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Have you received the tenogram results.???/- i can't stand the suspense anymore

Posted by Dr. Zuckerman on 1/30/01 at 11:52 (037748)

Ok,

If you don't get the results and some information I can't stand the suspense anymore. Is the Flexor Hallux Longus and the rest of the tendons in the tarsal tunnel normal or abnormal. What kind of surgery are we talking about.

My guess is that the Tarsal Tunnel will have to be opened and explored if the tendon is damaged it will be repaired, if the posterior tibial nerve is entraped it will have to be released.

Tell your doc I can't stand the wait . I can't imagine how you feel waiting. Oh I just realized I am waiting Eastern Standard Time and you are waiting Pacific Time. so I guess I have to just wait. Sorry!!!

Re: Have you received the tenogram results.???/- i can't stand the suspense anymore

Lauire R on 1/30/01 at 12:24 (037751)

You and me both......... I am still waiting for him to call. His nurse said that he does not get in until 12:00 pm today. It is only 10:15 am here right now. I promise I will post as soon as he calls me. First thing when I got up today this was on my mind.........Also as soon as I get a copy of the report I will fax it to you. Thanks Dr.Z for your concern *~* . Laurie R

Re: Have you received the tenogram results.???/- i can't stand the suspense anymore

Donna SL on 1/30/01 at 13:28 (037754)

Hi Lorie,

I can't stand the suspense either. Will you let us all know about the report too when you get it?

I still have pain in my arch, and my MRI just showed fluid mostly in the midfoot, ankles, and big toe joints. The pain has improved somewht, and doesn't appear anything nearly as bad as yours, but is still reccuring at times, but it is not constant. I got a big stabbing pain out of the blue yesterday. The pain throughout the rest of my foot, (heels forefoot,etc.), is not as severe as it once was, because of PT.

My doctor hasn't made any more suggestions, or tried to figure out what it may be. It's been almost a year since this first occurred. I'm waiting for an additional report of the MRI done with contrast, but I don't think it is going to show much more.

Was the tenogram very painful? What is involved?

I live in Northern Californina. What doctors have you seen?

Donna

Re: Have you received the tenogram results.???/- i can't stand the suspense anymore

Laurie R on 1/30/01 at 14:25 (037758)

Hi Donna,
I also live in Northern CA,right by Oakland....Where do you live ?? Or I should say where do you live by? I know you probably don't wan tto give your city out on the internet. The tenogram was done at Stanford medical center. That is the only place they do it around here. My Pod is consulting with a doctor there and it was him who said I should have the test. My MRI only showed the fluid too. But again they only studied my ankle a little bit ,it was mostly for my PF .

Put it this way ,the MRI of course had no pain ,only the pain from keeping my foot in one place for a long time. The tenogram was very painful ,but if I had to do either again I would pick the tenogram. The reason being it was a lot faster.

What the tenogram is ,they use x-ray and you lay on your side . The radiologist numbed my ankle TT area a little bit and then inserted another needle to flow steriod dye in my flexor tendon. The reason it was so painful is the fluid had no where to go. I have scasr tissue all around that tendon. And they are taking x-rays while they are doing this. It took longer for the doctor to get everything ready then the test .The test took about 15 minutes tops. Again I will say the radiologist was wonderful.

Stanford is suppose to be the best ,so far they have been wonderful to me. MY Pod is not there though .He did do his intership there .

What city is your doctor in?? If you would like to e-mail me please feel free to do so .angels4111@prodigy.net

MY very best to you Donna.....Laurie

Re: Have you received the tenogram results.???/- i can't stand the suspense anymore

Laurie R on 1/30/01 at 16:19 (037765)

Hi Dr.Z and Dr.Kosova I think I need your help understanding this.

I just got off the phone with my wonderful Pod. He read part of the report to me. I have 'Tenosynovitis' ,he needs the films to look at .My husband is on his way right now to bring them.

I will be having surgery to correct this. He wants to consult with the other foot specialist (this is the one that had me have the tenogram) . My Pod was very happy to find out that this is the main cause of my pain. I am just so happy it can be fixed. Doctors I am having my husband get a copy of the tenogram and I will fax it to both of you.

I asked my Pod if he will be doing the surgery and he said he and the other doctor would do it together . The other doctor has done many of this type of surgery.

Now Dr.Z can you do a fascia release with this type of tendon surgery at the same time?? I forgot to ask him. He will be going to see this other doctor this week to have a plan for me.

Dr Z I need your fax nuber again .my husband just came in with the report an I would like to fax it to you.

Thank you ,Laurie R

Re: Laurie: Dr. Z's fax is (856)848-5122 eom

Steve P on 1/30/01 at 16:52 (037767)

.

Re: Laurie: Dr. Z's fax is (856)848-5122 eom

Dr. Zuckerman on 1/30/01 at 17:07 (037769)

Yes

Fax this over to your cuz. I won't be in the office tommorrow but will ask my staff to be on the look out for this fax when you get a chance
fax it over. Let Dr. K take a look he has the experience in doing this surgery. I have two surgeons that I have working for me that are fellowship trained in this procedure who I will have take a look. So you are the whole heelspur gang involved.

Re: Have you received the tenogram results.???/- i can't stand the suspense anymore

Dr. Zuckerman on 1/30/01 at 17:21 (037772)

You can open up the upper and lower part of the Tarsal Tunnel. This is where I believe the Tendon is imflamed. The word Tenosynovitis is where the tendon and part of the joint capsule is imflamed. So you have a tendon that is injury and maybe torned. I would think that the mri would show this.
but it didn't

If it is determined that there is damage to one of the tendons in the tarsal tunnel. I am assuming that is where the tenosynovitis is located. It could also be behind the talus bone. I am not sure which part of the tendon's route the test was performed. The fact that you had TTS type pain I am assuming that the problem is with the tendons within the Tarsal Tunnel which is on the inside of the ankle bone. It travels thru this tunnel along with the posterior tibial nerve and then goes deep into the foot and if it is the FHL will attach into the bones into the big toe
If with are talking about the FDL . This attaches into the bottom of the 2-5 toes. If we are talking about the posterior tibial tendon this inserts intot the arch area.

So it could be anyone of these tendon.

I would think that all of the tendons will be examined at the time of surgery and repaired as to the need and degree of damage.

I always felt that you would need an exploration , evaluation and repair of the structure within the Tarsal Tunnel..

So lets see what your local doctors have in mind for you.

The source of your problem is identified. !!!!

Re: Have you received the tenogram results.???/- i can't stand the suspense anymore

Laurie R on 1/30/01 at 18:24 (037782)

Dear Dr.Z ,
I would like to thank you very ,very much for taking the time out to read my report.

And you must know me by now. What is the recovery for this type of surgery?? What kind of cut are we talking about?? Is it in and out surgery or will I have to stay in the hospital??

I am just so happy to finally have an answer to my pain. No I am not looking forward to having surgery ,but if it can be fixed that is all that will matter.

One more question. How long will I have to stay off my foot after surgery?

Thank you again I so appreciate your time.Laurie R

Re: Have you received the tenogram results.???/- i can't stand the suspense anymore

Dr. Kosova on 1/30/01 at 18:26 (037783)

Laurie,

As I have said before that there is a tear in this area of the FHL and that is causing inflammation to the p.t. nerve giving you your pain. Your pod. will be assiting the other doctor and rightly so you dont need to be his training model. Alot of mris come back tenosynovitis and in reality are tears that the mri cant pick up or the tendon flaps over on itself while they are doing the mri. I cant tell you how many 'normal' mri are tears when we go in surgically to repair them. All the tendons will be examined and the tarsal tunnel will be released as a safe measure. This is pretty standard.

I am looking forward to your results.

Dr. Kosova

Re: Have you received the tenogram results.???/- i can't stand the suspense anymore

Dr. Zuckerman on 1/30/01 at 19:39 (037790)

I would think anywhere from three to six months . This is a curved incision around the ankle down to the edge of the bottom of the foot. Depends on the hospital/ outpatient department and rules of the insurance company. In my area it is done outpatient. I like overnite but it will depend on your insurance and what is usually done with your doctor. We do both ways. I like overnite for this but in and out is also ok.

You are doing to have to be off your feet . I would think that you would be off your feet somewhere between eight to ten weeks maybe twelve. Depends on what they find. It also depend on the degree of tendon tear and the type of repair.

There is going to have to be some physical therapy after the surgery and cast are off.

I am looking forward to the pre-operative , intra-operative and long term posting from you.

Ask them to let you bring a cable modeum and laptop into the operating room

Wasn't there a baby delivered on the internet. We could have your tendon repaired live on the internet.

Scott what do you think. ?

Live from heelspurs.com I mean tendon.com .

Everything is going to be fine.

Re: Thanks Laurie

Donna SL on 1/31/01 at 03:33 (037820)

Hi Laurie,

I live in the Pacific Heights area of San francisco. UCSF isn't that far. I think they merged with Stanford, so maybe your doctor also goes to the UCSF Campus, or knows someone at UCSF. Is he a specialist? I'm looking for a good general podiatrist or a foot/ankle MD also. I understand some doctors don't want their name on the internet. If you can't do that let me know and I'll email you.

Best of luck to you. I'm glad you are finally getting some answers to your pain, and hope everything will be resolved in the very near future.

Donna

Re: Thanks Laurie To Donna

Laurie R on 2/01/01 at 12:22 (037974)

Hi Donna,
Yes please e-mail me .My main doctor (Pod) is in Hayward and the specialist is at Stanford.I haven't even seen the specialist.My Pod is setting that up . I have to wait for workmans comp to approve the pre-opp appointment.

I am from San Francisco ,born and raised ... I grew up in the mission....Small world.....

If you don't mind, tell me your story. How long have you had PF ??

I know UCSF is suppose to be one of the best. I think Stanford and UCSF are the same now.

My best to you Donna. Laurie R

Re: To Laurie from Donna

Donna SL on 2/08/01 at 00:50 (038408)

Hi Laurie,

I've beeen so busy, and haven't had a chance to give you my foot background, but I thought of you today , because you live near my area.

I don't know if you are going to need orthotics, but I met with an incredible man today who has 20 years experience as an orthotist, and is also a Cped, and has an incredible knowlege of so many materials for making orthotics, that are comfortable, and supportive. He is out in San Leando (sp?), but comes into SF twice a week. His fees are very inexpensive, and he is also very nice.

Also if you have surgery, and need any type of bracing after he would be excellent, because as an certified orthotist, he has vast experience in bracing for the entire body. He seems to be very concerned about comfort of the patient. Also, as a Cped he could do any alterations to shoes if you need it like rocker bottoms, etc, besides making custom orthotics. He is the best of both worlds.

I'm going to see him on again on Saturday to get casted for orthotics, and I'll ask if I can post his name. He may not want his name on the board. If you need his services now, let me know, and I'll email ASCP.

His cost are so reasonable, it may be worth seeing him now to see if he can do anything orthotic wise, until you have surgery to make you more comfortable.

I'll know for sure after he makes my first pair of orthotics which should be in a couple of weeks, but I have a lot of confidence in him.

Hope nobody gets mad this isn't under the IOS section, but I wasn't sure you would see it there.

Hope you're doing well otherwise.

Donna

Re: To Laurie from Donna

Laurie R on 2/08/01 at 16:20 (038456)

Hi Donna,
Thank you so much for your post. I already have a wonderful pair of custom othotics my Pod made me about a year ago. They are a perfect fit. Thye were about 300.00 to 400.00 dallors .Workmans comp paid for them . My Pod checks them every time I fo in the office. Thanks for thinking of me. I live right next to San Leandro. Laurie R

Re: Have you received the tenogram results.???/- i can't stand the suspense anymore

Lauire R on 1/30/01 at 12:24 (037751)

You and me both......... I am still waiting for him to call. His nurse said that he does not get in until 12:00 pm today. It is only 10:15 am here right now. I promise I will post as soon as he calls me. First thing when I got up today this was on my mind.........Also as soon as I get a copy of the report I will fax it to you. Thanks Dr.Z for your concern *~* . Laurie R

Re: Have you received the tenogram results.???/- i can't stand the suspense anymore

Donna SL on 1/30/01 at 13:28 (037754)

Hi Lorie,

I can't stand the suspense either. Will you let us all know about the report too when you get it?

I still have pain in my arch, and my MRI just showed fluid mostly in the midfoot, ankles, and big toe joints. The pain has improved somewht, and doesn't appear anything nearly as bad as yours, but is still reccuring at times, but it is not constant. I got a big stabbing pain out of the blue yesterday. The pain throughout the rest of my foot, (heels forefoot,etc.), is not as severe as it once was, because of PT.

My doctor hasn't made any more suggestions, or tried to figure out what it may be. It's been almost a year since this first occurred. I'm waiting for an additional report of the MRI done with contrast, but I don't think it is going to show much more.

Was the tenogram very painful? What is involved?

I live in Northern Californina. What doctors have you seen?

Donna

Re: Have you received the tenogram results.???/- i can't stand the suspense anymore

Laurie R on 1/30/01 at 14:25 (037758)

Hi Donna,
I also live in Northern CA,right by Oakland....Where do you live ?? Or I should say where do you live by? I know you probably don't wan tto give your city out on the internet. The tenogram was done at Stanford medical center. That is the only place they do it around here. My Pod is consulting with a doctor there and it was him who said I should have the test. My MRI only showed the fluid too. But again they only studied my ankle a little bit ,it was mostly for my PF .

Put it this way ,the MRI of course had no pain ,only the pain from keeping my foot in one place for a long time. The tenogram was very painful ,but if I had to do either again I would pick the tenogram. The reason being it was a lot faster.

What the tenogram is ,they use x-ray and you lay on your side . The radiologist numbed my ankle TT area a little bit and then inserted another needle to flow steriod dye in my flexor tendon. The reason it was so painful is the fluid had no where to go. I have scasr tissue all around that tendon. And they are taking x-rays while they are doing this. It took longer for the doctor to get everything ready then the test .The test took about 15 minutes tops. Again I will say the radiologist was wonderful.

Stanford is suppose to be the best ,so far they have been wonderful to me. MY Pod is not there though .He did do his intership there .

What city is your doctor in?? If you would like to e-mail me please feel free to do so .angels4111@prodigy.net

MY very best to you Donna.....Laurie

Re: Have you received the tenogram results.???/- i can't stand the suspense anymore

Laurie R on 1/30/01 at 16:19 (037765)

Hi Dr.Z and Dr.Kosova I think I need your help understanding this.

I just got off the phone with my wonderful Pod. He read part of the report to me. I have 'Tenosynovitis' ,he needs the films to look at .My husband is on his way right now to bring them.

I will be having surgery to correct this. He wants to consult with the other foot specialist (this is the one that had me have the tenogram) . My Pod was very happy to find out that this is the main cause of my pain. I am just so happy it can be fixed. Doctors I am having my husband get a copy of the tenogram and I will fax it to both of you.

I asked my Pod if he will be doing the surgery and he said he and the other doctor would do it together . The other doctor has done many of this type of surgery.

Now Dr.Z can you do a fascia release with this type of tendon surgery at the same time?? I forgot to ask him. He will be going to see this other doctor this week to have a plan for me.

Dr Z I need your fax nuber again .my husband just came in with the report an I would like to fax it to you.

Thank you ,Laurie R

Re: Laurie: Dr. Z's fax is (856)848-5122 eom

Steve P on 1/30/01 at 16:52 (037767)

.

Re: Laurie: Dr. Z's fax is (856)848-5122 eom

Dr. Zuckerman on 1/30/01 at 17:07 (037769)

Yes

Fax this over to your cuz. I won't be in the office tommorrow but will ask my staff to be on the look out for this fax when you get a chance
fax it over. Let Dr. K take a look he has the experience in doing this surgery. I have two surgeons that I have working for me that are fellowship trained in this procedure who I will have take a look. So you are the whole heelspur gang involved.

Re: Have you received the tenogram results.???/- i can't stand the suspense anymore

Dr. Zuckerman on 1/30/01 at 17:21 (037772)

You can open up the upper and lower part of the Tarsal Tunnel. This is where I believe the Tendon is imflamed. The word Tenosynovitis is where the tendon and part of the joint capsule is imflamed. So you have a tendon that is injury and maybe torned. I would think that the mri would show this.
but it didn't

If it is determined that there is damage to one of the tendons in the tarsal tunnel. I am assuming that is where the tenosynovitis is located. It could also be behind the talus bone. I am not sure which part of the tendon's route the test was performed. The fact that you had TTS type pain I am assuming that the problem is with the tendons within the Tarsal Tunnel which is on the inside of the ankle bone. It travels thru this tunnel along with the posterior tibial nerve and then goes deep into the foot and if it is the FHL will attach into the bones into the big toe
If with are talking about the FDL . This attaches into the bottom of the 2-5 toes. If we are talking about the posterior tibial tendon this inserts intot the arch area.

So it could be anyone of these tendon.

I would think that all of the tendons will be examined at the time of surgery and repaired as to the need and degree of damage.

I always felt that you would need an exploration , evaluation and repair of the structure within the Tarsal Tunnel..

So lets see what your local doctors have in mind for you.

The source of your problem is identified. !!!!

Re: Have you received the tenogram results.???/- i can't stand the suspense anymore

Laurie R on 1/30/01 at 18:24 (037782)

Dear Dr.Z ,
I would like to thank you very ,very much for taking the time out to read my report.

And you must know me by now. What is the recovery for this type of surgery?? What kind of cut are we talking about?? Is it in and out surgery or will I have to stay in the hospital??

I am just so happy to finally have an answer to my pain. No I am not looking forward to having surgery ,but if it can be fixed that is all that will matter.

One more question. How long will I have to stay off my foot after surgery?

Thank you again I so appreciate your time.Laurie R

Re: Have you received the tenogram results.???/- i can't stand the suspense anymore

Dr. Kosova on 1/30/01 at 18:26 (037783)

Laurie,

As I have said before that there is a tear in this area of the FHL and that is causing inflammation to the p.t. nerve giving you your pain. Your pod. will be assiting the other doctor and rightly so you dont need to be his training model. Alot of mris come back tenosynovitis and in reality are tears that the mri cant pick up or the tendon flaps over on itself while they are doing the mri. I cant tell you how many 'normal' mri are tears when we go in surgically to repair them. All the tendons will be examined and the tarsal tunnel will be released as a safe measure. This is pretty standard.

I am looking forward to your results.

Dr. Kosova

Re: Have you received the tenogram results.???/- i can't stand the suspense anymore

Dr. Zuckerman on 1/30/01 at 19:39 (037790)

I would think anywhere from three to six months . This is a curved incision around the ankle down to the edge of the bottom of the foot. Depends on the hospital/ outpatient department and rules of the insurance company. In my area it is done outpatient. I like overnite but it will depend on your insurance and what is usually done with your doctor. We do both ways. I like overnite for this but in and out is also ok.

You are doing to have to be off your feet . I would think that you would be off your feet somewhere between eight to ten weeks maybe twelve. Depends on what they find. It also depend on the degree of tendon tear and the type of repair.

There is going to have to be some physical therapy after the surgery and cast are off.

I am looking forward to the pre-operative , intra-operative and long term posting from you.

Ask them to let you bring a cable modeum and laptop into the operating room

Wasn't there a baby delivered on the internet. We could have your tendon repaired live on the internet.

Scott what do you think. ?

Live from heelspurs.com I mean tendon.com .

Everything is going to be fine.

Re: Thanks Laurie

Donna SL on 1/31/01 at 03:33 (037820)

Hi Laurie,

I live in the Pacific Heights area of San francisco. UCSF isn't that far. I think they merged with Stanford, so maybe your doctor also goes to the UCSF Campus, or knows someone at UCSF. Is he a specialist? I'm looking for a good general podiatrist or a foot/ankle MD also. I understand some doctors don't want their name on the internet. If you can't do that let me know and I'll email you.

Best of luck to you. I'm glad you are finally getting some answers to your pain, and hope everything will be resolved in the very near future.

Donna

Re: Thanks Laurie To Donna

Laurie R on 2/01/01 at 12:22 (037974)

Hi Donna,
Yes please e-mail me .My main doctor (Pod) is in Hayward and the specialist is at Stanford.I haven't even seen the specialist.My Pod is setting that up . I have to wait for workmans comp to approve the pre-opp appointment.

I am from San Francisco ,born and raised ... I grew up in the mission....Small world.....

If you don't mind, tell me your story. How long have you had PF ??

I know UCSF is suppose to be one of the best. I think Stanford and UCSF are the same now.

My best to you Donna. Laurie R

Re: To Laurie from Donna

Donna SL on 2/08/01 at 00:50 (038408)

Hi Laurie,

I've beeen so busy, and haven't had a chance to give you my foot background, but I thought of you today , because you live near my area.

I don't know if you are going to need orthotics, but I met with an incredible man today who has 20 years experience as an orthotist, and is also a Cped, and has an incredible knowlege of so many materials for making orthotics, that are comfortable, and supportive. He is out in San Leando (sp?), but comes into SF twice a week. His fees are very inexpensive, and he is also very nice.

Also if you have surgery, and need any type of bracing after he would be excellent, because as an certified orthotist, he has vast experience in bracing for the entire body. He seems to be very concerned about comfort of the patient. Also, as a Cped he could do any alterations to shoes if you need it like rocker bottoms, etc, besides making custom orthotics. He is the best of both worlds.

I'm going to see him on again on Saturday to get casted for orthotics, and I'll ask if I can post his name. He may not want his name on the board. If you need his services now, let me know, and I'll email ASCP.

His cost are so reasonable, it may be worth seeing him now to see if he can do anything orthotic wise, until you have surgery to make you more comfortable.

I'll know for sure after he makes my first pair of orthotics which should be in a couple of weeks, but I have a lot of confidence in him.

Hope nobody gets mad this isn't under the IOS section, but I wasn't sure you would see it there.

Hope you're doing well otherwise.

Donna

Re: To Laurie from Donna

Laurie R on 2/08/01 at 16:20 (038456)

Hi Donna,
Thank you so much for your post. I already have a wonderful pair of custom othotics my Pod made me about a year ago. They are a perfect fit. Thye were about 300.00 to 400.00 dallors .Workmans comp paid for them . My Pod checks them every time I fo in the office. Thanks for thinking of me. I live right next to San Leandro. Laurie R