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What does this sound like?

Posted by Carol C on 9/14/01 at 23:19 (060414)

A question for you docs that normally treat foot problems and especially TTS---For three months, I have had numbness in my big toe and my second
and third toes as well as into the ball of my foot with tenderness in the
arch area of my foot. I do have some sharp needle like pains in the end of
my big toe and some extreme tenderness along the lateral side of the same foot from the little toe to about 1/3 of the way down the side of the foot. I have had a negative nerve conduction study, have been taking
Topamax, Vioxx, and have now changed from Vioxx to Celebrex.
Last week I had a Cortisone injection into the Tarsal Tunnel that provided
overall, about 50% relief in the foot for about 8-9 days and now the
relief is gone and there seems to be a slight exaggeration of the original
symptoms. Does this sound like TTS??? Or can you point me in the direction of something that it possibly sounds like to any on of you guys?
I appreciate your guidance and advice.

Re: What does this sound like?

Ed Davis, DPM on 9/16/01 at 02:43 (060545)

TTS is a possibility. The fact that the injection into the tarsal tunnel provided relief tends to strengthen the evidence in favor of TTS. Is your doc planning on repeating the injection?
Ed

Re: What does this sound like?

Carol C on 9/16/01 at 17:27 (060612)

We have not discussed that. I go back to him this coming Friday.
Is repeating the injection an option? How frequently can you have
these injections done and how many times can they be repeated?
How long should the relief from the injection last. I was disappointed
that is did not last much over a week.
Thanks for your input.

Re: What does this sound like?

wendyn on 9/16/01 at 22:48 (060647)

Carol - have you had a positive nerve conduction test?

Re: What does this sound like?

Carol C on 9/17/01 at 05:37 (060670)

No, I had a negative nerve conduction test.

Re: What does this sound like?

wendyn on 9/17/01 at 08:03 (060676)

Carol please bear with me if you're having to repeat yourself...but there are an awful lot of people to keep straight on this board.

Have you had TTS for a long time?

Please, discuss your surgical decision with others here - especially Dr ED (and the fact you've had a negative nerve conduction test). Also - research the surgery and it's success rates carefully. I am worried that, especially with your intent to return to work after 1 week - your expectations for the surgery may be unrealistic.

Re: What does this sound like?

Carol C on 9/17/01 at 12:44 (060724)

Symptoms appeared on June 15, 2001. Began with numbness in toes and ball of foot...

Re: What does this sound like?

Ed Davis, DPM on 9/17/01 at 15:05 (060751)

Carol:

The injection has both therapeutic and diagnostic value. The diagnostic value lies in the ability to better isolate the cause of the pain which, based on your decription of the eefect of the shot, sounds like tarsal tunne syndrome. The number or frequency of shots depends, in part, by what ingredients are in the shot. It generally does take more than one shot to see long lasting effects and would not be discouraged by the fact that the effects of one shot did not last. I would be encouraged by the effects of the first shot.
Ed

Re: What does this sound like?

Carol C on 9/17/01 at 18:42 (060781)

The shot was 3cc of Lidocaine and 2cc of Celestone according to my copy of the bill from that day. So, from what you are saying, I take it that you
would recommend that I try more injections and see how I respond to those?
What would you do if it were YOUR foot? That is always what I ask my doctors...what would you do if it were you.....

Re: What does this sound like?

Ed Davis, DPM on 9/17/01 at 19:18 (060794)

Carol:

Considering the ingredients, would probably limit the shots to 3 or 4. If it was my foot, I would definitely try a second and possibly a third shot. The hope and expectation is that the Celestone will decrease fibrosis around the nerve and thus effect a cure. Injection therapy has about a 30 to 40 cure rate. Considering the relatively low risk and considering the opportunity to avoid potential surgery it is generally worthwhile.
Ed

Re: What does this sound like?

Carol C on 9/17/01 at 19:34 (060799)

Thanks for that Advice....I go to the doctor this Friday----we will see
what he suggest at that time....
I was terrified of the first shot, but it turned out not to be so bad, so
I would not mind trying another one or two.

Re: What does this sound like?

Carol C on 9/18/01 at 05:47 (060832)

Wendyn---I realize the surgery may take a good while for full recovery---
My job is one that does not require a lot of movement. Once I reach my desk each day, the only real reason that I must move away from it is to
use the restroom. There may be a total of 50 steps from my car to my desk.
I am in a situation where I can sit at my desk with my foot comfortable &
elevated on a chair or whatever is necessary. I have an extremely
understanding employer who will work with me in any way to make me
comfortable and make sure that I do not overdo in any way. Under different
circumstances, I would realize that I could not return to work so quickly,
but with the support that I will receive at work, I think it would be ok
to do so....assuming that I end up having surgery. Maybe I won't have to
have it.

Re: What does this sound like?

wendyn on 9/18/01 at 07:39 (060838)

Carol - although I never did have TTS surgery...I did have bunion surgery. I received a real rude awakening on how painful and slow it can be to recover from foot surgery. Feet are very slow healing. You may need to have your foot really elevatad...and those 50 steps to the bathroom could be rough.

I'm very happy to hear you have an accomodating employer...that will be important. My biggest concerns are that you've only hat TTS 3 months (if my calculations are correct), you've had a negative nerve conduction test, and you are expecting a fast recovery.

I know that eventually you will make the decision that is best for you, but please take some time to do thorough research...and if you haven't already had one - seek a second opinion just to be sure.

Re: What does this sound like?

Ed Davis, DPM on 9/16/01 at 02:43 (060545)

TTS is a possibility. The fact that the injection into the tarsal tunnel provided relief tends to strengthen the evidence in favor of TTS. Is your doc planning on repeating the injection?
Ed

Re: What does this sound like?

Carol C on 9/16/01 at 17:27 (060612)

We have not discussed that. I go back to him this coming Friday.
Is repeating the injection an option? How frequently can you have
these injections done and how many times can they be repeated?
How long should the relief from the injection last. I was disappointed
that is did not last much over a week.
Thanks for your input.

Re: What does this sound like?

wendyn on 9/16/01 at 22:48 (060647)

Carol - have you had a positive nerve conduction test?

Re: What does this sound like?

Carol C on 9/17/01 at 05:37 (060670)

No, I had a negative nerve conduction test.

Re: What does this sound like?

wendyn on 9/17/01 at 08:03 (060676)

Carol please bear with me if you're having to repeat yourself...but there are an awful lot of people to keep straight on this board.

Have you had TTS for a long time?

Please, discuss your surgical decision with others here - especially Dr ED (and the fact you've had a negative nerve conduction test). Also - research the surgery and it's success rates carefully. I am worried that, especially with your intent to return to work after 1 week - your expectations for the surgery may be unrealistic.

Re: What does this sound like?

Carol C on 9/17/01 at 12:44 (060724)

Symptoms appeared on June 15, 2001. Began with numbness in toes and ball of foot...

Re: What does this sound like?

Ed Davis, DPM on 9/17/01 at 15:05 (060751)

Carol:

The injection has both therapeutic and diagnostic value. The diagnostic value lies in the ability to better isolate the cause of the pain which, based on your decription of the eefect of the shot, sounds like tarsal tunne syndrome. The number or frequency of shots depends, in part, by what ingredients are in the shot. It generally does take more than one shot to see long lasting effects and would not be discouraged by the fact that the effects of one shot did not last. I would be encouraged by the effects of the first shot.
Ed

Re: What does this sound like?

Carol C on 9/17/01 at 18:42 (060781)

The shot was 3cc of Lidocaine and 2cc of Celestone according to my copy of the bill from that day. So, from what you are saying, I take it that you
would recommend that I try more injections and see how I respond to those?
What would you do if it were YOUR foot? That is always what I ask my doctors...what would you do if it were you.....

Re: What does this sound like?

Ed Davis, DPM on 9/17/01 at 19:18 (060794)

Carol:

Considering the ingredients, would probably limit the shots to 3 or 4. If it was my foot, I would definitely try a second and possibly a third shot. The hope and expectation is that the Celestone will decrease fibrosis around the nerve and thus effect a cure. Injection therapy has about a 30 to 40 cure rate. Considering the relatively low risk and considering the opportunity to avoid potential surgery it is generally worthwhile.
Ed

Re: What does this sound like?

Carol C on 9/17/01 at 19:34 (060799)

Thanks for that Advice....I go to the doctor this Friday----we will see
what he suggest at that time....
I was terrified of the first shot, but it turned out not to be so bad, so
I would not mind trying another one or two.

Re: What does this sound like?

Carol C on 9/18/01 at 05:47 (060832)

Wendyn---I realize the surgery may take a good while for full recovery---
My job is one that does not require a lot of movement. Once I reach my desk each day, the only real reason that I must move away from it is to
use the restroom. There may be a total of 50 steps from my car to my desk.
I am in a situation where I can sit at my desk with my foot comfortable &
elevated on a chair or whatever is necessary. I have an extremely
understanding employer who will work with me in any way to make me
comfortable and make sure that I do not overdo in any way. Under different
circumstances, I would realize that I could not return to work so quickly,
but with the support that I will receive at work, I think it would be ok
to do so....assuming that I end up having surgery. Maybe I won't have to
have it.

Re: What does this sound like?

wendyn on 9/18/01 at 07:39 (060838)

Carol - although I never did have TTS surgery...I did have bunion surgery. I received a real rude awakening on how painful and slow it can be to recover from foot surgery. Feet are very slow healing. You may need to have your foot really elevatad...and those 50 steps to the bathroom could be rough.

I'm very happy to hear you have an accomodating employer...that will be important. My biggest concerns are that you've only hat TTS 3 months (if my calculations are correct), you've had a negative nerve conduction test, and you are expecting a fast recovery.

I know that eventually you will make the decision that is best for you, but please take some time to do thorough research...and if you haven't already had one - seek a second opinion just to be sure.