoms. First check out the circulation.

Re: tarsal tunnel syndrome signs ?

Dr. Zuckerman on 9/10/00 at 22:46 (027861)

How about an MRI of the tarsal tunnel and ankle. Let's see if there is a lesion or tumor in the area. Is stress that the ankle should be included along with the tunnel and rear foot.

Re: Response to gilbert

sandy h. on 9/11/00 at 00:04 (027869)

hi gilbert, just a few answers/comments i was given a 50% success rate for surgery by most doctors/research, the doc i eventually decided to have do the surgery gave me an 80% success rate. i had a failed pf release in feb 99 and continued to get what i thought was worse pf symptoms added to that feet would hurt first steps in am then be ok for a while then get worse again after any standing or walking, the woe of the hmo did not allow me to get any diagnostics because 'you already have a diagnosis' for almost a year i was in limbo until being able to get good insurance, in the year my big toe became numb and walking became torture almost like walking on broken glass and having a large knife in my heal, with pain going up both sides of my heal and a very positive tinnels sign. the right foot the 'better one' i never got any numbness of the toe but did have tingling when resting.got a second and third opinion and testing , all agreed on the diagnosis. with my origional pods blessing i went with the most experience, i found an orthopedic foot and ankle surgeon in phoenix az. i had been dealing with heel pain since 1991 and tried nearly everything, i felt at the time that my choices were to go on total disability or to try surgery.hang in there everyone, i hope this answers some questions gilbert its not an easy decision. hope im making some sense as ive got stiches under a cast that are driving me crazy itching at the moment.

Re: tarsal tunnel syndrome signs ?

gilbert on 9/11/00 at 16:34 (027937)

Dr. Zuckerman,
The MRIs for the lower back and the bilateral Tarsal Tunnel on both feet didn't show anything unusual.

The pulse at the ankle and foot levels on both feet is strong. I am not sure about the Doppler test but one of my doctors checked it thoroughly, at least a physical checks.

Re: tarsal tunnel syndrome signs ?

Bob Ray on 9/13/00 at 16:55 (028127)

The circulation in my left has always been ok. The right was dead about 4 months ago. But since becoming aware I have restored circulation.

Re: tarsal tunnel syndrome signs! New to all of this

Tricia on 10/05/00 at 16:17 (029857)

Hi everyone! I am new to the board. I found Doctor Z's website and am wishing I lived in New Jersey! Used to- in Medford Lakes- loved it there! Now I'm in sunny California! My podiatrist sent me to neurlogist who diagnosed TTS in my left foot and said my right foot will follow! Is there any way to save my right foot before it get that far. I rub it every night- I feel zinging pains going thru the arch and throbbing even in the back of my calf and burning pain at the end of the toes- I say 'no no go away, Tricia doesn't want to play' LOL! I don't think its going to work though! My left foot went TTS about 5 weeks ago. Was in a car accident 20 years ago and both feet were slammed against the floor of the car- I was driving and was heat head on by a drunk driver. The feet suffered numberous small hairline fractures. The balls of my feet got really really sore and I saw a podiatrist for the first time and he x rayed them. He showed me the injuries my feet had substained and told me I had plantar fascitis and then ordered orthotics for me. The next time I saw him I told him that my left foot was itching and burning and I woke up one day to find the first three does numb and cold and the PAIN- my god- I had to have a cortisone- that's the only thing that is helping now - then he had to prescribe Neurontin because my hands also started to hurt the same way- zinging pains- does anyone have an idea what is going on. I have a very painful spot in my back between my wing bones and I know its full of arthritis. I am having that looked at and an MRI done. Should I also ask that an MRI be done of my feet? Do you think this is all related to my back. The back of my upper arms tingle too. This is all so wierd but I AM SO GLAD I found all of you. Its hard to describe to others what is going on!

Re: tarsal tunnel syndrome signs ?

Shannon on 10/10/00 at 22:33 (030254)

Hi, I was recently diagnosed in June with a mild case of tarsal tunnel syndrome in my right foot. I started out with pain shooting down my shin into the top of my foot and now the pain is strictly on the medial side of the ankle. Usually, I just get some tingling and burning on the sole of the foot and on the medial side. I just recently saw a podiatrist, and he told me that I had to take another 6 months off from running. So far, I have been resting from running for 7 months. Also, my EMG indicated that there were no muscle masses or lesions impinging the nerve. Therefore, I have no idea what is causing the latency in my medial plantar nerve. Sometimes, when my inside of my ankle hurts, the medial side of my calf gets really tight and tender, as does my soleus and gastroc. Does any of this make sense? I don't know what to do. Could you suggest any form of treatment? Thanks.

Re: tarsal tunnel syndrome signs ?

wendyn on 10/11/00 at 22:45 (030346)

Shannon, TTS takes a LONG time to recover from. Do they know what's causing it in your case?

Stay away from the running, and if your pain is acute - you may want to avoid a lot of overstretching the nerve (like you would in biking). Just take it really easy.

Sometimes (for reasons I don't fully understand) massage helps. Don't massage the TTS area itself - but go to someone reputable and have a good lower body massage. Focus mainly on the lower back/glutes/legs and calves. Listen to your body and if something hurts - don't let them do it. For whatever reason - this helps a lot with the pain you're referring too. Also, gentle yoga and stretching helps.

In the past, I could not bike without aggravating my pain - but I'm at the point now where I usually find that it helps.

Please let us know how you do.

Re: tarsal tunnel syndrome signs ?

gilbert on 10/18/00 at 15:37 (030797)

the MRI is recommended probably to check if there is something unusual
with the foot. probably like a tumor that is pressing against the nerves.

Re: Response to gilbert

gilbert on 10/18/00 at 15:42 (030798)

Sandy, how is your recovery from the TTS surgery going? did you doc
recommend any excercise to help with this? are you taking any vitamins?

Re: Response to gilbert

sandy h. on 10/21/00 at 09:28 (030964)

Hello Gilbert, Im afraid to say it out loud, but both feet are still recovering nicely,9 months and 9 weeks later. OK Ive jinxed myself. Im going back to work next week on cement floors(although only 4 hours at a time) so that will be the true test. Im doing stretching and strengthing exercizes, I have been cut off from formal PT by my insurance company,Ive always taken vits. multivits also e and c dont know if they help anything, they dont hurt anything. How are you coming along? Progressing or regressing? Any decisions about surgery? Anyone thinking of surgery for tts I have found a great doctor in Phoenix who is very experienced and worth traveling to.

Re: Response to gilbert

gilbert on 10/23/00 at 11:06 (031069)

Sandy
I was talking to my doctor in Baltimore, he said that the recovery
time for a TTS usually takes three weeks. he said I wouldn't be able to resume normal sports activities for about three months, but since I have a desk job so it shouldn't put me out of work for more than three weeks. is that too agressive?

Re: tarsal tunnel syndrome signs ?

Jeff D on 10/24/00 at 13:52 (031159)

I had an EMG onmy leg, foot and back. All negative. I have systoms but no conclusive proof. Frustrsting! My pain is only invoked when I walk or run, etc. I do however know it is there all the time.

Re: tarsal tunnel syndrome signs ?

Karin on 10/25/00 at 16:40 (031266)

Gilbert,
I too had TTS in the right foot along with PF. Because I had numbness and tingling from the ball of the foot up through the toes, my Dr. did the release surgery in April, 2000. The TTS surgery was a complete success! All feeling has returned. The PF release surgery, however was not successful. I still have pain after 18 months, injections, PT, inserts, taping, you name it. I am now going to undergo the Ossatron treatment probably within the next 2 weeks. If that doesn't do the trick, don't know what I'll do.
But, if I were you, I would definitely go ahead with the TTS surgery, IF you have complete trust in your Dr. Is he a podiatrist? They are the only Dr. trained in feet and feet alone. I know, I am an Occupational Therapist.
Good luck!

Re: tarsal tunnel syndrome signs ?

wendyn on 10/25/00 at 17:40 (031275)

Karen, I'm so happy to hear that you had good results from your TTS surgery. I disagree about your recommendation to have a pod do a TT release, I would recommend an orthapedic surgeon who specializes in Foot and Ankle surgery - but you're right - it does come down to a matter of trust. The stats for Tarsal Tunnel release are lousy, and the surgery should only be pursued as a last resort. Do you know what exactly they found in your tarsal tunnel that they were able to correct?

Re: Response to gilbert

sandy h. on 10/25/00 at 20:39 (031286)

Are you contemplating 'just' tts surgery? 3 weeks sounds pretty optomistic for recovery from any surgery. I also had pf releases and the heel spurs removed with mine which complicated things and made recovery longer. I was on crutches for 3 weeks and in a cast 8 weeks first time and 6 weeks second time, my doc would have let me go back to work at 6 weeks with a desk job but unfortunately must do a lot of walking and standing at my job. I resumed swimming almost immediatly after they cut the cast off, as I have been dealing with this for 9 years I havent been doing much other activity but hope to start going for walks soon. My only regret is that I didnt do surgery sooner, the docs Ive seen over the years as well as the people on this board are for the majority anti-surgery, but Im so glad I listened to my gut and had surgery. Hang in there and dont forget to keep us posted on progress.

Re: tarsal tunnel syndrome signs ?

Jeff D on 10/26/00 at 08:26 (031317)

I have been seeing a Otropedic Surgeon that specializes in foot and ankle. I am told that he is the best at the Hospital. I live in the Detroit area and he is at the two William Beaumont Hospitals. However is is reluctant to do surgery because of the success rate. Currently my treatment is going to a PT. The PT massages the Tarsal Zone, whirlpool, and Ultrasoud with 1% Cortisone Creme. It seems to be helping but I am still unable to do a long walk without paying for it the next day. I have not yet had any kind of an injection. What about an MRI? I have an appointment at a POD next week for another oponion. Any suggestions?

Re: tarsal tunnel syndrome signs ?.... STATS??

Scott Hovey on 10/27/00 at 02:32 (031425)

Karen, Do you have an information on the stats? I am now in negotiatios with the insurance company on a TTS brought on by a motorcycle accident. I am trying to explain to them the long road to recovery. After one year I still have substantial pain and that pins and needles feeling has now spread to my arch and towards my toes. I need some stats, good or bad. What about surgery?? Good or bad. I am scared to have the surgery.

Re: RE: Tarsal Tunnel Syndrome

Jo Jo on 10/27/00 at 08:09 (031434)

I have been a city mail carrier for 4 months now. I started having numbness, burning, and tingling in both of my feet shortly after I started. The pain is mostly in the inside of both of my feet. Sometimes I get sharp pains in my heels and it shoots up into my calf once in a while. When walking on my route, the pain gets so bad I have to stop walking and rest for a little while. I am 32 years old. I have not seen a doctor yet. Do I really need to or is it just a matter of getting use to being on my feet all the time?

Re: RE: Tarsal Tunnel Syndrome

wendyn on 10/27/00 at 09:02 (031444)

You need to see a doctor for sure. There are all kinds of things that mimic TTS symptoms - some serious. Only a doctor will know for sure what's going on.

And although I certainly don't claim to know everything about TTS - I can assure you of one thing.

You will NEVER 'walk through' the pain of it. If you continue to be on your feet walking so much - you will get worse. This I know. You will not 'get used' to intense nerve pain.

Please see a good doctor (and also a second opinion) as soon as possible. See if you can go off on immediate leave from work to get your problem under control.

Re: Tarsal Tunnel Syndrome

Jo Jo on 10/27/00 at 19:29 (031481)

Thank you for answering my question for me, and so promptly too! I wasn't sure if it was just a matter of getting use to the pain or what.
The numbness and pain are driving me crazy!

I will keep in touch and let you know what happens.

Thanks again!

Re: Response to gilbert

john h on 10/28/00 at 19:04 (031542)

i had a tts release in august 99.

Re: Response to gilbert

john h on 10/28/00 at 19:06 (031543)

wendy: one thing has changed since my tts release. i cannot reproduce a tts response when i tap on the inside of my ankle on the foot that had surgery. i can reproduce a response on the other foot.

Re: tarsal tunnel syndrome signs ?

Jeff D on 11/01/00 at 11:03 (031760)

My POD suggested a shot to block the nerve. He says this will be a definitive way to determine the compression. All his x-rays show no other abnormalities and he believes it is TTS. He has performed many TTS surgeries (12 this year). Any experience with this shot?

Re: tarsal tunnel syndrome signs ?

wendyn on 11/01/00 at 14:20 (031768)

I believe that the shot does not so much confirm compression - but confirm that you have the right nerve causing the problems. If they numb the nerve and your pain goes away - then chances are the problem is in your foot and not your back etc.

I think.

Re: tarsal tunnel syndrome signs ?

wendyn on 11/01/00 at 14:22 (031769)

You're right - 12 is a lot of TTS releases - especially since many doctors won't do them unless there's a confirmed mass in the tunnel. How's his success rate? - talk to some patients he's performed it on if possible. I know that's hard with confidentiality etc - but I'd be real interested to know how those 12 people are all doing.

Re: Response to gilbert

Janette on 11/28/00 at 23:12 (033776)

I am glad I found this site. I have been doing lots of research on TTS and what can help. I have also found out what doesn't work. Therefore my next step should be surgery.

I have been putting off TTS for a couple of reasons. I think it was Sandy H that said, finding a doctor you can trust and that has performed lots, (especially successful) of surgeries. Then the debate is do you go with a podiatrist who just specializes in feet or an orthopedic surgeon who has more training.

Re: Response to gilbert

wendyn on 9/07/00 at 08:43 (027456)

Hi Gilbert - I responded to your message but it ended up above your post. Please see response there.

Re: Response to gilbert

john h on 9/07/00 at 14:31 (027487)

i wonder if poor blood circulation could not produce some of these same symptoms? have you given support stockings a try which might help with circulation. there are some test to check for circulation in the feet. if you had internal vericose veins when you stand they would of course swell and perhaps touch a nerve creating tts and perhaps some other sensations. how about it dr z what kind of test for blood flow in the feet. i read about one somewhere.

Re: Response to gilbert

gilbert on 9/07/00 at 22:15 (027527)

I have no circulation problems, I still excercise sometimes four times a week. I did a complete blood test, it came back okay.

what is strange about the situation I have is following:

- after sitting for even 10-15minutes the throbbing, numbness and tingling will begin at the bottom of the foot and go up to around the ankles and I will even feel the numbness as well in the knees (no swelling visible, both feet equal)

- after standing still for 20 minutes my feet will be very tired and fatigued and will have to sit down.

- after a walking for a mile the feet will be very tired and will have to sit down.

A good night sleep will ease any tingling and numbness, and throbbing in the feet. in other words when I wake up in the morning, I have no problems. just maybe some sensitivity and little burning sensation at the bottom of my feet.

Wendyn, John h. do you know anyone who has had the TTS done?

Re: Response to gilbert

wendyn on 9/07/00 at 22:51 (027534)

John has had the release done. It did not change the situation with his foot either way. I will let him respond with details.

I also correspond with another woman who was diagnosed with TTS. She had the release done at the one year point in August 99. It did not change her symptoms either. She was later diagnosed with idiopathic neuropathy. I followed both their situations carefully because all three of us were diagnosed around the same time.

A complete blood work up (blood count etc) does not necessarily mean they looked for all those things. You may want to ask to be sure -especially about the B12 (low b12 is an easily reversible cause of neuropathy).

If you research statistics on TTS release, you will find that the positive results don't seem to be nearly has high as patients would like them to be (I really wish that wasn't the case). I have some stats here I can dig out if you like - I can probably get you website addresses as well.

The problem with the release is this... (and this is also the Gospel according to my foot and ankle surgeon).

In comparison - carpal tunnel releases are where there is compression in the carpal tunnel from repetitive strain causing increased pressure and swelling. By going in and releasing the tough band of fibre - the pressure is released and the pain gone. Theoretically.

In Tarsal Tunnel Syndrome - there may be compression of the nerve in the tarsal tunnel. There is bone in the inside and a tough band on the outside called the flexor retinaculum. In a release - they go in and free up the nerve, theoretically releasing the pressure.

The problem is - according to my research and the doctors I've talked to- often TTS is not caused by compression that can be released with this band. In my case - the symptoms are caused by the nerve being stretched. A release can't fix this. With many cases of neuropathy - the nerve itself is not well, and a release can't fix that either.

On the other hand, if a varicose vein is causing the compression - it can be removed. If there's a nerve ganglion pushing on the nerve - it could be removed and the problem would be solved. So you see, it all depends on what's wrong in the first place. The surgery stats are much better if the surgery is done to fix a previously identified problem like a tumor.

I am having an MRI done next month, my doctor told me that the only way he will go in and do a release is if they can see a tumor or mass compressing the nerve in the tunnel. Otherwise, it is unlikely to help me and it may make my condition worse. Depending on the MRI, I may be having reconstructive surgery to correct the structural problems in my feet.

Dr's Z and B- do you have any comments on this??? Any insight would be helpful...

Re: tarsal tunnel syndrome signs ?

Bob Ray on 9/08/00 at 16:55 (027599)

Hi Gilbert;
Look at the success stats on TTS surgery you'll see they are less than 50%. I had TTS release and can't say it helped much. I would suggest trying ESWT first, before surgery. If you do elect surgery tell your surgion to check out the article by Dr Michihiro Kohno 'Neurovascular Decompression for idiopathic tarsal Tunnel Syndrome' 2000;69:87-90 July at JNNP on line. His email is mkouno-nsu@umin.ac.jc
It involves transplanting your own fat to insulate the nerve from scar tissue build up as a result of surgery. He is having over 90% success with this technique.
Good luck,
Bob

Re: Response to gilbert

sandy h. on 9/08/00 at 21:11 (027633)

just a comment as i have had 2 tts releases. in jan of this year with good success, not pain free, i went in with the expectation of having a liveable level of pain which it is on most days, unfortunately the other foot decided to follow suit and i had that surgery 3 weeks ago and am hoping for the same. i think 2 things to consider before deciding on surgery are what it going on anatomically,(is it fixable) and probably more importantly pick your surgeon carefully, i had been warned that it wasnt a very successful surgery, i did some exploring and talking to quite a few docs. luckily i found one 3 hours away with a better than average success rate. i was anti-surgery for many years, but so far im glad i did it. imhoping im one of the 'lucky' ones, good luck to all

Re: Response to gilbert

gilbert on 9/10/00 at 20:10 (027852)

Sandy, Bob,

From what I hear is that depending on the patient's condition, and diagnosis, the surgery can be successfull. I am not sure about the success numbers and stats, they can be a bit discouraging.

At this time, I am still trying to find out is if TTS is really what I have and not something else.

I have had my tingling and numbeness for over three years now. it does not seem to get a lot worse but I can't stand it anymore. The tingling and numbeness and throbbing starts in my feet after about
10-15minutes of sitting or if I am standing still. It will begin at the bottom of the foot and the tingling will go up to around the ankles, and I will even feel it around the knees on both feet.
Also, if I am walking for a while, my feet will be very tired and I'll have to sit down.

just a few questions:

- since you mentioned pain, what kind of pain did you have
before the surgery?
- any tingling, numbness while sitting?
- did you experience throbbing in the feet?
- How long did you have those sensations and symptoms before you decided on the surgery?
- What city did you have your TTS surgery done and how did you decide on your doctor. was he an orthopaedic? Did he have a lot of TTS experience?
- does anyone know the risks of this surgery?

Thank you for any answers on these questions. It has been really hard not being able to find ANYONE who understands what is going on with my feet.

Re: Response to gilbert

wendyn on 9/10/00 at 22:21 (027853)

The feeling of being alone is awful - don't worry...you've found a lot of new friends here. No matter what you decide, we'll be here with you.

I have spent an absolutely obscene amount of time researching TTS over the last almost 2 years.

I will share some stats with you as I dig them out of this pile of 'stuff' I have accumulated.

According to Springer Internation Orthopaedics
'The tasrsal tunnel syndrome: evaluation of surgical results using multivariate analysis.'

I will summarize.

34 patients w/TTS treated by decompression of post tib nerve. Bilateral in 3 cases...9 men 25 women average age 41 yr. Avg follow up 3.8 years. Outcome is influenced in order of importance by fibrosis around the nerve, the preoperative severity of the condition, history of sprained ankle, workers compensation, long history and heavy work. The results were favorable when the was a short history, prescence of a ganglion, no spains and light work. Precise cause of syndrome and its effect on treatment should be considered before operation.

According to MEDLINE on the web
Database med98-99
Clinical and electrophysiological findings and follow up in tarsal tunnel syndrome.
Azienda Sanitaria Locale 7, Institute of Neurological Sciences

59 patients w/TTS follow up in 23. Entrapment prevalent in females, bilateral 6 patients...23 were idopathic, 13 had history of local trauma, 3 had systemic disease others had external or intrinsic compresions...6 feet underwent surgery with excellent or good results in 5, 4 showed improvement of distal conduction of the plantar nerves. 9 were treated with local steroid injections with good results shown in 6 patients. 9 other patients who did not receive any therapy showed a disapperance of symptoms or good outcome in 6 cases. Subjects with poor theraapeutic results had S1 radiculopathy or systemic diseases. Note that surgical release should be limited to cases with space occupying lesions and when conservative treatments fail.

Wheeless' Textbook of Orthopaedics
Clinical Results after Taral Tunnel Decompression.

...32 feet avg follow up 31 months mostly female avg age 47 years. Overall 44% benefited markedly from the operative procedure (a good or excelleng result). Of 5 patients who were completly satisfied 3 had a ganglion cyst, accessory naviculor bone or medial talocalcaneal coalition in or near the tarsal tunnel that had been treated at the same time. 11 patients (38%) were clearly dissatisfied with the result and had no long term relief of the pain. Pain was decreased in 19% but the patients still had some pain and disability. 13% complications - 3 wound infections and 1 delay in wound healing.....Our findings suggest that, unless there is an associated lesion near or within the tarsal tunnel preoperatively, deompression of the posterior tibial nerve should be considered with caution.

I have other stats somewhere.

Doctors seem to often give about a 50/50 chance that you'll be better off with surgery. One patient here - was it Alan, had a doctor that originally told him it was 90% succesful, then 75% and then I think even lower.

Like I said before, it really seems to depend on what's causing the problem in the first place.

Re: tarsal tunnel syndrome signs ?

Dr. Zuckerman on 9/10/00 at 22:41 (027859)

I would in addition check out your blood flow to the lower extremity and feet. This is done by clinical evaluation and good history. If there is any doubt lower extremity doppler ultrasound will tell you alot. I find it difficult to believe that you have TTS caused by local trauma due to the condition being both feet. There are alot of other causes for TTS symptoms. First check out the circulation.

Re: tarsal tunnel syndrome signs ?

Dr. Zuckerman on 9/10/00 at 22:46 (027861)

How about an MRI of the tarsal tunnel and ankle. Let's see if there is a lesion or tumor in the area. Is stress that the ankle should be included along with the tunnel and rear foot.

Re: Response to gilbert

sandy h. on 9/11/00 at 00:04 (027869)

hi gilbert, just a few answers/comments i was given a 50% success rate for surgery by most doctors/research, the doc i eventually decided to have do the surgery gave me an 80% success rate. i had a failed pf release in feb 99 and continued to get what i thought was worse pf symptoms added to that feet would hurt first steps in am then be ok for a while then get worse again after any standing or walking, the woe of the hmo did not allow me to get any diagnostics because 'you already have a diagnosis' for almost a year i was in limbo until being able to get good insurance, in the year my big toe became numb and walking became torture almost like walking on broken glass and having a large knife in my heal, with pain going up both sides of my heal and a very positive tinnels sign. the right foot the 'better one' i never got any numbness of the toe but did have tingling when resting.got a second and third opinion and testing , all agreed on the diagnosis. with my origional pods blessing i went with the most experience, i found an orthopedic foot and ankle surgeon in phoenix az. i had been dealing with heel pain since 1991 and tried nearly everything, i felt at the time that my choices were to go on total disability or to try surgery.hang in there everyone, i hope this answers some questions gilbert its not an easy decision. hope im making some sense as ive got stiches under a cast that are driving me crazy itching at the moment.

Re: tarsal tunnel syndrome signs ?

gilbert on 9/11/00 at 16:34 (027937)

Dr. Zuckerman,
The MRIs for the lower back and the bilateral Tarsal Tunnel on both feet didn't show anything unusual.

The pulse at the ankle and foot levels on both feet is strong. I am not sure about the Doppler test but one of my doctors checked it thoroughly, at least a physical checks.

Re: tarsal tunnel syndrome signs ?

Bob Ray on 9/13/00 at 16:55 (028127)

The circulation in my left has always been ok. The right was dead about 4 months ago. But since becoming aware I have restored circulation.

Re: tarsal tunnel syndrome signs! New to all of this

Tricia on 10/05/00 at 16:17 (029857)

Hi everyone! I am new to the board. I found Doctor Z's website and am wishing I lived in New Jersey! Used to- in Medford Lakes- loved it there! Now I'm in sunny California! My podiatrist sent me to neurlogist who diagnosed TTS in my left foot and said my right foot will follow! Is there any way to save my right foot before it get that far. I rub it every night- I feel zinging pains going thru the arch and throbbing even in the back of my calf and burning pain at the end of the toes- I say 'no no go away, Tricia doesn't want to play' LOL! I don't think its going to work though! My left foot went TTS about 5 weeks ago. Was in a car accident 20 years ago and both feet were slammed against the floor of the car- I was driving and was heat head on by a drunk driver. The feet suffered numberous small hairline fractures. The balls of my feet got really really sore and I saw a podiatrist for the first time and he x rayed them. He showed me the injuries my feet had substained and told me I had plantar fascitis and then ordered orthotics for me. The next time I saw him I told him that my left foot was itching and burning and I woke up one day to find the first three does numb and cold and the PAIN- my god- I had to have a cortisone- that's the only thing that is helping now - then he had to prescribe Neurontin because my hands also started to hurt the same way- zinging pains- does anyone have an idea what is going on. I have a very painful spot in my back between my wing bones and I know its full of arthritis. I am having that looked at and an MRI done. Should I also ask that an MRI be done of my feet? Do you think this is all related to my back. The back of my upper arms tingle too. This is all so wierd but I AM SO GLAD I found all of you. Its hard to describe to others what is going on!

Re: tarsal tunnel syndrome signs ?

Shannon on 10/10/00 at 22:33 (030254)

Hi, I was recently diagnosed in June with a mild case of tarsal tunnel syndrome in my right foot. I started out with pain shooting down my shin into the top of my foot and now the pain is strictly on the medial side of the ankle. Usually, I just get some tingling and burning on the sole of the foot and on the medial side. I just recently saw a podiatrist, and he told me that I had to take another 6 months off from running. So far, I have been resting from running for 7 months. Also, my EMG indicated that there were no muscle masses or lesions impinging the nerve. Therefore, I have no idea what is causing the latency in my medial plantar nerve. Sometimes, when my inside of my ankle hurts, the medial side of my calf gets really tight and tender, as does my soleus and gastroc. Does any of this make sense? I don't know what to do. Could you suggest any form of treatment? Thanks.

Re: tarsal tunnel syndrome signs ?

wendyn on 10/11/00 at 22:45 (030346)

Shannon, TTS takes a LONG time to recover from. Do they know what's causing it in your case?

Stay away from the running, and if your pain is acute - you may want to avoid a lot of overstretching the nerve (like you would in biking). Just take it really easy.

Sometimes (for reasons I don't fully understand) massage helps. Don't massage the TTS area itself - but go to someone reputable and have a good lower body massage. Focus mainly on the lower back/glutes/legs and calves. Listen to your body and if something hurts - don't let them do it. For whatever reason - this helps a lot with the pain you're referring too. Also, gentle yoga and stretching helps.

In the past, I could not bike without aggravating my pain - but I'm at the point now where I usually find that it helps.

Please let us know how you do.

Re: tarsal tunnel syndrome signs ?

gilbert on 10/18/00 at 15:37 (030797)

the MRI is recommended probably to check if there is something unusual
with the foot. probably like a tumor that is pressing against the nerves.

Re: Response to gilbert

gilbert on 10/18/00 at 15:42 (030798)

Sandy, how is your recovery from the TTS surgery going? did you doc
recommend any excercise to help with this? are you taking any vitamins?

Re: Response to gilbert

sandy h. on 10/21/00 at 09:28 (030964)

Hello Gilbert, Im afraid to say it out loud, but both feet are still recovering nicely,9 months and 9 weeks later. OK Ive jinxed myself. Im going back to work next week on cement floors(although only 4 hours at a time) so that will be the true test. Im doing stretching and strengthing exercizes, I have been cut off from formal PT by my insurance company,Ive always taken vits. multivits also e and c dont know if they help anything, they dont hurt anything. How are you coming along? Progressing or regressing? Any decisions about surgery? Anyone thinking of surgery for tts I have found a great doctor in Phoenix who is very experienced and worth traveling to.

Re: Response to gilbert

gilbert on 10/23/00 at 11:06 (031069)

Sandy
I was talking to my doctor in Baltimore, he said that the recovery
time for a TTS usually takes three weeks. he said I wouldn't be able to resume normal sports activities for about three months, but since I have a desk job so it shouldn't put me out of work for more than three weeks. is that too agressive?

Re: tarsal tunnel syndrome signs ?

Jeff D on 10/24/00 at 13:52 (031159)

I had an EMG onmy leg, foot and back. All negative. I have systoms but no conclusive proof. Frustrsting! My pain is only invoked when I walk or run, etc. I do however know it is there all the time.

Re: tarsal tunnel syndrome signs ?

Karin on 10/25/00 at 16:40 (031266)

Gilbert,
I too had TTS in the right foot along with PF. Because I had numbness and tingling from the ball of the foot up through the toes, my Dr. did the release surgery in April, 2000. The TTS surgery was a complete success! All feeling has returned. The PF release surgery, however was not successful. I still have pain after 18 months, injections, PT, inserts, taping, you name it. I am now going to undergo the Ossatron treatment probably within the next 2 weeks. If that doesn't do the trick, don't know what I'll do.
But, if I were you, I would definitely go ahead with the TTS surgery, IF you have complete trust in your Dr. Is he a podiatrist? They are the only Dr. trained in feet and feet alone. I know, I am an Occupational Therapist.
Good luck!

Re: tarsal tunnel syndrome signs ?

wendyn on 10/25/00 at 17:40 (031275)

Karen, I'm so happy to hear that you had good results from your TTS surgery. I disagree about your recommendation to have a pod do a TT release, I would recommend an orthapedic surgeon who specializes in Foot and Ankle surgery - but you're right - it does come down to a matter of trust. The stats for Tarsal Tunnel release are lousy, and the surgery should only be pursued as a last resort. Do you know what exactly they found in your tarsal tunnel that they were able to correct?

Re: Response to gilbert

sandy h. on 10/25/00 at 20:39 (031286)

Are you contemplating 'just' tts surgery? 3 weeks sounds pretty optomistic for recovery from any surgery. I also had pf releases and the heel spurs removed with mine which complicated things and made recovery longer. I was on crutches for 3 weeks and in a cast 8 weeks first time and 6 weeks second time, my doc would have let me go back to work at 6 weeks with a desk job but unfortunately must do a lot of walking and standing at my job. I resumed swimming almost immediatly after they cut the cast off, as I have been dealing with this for 9 years I havent been doing much other activity but hope to start going for walks soon. My only regret is that I didnt do surgery sooner, the docs Ive seen over the years as well as the people on this board are for the majority anti-surgery, but Im so glad I listened to my gut and had surgery. Hang in there and dont forget to keep us posted on progress.

Re: tarsal tunnel syndrome signs ?

Jeff D on 10/26/00 at 08:26 (031317)

I have been seeing a Otropedic Surgeon that specializes in foot and ankle. I am told that he is the best at the Hospital. I live in the Detroit area and he is at the two William Beaumont Hospitals. However is is reluctant to do surgery because of the success rate. Currently my treatment is going to a PT. The PT massages the Tarsal Zone, whirlpool, and Ultrasoud with 1% Cortisone Creme. It seems to be helping but I am still unable to do a long walk without paying for it the next day. I have not yet had any kind of an injection. What about an MRI? I have an appointment at a POD next week for another oponion. Any suggestions?

Re: tarsal tunnel syndrome signs ?.... STATS??

Scott Hovey on 10/27/00 at 02:32 (031425)

Karen, Do you have an information on the stats? I am now in negotiatios with the insurance company on a TTS brought on by a motorcycle accident. I am trying to explain to them the long road to recovery. After one year I still have substantial pain and that pins and needles feeling has now spread to my arch and towards my toes. I need some stats, good or bad. What about surgery?? Good or bad. I am scared to have the surgery.

Re: RE: Tarsal Tunnel Syndrome

Jo Jo on 10/27/00 at 08:09 (031434)

I have been a city mail carrier for 4 months now. I started having numbness, burning, and tingling in both of my feet shortly after I started. The pain is mostly in the inside of both of my feet. Sometimes I get sharp pains in my heels and it shoots up into my calf once in a while. When walking on my route, the pain gets so bad I have to stop walking and rest for a little while. I am 32 years old. I have not seen a doctor yet. Do I really need to or is it just a matter of getting use to being on my feet all the time?

Re: RE: Tarsal Tunnel Syndrome

wendyn on 10/27/00 at 09:02 (031444)

You need to see a doctor for sure. There are all kinds of things that mimic TTS symptoms - some serious. Only a doctor will know for sure what's going on.

And although I certainly don't claim to know everything about TTS - I can assure you of one thing.

You will NEVER 'walk through' the pain of it. If you continue to be on your feet walking so much - you will get worse. This I know. You will not 'get used' to intense nerve pain.

Please see a good doctor (and also a second opinion) as soon as possible. See if you can go off on immediate leave from work to get your problem under control.

Re: Tarsal Tunnel Syndrome

Jo Jo on 10/27/00 at 19:29 (031481)

Thank you for answering my question for me, and so promptly too! I wasn't sure if it was just a matter of getting use to the pain or what.
The numbness and pain are driving me crazy!

I will keep in touch and let you know what happens.

Thanks again!

Re: Response to gilbert

john h on 10/28/00 at 19:04 (031542)

i had a tts release in august 99.

Re: Response to gilbert

john h on 10/28/00 at 19:06 (031543)

wendy: one thing has changed since my tts release. i cannot reproduce a tts response when i tap on the inside of my ankle on the foot that had surgery. i can reproduce a response on the other foot.

Re: tarsal tunnel syndrome signs ?

Jeff D on 11/01/00 at 11:03 (031760)

My POD suggested a shot to block the nerve. He says this will be a definitive way to determine the compression. All his x-rays show no other abnormalities and he believes it is TTS. He has performed many TTS surgeries (12 this year). Any experience with this shot?

Re: tarsal tunnel syndrome signs ?

wendyn on 11/01/00 at 14:20 (031768)

I believe that the shot does not so much confirm compression - but confirm that you have the right nerve causing the problems. If they numb the nerve and your pain goes away - then chances are the problem is in your foot and not your back etc.

I think.

Re: tarsal tunnel syndrome signs ?

wendyn on 11/01/00 at 14:22 (031769)

You're right - 12 is a lot of TTS releases - especially since many doctors won't do them unless there's a confirmed mass in the tunnel. How's his success rate? - talk to some patients he's performed it on if possible. I know that's hard with confidentiality etc - but I'd be real interested to know how those 12 people are all doing.

Re: Response to gilbert

Janette on 11/28/00 at 23:12 (033776)

I am glad I found this site. I have been doing lots of research on TTS and what can help. I have also found out what doesn't work. Therefore my next step should be surgery.

I have been putting off TTS for a couple of reasons. I think it was Sandy H that said, finding a doctor you can trust and that has performed lots, (especially successful) of surgeries. Then the debate is do you go with a podiatrist who just specializes in feet or an orthopedic surgeon who has more training.