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post tts & pf surgery lateral pain

Posted by Dave S. on 11/18/00 at 00:15 (032989)

I had EPF and Tarsal Tunnel Release surgery performed on both of my feet about six months ago (surgeries were one month apart). Now I feel pain returning, including pain in my little toe and the outside of my foot. I can't explain my disappointment because I was an avid hiker and backpacker and have had to cease these activities. Does anyone know how I can stretch or heal this new outside foot pain? The pain is too vague to massage and occurs later in the day. It sometimes prevents me from sleeping. I now sleep with my feet on top of about 2 feet of pillows. I tried using those exercise bands, but they don't seem to stretch the area that hurts. Is there any product that will keep my FootFlexed during the night?

Re: post tts & pf surgery lateral pain

wendyn on 11/18/00 at 09:39 (033001)

David - I'm really sorry to hear that you're not recovering as quickly as you'd hoped. I don't know if you've posted here before - can you post a bit of your history before your surgery?

The area you are describing (baby toe outside of the foot) is affected by the lateral plantar nerve. This is one of the three nervest that branches from the Post Tib Nerve (the one that runs through the Tarsal Tunnel). I would be reluctant to stretch much if you're recoving from a Tarsal Tunnel Release - what has your doctor said about your new pain?

Re: post tts & pf surgery lateral pain

Kay S on 11/18/00 at 23:23 (033043)

I too am sorry to hear of your continuing pain post op. I know it is discouraging. Have you been back to the surgeon? And how was your motion after the surgeries? Is it worse now? If it makes you feel any better, I have to sleep with my legs on a pillow also, and my surgery was in September. Actually, I slept with them up like that before the surgery also. Do you think you got better and now you're worse again? Where you describe pain, I have numbness or tingling, but not pain. (in my other foot which I did not have the surgery on, but have tts.) I sure hope this is short-lived for you and just a little bump in your road to recovery.

Re: post tts & pf surgery lateral pain

Dr. Zuckeman on 11/19/00 at 15:53 (033078)

Hi,

After plantar fascia release surgery there is going to be strain on the lateral aspect of the foot especially the calcaneal-cuboid joint and the peroneal brevis tendons and some time the midfoot and lateral ankle area.

The release of the medial band of the pf has to still heal. I will first speak with your surgeon. Rest the foot , don't stretch, wear an ankle support to keep the foot in neutral position . The purpose is so that the
lateral aspect of the foot isn't strained anymore then it is . Having both feet done even within a one month period could take the foot longer to adjust and healing. Healing in TTS surgery and pf releases in a both could take six months to one year.

Are you sure you had EPF . Its no problem just never heard of doing EPF and TTS release surgery together. I would think that you would open open the rest of the foot since you had the tarsal tunnel open already . I am not saying this isn't a wrong or bad approach just never heard of this approach.

So rest, no bare feet , no stretch.
May need orthosis if there is any biomechanical or abnormal motion problems with your gai.

Re: post tts & pf surgery lateral pain

Dave S. on 11/29/00 at 11:58 (033801)

Here is a breif summary about my situation. I am 29 years old and a year and a half ago my feet started to hurt badly, not only first thing in the morning but also later in the evening after work. I tried stretching, new shoes, and a ton of ibuprofen but nothing was working. I saw my doctor and he thought I might have PF. We tried shoe inserts, stretching exercises, 2 months of bi-weekly cortisone injections. Nothing worked except the cortisone (which would wear off in 6-7 days). My doctor concluded from my symptoms,a positive Tinel sign and a lack of treatability, that I probably had both PF and TTS in both feet. The pain was getting unbearable so I agreed with him that surgery would be necessary. I had never had any foot pain ever in my life prior to this. I was in good shape and hiking or bike riding vigorously almost every weekend. The only change in my life that I can point to is the fact that I purchased new hiking boots during the winter before the problem started. I may not have been in backpacking shape for my first trip out with the new boots either. I am no longer in good shape. Since this problem arose I have been able to do nothing but sit down, outside of work (I supervise a chemistry lab). The surgeries were one month apart. After each surgery, I was back on my feet (In a surgical boot) in five days. The foot that is really hurting now is the first one that was operated on. I wonder if having the second surgery so soon was a mistake. I have an appointment with my surgeon tomorrow to see what he recommends. I hope for good news.

Re: post tts & pf surgery lateral pain

Dave S. on 11/29/00 at 13:33 (033808)

I just wanted to add my thanks to Dr. Z. for his advice. I did have both surgeries on both feet. I have scars about 4' long on the insides of both ankles and also small round scars on either side of each foot from the EPF. After the operations, I was given photographs of the endoscope. They look just like the ones on the web site. I am thinking about having them framed as a memorial to my feet.

Re: post tts & pf surgery lateral pain

Dan on 12/10/00 at 18:20 (034611)

hi
i am a 33 yo with painful feet for about 6 years or longer but only until recently was it picked up as possible TTS. Had an EMG/NCV of the right and left foot since both hurt. The left showed mild TTS and left showed as normal. my Heel and feet have a burning pain feeling when i stand too long and when i goto rest i still feel some pain and different sensations in foot and makes me to the point i cant sit still and have to walk or goto bed. We have tried orthotics....and have used other anti-inflammatory's in the past. I guess my question is first of all does TTS cause heel pain that you cant stand for a long time. Does it also cause those sensations and pain when you sit. seems like the only time i feel releif is by 6:00am in the morning after i have been off feet for 6 hours in bed but when i get up as the day progresses the feet start to burn in pain and i cant stand on them. Does a EMG/NCV when it shows mild TTS indicate for sure compression the nerve which is TTS? or is it not accurate. I was told by my podiatrist that if the EMG/NCV is negative doesnt mean it is Negative since you are at rest when they take the test and he said if it is positive it is very definitive. Also when he taps for TINELS sign i dont get it all the time although i have tapped it myself at the end of a day and the pain shoots into big toe. When the doctor pushes in over the nerve bundle under ankle it hurts and tender. DOes any of this sound like TTS? i am considering surgery this week since i cant take much of this anymore..its too painful. just got over a bad shoulder surgery and want have no pain anymore. My podiatrist has told me the reason why most of these Decompression's surgeries fail is beacuse there wasn't an adequate release...for the 'High' and 'LOw' Tarsal tunnel areas. He said he will release both areas and the arch. I think he has alot of knowledge and has been recongnized by many doctors in the area as a good podiatrist. But I really dont see much about the success of these surgeries and wonder what the odds are in getting better. Anybody out there that can shed some light on the subject..i appreciate it
Dan

Re: post tts & pf surgery lateral pain

wendyn on 12/11/00 at 23:19 (034724)

Dan - the symptoms and pain you described are very similar to my own. No one can say for sure if a TTS release is your answer - the stats are very iffy - they seem to be 50/50 at best. I really think you're best bet at this point, is to take all your test results and seek a second opinion from an orthapedic foot and ankle surgeon.

A second opinion is always wise - when considering surgery for anything from a hemmerhoid to a triple by-pass. You've dealt with this for A LONG time - what's a little longer to be sure that you've covered all your bases? If the surgeon agrees - then you will feel twice as confident going in. If he/she disagrees - then you will have some other things to consider before you make your decision.

p.s. first thing in the morning is usually my best time for my feet too. They're a little stiff at first - but they never have any burning or throbbing like the end of the day. Elevating you're feet at the end of the day can help some. Have they ruled out any lower back/spinal/systemic problems for you?

My surgeon will not do a TTS release unless there is an identified mass or cause of compression within the tarsal tunnel. This can be confirmed/ruled out with an MRI.

Re: post tts & pf surgery lateral pain

wendyn on 11/18/00 at 09:39 (033001)

David - I'm really sorry to hear that you're not recovering as quickly as you'd hoped. I don't know if you've posted here before - can you post a bit of your history before your surgery?

The area you are describing (baby toe outside of the foot) is affected by the lateral plantar nerve. This is one of the three nervest that branches from the Post Tib Nerve (the one that runs through the Tarsal Tunnel). I would be reluctant to stretch much if you're recoving from a Tarsal Tunnel Release - what has your doctor said about your new pain?

Re: post tts & pf surgery lateral pain

Kay S on 11/18/00 at 23:23 (033043)

I too am sorry to hear of your continuing pain post op. I know it is discouraging. Have you been back to the surgeon? And how was your motion after the surgeries? Is it worse now? If it makes you feel any better, I have to sleep with my legs on a pillow also, and my surgery was in September. Actually, I slept with them up like that before the surgery also. Do you think you got better and now you're worse again? Where you describe pain, I have numbness or tingling, but not pain. (in my other foot which I did not have the surgery on, but have tts.) I sure hope this is short-lived for you and just a little bump in your road to recovery.

Re: post tts & pf surgery lateral pain

Dr. Zuckeman on 11/19/00 at 15:53 (033078)

Hi,

After plantar fascia release surgery there is going to be strain on the lateral aspect of the foot especially the calcaneal-cuboid joint and the peroneal brevis tendons and some time the midfoot and lateral ankle area.

The release of the medial band of the pf has to still heal. I will first speak with your surgeon. Rest the foot , don't stretch, wear an ankle support to keep the foot in neutral position . The purpose is so that the
lateral aspect of the foot isn't strained anymore then it is . Having both feet done even within a one month period could take the foot longer to adjust and healing. Healing in TTS surgery and pf releases in a both could take six months to one year.

Are you sure you had EPF . Its no problem just never heard of doing EPF and TTS release surgery together. I would think that you would open open the rest of the foot since you had the tarsal tunnel open already . I am not saying this isn't a wrong or bad approach just never heard of this approach.

So rest, no bare feet , no stretch.
May need orthosis if there is any biomechanical or abnormal motion problems with your gai.

Re: post tts & pf surgery lateral pain

Dave S. on 11/29/00 at 11:58 (033801)

Here is a breif summary about my situation. I am 29 years old and a year and a half ago my feet started to hurt badly, not only first thing in the morning but also later in the evening after work. I tried stretching, new shoes, and a ton of ibuprofen but nothing was working. I saw my doctor and he thought I might have PF. We tried shoe inserts, stretching exercises, 2 months of bi-weekly cortisone injections. Nothing worked except the cortisone (which would wear off in 6-7 days). My doctor concluded from my symptoms,a positive Tinel sign and a lack of treatability, that I probably had both PF and TTS in both feet. The pain was getting unbearable so I agreed with him that surgery would be necessary. I had never had any foot pain ever in my life prior to this. I was in good shape and hiking or bike riding vigorously almost every weekend. The only change in my life that I can point to is the fact that I purchased new hiking boots during the winter before the problem started. I may not have been in backpacking shape for my first trip out with the new boots either. I am no longer in good shape. Since this problem arose I have been able to do nothing but sit down, outside of work (I supervise a chemistry lab). The surgeries were one month apart. After each surgery, I was back on my feet (In a surgical boot) in five days. The foot that is really hurting now is the first one that was operated on. I wonder if having the second surgery so soon was a mistake. I have an appointment with my surgeon tomorrow to see what he recommends. I hope for good news.

Re: post tts & pf surgery lateral pain

Dave S. on 11/29/00 at 13:33 (033808)

I just wanted to add my thanks to Dr. Z. for his advice. I did have both surgeries on both feet. I have scars about 4' long on the insides of both ankles and also small round scars on either side of each foot from the EPF. After the operations, I was given photographs of the endoscope. They look just like the ones on the web site. I am thinking about having them framed as a memorial to my feet.

Re: post tts & pf surgery lateral pain

Dan on 12/10/00 at 18:20 (034611)

hi
i am a 33 yo with painful feet for about 6 years or longer but only until recently was it picked up as possible TTS. Had an EMG/NCV of the right and left foot since both hurt. The left showed mild TTS and left showed as normal. my Heel and feet have a burning pain feeling when i stand too long and when i goto rest i still feel some pain and different sensations in foot and makes me to the point i cant sit still and have to walk or goto bed. We have tried orthotics....and have used other anti-inflammatory's in the past. I guess my question is first of all does TTS cause heel pain that you cant stand for a long time. Does it also cause those sensations and pain when you sit. seems like the only time i feel releif is by 6:00am in the morning after i have been off feet for 6 hours in bed but when i get up as the day progresses the feet start to burn in pain and i cant stand on them. Does a EMG/NCV when it shows mild TTS indicate for sure compression the nerve which is TTS? or is it not accurate. I was told by my podiatrist that if the EMG/NCV is negative doesnt mean it is Negative since you are at rest when they take the test and he said if it is positive it is very definitive. Also when he taps for TINELS sign i dont get it all the time although i have tapped it myself at the end of a day and the pain shoots into big toe. When the doctor pushes in over the nerve bundle under ankle it hurts and tender. DOes any of this sound like TTS? i am considering surgery this week since i cant take much of this anymore..its too painful. just got over a bad shoulder surgery and want have no pain anymore. My podiatrist has told me the reason why most of these Decompression's surgeries fail is beacuse there wasn't an adequate release...for the 'High' and 'LOw' Tarsal tunnel areas. He said he will release both areas and the arch. I think he has alot of knowledge and has been recongnized by many doctors in the area as a good podiatrist. But I really dont see much about the success of these surgeries and wonder what the odds are in getting better. Anybody out there that can shed some light on the subject..i appreciate it
Dan

Re: post tts & pf surgery lateral pain

wendyn on 12/11/00 at 23:19 (034724)

Dan - the symptoms and pain you described are very similar to my own. No one can say for sure if a TTS release is your answer - the stats are very iffy - they seem to be 50/50 at best. I really think you're best bet at this point, is to take all your test results and seek a second opinion from an orthapedic foot and ankle surgeon.

A second opinion is always wise - when considering surgery for anything from a hemmerhoid to a triple by-pass. You've dealt with this for A LONG time - what's a little longer to be sure that you've covered all your bases? If the surgeon agrees - then you will feel twice as confident going in. If he/she disagrees - then you will have some other things to consider before you make your decision.

p.s. first thing in the morning is usually my best time for my feet too. They're a little stiff at first - but they never have any burning or throbbing like the end of the day. Elevating you're feet at the end of the day can help some. Have they ruled out any lower back/spinal/systemic problems for you?

My surgeon will not do a TTS release unless there is an identified mass or cause of compression within the tarsal tunnel. This can be confirmed/ruled out with an MRI.