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Still experiencing inside ankle pain post EPF surgery 4 mths. ago

Posted by Amy on 2/22/01 at 11:50 (039646)

Well, Dr. Z. I took your advice - wearing my orthotics, stopped walking, resting most of the time, used an ankle support, ibuprofen, ice and warm baths (also my podiatrist's suggestions) and after a month am still experiencing this ankle pain. It radiates around my ankle, feels hot down the inside of my foot and sometimes will shoot about 5' above my ankle. Have gained another 5 lbs. (already 30 lbs. heavier than I should be) and am deeply depressed. My plan is to join the Y and take a water aerobics class to take off the weight and improve my attitude. My doctor will probably want me to come in for a cortisone shot, but I thought I read here that shots could be damaging and don't really want to depend on shots. How do you know if you have nerve entrapment?

Re: Still experiencing inside ankle pain post EPF surgery 4 mths. ago

Dr. Zuckerman on 2/22/01 at 11:57 (039647)

Stop with the orthosis and see if this helps A nerve entrapement is evaluated by a physical examination and at time EMG studies. The clinical examination is the most important way to detemine if you do have a nerve entrapement.

Re: Still experiencing inside ankle pain post EPF surgery 4 mths. ago

Amy on 2/22/01 at 17:25 (039670)

Thanks Dr. Z for answering so quickly and for your advice, which I will take. What is your opinion of cortisone shots in the ankle? I don't know where I got the idea that they were not good if this is nerve entrapment. I really do not want anymore surgery. Is there another treatment for nerve entrapment besides cortisone and/or surgery?

Re: Still experiencing inside ankle pain post EPF surgery 4 mths. ago

Dr. Zuckerman on 2/22/01 at 20:27 (039686)

If there is a specific area that can be located then a local steriod injection is indicated. Usually what you are experiencing is imflamation of the lining of the ankle joint. If this the case then the injection could help you. The examination is very important and fairly straight forward to determine if the ankle lining is the problem or if it is a nerve. I doubt if it is a nerve entrapment .

Re: Still experiencing inside ankle pain post EPF surgery 4 mths. ago

Amy on 2/23/01 at 08:18 (039717)

Being the curious person that I am, I have one last question. What causes the lining to the ankle joint to swell? I truly have not been on my feet much at all. It's almost as if the less I'm on my feet, the more this hurts - it doesn't make any sense to me. Do you think this swelling will disappear as I get closer to the 6 month post op mark? Thanks Dr. Z.

Re: Still experiencing inside ankle pain post EPF surgery 4 mths. ago

Dr. Zuckerman on 2/23/01 at 21:05 (039776)

The only thing that I can tell you is this. I have found that whenever you do a plantar fascia release. It can hurt here it can hurt there. It could move to one place then to another. This can go on for one week, one months,six months.

When I do heel spur and or pf releases I just tell the patients that this is what the healing can be like. Some patients will feel great the next day, some the next week , some the next month and a few in six months and a very few never.

So this is why I even looked into ESWT. I found this to alot different with ESWT but in some cases still the same healing type of situation except only it take three months. Another thing with ESWT is that there isn't going to be that few that never heal just the more then a few that are very unhappy that they spent money and then still have the pain and have to consider foot surgery.

So back to your case. Support the foot and ankle. Rest, maybe a steriod injection and just plain time is the anwser. I always thought that after the heel spur operation my job was to make the patient feel as best as I could until the surgery finally healed and it can take a very long time.

Re: Still experiencing inside ankle pain post EPF surgery 4 mths. ago

Amy on 2/24/01 at 10:21 (039791)

My doctor did an ankle x-ray yesterday and to both of our surprise found that I have a spur on the bottom of my ankle, which he feels has been growing for at least 5 years. He feels that the odd way I was walking post EPF surgery inflammed the tissue in this area and that is why I feel the pain. The (hope I get this right) posterior tibular nerve is being aggravated by the spur and inflammation. SOOOOOOOO, he gave me the first of two cortisone shots which hurt like the dickens - he put the shot right into the nerve (this is where it should go, I realized afterwards)and I just about flew off the table - the needle flew up into the air - I was so embarassed. The pain ran up and down alongside the inside of my foot from toe to heel - OUCH!!! He then put the shot under the nerve, while both his assistant and myself held my leg down. He did, however, explain that this would not be as helpful for the swelling as going right into the nerve. I'm confused though, aren't we trying to alleviate swelling of the tissue around the nerve not the swollen nerve? Does the nerve swell too? Beleive it or not I actually feel releived that I know WHY I have this pain. That it's really not a complication from EPF surgery (except for the way I walked) or nerve entrapment. If cortisone doesn't help, then he suggested removing the spur. What's your opinion Dr. Z. of the shot in the NERVE vs. tissue and removal of the spur as a last resort? Thanks again.

Re: Still experiencing inside ankle pain post EPF surgery 4 mths. ago

Dr. Zuckerman on 2/25/01 at 16:49 (039860)

I am not quite sure what you are talking about but here goes. The purpose of the steriod injection is that the ankle joint has imflamed tissue and a spur formation that is restricting the motion at the ankle joint. This I have seen become what we call symtomatic after the foot surgery. This is especially true after heel spur of plantar fascia release. The heel doesn't hurt but the ankle now does. I have seen this and have removed the spur and the inflamed tissue. This is usually done with ankle arthoscopic procedure.

Why this happens I can only give you a theory. The two problems were there before the surgery and now that you are walking differently the foot and
ankle are functioning differently. It is possible that the ankle problem was the root of the plantar fascia problem

Not sure why the steriod is going into the nerve. Usually is around the nerve and the Tarsal Tunnel tissues.

Is very possible that if the tarsal tunnel tissue is imflamed then the steriod could clear this up.

Is it my understanding that the spur is at the ankle joint where it blends.
The posterior tibial nerve is on the inside of the ankle.

The reason you had the jumping reaction was the local anethetic and or steriod or the needle touching the nerve. It usually feels like an electric shock feeling.

So let seen what relief you get with the injections.

Re: Still experiencing inside ankle pain post EPF surgery 4 mths. ago

Amy on 2/26/01 at 13:18 (039910)

The spur is actually at the bottom right side of the inside ankle, not where the foot bends. There is no restriction in ankle movement, just a sharp pain that goes down to my heel and sometimes up about 5'. Could it be that the posterior tibial nerve is inflammed that's why my doctor tried to put the steroid injection there first? Now I have a burn looking mark about the size of a nickle where he placed the injection and it burns.

Re: Still experiencing inside ankle pain post EPF surgery 4 mths. ago

wendyn on 2/26/01 at 14:15 (039912)

I always understood that the shot should not actually hit the nerve OR the artery?

Re: Still experiencing inside ankle pain post EPF surgery 4 mths. ago

Dr. Zuckerman on 2/27/01 at 07:08 (039976)

He placed the injection around the area of the nerve and into the tarsal tunnel to reduce the swelling in that area. I see where Wendy state that the steriod shouldn't go into the nerve . She is right and I doubt whether yours did. The doctor tried to numb the area first. So talk to him about the shot going into the nerve. I you have pain from the injectoin ice it
If soreness heat

Re: Still experiencing inside ankle pain post EPF surgery 4 mths. ago

wendyn on 2/27/01 at 07:43 (039980)

Dr Z - if we've verified that the shouldn't go INTO the nerve - WHY shouldn't it go into the nerve? What will happen? Does it ever happen?

Re: Still experiencing inside ankle pain post EPF surgery 4 mths. ago

Dr. Zuckerman on 2/27/01 at 11:35 (039999)

To put into the nerve you have to stick the needle into the injury and that in inself can cause a trauma to the nerve itself. Why injury a nerve that is already injuried

Re: Still experiencing inside ankle pain post EPF surgery 4 mths. ago

Dr. Zuckerman on 2/22/01 at 11:57 (039647)

Stop with the orthosis and see if this helps A nerve entrapement is evaluated by a physical examination and at time EMG studies. The clinical examination is the most important way to detemine if you do have a nerve entrapement.

Re: Still experiencing inside ankle pain post EPF surgery 4 mths. ago

Amy on 2/22/01 at 17:25 (039670)

Thanks Dr. Z for answering so quickly and for your advice, which I will take. What is your opinion of cortisone shots in the ankle? I don't know where I got the idea that they were not good if this is nerve entrapment. I really do not want anymore surgery. Is there another treatment for nerve entrapment besides cortisone and/or surgery?

Re: Still experiencing inside ankle pain post EPF surgery 4 mths. ago

Dr. Zuckerman on 2/22/01 at 20:27 (039686)

If there is a specific area that can be located then a local steriod injection is indicated. Usually what you are experiencing is imflamation of the lining of the ankle joint. If this the case then the injection could help you. The examination is very important and fairly straight forward to determine if the ankle lining is the problem or if it is a nerve. I doubt if it is a nerve entrapment .

Re: Still experiencing inside ankle pain post EPF surgery 4 mths. ago

Amy on 2/23/01 at 08:18 (039717)

Being the curious person that I am, I have one last question. What causes the lining to the ankle joint to swell? I truly have not been on my feet much at all. It's almost as if the less I'm on my feet, the more this hurts - it doesn't make any sense to me. Do you think this swelling will disappear as I get closer to the 6 month post op mark? Thanks Dr. Z.

Re: Still experiencing inside ankle pain post EPF surgery 4 mths. ago

Dr. Zuckerman on 2/23/01 at 21:05 (039776)

The only thing that I can tell you is this. I have found that whenever you do a plantar fascia release. It can hurt here it can hurt there. It could move to one place then to another. This can go on for one week, one months,six months.

When I do heel spur and or pf releases I just tell the patients that this is what the healing can be like. Some patients will feel great the next day, some the next week , some the next month and a few in six months and a very few never.

So this is why I even looked into ESWT. I found this to alot different with ESWT but in some cases still the same healing type of situation except only it take three months. Another thing with ESWT is that there isn't going to be that few that never heal just the more then a few that are very unhappy that they spent money and then still have the pain and have to consider foot surgery.

So back to your case. Support the foot and ankle. Rest, maybe a steriod injection and just plain time is the anwser. I always thought that after the heel spur operation my job was to make the patient feel as best as I could until the surgery finally healed and it can take a very long time.

Re: Still experiencing inside ankle pain post EPF surgery 4 mths. ago

Amy on 2/24/01 at 10:21 (039791)

My doctor did an ankle x-ray yesterday and to both of our surprise found that I have a spur on the bottom of my ankle, which he feels has been growing for at least 5 years. He feels that the odd way I was walking post EPF surgery inflammed the tissue in this area and that is why I feel the pain. The (hope I get this right) posterior tibular nerve is being aggravated by the spur and inflammation. SOOOOOOOO, he gave me the first of two cortisone shots which hurt like the dickens - he put the shot right into the nerve (this is where it should go, I realized afterwards)and I just about flew off the table - the needle flew up into the air - I was so embarassed. The pain ran up and down alongside the inside of my foot from toe to heel - OUCH!!! He then put the shot under the nerve, while both his assistant and myself held my leg down. He did, however, explain that this would not be as helpful for the swelling as going right into the nerve. I'm confused though, aren't we trying to alleviate swelling of the tissue around the nerve not the swollen nerve? Does the nerve swell too? Beleive it or not I actually feel releived that I know WHY I have this pain. That it's really not a complication from EPF surgery (except for the way I walked) or nerve entrapment. If cortisone doesn't help, then he suggested removing the spur. What's your opinion Dr. Z. of the shot in the NERVE vs. tissue and removal of the spur as a last resort? Thanks again.

Re: Still experiencing inside ankle pain post EPF surgery 4 mths. ago

Dr. Zuckerman on 2/25/01 at 16:49 (039860)

I am not quite sure what you are talking about but here goes. The purpose of the steriod injection is that the ankle joint has imflamed tissue and a spur formation that is restricting the motion at the ankle joint. This I have seen become what we call symtomatic after the foot surgery. This is especially true after heel spur of plantar fascia release. The heel doesn't hurt but the ankle now does. I have seen this and have removed the spur and the inflamed tissue. This is usually done with ankle arthoscopic procedure.

Why this happens I can only give you a theory. The two problems were there before the surgery and now that you are walking differently the foot and
ankle are functioning differently. It is possible that the ankle problem was the root of the plantar fascia problem

Not sure why the steriod is going into the nerve. Usually is around the nerve and the Tarsal Tunnel tissues.

Is very possible that if the tarsal tunnel tissue is imflamed then the steriod could clear this up.

Is it my understanding that the spur is at the ankle joint where it blends.
The posterior tibial nerve is on the inside of the ankle.

The reason you had the jumping reaction was the local anethetic and or steriod or the needle touching the nerve. It usually feels like an electric shock feeling.

So let seen what relief you get with the injections.

Re: Still experiencing inside ankle pain post EPF surgery 4 mths. ago

Amy on 2/26/01 at 13:18 (039910)

The spur is actually at the bottom right side of the inside ankle, not where the foot bends. There is no restriction in ankle movement, just a sharp pain that goes down to my heel and sometimes up about 5'. Could it be that the posterior tibial nerve is inflammed that's why my doctor tried to put the steroid injection there first? Now I have a burn looking mark about the size of a nickle where he placed the injection and it burns.

Re: Still experiencing inside ankle pain post EPF surgery 4 mths. ago

wendyn on 2/26/01 at 14:15 (039912)

I always understood that the shot should not actually hit the nerve OR the artery?

Re: Still experiencing inside ankle pain post EPF surgery 4 mths. ago

Dr. Zuckerman on 2/27/01 at 07:08 (039976)

He placed the injection around the area of the nerve and into the tarsal tunnel to reduce the swelling in that area. I see where Wendy state that the steriod shouldn't go into the nerve . She is right and I doubt whether yours did. The doctor tried to numb the area first. So talk to him about the shot going into the nerve. I you have pain from the injectoin ice it
If soreness heat

Re: Still experiencing inside ankle pain post EPF surgery 4 mths. ago

wendyn on 2/27/01 at 07:43 (039980)

Dr Z - if we've verified that the shouldn't go INTO the nerve - WHY shouldn't it go into the nerve? What will happen? Does it ever happen?

Re: Still experiencing inside ankle pain post EPF surgery 4 mths. ago

Dr. Zuckerman on 2/27/01 at 11:35 (039999)

To put into the nerve you have to stick the needle into the injury and that in inself can cause a trauma to the nerve itself. Why injury a nerve that is already injuried