Home The Book Dr Articles Products Message Boards Journal Articles Search Our Surveys Surgery ESWT Dr Messages Find Good Drs video

To Vicki M

Posted by Laurie R on 1/18/01 at 20:38 (036820)

Hi Vicki,
I was reading on the other board that you had surgery. Frist of all I would like to say that I am very sorry that you are still in pain.You said you had surgery on one of your tendons ,if I read your post right. Anyway I was wondering if you can tell me what was wrong with your tendon and what type of surgery you had for it?? Thank you so much.The reason I am asking you is ,I have to have a Tenogram done next week. Did you have one done before your surgery?? This is a test they do with dye and x-ray to see if their is scar tissue or damage to the tendon. I had a MRI and it showed fluid in my flexor tendon. My Pod thinks this is what is causing all my pain. I have been in major pain for a while now. I also have PF as well as fluid in three different places in my foot and ankle. I had a hard cast taken off one week ago and the next day I was to have the Tenogram .I made it to the hospital and even in the x-ray room ,but i could not go through with the test due to having to much pain . Their was no way they were going to insert a needle and keep it in my foot for an hour.

I was just wondering if we had the same thing wrong with our tendon and if it is the same tendon. Thank you I appreciate and help you can give me. My best to you and I hope your pain level is down.

Laurie R

Re: To Vickie M

Laurie R on 1/18/01 at 23:05 (036827)

Sorry for the misspell in your name.....

Re: To Vicki M

Dr. Kosova on 1/19/01 at 04:00 (036837)

Hi Laurie,
What other areas have fluid in your foot and ankle? Why is your dr. doing a tenogram after the mri? How long did you wear the cast and what are your symptoms? Try to find out what flexor tendon was injured. Do you have any swelling in your foot or ankle?

Dr. Kosova

Re: RE Dr Kosova

Laurie R on 1/19/01 at 18:04 (036885)

Hello Dr.Kosova,
Thanks for taking a interest in my foot. I will try to answer your questions the best I know how. I have fluid on my fascia and I also have fluid on the side top of my ankle which is very painful . The third place I have fluid is in or around the Flexor hallicus longus tendon sheath .I got this off the MRI report.

You asked me why my Pod is having me have a tenogram after having a MRI.What happened after the MRI ,my Pod wanted me to see a pod which is a foot (sports) specialist to give his opinion on my foot. He called him and they went over my case. This new doctor suggested that I go and have a tenogram. I think they feel that I have either scar tissue or damage to this tendon.

I will be very honest with you .I am very confused as to what is going on with my foot. I do know that I am always in alot of pain no matter what i do .

You asked how long I was in the hard cast. This time around it was 4 weeks. The cast heloed so much with my ankle ,but the rest of my foot no change at all.

My symptoms are: my fascia and my arch ALWAYS hurt . My foot goes numb from time to time . My pain goes from my big toe to my ankle .and if I tap or if my Pod tap on my inner ankle the pain shoots to my big toe. What do you call this ?? A positive tinel test?? At first my Pod thought I had TTS ,I have all the symptoms ,but the MRI shhowed that my tarsel tunnel was normal. I also get stabbing pains through my arch and the bottom of my foot. MY foot hurts wheather I am off it or on it ,sometimes my foot hurts more to be off it resting not doing anything.MY foot even before I get out of bed.

I am wearing a air cast now . I have had PF now for 19 months . I have had a EMG test ,x-rays and MRI. I also have had PT 50+ visits ,three walking casts and the one air cast .I think I have been in about 6 hard casts .I had 3 cortisone shots that did not help me and I had about 4 shots just to numb my foot ,now they worked ,but as soon as it wore off the pain was back. My Pod even tried a toradol shot ,it did not help with the pain at all ,it just made me sick to my stomach .

I feel I have a wonderful doctor ,he believes in conservitive treatment frist before surgery . He wants to be 100% sure what is causing my pain. I really appreciate his way of treating my foot .

He will not tell me what he thinks is wrong with my foot until after the tenogram ,which I will be having next Friday . Also he siad after he gets the results from the tenogram he is going to consult with the other doctor.

I have a question for you. I don't want to jump the gun here but I do think what about if. If I do have damage to this tendon ,what kind of surgery would I be looking at ? I mean where do they cut your foot and how big is the cut ?? How long would I have to be off my foot?

I forgot to tell you that I also use a night splint ,and have tried all kids of anti imflamms. I can't take them anymore because they make me very sick. I also wear 'Salonpas' pads ,they help a little.

I don't know where you live but I am sure you have heard of 'Stanford ' Hospital ,thats where I will be having the Tenogram done.

Thank you again for your interest in my foot. If you have anything that you think would help me PLEASE feel free to tell me. I will try anything once.I will tell you it really sucks being in pain.I just would like my life back to some degree.

Laurie R

Re: RE Dr Kosova

DR. Kosova on 1/19/01 at 21:05 (036894)

Dear Laurie,
Your are pretty much my typical patient. If you have your MRI report with you and want to Type it word for word and I'll read it . Or fax it to my office 630 852-8612. My office # is 630-852-8650 feel free to call I will be there Saturday from 9-100pm. It would be helpful to know your history in order of tx plan and where the injections were given. I live in Chicago but Practice in Westmont. I am currently tx a patient with a FHL tear and his goal in Oct. was to down hill ski in late Febuary. He is now in Physical Therapy Painfree but getting him strong for this activity. It took him so long because he refused to be casted ofr about one month.

I respect your podiatrist for getting a second opinion but per your history I dont think they are looking at the obvious. If it smells like a duck and quacks like a duck and looks like a duck. You get the idea. 85% of any exam is the history. I wish I could palpate yourleg to locate the pain. If you have fluid in the FHL this is probaly from a partial tear of the tendon. Tendons with small amount of fluid could be inflammation but go with this. It is causing swelling of the tarsal canal and adding presure on the nerve hence Tarsal Tunnel Pain. Your doctor is reading the MRI for the magical Diagnosis.MRI REPORTS DO NOT ALWAYS SHOW WHAT THE PATHOLOGY IS. Patients are ALWAYS right. This is what I teach doctors in training. If the mri in negative does that mean that you dont have any pain? If you have a longitudinal tear in the tendon the tendon can flap over itself when the mri was performed and the radiologist would not see it. This occurs alot. I have done exploratory surgery on patients with normal mrIs (after two indepentdent readings) to find 3-7cm tears that the mri missed. The posterior tibial tendon should be examined more closely also. I find a Tenogram useless but I do have different views on many topics so you are warned. Take your leg and extend it straight have someone take your big toe and move it upand down. Does this hurt? Now as you bend the big toe down try to lift the big toe up against resistance with your hand. Does this hurt? What was the emg report result? Why did you go to physical therapy for so long with no benefit? The pf pain is the easy one to tx but you must tx the fhl first to be sucessful. How did you hurt your self? Tx suggestions after getting the mri results.

Have you applied ice packs to this area? Put some on tonight 20 minutes every two hours to the area put a thin towel on your skin first. NO HEAT!!!

I have to go put my daughter to sleep now.

DR. Kosova

Re: RE Dr Kosova

Dr Kosova on 1/19/01 at 23:10 (036909)

Laurie I am not saying not to have the tenogram but what are you going to do if it is positve or negitive?
Dr. Kosova

Re: RE Dr Kosova

Laurie R on 1/20/01 at 00:45 (036914)

Hi Dr.Kosova,
Ok ,that is my question to you,what do I do if it is positive and then again what do I if it is negitive??? What are my options ? I would think that if I do have a tear that sugery would fix it right??? If it comes out negitive ,I have no clue what is next. All I know their is something wrong with my foot and ankle besides PF. I have said this all along. My Pod also has PF and I feel he understands my pain ,he is very compassionate and I feel he is tyring everything he knows at this point.

I did fax my MRI report to Dr.Z and he said that nothing really jumped put at him. If yiou don't mind I will fax the report to you .I also have the EMG report too.

Thank you for your time Dr.Kosova.

I have one more question for you,now remenber I really don't know about this tenogram . What does a positive mean ?? And I guess a negitive would mean no damage or scar tissue in the tendon right??

Laurie R

Re: RE Dr Kosova

Dr. Kosova on 1/20/01 at 07:36 (036924)

Laurie I am going to work now and look forward to seeing the reports. Again What was the order of your tx.plan? This would help.I also have pf since 1982 but I am well controlled with orthotics and strectching of the pf and achilles tendon when needed. My wife Dr. Reid has to inject my heel about once a year or so when it gets severe and you should hear what comes out of my mouth!!! If you could call the office 6308528650 I could probaly get a better hx. Again when a report is negitive and a pt. still has pain, trust the patient. About having sx or not is a tricky question to answer since I dont now your whole hx callthe office I am there only from9-1pm on SAT

Dr. KOSOVA

Re: RE Dr Kosova

lenore r on 1/20/01 at 14:49 (036943)

hi laurie, i have been following your posts and this last one really hit home with me i could have sworn you were talking about my foot!!! i had the surgery in sept 99 and now i have all these other symptoms. the pt has taken away some of the stabbing pains and numbness out of my foot but i like you were in pain standing sitting or sleeping. many times i had to get up and take a pain pill to get back to sleep in the middle of the night . good luck with your test and ill be watching for your results

Re: RE Lenore

Laurie R on 1/20/01 at 20:50 (036970)

Hello Lenore,
What kind of surgery did you have?? And what is wrong with your foot ? I mean do you have PF ,TTS or both or do you have tenden damage?? Do you think the surgery helped your foot? Sorry for all the questions ,I just like to know the whole story on people so I can learn as much as I can. Thank you for your post. My very best to you.Laurie R

Re: To Vickie M

Laurie R on 1/18/01 at 23:05 (036827)

Sorry for the misspell in your name.....

Re: To Vicki M

Dr. Kosova on 1/19/01 at 04:00 (036837)

Hi Laurie,
What other areas have fluid in your foot and ankle? Why is your dr. doing a tenogram after the mri? How long did you wear the cast and what are your symptoms? Try to find out what flexor tendon was injured. Do you have any swelling in your foot or ankle?

Dr. Kosova

Re: RE Dr Kosova

Laurie R on 1/19/01 at 18:04 (036885)

Hello Dr.Kosova,
Thanks for taking a interest in my foot. I will try to answer your questions the best I know how. I have fluid on my fascia and I also have fluid on the side top of my ankle which is very painful . The third place I have fluid is in or around the Flexor hallicus longus tendon sheath .I got this off the MRI report.

You asked me why my Pod is having me have a tenogram after having a MRI.What happened after the MRI ,my Pod wanted me to see a pod which is a foot (sports) specialist to give his opinion on my foot. He called him and they went over my case. This new doctor suggested that I go and have a tenogram. I think they feel that I have either scar tissue or damage to this tendon.

I will be very honest with you .I am very confused as to what is going on with my foot. I do know that I am always in alot of pain no matter what i do .

You asked how long I was in the hard cast. This time around it was 4 weeks. The cast heloed so much with my ankle ,but the rest of my foot no change at all.

My symptoms are: my fascia and my arch ALWAYS hurt . My foot goes numb from time to time . My pain goes from my big toe to my ankle .and if I tap or if my Pod tap on my inner ankle the pain shoots to my big toe. What do you call this ?? A positive tinel test?? At first my Pod thought I had TTS ,I have all the symptoms ,but the MRI shhowed that my tarsel tunnel was normal. I also get stabbing pains through my arch and the bottom of my foot. MY foot hurts wheather I am off it or on it ,sometimes my foot hurts more to be off it resting not doing anything.MY foot even before I get out of bed.

I am wearing a air cast now . I have had PF now for 19 months . I have had a EMG test ,x-rays and MRI. I also have had PT 50+ visits ,three walking casts and the one air cast .I think I have been in about 6 hard casts .I had 3 cortisone shots that did not help me and I had about 4 shots just to numb my foot ,now they worked ,but as soon as it wore off the pain was back. My Pod even tried a toradol shot ,it did not help with the pain at all ,it just made me sick to my stomach .

I feel I have a wonderful doctor ,he believes in conservitive treatment frist before surgery . He wants to be 100% sure what is causing my pain. I really appreciate his way of treating my foot .

He will not tell me what he thinks is wrong with my foot until after the tenogram ,which I will be having next Friday . Also he siad after he gets the results from the tenogram he is going to consult with the other doctor.

I have a question for you. I don't want to jump the gun here but I do think what about if. If I do have damage to this tendon ,what kind of surgery would I be looking at ? I mean where do they cut your foot and how big is the cut ?? How long would I have to be off my foot?

I forgot to tell you that I also use a night splint ,and have tried all kids of anti imflamms. I can't take them anymore because they make me very sick. I also wear 'Salonpas' pads ,they help a little.

I don't know where you live but I am sure you have heard of 'Stanford ' Hospital ,thats where I will be having the Tenogram done.

Thank you again for your interest in my foot. If you have anything that you think would help me PLEASE feel free to tell me. I will try anything once.I will tell you it really sucks being in pain.I just would like my life back to some degree.

Laurie R

Re: RE Dr Kosova

DR. Kosova on 1/19/01 at 21:05 (036894)

Dear Laurie,
Your are pretty much my typical patient. If you have your MRI report with you and want to Type it word for word and I'll read it . Or fax it to my office 630 852-8612. My office # is 630-852-8650 feel free to call I will be there Saturday from 9-100pm. It would be helpful to know your history in order of tx plan and where the injections were given. I live in Chicago but Practice in Westmont. I am currently tx a patient with a FHL tear and his goal in Oct. was to down hill ski in late Febuary. He is now in Physical Therapy Painfree but getting him strong for this activity. It took him so long because he refused to be casted ofr about one month.

I respect your podiatrist for getting a second opinion but per your history I dont think they are looking at the obvious. If it smells like a duck and quacks like a duck and looks like a duck. You get the idea. 85% of any exam is the history. I wish I could palpate yourleg to locate the pain. If you have fluid in the FHL this is probaly from a partial tear of the tendon. Tendons with small amount of fluid could be inflammation but go with this. It is causing swelling of the tarsal canal and adding presure on the nerve hence Tarsal Tunnel Pain. Your doctor is reading the MRI for the magical Diagnosis.MRI REPORTS DO NOT ALWAYS SHOW WHAT THE PATHOLOGY IS. Patients are ALWAYS right. This is what I teach doctors in training. If the mri in negative does that mean that you dont have any pain? If you have a longitudinal tear in the tendon the tendon can flap over itself when the mri was performed and the radiologist would not see it. This occurs alot. I have done exploratory surgery on patients with normal mrIs (after two indepentdent readings) to find 3-7cm tears that the mri missed. The posterior tibial tendon should be examined more closely also. I find a Tenogram useless but I do have different views on many topics so you are warned. Take your leg and extend it straight have someone take your big toe and move it upand down. Does this hurt? Now as you bend the big toe down try to lift the big toe up against resistance with your hand. Does this hurt? What was the emg report result? Why did you go to physical therapy for so long with no benefit? The pf pain is the easy one to tx but you must tx the fhl first to be sucessful. How did you hurt your self? Tx suggestions after getting the mri results.

Have you applied ice packs to this area? Put some on tonight 20 minutes every two hours to the area put a thin towel on your skin first. NO HEAT!!!

I have to go put my daughter to sleep now.

DR. Kosova

Re: RE Dr Kosova

Dr Kosova on 1/19/01 at 23:10 (036909)

Laurie I am not saying not to have the tenogram but what are you going to do if it is positve or negitive?
Dr. Kosova

Re: RE Dr Kosova

Laurie R on 1/20/01 at 00:45 (036914)

Hi Dr.Kosova,
Ok ,that is my question to you,what do I do if it is positive and then again what do I if it is negitive??? What are my options ? I would think that if I do have a tear that sugery would fix it right??? If it comes out negitive ,I have no clue what is next. All I know their is something wrong with my foot and ankle besides PF. I have said this all along. My Pod also has PF and I feel he understands my pain ,he is very compassionate and I feel he is tyring everything he knows at this point.

I did fax my MRI report to Dr.Z and he said that nothing really jumped put at him. If yiou don't mind I will fax the report to you .I also have the EMG report too.

Thank you for your time Dr.Kosova.

I have one more question for you,now remenber I really don't know about this tenogram . What does a positive mean ?? And I guess a negitive would mean no damage or scar tissue in the tendon right??

Laurie R

Re: RE Dr Kosova

Dr. Kosova on 1/20/01 at 07:36 (036924)

Laurie I am going to work now and look forward to seeing the reports. Again What was the order of your tx.plan? This would help.I also have pf since 1982 but I am well controlled with orthotics and strectching of the pf and achilles tendon when needed. My wife Dr. Reid has to inject my heel about once a year or so when it gets severe and you should hear what comes out of my mouth!!! If you could call the office 6308528650 I could probaly get a better hx. Again when a report is negitive and a pt. still has pain, trust the patient. About having sx or not is a tricky question to answer since I dont now your whole hx callthe office I am there only from9-1pm on SAT

Dr. KOSOVA

Re: RE Dr Kosova

lenore r on 1/20/01 at 14:49 (036943)

hi laurie, i have been following your posts and this last one really hit home with me i could have sworn you were talking about my foot!!! i had the surgery in sept 99 and now i have all these other symptoms. the pt has taken away some of the stabbing pains and numbness out of my foot but i like you were in pain standing sitting or sleeping. many times i had to get up and take a pain pill to get back to sleep in the middle of the night . good luck with your test and ill be watching for your results

Re: RE Lenore

Laurie R on 1/20/01 at 20:50 (036970)

Hello Lenore,
What kind of surgery did you have?? And what is wrong with your foot ? I mean do you have PF ,TTS or both or do you have tenden damage?? Do you think the surgery helped your foot? Sorry for all the questions ,I just like to know the whole story on people so I can learn as much as I can. Thank you for your post. My very best to you.Laurie R