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I have one for you--Weak feet??!!!!!!

Posted by dfeet on 11/16/00 at 20:00 (032879)

Hi, Docs. I've noticed since having TTS(PF resolved) bilaterally for about 1 year now(I have made tremendous progress with various treatments excluding surgical ones), I have developed weakening of my feet,ie, I notice I stumble a lot,etc. My PT(who has been a wonderful clinician and given me a great deal of support) had given me a multitude of strengthening exercises at the onset of my affliction, but it has only been recently that I have been able to perform them. I have found that my feet do not flex nor feel as though they have any strength in them whatsoever. My PT had me do some tests, and he indeed concluded that my feet had weakened. Interesting. But I guess it makes sense in that when the nerves are impeded, the musculature isn't functioning properly either. What may be the long term effects? Will I gain my strength back or is the condition a degenerative one? Any insights would be of great help. Thanks-dfeet

Re: I have one for you--Weak feet??!!!!!!

Dr. Zuckerman on 11/16/00 at 20:27 (032885)

This makes alot of sense due to the TTS involving the PT nerve. You have lost of motor function or weakness in the intrintic muscles of the feet. I have a patient that had his entire posterior nerve cut by a very bright doctor for the treatment of TTS. Anyway he has atrophy of the plantar muscules . The atrophy is very bad. So what can be done. I would consider the personal foot trainer. It is possible to isolate all of the plantar and leg muscles of the foot. I would also make sure that there is no lower back nerve problems such as disc, spinal stenosis. Has the back been tested.

Dr. Z

Re: I have one for you--Weak feet??!!!!!!

dfeet on 11/16/00 at 21:08 (032890)

Hi, doc Z. Thanks for the response. Funny you should mention the back. I've been being treated for my lower back. The lower back symptoms coincidently or not so coincidently began after having severe difficulty with rigid orhotics-which while being treated with PF in my right foot, coincidently or not, coincided with my development of bilat. TTS. Hmmmmmm. Interesting. Very interesting.(I'm in semi-rigids now)
My back MRI was insignificant, no findings, WNL. But the pain comes and goes. I think my back is affected by my gait and my profession. Although, my PT doesn't think my gait is too bad. My neurological testing was positive for bilateral TTS, but the back was inconclusive, hence the MRI being ordered which was-negative. Bloodwork-negative. No lesions or masses. Idiopathic or Iatrogenic(rigid orthotics)? I don't know.
So what's the deal with these weak feet?? I know that atrophy can be reversed, but what about the lack of nerve potentials? Can the atrophy ever be reversed in these cases? I have an arch/foot exerciser which my PT gave me, but I can barely get the little spring thingamajig to move.
Is this a progressive, degenerative process, or is there hope of regaining the strength I once had by working out? Please, I don't want a candy coated,'Well...Maybe...etc' Is my decrease in pain directly related to the nerves burning themselves out? I don't mean to sound harsh. Please, I need to know. Thank you again. You and doc B are such gifts to this message board and the people you help. Thank you-dfeet

Re: I have one for you--Weak feet??!!!!!!

Dr. Zuckerman on 11/16/00 at 21:29 (032895)

Ok,

You have the sensory branch of the nerve and the motor nerve of the nerve.
So how is the sensory portion the nerve. We know how the motor portion is weakness of the flexors etc in the foot. There is something very wrong here and i don't know what it is . As you can tell i am trying to use logic. I don't have the experience in neurology and or immunology which this is. I can believe that you can get bilateral TTS which isn't from some type of systemic disease . just doesn't make sense. now back to what really matters . What can you do about you foot imbalance and loss of function and power or weak feet. I will speask with Mike Wilmott and have him help you put on a program . Let me ask another question let say that you have lymes disease. Would you go for the antibiotic treatments that are being offered at this time as the only treatment. i have alot of patients that i feel have lymes disease but just can't take antibotic due to the side effect. You have to decide if you are going to take the treatment if you find the cause. This is a different type of approach . I ask my patient many times let say that i send you to Dr. such and such and he finds such and such would you be willing to do such and such .

Re: I have one for you--Weak feet??!!!!!!

Dr. Biehler on 11/17/00 at 09:16 (032913)

If the weakness is progresing you need a nerological exam to pin point the area of involvment. There is a cauda equinus syndrom where the nerves in the back bone get caught on a bone spur in the lower spine and can cause weakness in the feet. Either way you need to find out where the problem is originatig. Dr. B.

Re: I have one for you--Weak feet??!!!!!! Thanks Docs!

dfeet on 11/18/00 at 10:49 (033012)

Hi, Docs. I completely agree that I must determine a cause!! But I seem to have run the full gamut of testing-lyme disease, thyroid function, Rheumatoid, Ankylosis, fibromalasia, vitamin deficiency, etc, etc,. All negative.(I've had a couple of the tests done more than once over the last year or so-again all negative). I'm truly at my wits end. I did initially have a neurological evaluation which included EMG , point/stimualtion/reaction testing, MRI for both my feet and back. The back was insignificant-no findings and WNL. The feet showed a PF rupture on the right and bilateral tenosynovitis, with areas of marked inflamation in both. But no masses, lesions, anatomical/biomechanical anomolies found in either my back or feet.
The sensory /motor thing has me baffled. But I now experience a different type of pain than at the onset of my injury about 1 year ago. It is almost like an 'itchy' type of pain in my feet. Tinglings with the occaisional zinger. Pretty constant, but more acute at night while in bed. But again, the pain is so much less than the first 5 months after the initial onset of the injury. I'm ambling about and manage to do some sports. It depends on how I feel-some days more tolerable than others. But never 'normal' or completely pain free (including my back).

I just find it coincidental that my back was completely fine, absolutely no problems or pain,prior to and including the first 2-3 months after the initial onset of my feet. Then after about 3 months my back began to bother me. Hmmm. I'm at a loss.

Doc Z, you have me a little concerned with your implied urgency about the weakness in my feet. It makes me think that this is a progressive or has the potential to be a progessive or degenerative type of problem. I realize that neither you nor Doc B have a specialty in neurology, but just being able to have a dialogue about courses of action is tremendously helpful to me at this point.Thank you so much for both your inputs.-dfeet

Re: I have one for you--Weak feet??!!!!!!

Dr. Zuckerman on 11/16/00 at 20:27 (032885)

This makes alot of sense due to the TTS involving the PT nerve. You have lost of motor function or weakness in the intrintic muscles of the feet. I have a patient that had his entire posterior nerve cut by a very bright doctor for the treatment of TTS. Anyway he has atrophy of the plantar muscules . The atrophy is very bad. So what can be done. I would consider the personal foot trainer. It is possible to isolate all of the plantar and leg muscles of the foot. I would also make sure that there is no lower back nerve problems such as disc, spinal stenosis. Has the back been tested.

Dr. Z

Re: I have one for you--Weak feet??!!!!!!

dfeet on 11/16/00 at 21:08 (032890)

Hi, doc Z. Thanks for the response. Funny you should mention the back. I've been being treated for my lower back. The lower back symptoms coincidently or not so coincidently began after having severe difficulty with rigid orhotics-which while being treated with PF in my right foot, coincidently or not, coincided with my development of bilat. TTS. Hmmmmmm. Interesting. Very interesting.(I'm in semi-rigids now)
My back MRI was insignificant, no findings, WNL. But the pain comes and goes. I think my back is affected by my gait and my profession. Although, my PT doesn't think my gait is too bad. My neurological testing was positive for bilateral TTS, but the back was inconclusive, hence the MRI being ordered which was-negative. Bloodwork-negative. No lesions or masses. Idiopathic or Iatrogenic(rigid orthotics)? I don't know.
So what's the deal with these weak feet?? I know that atrophy can be reversed, but what about the lack of nerve potentials? Can the atrophy ever be reversed in these cases? I have an arch/foot exerciser which my PT gave me, but I can barely get the little spring thingamajig to move.
Is this a progressive, degenerative process, or is there hope of regaining the strength I once had by working out? Please, I don't want a candy coated,'Well...Maybe...etc' Is my decrease in pain directly related to the nerves burning themselves out? I don't mean to sound harsh. Please, I need to know. Thank you again. You and doc B are such gifts to this message board and the people you help. Thank you-dfeet

Re: I have one for you--Weak feet??!!!!!!

Dr. Zuckerman on 11/16/00 at 21:29 (032895)

Ok,

You have the sensory branch of the nerve and the motor nerve of the nerve.
So how is the sensory portion the nerve. We know how the motor portion is weakness of the flexors etc in the foot. There is something very wrong here and i don't know what it is . As you can tell i am trying to use logic. I don't have the experience in neurology and or immunology which this is. I can believe that you can get bilateral TTS which isn't from some type of systemic disease . just doesn't make sense. now back to what really matters . What can you do about you foot imbalance and loss of function and power or weak feet. I will speask with Mike Wilmott and have him help you put on a program . Let me ask another question let say that you have lymes disease. Would you go for the antibiotic treatments that are being offered at this time as the only treatment. i have alot of patients that i feel have lymes disease but just can't take antibotic due to the side effect. You have to decide if you are going to take the treatment if you find the cause. This is a different type of approach . I ask my patient many times let say that i send you to Dr. such and such and he finds such and such would you be willing to do such and such .

Re: I have one for you--Weak feet??!!!!!!

Dr. Biehler on 11/17/00 at 09:16 (032913)

If the weakness is progresing you need a nerological exam to pin point the area of involvment. There is a cauda equinus syndrom where the nerves in the back bone get caught on a bone spur in the lower spine and can cause weakness in the feet. Either way you need to find out where the problem is originatig. Dr. B.

Re: I have one for you--Weak feet??!!!!!! Thanks Docs!

dfeet on 11/18/00 at 10:49 (033012)

Hi, Docs. I completely agree that I must determine a cause!! But I seem to have run the full gamut of testing-lyme disease, thyroid function, Rheumatoid, Ankylosis, fibromalasia, vitamin deficiency, etc, etc,. All negative.(I've had a couple of the tests done more than once over the last year or so-again all negative). I'm truly at my wits end. I did initially have a neurological evaluation which included EMG , point/stimualtion/reaction testing, MRI for both my feet and back. The back was insignificant-no findings and WNL. The feet showed a PF rupture on the right and bilateral tenosynovitis, with areas of marked inflamation in both. But no masses, lesions, anatomical/biomechanical anomolies found in either my back or feet.
The sensory /motor thing has me baffled. But I now experience a different type of pain than at the onset of my injury about 1 year ago. It is almost like an 'itchy' type of pain in my feet. Tinglings with the occaisional zinger. Pretty constant, but more acute at night while in bed. But again, the pain is so much less than the first 5 months after the initial onset of the injury. I'm ambling about and manage to do some sports. It depends on how I feel-some days more tolerable than others. But never 'normal' or completely pain free (including my back).

I just find it coincidental that my back was completely fine, absolutely no problems or pain,prior to and including the first 2-3 months after the initial onset of my feet. Then after about 3 months my back began to bother me. Hmmm. I'm at a loss.

Doc Z, you have me a little concerned with your implied urgency about the weakness in my feet. It makes me think that this is a progressive or has the potential to be a progessive or degenerative type of problem. I realize that neither you nor Doc B have a specialty in neurology, but just being able to have a dialogue about courses of action is tremendously helpful to me at this point.Thank you so much for both your inputs.-dfeet