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Sinus Tarsi Syndrome/post EPF ankle problems

Posted by KellyD on 6/25/01 at 16:17 (051501)

I posted a similar question here in January, but am wondering if anyone has any new information on the subject. I had EPF 9/00, and in January developed an ankle problem. Two MRIs have diagnosed Sinus Tarsi, but nothing seems to be helping long term. We've done the shots - which give relief for about a week at a time - changed orthotics, etc. Hoping for new info...

Re: Sinus Tarsi Syndrome/post EPF ankle problems

Nancy M on 6/25/01 at 19:11 (051513)

Hi Kelly, I'm not a doctor, but I've had sinus tarsi. For those of you that don't know what sinus tarsi is, it's like carpal tunnel but in your foot. I had shots three times that lasted only a couple of days, PT, and then surgery the end of April to clean out the carpal. Foot is feeling great now, does let me know if I've walked too much during the day and I know that from all the other surgeries I've had on my feet (see below) that it takes anywhere from 6 months to a year to completely heal. I didn't even have a MRI done. My pod not able to figure out why I was having the pain finally sent me to an ortho. Told him where it hurt and he knew right away what it was. By the way I've also had EPF surgery on both feet, three neuroma's removed (2 left, 1 right) and two stress factures in my left foot, one on the top of my foot and another in my cuboid bone.

Nancy M in AZ

Re: Looking for Doctor's comments

KellyD on 6/26/01 at 12:30 (051557)

I appreciate the layperson perspective, but I'm definitely not interested in another surgery and am looking for a physician's advice.

Re: Looking for Doctor's comments

Nancy M on 6/26/01 at 18:28 (051573)

Excuse me!!!!!

Re: Looking for Doctor's comments

wendyn on 6/26/01 at 21:05 (051578)

Don't take it personally Nancy. It takes a lot of time to read these posts and go to the effort to respond to them. 99.9% of the people who post here appreciate that.

Re: Looking for Doctor's comments / I apreciate it friends!!!

Tammie on 6/26/01 at 21:17 (051580)

Ditto, I agree I just wanted to say I always appreciate your kindness even if it is something I did not WANT to hear lol ! Keep up the good work!

Re: Looking for Doctor's comments

Mary S. on 6/26/01 at 22:38 (051591)

I have learned so much from all of the sharing of information that is passed through all of the wonderful people on this message board. We all have something in common-we suffer with our feet. We have all spent tons of money on doctor's advice, treatments, therapy, surgery, etc. We have had good experiences and bad experiences that we have all learned from. The doctors are absolutely great--I sorta think of them as the coaches, but I can assure you that they approve of the rest of us working as a team to help each other.
If you ever need the support of others who know what you are going through, this is the place to come. You will find us all on the Social Board too. Wishing you well on many levels.

Re: Looking for Doctor's comments

Julie on 6/27/01 at 02:45 (051606)

Nancy, having had a similar sort of brush-off yesterday after spending a good half hour writing a response to someone here, I know how you felt. But as Wendy and the others have made clear, most people do appreciate the time and effort that goes into giving information and support, so please don't let it bug you. I think maybe Kelly (I think she is new: am I right, Kelly?) doesn't realize that the doctors themselves appreciate our 'lay' input, and have said so.

Kelly, I'm sure you will get a response from one of the doctors - just be patient. They are sterling souls who give their time and expertise here for nothing, and they have lots of other things to do. You'll find that most people who post here get a welcome and possibly some information from us lay folk, and unless what is said is way off base, it's usually a help to the docs.

Re: Thanks Everyone

Nancy M on 6/27/01 at 06:32 (051616)

I've been reading and posting occassionally on the board for almost 4 years. I just wasn't thrilled with here attitude. Thanks again!

Nancy M in AZ

Re: Full of bullet holes, but still looking for advice

KellyD on 6/27/01 at 11:34 (051633)

Okay ladies, if you're done ripping me apart, I'd like to draw your attention to the title of the board - 'Ask the Foot Doctors' - forgive me if I took it literally. I too have read and posted to this board extensively since my problems with PF began (NO - I'm not new)- and find it a wonderfully helpful tool with terrific people. But I specifically posted here because I wanted a doctor's opinion. I had already done extensive searches and read Nancy's several other posts on this subject. I'm certain you meant well, and I didn't mean to offend you, but I wanted to make it clear that while your input was appreciated, I didn't want them to overlook the post because it had been responded to.

Something else Nancy mentioned brought up another question. Perhaps the doctors can also provide additional clarification on what sinus tarsi syndrome is - versus tarsel tunnel syndrome. They are 2 different conditions, and my understanding is that tarsel tunnel is similar to carpel tunnel.

Re: Full of bullet holes, but still looking for advice

Richard Perez, DPM on 6/27/01 at hrmin (051635)

Kelly,

Sinus Tarsi sydrome is an inflamation of the sinus tarsi canal, which is part of the subtalar joint. Once the problem begins, it can be very difficult to treat. Besides injections and orthosis, I also treat my recalcitrant cases with BK fiberglass cast..not cam-boots..IF all else fails, sinus tarsectomy may be an option.
However, if the cause of the sinus tarsi syndrome was the EPF, surgical failure rate would be much higher since you are treating a symptom.

Richard Perez, DPM

Re: Full of bullet holes, but still looking for advice

KellyD on 6/27/01 at 14:13 (051649)

Dr Perez - Thanks so much for your response. We did try the CAM boot for about 3 weeks and there was no improvement (except when in the boot of course!). How long do you cast for? What percentage of your recalcitrant cases have ended up with the sinus tarsectomy?

Re: Full of bullet holes, but still looking for advice

Richard Perez, DPM on 6/27/01 at hrmin (051650)

Generally 4-6 weeks of fiberglass casting..I use Cam-walkers for a great many problems, but when you want rigid complete imobilization, fiber glass is the best.

As far as who goes to surgery, very few..Then again, the diagnosis of sinus tarsi syndrome is rare. My procedure of choice in a small incision directly over the sinus tarsi, evacuate the entire space with an #11 blade. Postop shoe, TLS drain and PT.

Richard Perez, DPM

Re: Looking for Doctor's comments

Dr. Zuckerman on 6/27/01 at 17:12 (051666)

Hi,
I am a doctor and the answer that was given by Nany M is a great and truthful answer and she didn't stay at a holiday Inn. Joke. Keep up the great postings on this ask the doctor's board my friends.

Good answers are good answser no matter where they come from .

Re: Full of bullet holes, but still looking for advice

Dr. Zuckerman on 6/27/01 at 17:22 (051669)

Hi,

If you are going to consider sinus tarus surgery post EPF the failure rate could be high or short lived due to the abnormal joint functioning going on.

Some cases will need a fusion of the joints to eliminate the abnormal motion going on there . Your age , what the joints are like and the amount of activity level is a very important consideration.

Re: Full of bullet holes, but still looking for advice

Linda L. on 7/31/01 at hrmin (054960)

I have never used this form of communiction before but here goes...My mom is 73 years old an has had foot problems for 25 years-injections-lifts-holistic candles-support stockings and many other thisngs but no casts- her doctor is recommending surgery-what questions should I have my Mom ask the doctor-sucess rate- how long laid up- do I need to fly there??? Thank-you for your time.

Re: Sinus Tarsi Syndrome/post EPF ankle problems

Nancy M on 6/25/01 at 19:11 (051513)

Hi Kelly, I'm not a doctor, but I've had sinus tarsi. For those of you that don't know what sinus tarsi is, it's like carpal tunnel but in your foot. I had shots three times that lasted only a couple of days, PT, and then surgery the end of April to clean out the carpal. Foot is feeling great now, does let me know if I've walked too much during the day and I know that from all the other surgeries I've had on my feet (see below) that it takes anywhere from 6 months to a year to completely heal. I didn't even have a MRI done. My pod not able to figure out why I was having the pain finally sent me to an ortho. Told him where it hurt and he knew right away what it was. By the way I've also had EPF surgery on both feet, three neuroma's removed (2 left, 1 right) and two stress factures in my left foot, one on the top of my foot and another in my cuboid bone.

Nancy M in AZ

Re: Looking for Doctor's comments

KellyD on 6/26/01 at 12:30 (051557)

I appreciate the layperson perspective, but I'm definitely not interested in another surgery and am looking for a physician's advice.

Re: Looking for Doctor's comments

Nancy M on 6/26/01 at 18:28 (051573)

Excuse me!!!!!

Re: Looking for Doctor's comments

wendyn on 6/26/01 at 21:05 (051578)

Don't take it personally Nancy. It takes a lot of time to read these posts and go to the effort to respond to them. 99.9% of the people who post here appreciate that.

Re: Looking for Doctor's comments / I apreciate it friends!!!

Tammie on 6/26/01 at 21:17 (051580)

Ditto, I agree I just wanted to say I always appreciate your kindness even if it is something I did not WANT to hear lol ! Keep up the good work!

Re: Looking for Doctor's comments

Mary S. on 6/26/01 at 22:38 (051591)

I have learned so much from all of the sharing of information that is passed through all of the wonderful people on this message board. We all have something in common-we suffer with our feet. We have all spent tons of money on doctor's advice, treatments, therapy, surgery, etc. We have had good experiences and bad experiences that we have all learned from. The doctors are absolutely great--I sorta think of them as the coaches, but I can assure you that they approve of the rest of us working as a team to help each other.
If you ever need the support of others who know what you are going through, this is the place to come. You will find us all on the Social Board too. Wishing you well on many levels.

Re: Looking for Doctor's comments

Julie on 6/27/01 at 02:45 (051606)

Nancy, having had a similar sort of brush-off yesterday after spending a good half hour writing a response to someone here, I know how you felt. But as Wendy and the others have made clear, most people do appreciate the time and effort that goes into giving information and support, so please don't let it bug you. I think maybe Kelly (I think she is new: am I right, Kelly?) doesn't realize that the doctors themselves appreciate our 'lay' input, and have said so.

Kelly, I'm sure you will get a response from one of the doctors - just be patient. They are sterling souls who give their time and expertise here for nothing, and they have lots of other things to do. You'll find that most people who post here get a welcome and possibly some information from us lay folk, and unless what is said is way off base, it's usually a help to the docs.

Re: Thanks Everyone

Nancy M on 6/27/01 at 06:32 (051616)

I've been reading and posting occassionally on the board for almost 4 years. I just wasn't thrilled with here attitude. Thanks again!

Nancy M in AZ

Re: Full of bullet holes, but still looking for advice

KellyD on 6/27/01 at 11:34 (051633)

Okay ladies, if you're done ripping me apart, I'd like to draw your attention to the title of the board - 'Ask the Foot Doctors' - forgive me if I took it literally. I too have read and posted to this board extensively since my problems with PF began (NO - I'm not new)- and find it a wonderfully helpful tool with terrific people. But I specifically posted here because I wanted a doctor's opinion. I had already done extensive searches and read Nancy's several other posts on this subject. I'm certain you meant well, and I didn't mean to offend you, but I wanted to make it clear that while your input was appreciated, I didn't want them to overlook the post because it had been responded to.

Something else Nancy mentioned brought up another question. Perhaps the doctors can also provide additional clarification on what sinus tarsi syndrome is - versus tarsel tunnel syndrome. They are 2 different conditions, and my understanding is that tarsel tunnel is similar to carpel tunnel.

Re: Full of bullet holes, but still looking for advice

Richard Perez, DPM on 6/27/01 at hrmin (051635)

Kelly,

Sinus Tarsi sydrome is an inflamation of the sinus tarsi canal, which is part of the subtalar joint. Once the problem begins, it can be very difficult to treat. Besides injections and orthosis, I also treat my recalcitrant cases with BK fiberglass cast..not cam-boots..IF all else fails, sinus tarsectomy may be an option.
However, if the cause of the sinus tarsi syndrome was the EPF, surgical failure rate would be much higher since you are treating a symptom.

Richard Perez, DPM

Re: Full of bullet holes, but still looking for advice

KellyD on 6/27/01 at 14:13 (051649)

Dr Perez - Thanks so much for your response. We did try the CAM boot for about 3 weeks and there was no improvement (except when in the boot of course!). How long do you cast for? What percentage of your recalcitrant cases have ended up with the sinus tarsectomy?

Re: Full of bullet holes, but still looking for advice

Richard Perez, DPM on 6/27/01 at hrmin (051650)

Generally 4-6 weeks of fiberglass casting..I use Cam-walkers for a great many problems, but when you want rigid complete imobilization, fiber glass is the best.

As far as who goes to surgery, very few..Then again, the diagnosis of sinus tarsi syndrome is rare. My procedure of choice in a small incision directly over the sinus tarsi, evacuate the entire space with an #11 blade. Postop shoe, TLS drain and PT.

Richard Perez, DPM

Re: Looking for Doctor's comments

Dr. Zuckerman on 6/27/01 at 17:12 (051666)

Hi,
I am a doctor and the answer that was given by Nany M is a great and truthful answer and she didn't stay at a holiday Inn. Joke. Keep up the great postings on this ask the doctor's board my friends.

Good answers are good answser no matter where they come from .

Re: Full of bullet holes, but still looking for advice

Dr. Zuckerman on 6/27/01 at 17:22 (051669)

Hi,

If you are going to consider sinus tarus surgery post EPF the failure rate could be high or short lived due to the abnormal joint functioning going on.

Some cases will need a fusion of the joints to eliminate the abnormal motion going on there . Your age , what the joints are like and the amount of activity level is a very important consideration.

Re: Full of bullet holes, but still looking for advice

Linda L. on 7/31/01 at hrmin (054960)

I have never used this form of communiction before but here goes...My mom is 73 years old an has had foot problems for 25 years-injections-lifts-holistic candles-support stockings and many other thisngs but no casts- her doctor is recommending surgery-what questions should I have my Mom ask the doctor-sucess rate- how long laid up- do I need to fly there??? Thank-you for your time.