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

Has anyone had this problem?

Posted by Carol C on 8/28/01 at 19:53 (058297)

My 'Possible TTS' is in my LEFT foot....I have noticed lately that when I
stand with both feet flat on the ground, I can seperate my big toe and the
toe next to it on the RIGHT foot, but on the foot possibly affected by
the TTS, I can not seperate my big toe and the toe next to it. By seperating, I mean a side to side seperation. I can raise and lower the
the big toe, I just can not pull it away from the toe next to it on the
affected foot.
Is this caused by some nerve damage or what could possibly be causing
this to happen? Any suggestions?

Re: Has anyone had this problem?

Ed Davis, DPM on 8/28/01 at 19:56 (058298)

Up and down motion of the big toe comes from muscles outside the foot. The ability to pull the big toe away from the second toe comes from the abductor hallucis muscle( within the foot and innervated by the post. tib. nerve) so TTS could have a direct effect.Ed

Re: Has anyone had this problem?

Carol C on 8/28/01 at 20:03 (058299)

Thanks for the quick reply. Unfortunately, I think that as time progresses, I am finding more and more symptoms that seem to define
my diagnosis as TTS. If only the Nerve conduction had been positive
it would be so much easier to prove. As it is, it seems to be a rule
out everything else process. My ortho and the Neuro consultant both
seem to feel that it is TTS even with the negative Nerve conduction
study...One more step...the Cortizone Injection and then we will
progress to surgery. Hopefully with early intervention, this will
respond well and I will have a full recovery. I only began to notice
my symptoms on June 15 and it was a sudden onset of Numbness followed
by increasing pain.

Re: Has anyone had this problem?

elliott on 8/28/01 at 21:41 (058303)

Exactly where and what are your nerve symptoms?

Re: Has anyone had this problem?

susanm on 8/28/01 at 21:59 (058304)

Carol,

I am also having problems with my toes. Once fairly evenly spaced, two on each foot have grown closer together and I can't spread them apart. When I curl my toes upward, they don't go. What could be going on? I am suspicious of all the injections I've had for neuroma.

Re: Has anyone had this problem?

wendyn on 8/28/01 at 23:25 (058309)

Carol - without a positive nerve conduction test - consider your surgical option VERY carefully. If they are going to operate - WHAT are they going to fix?

I have heard WAY WAY too many times on this board and others of people who had negative tests, surgery, and poor results.

If there is a lump, or a mass sitting in the tunnel that a doctor can remove - results are often good. It's those 'unknown' 'unexplained' cases that seem to more often have poor results.

Please take your time, and insist on an MRI and full blood work up prior to considering surgery. (If you've already done this - I apologize..I have a hard time keeping histories straight).

Re: Has anyone had this problem?

wendyn on 8/28/01 at 23:28 (058310)

I dunno Carol - I'm confused. When I stand on my feet I can't separate ANY of my toes. I can sort of separate them when I'm sitting - but not real well.

Re: Has anyone had this problem?

Ed Davis, DPM on 8/29/01 at 01:01 (058315)

Good point. Tarsal tunnel syndrome can mimick symptoms consistent with multiple intermetatarsal neuromas.
Ed

Re: Has anyone had this problem?

Ed Davis, DPM on 8/29/01 at 01:02 (058316)

An MRI is definitely worthwhile especially if the TTS symptoms seemed to have come on as rapidly as in your case.
Ed

Re: Has anyone had this problem?

cindyp on 8/29/01 at 06:06 (058322)

Well Ihave this problemwith the last three on my right foot. Sometimes I can and they shake really bad. Sometimes I cannot at all.But the dr.said that may never come back. I wouldn't worry thatmuch about it. Just make sure you get a concrete diagnosis. GET the MRI if possible.

Re: Has anyone had this problem?

Leslie W on 8/29/01 at 08:07 (058332)

My podiatrist has been treating me for Plantar Fasciitis for 10 months. After taping, injections, anti-inflammatory drugs, icing, stretching, etc...she casted me for 3 weeks.
The tendon improved but the heel pain remained. After walking for 3 days, my arch swelled huge. She then referred me for the nerve conduction study for TTS.

My question is this. I had an MRI of my foot which confirmed her original diagnosis of Plantar Fasciitis. If I hav TTS, would the MRI have indicated as such...or do the radiologists only seek to rule out or confirm the drs. original suspicion?

Thank you.

cwerner@mediaone.net :Leslie

Re: Has anyone had this problem?

wendyn on 8/29/01 at 08:20 (058333)

It is possible to have both (often the same structural problems can be involved). A nerve conduction test is the next logical step - I hope it provides you with some answers.

Re: Dr. Ed ??? (re: has anyone had this problem)

Carol C on 8/29/01 at 19:02 (058391)

If it were caused by Neuromas---would that cause the lateral pain on the side of the foot and also the tenderness in the arch and the ankle area as well?

Re: Has anyone had this problem?

Ed Davis, DPM on 8/29/01 at 22:52 (058410)

An MRI is done to see if their is a structure--cyst, ganglion, tumor, varicosity potentially impinging on the posterior tibal nerve. If no such structure is found on MRI, one of the major causes of TTS is ruled out but TTS itself is not ruled out. TTS can be caused without pressure from a growth visible on MRI--can be scar tissue within the tunnel.
Ed

Re: Has anyone tried this for this problem?

elliott on 8/30/01 at 01:01 (058418)

You muster all your willpower and concentration on trying to separate the toes (no hands allowed!). Exercise them daily, possibly leaving the muscles temporarily sore at times, but after several months, you might see some improvement.

As an aside, the EMG (needles) part of the nerve conduction test as well as visual observation by the neurologist may confirm or offer evidence of a TTS connection.

Re: anyone home?

elliott on 8/30/01 at 01:08 (058419)

I've asked so many people seeking TTS advice exactly where and what are their symptoms, and more often than not, they just ignore my post. I am just so sad. :-)

Re: anyone home?

wendyn on 8/30/01 at 09:41 (058443)

When my TTS was bad - the pain was primarily on the bottom of my foot (arch), into my toes and behind the ankle bone (inner ankle). I also had pain at times in my baby toe - and along the outside of my foot. The pain often treavelled up the tib nerve and into my calf and back of leg. I also sometimes had pain in the peroneal nerve area by my knee.

Now - the pain is usually isolated to a very specific area in the tunnel - right where you think it should be - along with the arches of my feet. The pain in my ankle most often will feel a lot like a tooth ache. I have additional pain from the tendon - but to me the 'nerve' pain and the 'tendon' pain feel very different...I don't even think I have a Tinnel's sign any more - I'm not going to whack around too hard to find out. When the doctors used to tap there- the shocks would go down into my foot and also up my inner leg.

Sometimes my feet will turn bright red and somewhat puffy. When they do that IT REALLY HURTS. Only ever happens in late evening and is always associated with a significant increase in pain. I like nice cool white feet.

Re: didn't mean you, but thanks anyway

elliott on 8/30/01 at 15:55 (058498)

I think I've seen yours before, but thanks for repeating it; maybe we should all repeat our symptoms periodically, as it may trigger some advice from someone seeing it for the first time who went through something similar. As you've said, your case apparently is one of those where numerous things are going on at once, and youv'e said it is degenerative (hope those that told you are wrong and you recover!).

Many come on here and immediately talk at length about the frustration of dealing with TTS and doctors, that they are contemplating surgery surprisingly only a month after pain started, that they're afraid of cortisone shots, etc. Fine, but they don't post their symptoms, which would be real helpful as the starting point for advice here. Of those who do, some complain only of things like pain just in the ball or toes only, sounding suspiciously not like TTS at all.

--------------

Re: anyone home?

Carol C on 8/30/01 at 19:40 (058519)

Ok...here is my story! On June 15, 2001, I woke up with numbness in the ball of my foot extending down into the arch area. The day and evening before, I had done a large amount of house cleaning and moving furniture, vaccuming, hanging curtians, and deep cleaning things. Because of all that, I figured that I had just done something to aggrivate my foot. Over the next several days, I gradually had an increase in the 'depth' of numbness and development of pain in the ankle ankle and arch area. I went to see my family practice doctor who because of my history of cleaning, lifting, moving furniture and such, felt that I may have ruptured a disc
in my back and wanted me to see a Neuro consult. They also did a signifigant laboratory workup to rule out all possibility of diabetes as
being a contributing factor. By my choice, while waiting to see the Neuro
consult, I went to my Orthopedic physician that I had used over many years.
He felt confident that I did not have a disc injury and ruled out a back
injury as the cause. I do have bilateral carpal tunnel in both wrist.
I told all three doctors that I felt as if I had carpal tunnel in my foot.
The neurologist said that he felt that I had Tarsal Tunnel Syndrome based
on the numbness, positive Tinels sign, pain on the lateral side of the foot, pain in the little toe, pain in the arch and tenderness in the ankle. He waited two weeks and then did a Nerve Conduction study which was negative for TTS.As time has progressed, the numbness is still there, however at times, I will have episodes of shooting types of pain that
starts in my mid arch area and shoots into my big toe. However, based on the symptoms, the neurologist and my orthopedist, both feel confident that I do have TTS. I am scheduled to have the Cortisone injection next Wednesday to see if it provides relief,and if it does not, Surgery is the next option offered to me.
Medications to date have included Topamax and Vioxx. Neither of them have
provide any relief for the symptoms.
I also can not seperate the big toe from the toe next (lateral movement)
on the affected foot)
The affected foot will also have the sensation of being cold at times, however if I physically touch it with my hand, the affected foot is equally
as warm and the unaffected foot. I do not like for things such as socks
to touch my foot and it always feels like my socks or hose are 'bunched up'
underneath the ball of my foot even though they are not at all.
So----what doe all this sound like to you? Can you help me out?

Re: Has anyone had this problem?

Carol C on 8/30/01 at 20:13 (058523)

What Lab would you suggest?
I have had all the basic...CBC, CHEM PANELs, HGBA1C, Serum Insulin Level,
Rheumatoid Profile, Cholesterol/Triglycerides, Liver Profile, Thyroid Proifle, TSH, those are what I remember right off hand.
I have not had a MRI.
THe docs felt that the Negative Nerve Conduction was the result of my
having not had time for nerve damage to occour as of yet.
Thanks for any suggestions.
Do you think my symptoms sound like TTS or not?

Re: anyone home? Yes, but mine doesn't show up?

Chris M. on 8/30/01 at 20:25 (058525)

Hey Elliot:
I am home.
I am the author of the post '3 months post TTS release...' right after Cuboidal syndrome question. I wrote back, regarding symptoms, etc. and it is only apparent when you click the view thread and scroll down. As, from the subject line headings post, it lists only four. Check it out.

Re: wow! a hidden post!

elliott on 8/31/01 at 01:10 (058545)

No, I didn't see that one. Wonder if Scott knows about this. There are other mysterious goings on, especially in the treatments forum, where a separate new post often becomes a threadstarter for older ones. You may want to re-post your last one anew in case others have any ideas.

By posterior tibial area of ankle, do you mean directly behind and below the medial side of your ankle? Where exactly on the sole? You said you have intense pain up the interior (medial and frontal) shin. Not sure about that. I thought if it radiates on the proximal (knee) side of the ankle, it should be more up the back of the calf (that's what I had and what I've seen in print, and hence the word posterior) than at the front shin, but I didn't have it going all the way up, either; maybe one of the docs here can help on that. What clearly doesn't fit is your numbness on the top of the foot. Let me make sure I get this: you have numbness directly in dead center directly on top of the foot? Is that from instep area running along top of foot until toes 2 and 3? This just does not fit with TTS (although it can with other nerve entrapments), as the posterior tibial nerve or its branches just do not run there on top, and if you're very sure it's clearly just nos. 2 and 3, as opposed to general tingling in toes where it's sometimes hard to distinguish which toes it is, then that does not fit either. You are far enough post-op that you should've felt a change. Similar symptoms starting in other foot sounds like a possibly more global cause too. I think you need to seek out further opinions from other docs and neuros. If you post where you live, maybe someone here can refer you to ones they trust.

Hope things work out.

Re: thanks!

elliott on 8/31/01 at 01:25 (058548)

Not sure if I can help (maybe others can), but at least now I know your story. Not being able to separate big toe from next one happened all of a sudden? Please try icing five times a day/ 15 minutes a shot on affected areas if you have not already done so. Did you try ibuprofen? Careful stretching?

Where exactly is your pain on the lateral side? This could be important. From the rest of it, it sounds almost like you sprained or jarred something in the ball/arch, and that symptoms spread from there. I presume when you refer to arch you mean medial (inner) arch.

The bilateral carpal also gives something to think about. Were you tested for other things also (e.g. MS, rheumatoid arth, etc.)? It's still early for you. Recommend don't rush into surgery. The last thing you want is a TTS release at ankle area when your problem originates elsewhere.

Re: to susanm

elliott on 8/31/01 at 01:30 (058549)

Could you please post your complete symptoms and how they developed (see the 'anyone home?' subthread above). Maybe someone here can help.

Re: wow! a hidden post!

Scott R on 8/31/01 at 12:47 (058585)

yea, i got a little quirk in the programming. it may be because he use ' so-and-so ' in the message. minus signs can play havoc if the letters attached match my 2 and 3 letter codes for the message boards.

Re: wow! a hidden post!

Chris M. on 8/31/01 at 14:58 (058604)

Let me see if I can answer your questions. I had left calf pain from TTs BEFORE cortisone and orthotics. I really can say those two rememdies did offer some relief for me. In reference to the shin and knee pain, the PA from the ortho surg's office may have hit it, when he felt my altered gait was causing it. PA gave me Vioxx samples, it resolved, samples ended...and just don't get me started on the surgeon. I wanted him because he is board certified in sports med, and ortho surg. What a combo, unfortunately, having the personality of an onion, I will not see him again. I have a bone spur on my second left metatarsal (spelled right?) bone. I really wonder if it is scraping on the nerve. Not exactly sure where that dorsal foot nerve is. Although my ankle it Aches in the dead center. I mean deep inside the body, I guess it would be around the navicular, tibial articulation area.

When TTS began I was hill training at a 7.5 degree incline. I know that is killer on the achilles. Funny, I always thought, 'I'm going to blow out a knee'

My right foot has mild TTS. a long,long time ago, the right arch hurt to run, first surgery was to repair the post. tibial tendon, rupture sheath. Back within two years. same doc went in. I had grown a tumor there. It was as I was told 'fatty' as your body was trying to protect itself from trauma??? This is over 10 years ago, as I am OLD. That along with all this aches and pains

Had sciatica on the right for two years, it left. I did no intervention for that, it resolved.

I will see the neurologist on 9/4/01 and definitely I have thought that maybe I have something widespread and that problem manifested TTS.
I believe that eventually is will all sort out.

My left ankle incision is strange. The scar is not particullary wide. The tissue around it is like rock hard. Like unstretchy skin. How do I explain this? Like someone poured super glue into the incision and closed it. I think my body made it 'fibrotic' or rigid in the healing process.

More Later

Re: anyone home?

SonnyK on 9/03/01 at 23:17 (058974)

My symptoms started over a year ago. I had pain in my right ankle all the time..resting or not. The ankle was swollen sometimes and always tender to the touch...like my skin 'hurt'. When I woke up in the morning I had to limp out of bed and it got worse every day. The pain was on the inside of my right ankle but sometimes went up my leg and down to my toes too. It was like a sharp stabbing pain. I also felt tingling sensations up to my toes sometimes. If I ever bumped the inside os my ankle I would litterally cry it hurt so bad. My family doc told me I had arthritis and to take advil. Well, just by looking at my ankle you could see it looked different. I have since found out that I have flat feet and my ankles are turning in. My ortho thinks that this may have been pressing on the nerve(s). I had a positive EMG in July so he scheduled surgery for August 17. He said he didn't see any other 'conservative methods' working at this point. I had lived with the pain so long that I agreed. I had read things here about different meds, shots, etc. and it seemed like short term relief. I had read every thing I could get my hands on up to this point...so I knew about the surgery and what to expect. Of course I was scared of having my leg cut open but I felt desperate. My Ortho seemed confident (although I don't like his personality) so I went through with the surgery. I have a four inch incision over and up behind the ankle bone. I had pain after but no drainage or swelling. I kept my foot elevated almost all the time for the first week. I still have the stiches in (getting them out tomorrow) and I have started to bear weight on my foot with a 'boot' on. I still get the sharp pains once in a while and have felt some of that electrical tingling. I hope I am a success story because I have read so many horror stories. I am anxious to get on with my life.

Re: anyone home?

elliott on 9/04/01 at 18:49 (059032)

Thanks for that report.

Can I ask which toes you felt the tingling in? Also, nothing wrong with flat feet per se, and if by turning in you mean simply that you overpronate, that's pretty common too and correctible if causing problems e.g. with specific shoes or orthotics. A little late now, but did you try that? Of course, there are types of trendon dysfunction called such things as adult acquired flat foot, which are a different beast. In general, swelling is cause for concern, because it suggests possible unknown causes contributing towards your TTS.

Sharp shooting pains and a bit of electrical tingling is normal post-op (wish my first ortho would've told me that, though) and suggests healing. (In fact, producing such sensation post-op is the real definition of a Tinel's sign, unlike how everyone informally uses the terminology as a pre-surgical tapping test.) Of course, such problems, especially if it felt exactly the same pre-surgery, could be indicative of surgical failure. It's just too early for you to worry about it just yet, so don't. Rest up, take care, and let's all hope for the best.

Re: anyone home?Elliott

Tammie on 9/04/01 at 20:52 (059042)

Thanks for telling about the normal of the tingling , and the sharp shooting that it is normal post op! Yes it is such a small thing to the docs I think they forget to really stress that we may feel thease and to not worry it will be normal healing. I to was worried! Thank you! You do seem to have alot of good knowledge to share, I do read when you post. Thanks again.

Re: Foot problems

Pat W. on 10/08/01 at 01:20 (062453)

I have severe problems with my feet in this area. The worst is that it is not my big toe, but my little toes are really close to the toe next to them. It has now gotten to the point where sores are generating between these two toes. I don't know what to do. I constantly am drying them to no avail. I have used anti persperant on my feet to try and stop the sweating that is going on down there, but that has not help. I have been to a doctor who prescribed a stronger anti perspirant, but I cant apply it to open sores which they become often. I tried only wearing sandals, it seemed to help during the summer, but my tootsies get cold in the winter. Now I have burning, itching blisters forming all over my feet. That have no real cure. All I can do is put cortizone on them.

Re: Has anyone had this problem?

Ed Davis, DPM on 8/28/01 at 19:56 (058298)

Up and down motion of the big toe comes from muscles outside the foot. The ability to pull the big toe away from the second toe comes from the abductor hallucis muscle( within the foot and innervated by the post. tib. nerve) so TTS could have a direct effect.Ed

Re: Has anyone had this problem?

Carol C on 8/28/01 at 20:03 (058299)

Thanks for the quick reply. Unfortunately, I think that as time progresses, I am finding more and more symptoms that seem to define
my diagnosis as TTS. If only the Nerve conduction had been positive
it would be so much easier to prove. As it is, it seems to be a rule
out everything else process. My ortho and the Neuro consultant both
seem to feel that it is TTS even with the negative Nerve conduction
study...One more step...the Cortizone Injection and then we will
progress to surgery. Hopefully with early intervention, this will
respond well and I will have a full recovery. I only began to notice
my symptoms on June 15 and it was a sudden onset of Numbness followed
by increasing pain.

Re: Has anyone had this problem?

elliott on 8/28/01 at 21:41 (058303)

Exactly where and what are your nerve symptoms?

Re: Has anyone had this problem?

susanm on 8/28/01 at 21:59 (058304)

Carol,

I am also having problems with my toes. Once fairly evenly spaced, two on each foot have grown closer together and I can't spread them apart. When I curl my toes upward, they don't go. What could be going on? I am suspicious of all the injections I've had for neuroma.

Re: Has anyone had this problem?

wendyn on 8/28/01 at 23:25 (058309)

Carol - without a positive nerve conduction test - consider your surgical option VERY carefully. If they are going to operate - WHAT are they going to fix?

I have heard WAY WAY too many times on this board and others of people who had negative tests, surgery, and poor results.

If there is a lump, or a mass sitting in the tunnel that a doctor can remove - results are often good. It's those 'unknown' 'unexplained' cases that seem to more often have poor results.

Please take your time, and insist on an MRI and full blood work up prior to considering surgery. (If you've already done this - I apologize..I have a hard time keeping histories straight).

Re: Has anyone had this problem?

wendyn on 8/28/01 at 23:28 (058310)

I dunno Carol - I'm confused. When I stand on my feet I can't separate ANY of my toes. I can sort of separate them when I'm sitting - but not real well.

Re: Has anyone had this problem?

Ed Davis, DPM on 8/29/01 at 01:01 (058315)

Good point. Tarsal tunnel syndrome can mimick symptoms consistent with multiple intermetatarsal neuromas.
Ed

Re: Has anyone had this problem?

Ed Davis, DPM on 8/29/01 at 01:02 (058316)

An MRI is definitely worthwhile especially if the TTS symptoms seemed to have come on as rapidly as in your case.
Ed

Re: Has anyone had this problem?

cindyp on 8/29/01 at 06:06 (058322)

Well Ihave this problemwith the last three on my right foot. Sometimes I can and they shake really bad. Sometimes I cannot at all.But the dr.said that may never come back. I wouldn't worry thatmuch about it. Just make sure you get a concrete diagnosis. GET the MRI if possible.

Re: Has anyone had this problem?

Leslie W on 8/29/01 at 08:07 (058332)

My podiatrist has been treating me for Plantar Fasciitis for 10 months. After taping, injections, anti-inflammatory drugs, icing, stretching, etc...she casted me for 3 weeks.
The tendon improved but the heel pain remained. After walking for 3 days, my arch swelled huge. She then referred me for the nerve conduction study for TTS.

My question is this. I had an MRI of my foot which confirmed her original diagnosis of Plantar Fasciitis. If I hav TTS, would the MRI have indicated as such...or do the radiologists only seek to rule out or confirm the drs. original suspicion?

Thank you.

cwerner@mediaone.net :Leslie

Re: Has anyone had this problem?

wendyn on 8/29/01 at 08:20 (058333)

It is possible to have both (often the same structural problems can be involved). A nerve conduction test is the next logical step - I hope it provides you with some answers.

Re: Dr. Ed ??? (re: has anyone had this problem)

Carol C on 8/29/01 at 19:02 (058391)

If it were caused by Neuromas---would that cause the lateral pain on the side of the foot and also the tenderness in the arch and the ankle area as well?

Re: Has anyone had this problem?

Ed Davis, DPM on 8/29/01 at 22:52 (058410)

An MRI is done to see if their is a structure--cyst, ganglion, tumor, varicosity potentially impinging on the posterior tibal nerve. If no such structure is found on MRI, one of the major causes of TTS is ruled out but TTS itself is not ruled out. TTS can be caused without pressure from a growth visible on MRI--can be scar tissue within the tunnel.
Ed

Re: Has anyone tried this for this problem?

elliott on 8/30/01 at 01:01 (058418)

You muster all your willpower and concentration on trying to separate the toes (no hands allowed!). Exercise them daily, possibly leaving the muscles temporarily sore at times, but after several months, you might see some improvement.

As an aside, the EMG (needles) part of the nerve conduction test as well as visual observation by the neurologist may confirm or offer evidence of a TTS connection.

Re: anyone home?

elliott on 8/30/01 at 01:08 (058419)

I've asked so many people seeking TTS advice exactly where and what are their symptoms, and more often than not, they just ignore my post. I am just so sad. :-)

Re: anyone home?

wendyn on 8/30/01 at 09:41 (058443)

When my TTS was bad - the pain was primarily on the bottom of my foot (arch), into my toes and behind the ankle bone (inner ankle). I also had pain at times in my baby toe - and along the outside of my foot. The pain often treavelled up the tib nerve and into my calf and back of leg. I also sometimes had pain in the peroneal nerve area by my knee.

Now - the pain is usually isolated to a very specific area in the tunnel - right where you think it should be - along with the arches of my feet. The pain in my ankle most often will feel a lot like a tooth ache. I have additional pain from the tendon - but to me the 'nerve' pain and the 'tendon' pain feel very different...I don't even think I have a Tinnel's sign any more - I'm not going to whack around too hard to find out. When the doctors used to tap there- the shocks would go down into my foot and also up my inner leg.

Sometimes my feet will turn bright red and somewhat puffy. When they do that IT REALLY HURTS. Only ever happens in late evening and is always associated with a significant increase in pain. I like nice cool white feet.

Re: didn't mean you, but thanks anyway

elliott on 8/30/01 at 15:55 (058498)

I think I've seen yours before, but thanks for repeating it; maybe we should all repeat our symptoms periodically, as it may trigger some advice from someone seeing it for the first time who went through something similar. As you've said, your case apparently is one of those where numerous things are going on at once, and youv'e said it is degenerative (hope those that told you are wrong and you recover!).

Many come on here and immediately talk at length about the frustration of dealing with TTS and doctors, that they are contemplating surgery surprisingly only a month after pain started, that they're afraid of cortisone shots, etc. Fine, but they don't post their symptoms, which would be real helpful as the starting point for advice here. Of those who do, some complain only of things like pain just in the ball or toes only, sounding suspiciously not like TTS at all.

--------------

Re: anyone home?

Carol C on 8/30/01 at 19:40 (058519)

Ok...here is my story! On June 15, 2001, I woke up with numbness in the ball of my foot extending down into the arch area. The day and evening before, I had done a large amount of house cleaning and moving furniture, vaccuming, hanging curtians, and deep cleaning things. Because of all that, I figured that I had just done something to aggrivate my foot. Over the next several days, I gradually had an increase in the 'depth' of numbness and development of pain in the ankle ankle and arch area. I went to see my family practice doctor who because of my history of cleaning, lifting, moving furniture and such, felt that I may have ruptured a disc
in my back and wanted me to see a Neuro consult. They also did a signifigant laboratory workup to rule out all possibility of diabetes as
being a contributing factor. By my choice, while waiting to see the Neuro
consult, I went to my Orthopedic physician that I had used over many years.
He felt confident that I did not have a disc injury and ruled out a back
injury as the cause. I do have bilateral carpal tunnel in both wrist.
I told all three doctors that I felt as if I had carpal tunnel in my foot.
The neurologist said that he felt that I had Tarsal Tunnel Syndrome based
on the numbness, positive Tinels sign, pain on the lateral side of the foot, pain in the little toe, pain in the arch and tenderness in the ankle. He waited two weeks and then did a Nerve Conduction study which was negative for TTS.As time has progressed, the numbness is still there, however at times, I will have episodes of shooting types of pain that
starts in my mid arch area and shoots into my big toe. However, based on the symptoms, the neurologist and my orthopedist, both feel confident that I do have TTS. I am scheduled to have the Cortisone injection next Wednesday to see if it provides relief,and if it does not, Surgery is the next option offered to me.
Medications to date have included Topamax and Vioxx. Neither of them have
provide any relief for the symptoms.
I also can not seperate the big toe from the toe next (lateral movement)
on the affected foot)
The affected foot will also have the sensation of being cold at times, however if I physically touch it with my hand, the affected foot is equally
as warm and the unaffected foot. I do not like for things such as socks
to touch my foot and it always feels like my socks or hose are 'bunched up'
underneath the ball of my foot even though they are not at all.
So----what doe all this sound like to you? Can you help me out?

Re: Has anyone had this problem?

Carol C on 8/30/01 at 20:13 (058523)

What Lab would you suggest?
I have had all the basic...CBC, CHEM PANELs, HGBA1C, Serum Insulin Level,
Rheumatoid Profile, Cholesterol/Triglycerides, Liver Profile, Thyroid Proifle, TSH, those are what I remember right off hand.
I have not had a MRI.
THe docs felt that the Negative Nerve Conduction was the result of my
having not had time for nerve damage to occour as of yet.
Thanks for any suggestions.
Do you think my symptoms sound like TTS or not?

Re: anyone home? Yes, but mine doesn't show up?

Chris M. on 8/30/01 at 20:25 (058525)

Hey Elliot:
I am home.
I am the author of the post '3 months post TTS release...' right after Cuboidal syndrome question. I wrote back, regarding symptoms, etc. and it is only apparent when you click the view thread and scroll down. As, from the subject line headings post, it lists only four. Check it out.

Re: wow! a hidden post!

elliott on 8/31/01 at 01:10 (058545)

No, I didn't see that one. Wonder if Scott knows about this. There are other mysterious goings on, especially in the treatments forum, where a separate new post often becomes a threadstarter for older ones. You may want to re-post your last one anew in case others have any ideas.

By posterior tibial area of ankle, do you mean directly behind and below the medial side of your ankle? Where exactly on the sole? You said you have intense pain up the interior (medial and frontal) shin. Not sure about that. I thought if it radiates on the proximal (knee) side of the ankle, it should be more up the back of the calf (that's what I had and what I've seen in print, and hence the word posterior) than at the front shin, but I didn't have it going all the way up, either; maybe one of the docs here can help on that. What clearly doesn't fit is your numbness on the top of the foot. Let me make sure I get this: you have numbness directly in dead center directly on top of the foot? Is that from instep area running along top of foot until toes 2 and 3? This just does not fit with TTS (although it can with other nerve entrapments), as the posterior tibial nerve or its branches just do not run there on top, and if you're very sure it's clearly just nos. 2 and 3, as opposed to general tingling in toes where it's sometimes hard to distinguish which toes it is, then that does not fit either. You are far enough post-op that you should've felt a change. Similar symptoms starting in other foot sounds like a possibly more global cause too. I think you need to seek out further opinions from other docs and neuros. If you post where you live, maybe someone here can refer you to ones they trust.

Hope things work out.

Re: thanks!

elliott on 8/31/01 at 01:25 (058548)

Not sure if I can help (maybe others can), but at least now I know your story. Not being able to separate big toe from next one happened all of a sudden? Please try icing five times a day/ 15 minutes a shot on affected areas if you have not already done so. Did you try ibuprofen? Careful stretching?

Where exactly is your pain on the lateral side? This could be important. From the rest of it, it sounds almost like you sprained or jarred something in the ball/arch, and that symptoms spread from there. I presume when you refer to arch you mean medial (inner) arch.

The bilateral carpal also gives something to think about. Were you tested for other things also (e.g. MS, rheumatoid arth, etc.)? It's still early for you. Recommend don't rush into surgery. The last thing you want is a TTS release at ankle area when your problem originates elsewhere.

Re: to susanm

elliott on 8/31/01 at 01:30 (058549)

Could you please post your complete symptoms and how they developed (see the 'anyone home?' subthread above). Maybe someone here can help.

Re: wow! a hidden post!

Scott R on 8/31/01 at 12:47 (058585)

yea, i got a little quirk in the programming. it may be because he use ' so-and-so ' in the message. minus signs can play havoc if the letters attached match my 2 and 3 letter codes for the message boards.

Re: wow! a hidden post!

Chris M. on 8/31/01 at 14:58 (058604)

Let me see if I can answer your questions. I had left calf pain from TTs BEFORE cortisone and orthotics. I really can say those two rememdies did offer some relief for me. In reference to the shin and knee pain, the PA from the ortho surg's office may have hit it, when he felt my altered gait was causing it. PA gave me Vioxx samples, it resolved, samples ended...and just don't get me started on the surgeon. I wanted him because he is board certified in sports med, and ortho surg. What a combo, unfortunately, having the personality of an onion, I will not see him again. I have a bone spur on my second left metatarsal (spelled right?) bone. I really wonder if it is scraping on the nerve. Not exactly sure where that dorsal foot nerve is. Although my ankle it Aches in the dead center. I mean deep inside the body, I guess it would be around the navicular, tibial articulation area.

When TTS began I was hill training at a 7.5 degree incline. I know that is killer on the achilles. Funny, I always thought, 'I'm going to blow out a knee'

My right foot has mild TTS. a long,long time ago, the right arch hurt to run, first surgery was to repair the post. tibial tendon, rupture sheath. Back within two years. same doc went in. I had grown a tumor there. It was as I was told 'fatty' as your body was trying to protect itself from trauma??? This is over 10 years ago, as I am OLD. That along with all this aches and pains

Had sciatica on the right for two years, it left. I did no intervention for that, it resolved.

I will see the neurologist on 9/4/01 and definitely I have thought that maybe I have something widespread and that problem manifested TTS.
I believe that eventually is will all sort out.

My left ankle incision is strange. The scar is not particullary wide. The tissue around it is like rock hard. Like unstretchy skin. How do I explain this? Like someone poured super glue into the incision and closed it. I think my body made it 'fibrotic' or rigid in the healing process.

More Later

Re: anyone home?

SonnyK on 9/03/01 at 23:17 (058974)

My symptoms started over a year ago. I had pain in my right ankle all the time..resting or not. The ankle was swollen sometimes and always tender to the touch...like my skin 'hurt'. When I woke up in the morning I had to limp out of bed and it got worse every day. The pain was on the inside of my right ankle but sometimes went up my leg and down to my toes too. It was like a sharp stabbing pain. I also felt tingling sensations up to my toes sometimes. If I ever bumped the inside os my ankle I would litterally cry it hurt so bad. My family doc told me I had arthritis and to take advil. Well, just by looking at my ankle you could see it looked different. I have since found out that I have flat feet and my ankles are turning in. My ortho thinks that this may have been pressing on the nerve(s). I had a positive EMG in July so he scheduled surgery for August 17. He said he didn't see any other 'conservative methods' working at this point. I had lived with the pain so long that I agreed. I had read things here about different meds, shots, etc. and it seemed like short term relief. I had read every thing I could get my hands on up to this point...so I knew about the surgery and what to expect. Of course I was scared of having my leg cut open but I felt desperate. My Ortho seemed confident (although I don't like his personality) so I went through with the surgery. I have a four inch incision over and up behind the ankle bone. I had pain after but no drainage or swelling. I kept my foot elevated almost all the time for the first week. I still have the stiches in (getting them out tomorrow) and I have started to bear weight on my foot with a 'boot' on. I still get the sharp pains once in a while and have felt some of that electrical tingling. I hope I am a success story because I have read so many horror stories. I am anxious to get on with my life.

Re: anyone home?

elliott on 9/04/01 at 18:49 (059032)

Thanks for that report.

Can I ask which toes you felt the tingling in? Also, nothing wrong with flat feet per se, and if by turning in you mean simply that you overpronate, that's pretty common too and correctible if causing problems e.g. with specific shoes or orthotics. A little late now, but did you try that? Of course, there are types of trendon dysfunction called such things as adult acquired flat foot, which are a different beast. In general, swelling is cause for concern, because it suggests possible unknown causes contributing towards your TTS.

Sharp shooting pains and a bit of electrical tingling is normal post-op (wish my first ortho would've told me that, though) and suggests healing. (In fact, producing such sensation post-op is the real definition of a Tinel's sign, unlike how everyone informally uses the terminology as a pre-surgical tapping test.) Of course, such problems, especially if it felt exactly the same pre-surgery, could be indicative of surgical failure. It's just too early for you to worry about it just yet, so don't. Rest up, take care, and let's all hope for the best.

Re: anyone home?Elliott

Tammie on 9/04/01 at 20:52 (059042)

Thanks for telling about the normal of the tingling , and the sharp shooting that it is normal post op! Yes it is such a small thing to the docs I think they forget to really stress that we may feel thease and to not worry it will be normal healing. I to was worried! Thank you! You do seem to have alot of good knowledge to share, I do read when you post. Thanks again.

Re: Foot problems

Pat W. on 10/08/01 at 01:20 (062453)

I have severe problems with my feet in this area. The worst is that it is not my big toe, but my little toes are really close to the toe next to them. It has now gotten to the point where sores are generating between these two toes. I don't know what to do. I constantly am drying them to no avail. I have used anti persperant on my feet to try and stop the sweating that is going on down there, but that has not help. I have been to a doctor who prescribed a stronger anti perspirant, but I cant apply it to open sores which they become often. I tried only wearing sandals, it seemed to help during the summer, but my tootsies get cold in the winter. Now I have burning, itching blisters forming all over my feet. That have no real cure. All I can do is put cortizone on them.