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How much experience should the dr. have in TTS surgery

Posted by Helene M on 4/24/01 at 16:33 (045596)

Dear Drs.,
I know there is not one specific answer to this question & it's probably a matter of opinion. So, in your opinion, is it reasonable to want your surgeon to have done at least 100 T/T releases before he operates on you? Or is that asking too much?

Re: How much experience should the dr. have in TTS surgery

Dr. David S. Wander on 4/24/01 at 19:16 (045611)

Helene,
Experience is certainly important, but performing 100 tarsal tunnel surgeries is quite a large number. Tarsal tunnel surgery is not a procedure that is performed by most doctors on a 'routine' basis. If a doctor has performed over 100 tarsal tunnel releases, than he/she either has a practice that treats an extraordinary amount of tarsal tunnel syndrome or he/she performs surgery too quickly for tarsal tunnel patients. There are many conservative options. I wouldn't be concerned with a large number performed, but I would be concerned about the last time he/she performed the procedure. If he/she performed 25 tarsal tunnel releases, but hasn't performed one in several years, I would be more concerned. The actual surgery itself is not that complicated, and it is imperative that the entrapped nerve be dissected as far distally (forward) as possible, since the site of the entrapment is often at the medial aspect of the heel, as the nerve goes toward the bottom of the foot. Although the actual procedure is not very complicated, the complications that can occur can often be relatively serious. You must feel comfortable with the surgeon, and discuss your concerns. Performing 100 TT releases should certainly NOT be a pre-requisite. The success rate of the procedures that he/she has performed should be more of a concern. Good luck.

Re: How much experience should the dr. have in TTS surgery

cindyp on 4/24/01 at hrmin (045622)

Only because I am an alarmist and a chicken I ask this, what are the possible complications of tts surgery?

Re: How much experience should the dr. have in TTS surgery

wendyn on 4/24/01 at 22:39 (045628)

I second Dr Wander's opinion. I would be very hesitant to go to a doctor who had performed a lot of these - simply because it's supposed to be an infrequently done surgery.

I would be more interested in finding a doctor I felt comfortable with, who seems to be able to explain WHAT is wrong with the foot that can be FIXED by the surgery.

Re: I'm not rushing into surgery!

Helene M on 4/25/01 at hrmin (045659)

Thank you Dr. Wander. I am certainly not rushing into TT surgery. So far I have received no concrete explanation as to why I have nerve compression. I have long-term PF & I think the TTS has been slowing developing for the past few yrs. but was undiagnosed for much too long. I wish one of the drs. had caught this earlier. Now I feel like I am far gone. I was told it could be scar tissue in the tarsal tunnel compressing the nerve. Although I don't doubt that it may be true, 'could be' is not a good enough explanation for me. I have pain and swelling in my arches all the time and now I am also developing a small swollen 'ball' below my inside ankles. So this seems to be progressing. My recent NCV was positive but my bilateral foot and ankle MRI's did not show anything, which is hard for me to believe. It was read by the radiologist plus my dr. Still, with no satisfactory explanation, my mind cannot justify surgery at this time. In the meantime, though, I cannot walk more than, say 20 or 30 steps. So this is devastating and has ruined my life. I know I must do something... and fast! I just have not yet found an effective dr. who is interested enough in my case. I'm still trying. I don't care if it's a pod or ortho, just someone skilled and caring, who will listen for more than 5 minutes and make his best effort to help me. Any suggestions of a dr. in the NYC area or suburbs would be appreciated.
Since the pain is in the arches mostly, does that mean that the entrapped nerve would have to be disected as far as the arch? That sounds like a very large incision! Sorry this is so long-winded. I usually try to keep my posts short.

Re: How much experience should the dr. have in TTS surgery

Dr. David S. Wander on 4/25/01 at 14:51 (045688)

In several other postings, I mentioned a Dr. Dellon that has done some pioneering work regarding nerve entrapments. He is a plastic surgeon that uses a different testing method than EMG/NCV studies. He has authored textbooks and many journal articles, therefore you should be able to find information about him on the web. I know he also has a website, but I can't recall the name. As far as plantar fasciitis and TTS goes, sometimes you must determine which came first, the chicken or the egg. Maybe the heel pain/plantar fasciitis pain has been from a nerve entrapment from the beginning!

Re: How much experience should the dr. have in TTS surgery

Dr. David S. Wander on 4/25/01 at 14:56 (045690)

I found Dr. Dellon's website. His name is A. Lee Dellon, MD and his website address is very simple. http://www.dellon.com

Re: How much experience should the dr. have in TTS surgery

cindyp on 4/25/01 at hrmin (045711)

So again I ask what complications can result from tts surgery?

Re: How much experience should the dr. have in TTS surgery

Helene M on 4/26/01 at 08:33 (045792)

Thank you Dr. Wander. I will look at Dr. Dellon's website. By the way, I, too, am interested in knowing the possible complications from TTS surgery. Could you elaborate on this?

Re: How much experience should the dr. have in TTS surgery

Dr. David S. Wander on 4/24/01 at 19:16 (045611)

Helene,
Experience is certainly important, but performing 100 tarsal tunnel surgeries is quite a large number. Tarsal tunnel surgery is not a procedure that is performed by most doctors on a 'routine' basis. If a doctor has performed over 100 tarsal tunnel releases, than he/she either has a practice that treats an extraordinary amount of tarsal tunnel syndrome or he/she performs surgery too quickly for tarsal tunnel patients. There are many conservative options. I wouldn't be concerned with a large number performed, but I would be concerned about the last time he/she performed the procedure. If he/she performed 25 tarsal tunnel releases, but hasn't performed one in several years, I would be more concerned. The actual surgery itself is not that complicated, and it is imperative that the entrapped nerve be dissected as far distally (forward) as possible, since the site of the entrapment is often at the medial aspect of the heel, as the nerve goes toward the bottom of the foot. Although the actual procedure is not very complicated, the complications that can occur can often be relatively serious. You must feel comfortable with the surgeon, and discuss your concerns. Performing 100 TT releases should certainly NOT be a pre-requisite. The success rate of the procedures that he/she has performed should be more of a concern. Good luck.

Re: How much experience should the dr. have in TTS surgery

cindyp on 4/24/01 at hrmin (045622)

Only because I am an alarmist and a chicken I ask this, what are the possible complications of tts surgery?

Re: How much experience should the dr. have in TTS surgery

wendyn on 4/24/01 at 22:39 (045628)

I second Dr Wander's opinion. I would be very hesitant to go to a doctor who had performed a lot of these - simply because it's supposed to be an infrequently done surgery.

I would be more interested in finding a doctor I felt comfortable with, who seems to be able to explain WHAT is wrong with the foot that can be FIXED by the surgery.

Re: I'm not rushing into surgery!

Helene M on 4/25/01 at hrmin (045659)

Thank you Dr. Wander. I am certainly not rushing into TT surgery. So far I have received no concrete explanation as to why I have nerve compression. I have long-term PF & I think the TTS has been slowing developing for the past few yrs. but was undiagnosed for much too long. I wish one of the drs. had caught this earlier. Now I feel like I am far gone. I was told it could be scar tissue in the tarsal tunnel compressing the nerve. Although I don't doubt that it may be true, 'could be' is not a good enough explanation for me. I have pain and swelling in my arches all the time and now I am also developing a small swollen 'ball' below my inside ankles. So this seems to be progressing. My recent NCV was positive but my bilateral foot and ankle MRI's did not show anything, which is hard for me to believe. It was read by the radiologist plus my dr. Still, with no satisfactory explanation, my mind cannot justify surgery at this time. In the meantime, though, I cannot walk more than, say 20 or 30 steps. So this is devastating and has ruined my life. I know I must do something... and fast! I just have not yet found an effective dr. who is interested enough in my case. I'm still trying. I don't care if it's a pod or ortho, just someone skilled and caring, who will listen for more than 5 minutes and make his best effort to help me. Any suggestions of a dr. in the NYC area or suburbs would be appreciated.
Since the pain is in the arches mostly, does that mean that the entrapped nerve would have to be disected as far as the arch? That sounds like a very large incision! Sorry this is so long-winded. I usually try to keep my posts short.

Re: How much experience should the dr. have in TTS surgery

Dr. David S. Wander on 4/25/01 at 14:51 (045688)

In several other postings, I mentioned a Dr. Dellon that has done some pioneering work regarding nerve entrapments. He is a plastic surgeon that uses a different testing method than EMG/NCV studies. He has authored textbooks and many journal articles, therefore you should be able to find information about him on the web. I know he also has a website, but I can't recall the name. As far as plantar fasciitis and TTS goes, sometimes you must determine which came first, the chicken or the egg. Maybe the heel pain/plantar fasciitis pain has been from a nerve entrapment from the beginning!

Re: How much experience should the dr. have in TTS surgery

Dr. David S. Wander on 4/25/01 at 14:56 (045690)

I found Dr. Dellon's website. His name is A. Lee Dellon, MD and his website address is very simple. http://www.dellon.com

Re: How much experience should the dr. have in TTS surgery

cindyp on 4/25/01 at hrmin (045711)

So again I ask what complications can result from tts surgery?

Re: How much experience should the dr. have in TTS surgery

Helene M on 4/26/01 at 08:33 (045792)

Thank you Dr. Wander. I will look at Dr. Dellon's website. By the way, I, too, am interested in knowing the possible complications from TTS surgery. Could you elaborate on this?