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

Nerve entrapment and ESWT

Posted by Donna SL on 4/19/01 at 02:08 (045055)

Dr Reid,

I noticed in a old post on 2-21-01 that you mentioned that if you found out if someone had some type of nerve entrapment, that you would try ESWT first to see if it would resolve the nerve entrapment, if you thought the entrapment was due to PF. Have you had any cases yet where this happened, and the nerve entrapment problem was cured too? How do you confirm if the entrapment came from PF?

I just recently found out that I have entrapment of the lateral plantar nerves in both feet, and also the inferior calcaneal nerves. (Baxter's nerve). This was confirmed with a positive NCV test last week. The only diagnoses I had prior to this for over a year was PF , because of a positive bone scan. Could a positive bone scan have been from inflammed nerves? My MRI didn't really show anything significant, and the fascia was normal.

I started Active release (ART) therapy close to a month ago. I have gotten significant relief in all over foot pain from the ART, and the nerve pain has been reduced, but it's to early to tell if the nerves will totally become un-entraped. ART has been proven very successful for carpal tunnel syndrome, and they are now using ART for the lower extremities. I'm wondering if the Baxter's nerve is to deep to be affected by the ART. I dread the idea of surgery if this doesn't work, and was wondering if you've had any cases of PF, and confirmed nerve entrapment yet that were treated with the EWST.

The pod who I got a second opinion from, and diagnosed the entrapment, wanted to give me a cortisone shot in the nerves. I said I would consider that later, but want to give the ART more of a chance first. How have you treated nerve entrapments? Would you recommend trying cortisone right now?
Is that my only other alternative other than surgery if the ART doesn't work completely?

I would deeply appreciate any information you can give me. Also if any other doctor have had experience with nerve entrapment I would be greatful for any input you could provide.

Donna

Re: Nerve entrapment and ESWT

Dr. Marlene Reid on 4/19/01 at 16:57 (045116)

Donna,

Yes, I have seen the nerve entrapment resolve with the resolution of PF, but only if it is in the earlier stages. My treatment protocol for nerve entrapment/inflammation is with cortisone shots. What is ART??? I am very interested in hearing about it. The other option would be resting it, soft cast to keep the edema down and a surgical boot or CAM walker which is a removable cast or crutches.

Re: Nerve entrapment and ESWT

cindyp on 4/19/01 at hrmin (045121)

I was told that it wouldn't help me.

Re: Nerve entrapment and ESWT

Donna SL on 4/19/01 at 18:40 (045122)

Hi Dr Reid,

I just posted a lot of information in the treatment section on the board on ART yesterday. Look through the whole thread, because I kept adding info. 'Look under ART is Miraculous'. I think this is an incredible treatment to try. I wish I had known about it sooner.

If you could tell anything from the results of the NCV test below, I would appreciate it.

I had normal H-reflexes that rules out S1 radiculopathy. The normal sural sensory studies, and the normal medial plantar motor studies rules out most forms of polyneuropathy.

The results for the MS of the lateral plantar nerves were 6.8 for the left, 7.8 for the right, and the norm is less than (6.3).

The results for the MS of the Inferior calcaneal nerves were 5.8 for the left, and 7.1 for the right, and the norms are less than (5.1).

Amp testing was normal except for left ICN.

In the Summary is basically says study of motor fibers demonstrates slowing suggestive of demyelination bilaterally in the Lateral planter nerves. Evoked muscle amplitudes both normal. The inferior calcaneal nerves also showed slowing on the motor fiber test bilaterally. Also evoked muscle amplitude on the left ICN is dereased suggesting motor axon injury.

Also it said mixed sensory potentials could not be obtained for either the medial or lateral plantar nerves, on either side, and this could either represent a conduction block, or may be due to technical factors. (I'm
not quoting the report exactly as written. There's around 5 pages). Can nerves heal? Do you think there are any chances that with conservative treatment like ART, and any other forms of PT for this area, that this could get better? I also have an appointment around a week from now with a neurologist.

Are the above results considered advanced? Does cortizone work at this level?, and would ESWT not? Have you seen many people require surgery for this? Have you prescribed any other forms of PT for this area?

The only suggestions I've been given by the physiatrist whe did the testing was to stick with the ART, and swim or walk in the pool, which I'm going to do later tonight. I was using a Nordick track, but was told to stop, but that the recumbent bike was OK.

I know from my symptoms that this has been going on for quite a while. It wasn't properly diagnosed for way over a year by my treating pod. He just kept trying different orthotics which didn't help. I had PT, but not in that area. He was out of town when I was tested, but has contacted me, and wants to see me when he gets back. The second pod who I sought a second opinion from, and diagnosed me with this condition, suggested cortisone, or surgery.

Is this the same as tarsal tunnel syndrome? I don't have any tingling in my ankle area. Most of the pain is in the arches and the heels, and increases with activity.

Sorry for the long post.

Donna

Re: Nerve entrapment and ESWT

Dr. Marlene Reid on 4/19/01 at 20:12 (045150)

Ywa, it is a form of TTS. I would try the injections. They may help. What do they think is the cause? Something must be putting presssure on the nerves.

Re: Nerve entrapment and ESWT

Donna SL on 4/19/01 at 21:23 (045154)

Hi Dr. Reid,

Thank you so much for responding to me again, and so quickly.

No one is giving me a reason for this. Do you usually know what causes TTS? The pod who diagnosed me just said people with long standing PF can develop TTS after a while, and thought I should of had a cortisone shot a long time ago. The chiropractor thinks it's from such tight fascia tissue, adhesions, etc, pushing on the nerves.

I do have high arches, and was wearing the wrong orthotics, and shoes for my foot type when I started getting foot pain over 2 years ago. I kept having increasing pain, and the treating pod at the time never mentioned PF, or did an exam, and just kept playing with the orthotics, but I wasn't getting any better.

I finally went to a new Pod in April of 2000, because my pain was worse, and he said I got injured from the prior orthotics, but just called it PF at the time. He thought they were grossly supinating my already supinated feet, and that they put all this tension on my fascia, feet, etc. Two months prior to seeing him, I was on the Nordic Track, and felt a pop in my right foot, and that's when everything got really bad. The arch was swollen, and the heel pain increased in both feet. The new pod at the time just said it was PF, and kept trying to make different orthotics too in an attempt to stabilize my feet to reduce the pain, but most of them hurt to much to wear. The only ones I could tolerate were plaztazote ones, but they had horrible durability, and started to cause other problems. He finally sent me to PT, and I had some minor improvement.

The pod who finally diagnosed this said orthotics would have never have helped get rid of this.

Do you know of any one who has gotten injured from orthotics?

Can cortisone help with long standing cases? I'm really tempted to just try it already, but the pod said I need to make sure I get any additional neurological testing done first. From my test results is this a bad case?

Donna

Re: Nerve entrapment and ESWT

cindyp on 4/19/01 at hrmin (045156)

The one cortisone shot i had wouldn't have done any good anyway. I don't know what causes tts. Until recently I wasn't aware tht was part of my problems. But the dr. said he wanted to do a tts release in addition to the tumor excision, neurolysis and synovectomy. I myself have no arches whatsoever. My pain is like taking a live electrical wire and jamming it in my foot. That's on a good day then others it is the burning knife. What can cause tts? Beside pf?

Re: Causes of Tarsal Tunnel Syndrome

Donna SL on 4/20/01 at 05:42 (045162)

Cindy, and Dr. Reid,

I found a couple of sites that list the causes of TTS.

http://www.foot-specialist.com/html/tarsal_tunnel_repair.htm

http://www.chiroweb.com/archives/11/07/30.html

The second article says passively forcing the heel and forefoot into a valgus postition can cause TTS. The first pod made several pairs of orthotics for me. The first pair turned my foot in too much. My current pod said that first orthotic had an 8 degree forefoot valgus correction. (I obtained the orthotic lab forms), and I really only have between 0 to 1 degree forefoot valgus. This was confirmed by two other pods. I also have some rearfoot varus, which I think is getting worse. I started getting heel pain from the very first pair, but the first pod kept saying I need to get used to them. When I started getting more pain from them over the next several months he changed them, and went the opposite way, and made an inverted orthotic which was also wrong for my foot type, and I got additional injuries. I basically just needed a neutral orthotic, with some good cushioning like I had before.

I'm starting to definately think all these problems were caused from this biomechanical twighlight zone the first pod got me into. I feel like a fool for listening to him, and should have known that these were causing harm, but this guy WROTE a BOOK on Clinical Biomechanics, and I thought he knew what he was doing.

Cindy are you wearing any orthotics now? Are you having surgery soon? I feel terrible that you are suffering so much.

Donna

Re: To: Donna SL

Helene M on 4/20/01 at 10:43 (045185)

Same as you, my current TTS flareup came from a new pair of orthotics that I got in Jan 2000. I've been suffering ever since. I had listened to the dr.and tried to wear the orthotics several times. I explained the problem it was causing and he told me to wait a few days and try again. Looking back on it, the orthotics were just making me worse & worse. This is the first time in 9 years of foot pain that I have not recovered from an episode of this. We were brought up to listen to the dr. because he knows best. Well, I've learned the hard way that this is not always so! I, too, don't have a definite reason of what is causing the nerve entrapment. Thanks for your post to me on a previous thread. I currently wear Spenco cross trainer inserts which don't help much but at least don't hurt. I will try taping every day although sometimes I think the tape is making it worse.

Re: Causes of Tarsal Tunnel Syndrome

cindyp on 4/20/01 at hrmin (045192)

No i am not wearing orthos now. The dr.'s that I was seeing have basically told me to live with it. That was unacceptable to me to just treat the pain. So I paid out of pocket to see a foot and ankle reconstructive surgeon. My surgery is scheduled for 24 may. Probably will have to reschedule. Will be getting insurance and they may consider it a pre existing condition. Wait 90 days after getting insurance and then do it. I know sometimes we don't get answers to certain questions , the one that bugs me is no one can tell me why my foot is in such bad shape. No known injuries. Who knows?

Re: Nerve entrapment and ESWT

Kay S on 4/20/01 at hrmin (045213)

Dr. Reid
There are two people who do ART in our area, one in Brookfield, and one in Hinsdale. Dr. Svihlik is certified in lower extremity art, and Dr. Borgealt has not taken the certification yet but does do the art for pf and says she has had some good results.
I don't know if this is new or not, but it is another thing to try. Watch for my posts in a week or so, because this is my next attempt to find relief. DonnaSl was very pleased with her results.
Kay

Re: Nerve entrapment and ESWT

Dr. Marlene Reid on 4/20/01 at 23:58 (045252)

Thanks! I will have to check this out. Keep me posted. I would love to have the center send me some info on it if they have anything.

Re: ART Lower Body Cert Critical Re: Nerve entrapment and ESWT

Donna SL on 4/21/01 at 02:26 (045256)

Hi Kay, Dr Reid,

I wouldn't recommend anyone to a chiropractor who is not certified in lower body ART for foot problems. The knowledge my chiropractor has in the lower body is very intense, and through. His anatomy training would impress any foot and ankle specialist, surgeon, etc. He has an in dept knowledge of every tendon, nerve, and muscle, artery, etc. in the feet, and legs. This is critical to know this. He's dealing with removing adhesions between muscle, fascia, tendons, etc., and he also needs to understand the pathways of all the nerves in the foot, etc.

He is almost literaly going through my foot in layers, working deeper,and deeper, as outer layers become released. He also has the same intensive knowledge of the legs, and understands how they affect each part of the foot, and knows exactly where to work. I ask a lot of questions at each session, and he always explains what he's doing. He has several years experience in ART for the rest of the body, but still took this course.

Would you let a back surgeon work on your foot? This is not just some fancy massage. I view ART as serious medical procedure. Unless the non certified doctor went to podiatry school for example there is no way they could be as effective ART in the lower body. This is intricate manipulation of tissue and adhesions, etc, and I think they could do more harm than good, especially if you are dealing with someone with nerve entrapment.

This is an incredible treatment, but it has to be done by someone trained in that area. When I called the institute, and told them my problem, they said only go to someone certified in lower body. Now I understand why.

Here's the site again in case anyone needs it. I don't know if all practioners are listed so it's good to call.

http://www.activerelease.com/

Donna

Re: Nerve entrapment and ESWT

Dr. Marlene Reid on 4/19/01 at 16:57 (045116)

Donna,

Yes, I have seen the nerve entrapment resolve with the resolution of PF, but only if it is in the earlier stages. My treatment protocol for nerve entrapment/inflammation is with cortisone shots. What is ART??? I am very interested in hearing about it. The other option would be resting it, soft cast to keep the edema down and a surgical boot or CAM walker which is a removable cast or crutches.

Re: Nerve entrapment and ESWT

cindyp on 4/19/01 at hrmin (045121)

I was told that it wouldn't help me.

Re: Nerve entrapment and ESWT

Donna SL on 4/19/01 at 18:40 (045122)

Hi Dr Reid,

I just posted a lot of information in the treatment section on the board on ART yesterday. Look through the whole thread, because I kept adding info. 'Look under ART is Miraculous'. I think this is an incredible treatment to try. I wish I had known about it sooner.

If you could tell anything from the results of the NCV test below, I would appreciate it.

I had normal H-reflexes that rules out S1 radiculopathy. The normal sural sensory studies, and the normal medial plantar motor studies rules out most forms of polyneuropathy.

The results for the MS of the lateral plantar nerves were 6.8 for the left, 7.8 for the right, and the norm is less than (6.3).

The results for the MS of the Inferior calcaneal nerves were 5.8 for the left, and 7.1 for the right, and the norms are less than (5.1).

Amp testing was normal except for left ICN.

In the Summary is basically says study of motor fibers demonstrates slowing suggestive of demyelination bilaterally in the Lateral planter nerves. Evoked muscle amplitudes both normal. The inferior calcaneal nerves also showed slowing on the motor fiber test bilaterally. Also evoked muscle amplitude on the left ICN is dereased suggesting motor axon injury.

Also it said mixed sensory potentials could not be obtained for either the medial or lateral plantar nerves, on either side, and this could either represent a conduction block, or may be due to technical factors. (I'm
not quoting the report exactly as written. There's around 5 pages). Can nerves heal? Do you think there are any chances that with conservative treatment like ART, and any other forms of PT for this area, that this could get better? I also have an appointment around a week from now with a neurologist.

Are the above results considered advanced? Does cortizone work at this level?, and would ESWT not? Have you seen many people require surgery for this? Have you prescribed any other forms of PT for this area?

The only suggestions I've been given by the physiatrist whe did the testing was to stick with the ART, and swim or walk in the pool, which I'm going to do later tonight. I was using a Nordick track, but was told to stop, but that the recumbent bike was OK.

I know from my symptoms that this has been going on for quite a while. It wasn't properly diagnosed for way over a year by my treating pod. He just kept trying different orthotics which didn't help. I had PT, but not in that area. He was out of town when I was tested, but has contacted me, and wants to see me when he gets back. The second pod who I sought a second opinion from, and diagnosed me with this condition, suggested cortisone, or surgery.

Is this the same as tarsal tunnel syndrome? I don't have any tingling in my ankle area. Most of the pain is in the arches and the heels, and increases with activity.

Sorry for the long post.

Donna

Re: Nerve entrapment and ESWT

Dr. Marlene Reid on 4/19/01 at 20:12 (045150)

Ywa, it is a form of TTS. I would try the injections. They may help. What do they think is the cause? Something must be putting presssure on the nerves.

Re: Nerve entrapment and ESWT

Donna SL on 4/19/01 at 21:23 (045154)

Hi Dr. Reid,

Thank you so much for responding to me again, and so quickly.

No one is giving me a reason for this. Do you usually know what causes TTS? The pod who diagnosed me just said people with long standing PF can develop TTS after a while, and thought I should of had a cortisone shot a long time ago. The chiropractor thinks it's from such tight fascia tissue, adhesions, etc, pushing on the nerves.

I do have high arches, and was wearing the wrong orthotics, and shoes for my foot type when I started getting foot pain over 2 years ago. I kept having increasing pain, and the treating pod at the time never mentioned PF, or did an exam, and just kept playing with the orthotics, but I wasn't getting any better.

I finally went to a new Pod in April of 2000, because my pain was worse, and he said I got injured from the prior orthotics, but just called it PF at the time. He thought they were grossly supinating my already supinated feet, and that they put all this tension on my fascia, feet, etc. Two months prior to seeing him, I was on the Nordic Track, and felt a pop in my right foot, and that's when everything got really bad. The arch was swollen, and the heel pain increased in both feet. The new pod at the time just said it was PF, and kept trying to make different orthotics too in an attempt to stabilize my feet to reduce the pain, but most of them hurt to much to wear. The only ones I could tolerate were plaztazote ones, but they had horrible durability, and started to cause other problems. He finally sent me to PT, and I had some minor improvement.

The pod who finally diagnosed this said orthotics would have never have helped get rid of this.

Do you know of any one who has gotten injured from orthotics?

Can cortisone help with long standing cases? I'm really tempted to just try it already, but the pod said I need to make sure I get any additional neurological testing done first. From my test results is this a bad case?

Donna

Re: Nerve entrapment and ESWT

cindyp on 4/19/01 at hrmin (045156)

The one cortisone shot i had wouldn't have done any good anyway. I don't know what causes tts. Until recently I wasn't aware tht was part of my problems. But the dr. said he wanted to do a tts release in addition to the tumor excision, neurolysis and synovectomy. I myself have no arches whatsoever. My pain is like taking a live electrical wire and jamming it in my foot. That's on a good day then others it is the burning knife. What can cause tts? Beside pf?

Re: Causes of Tarsal Tunnel Syndrome

Donna SL on 4/20/01 at 05:42 (045162)

Cindy, and Dr. Reid,

I found a couple of sites that list the causes of TTS.

http://www.foot-specialist.com/html/tarsal_tunnel_repair.htm

http://www.chiroweb.com/archives/11/07/30.html

The second article says passively forcing the heel and forefoot into a valgus postition can cause TTS. The first pod made several pairs of orthotics for me. The first pair turned my foot in too much. My current pod said that first orthotic had an 8 degree forefoot valgus correction. (I obtained the orthotic lab forms), and I really only have between 0 to 1 degree forefoot valgus. This was confirmed by two other pods. I also have some rearfoot varus, which I think is getting worse. I started getting heel pain from the very first pair, but the first pod kept saying I need to get used to them. When I started getting more pain from them over the next several months he changed them, and went the opposite way, and made an inverted orthotic which was also wrong for my foot type, and I got additional injuries. I basically just needed a neutral orthotic, with some good cushioning like I had before.

I'm starting to definately think all these problems were caused from this biomechanical twighlight zone the first pod got me into. I feel like a fool for listening to him, and should have known that these were causing harm, but this guy WROTE a BOOK on Clinical Biomechanics, and I thought he knew what he was doing.

Cindy are you wearing any orthotics now? Are you having surgery soon? I feel terrible that you are suffering so much.

Donna

Re: To: Donna SL

Helene M on 4/20/01 at 10:43 (045185)

Same as you, my current TTS flareup came from a new pair of orthotics that I got in Jan 2000. I've been suffering ever since. I had listened to the dr.and tried to wear the orthotics several times. I explained the problem it was causing and he told me to wait a few days and try again. Looking back on it, the orthotics were just making me worse & worse. This is the first time in 9 years of foot pain that I have not recovered from an episode of this. We were brought up to listen to the dr. because he knows best. Well, I've learned the hard way that this is not always so! I, too, don't have a definite reason of what is causing the nerve entrapment. Thanks for your post to me on a previous thread. I currently wear Spenco cross trainer inserts which don't help much but at least don't hurt. I will try taping every day although sometimes I think the tape is making it worse.

Re: Causes of Tarsal Tunnel Syndrome

cindyp on 4/20/01 at hrmin (045192)

No i am not wearing orthos now. The dr.'s that I was seeing have basically told me to live with it. That was unacceptable to me to just treat the pain. So I paid out of pocket to see a foot and ankle reconstructive surgeon. My surgery is scheduled for 24 may. Probably will have to reschedule. Will be getting insurance and they may consider it a pre existing condition. Wait 90 days after getting insurance and then do it. I know sometimes we don't get answers to certain questions , the one that bugs me is no one can tell me why my foot is in such bad shape. No known injuries. Who knows?

Re: Nerve entrapment and ESWT

Kay S on 4/20/01 at hrmin (045213)

Dr. Reid
There are two people who do ART in our area, one in Brookfield, and one in Hinsdale. Dr. Svihlik is certified in lower extremity art, and Dr. Borgealt has not taken the certification yet but does do the art for pf and says she has had some good results.
I don't know if this is new or not, but it is another thing to try. Watch for my posts in a week or so, because this is my next attempt to find relief. DonnaSl was very pleased with her results.
Kay

Re: Nerve entrapment and ESWT

Dr. Marlene Reid on 4/20/01 at 23:58 (045252)

Thanks! I will have to check this out. Keep me posted. I would love to have the center send me some info on it if they have anything.

Re: ART Lower Body Cert Critical Re: Nerve entrapment and ESWT

Donna SL on 4/21/01 at 02:26 (045256)

Hi Kay, Dr Reid,

I wouldn't recommend anyone to a chiropractor who is not certified in lower body ART for foot problems. The knowledge my chiropractor has in the lower body is very intense, and through. His anatomy training would impress any foot and ankle specialist, surgeon, etc. He has an in dept knowledge of every tendon, nerve, and muscle, artery, etc. in the feet, and legs. This is critical to know this. He's dealing with removing adhesions between muscle, fascia, tendons, etc., and he also needs to understand the pathways of all the nerves in the foot, etc.

He is almost literaly going through my foot in layers, working deeper,and deeper, as outer layers become released. He also has the same intensive knowledge of the legs, and understands how they affect each part of the foot, and knows exactly where to work. I ask a lot of questions at each session, and he always explains what he's doing. He has several years experience in ART for the rest of the body, but still took this course.

Would you let a back surgeon work on your foot? This is not just some fancy massage. I view ART as serious medical procedure. Unless the non certified doctor went to podiatry school for example there is no way they could be as effective ART in the lower body. This is intricate manipulation of tissue and adhesions, etc, and I think they could do more harm than good, especially if you are dealing with someone with nerve entrapment.

This is an incredible treatment, but it has to be done by someone trained in that area. When I called the institute, and told them my problem, they said only go to someone certified in lower body. Now I understand why.

Here's the site again in case anyone needs it. I don't know if all practioners are listed so it's good to call.

http://www.activerelease.com/

Donna