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Positive NCS but neurologist discourages surgery

Posted by Jana on 10/16/01 at 00:02 (063041)

Here's a weird experience...

I had a positive nerve conduction study in May. I went to see an orthopedic and three podiatrists. I trusted the orthopedic because she has a great reputation. She wanted to do a TTS release and PF release.

Met with her again a week ago. She wants to repeat my neurological and rheumatology tests to double check them but still feels we should do both procedures (assuming my tests are the same).

Went to repeat my neurological tests with the same doctor I saw before. I had him test both my hands and my feet as I have RSI (upper extremities damage from computer use). He said that my feet were positive for TTS, my arms or negative for CTS (carpal tunnel syndrome) but he feels that I do have CTS regardless of the test and he feels TTS is not the source of my pain regardless of the test. He is not convinced I should do a TTS release and suggests I do only a PF release.

Kind of strange that his diagnosis for both is the opposite of the test results???

Anyone have a similar experience?

Here's the catch. With my arm injuries, I will not do well on crutches. I cannot even push my own wheelchair now. If they do the PF release then realize I should have done the TTS release, it will mean four surgeries instead of 2. Much worse on my arms_I want to be sure I make the best decision for all of my limbs.

Re: well, at least the catch is no catch

elliott on 10/16/01 at 09:05 (063056)

There is a device which you may find infinitely preferable to crutches. I don't know the name of it, but imagine a single-knee scooter on four wheels. You rest the knee of the surgeried foot on the cushion, with the foot hanging back over the edge, toes facing down. There is a handle for your hands. You push off and move with your good foot, with the swiveling wheels providing both stability and maneuverability. The device is narrow enough to steer through tight spaces and to get to the bathroom. Much safer in my opinion than crutches. Obviously, a drawback is stairs, but it is light enough to pick up and move. My foot/ankle ortho's office makes it available to patients who ask. (I found out about it only by seeing another patient in the waiting room who had it; it's a real conversation piece! I wish I had it for my surgeries, as the hobble on crutches from the parking lot to my office was quite far; in addition to sore armpits and palms, I had nerve problems in my hands as a result which lasted for a good year after surgery.) It can be rented for $25 a week or bought for around $250. Check into it; maybe a medical supplies company can help if your ortho can't.

I recall an earlier post of yours in which you said you have no clearcut nervy sensations in your feet. I would then be real careful before rushing into surgery just yet, especially since it's unclear if it's for PF or TTS or both. Exactly how much pain are you in and how limiting is it? What else have you done for the PF?

You said the tester felt TTS is not the source of your pain regardless of the test. This may not be a contradiction, e.g. if the source of your pain were elsewhere than the tarsal tunnel but still affected the nerves. You may want to phone the tester and ask more questions; you have the right. You could also get tested by another and compare. But the nerve conduction tests are not completely foolproof; view them as supportive (or in this case, muddling :-)) evidence.

Re: well, at least the catch is no catch

Scott R on 10/16/01 at 10:08 (063063)

For a much better option for about the same price, see the video of me using one at https://plus37.safe-order.net/cgi-heelspurs/a/b.cgi?p=iwf

I'm about to no longer stock this item because the sales were zero, so anybody reading this message can buy one for $250 instead of the advertised $350. Just mention in the comments blank that you want it for $250 and you understand that there's no refund at that price.

Re: P.S. Night Splints too

Scott R on 10/16/01 at 10:11 (063064)

I've got a couple more used night splints. $35 each instead of $90. Just say $35 in the comments blank and mention you understand there's no refund.

Re: OK, it may score something for maneuverabilty

elliott on 10/16/01 at 10:46 (063068)

Maybe worth considering, but isn't it real risky down steps? Also, seems to me like the risk of falling is greater and that there would be increased pressure on the knee (and crotch?!?), especially for anything longer than very short distances. Also, every time you get up to go to the bathroom or the kitchen, you have to strap up. I hated that even with my walking boot.

Re: hands-free crutch

Scott R on 10/16/01 at 11:06 (063072)

I've worn it for a few hours and it's like wearing nothing. You can wear it sitting down, but it's really meant for a working or playing environment where you're on your feet a lot. I don't think it would be safe going down stairs but I haven't tried it. Going up would probably be safer. But the other can't be used at all, so you could carry one or the other.

Re: Positive NCS but neurologist discourages surgery

Ed Davis, DPM on 10/17/01 at 16:12 (063171)

Sounds like a tough decision. Nevertheless, plantar fasciitis usually can be cured non-surgically while TTS can be difficult to cure non-surgically.
Study this site with attention to Scott's heel pain book in order to answer the question: 'Have I had all the non-surgical treatment options for plantar fasciitis performed before considering surgery?'
Ed

Re: well, at least the catch is no catch

elliott on 10/16/01 at 09:05 (063056)

There is a device which you may find infinitely preferable to crutches. I don't know the name of it, but imagine a single-knee scooter on four wheels. You rest the knee of the surgeried foot on the cushion, with the foot hanging back over the edge, toes facing down. There is a handle for your hands. You push off and move with your good foot, with the swiveling wheels providing both stability and maneuverability. The device is narrow enough to steer through tight spaces and to get to the bathroom. Much safer in my opinion than crutches. Obviously, a drawback is stairs, but it is light enough to pick up and move. My foot/ankle ortho's office makes it available to patients who ask. (I found out about it only by seeing another patient in the waiting room who had it; it's a real conversation piece! I wish I had it for my surgeries, as the hobble on crutches from the parking lot to my office was quite far; in addition to sore armpits and palms, I had nerve problems in my hands as a result which lasted for a good year after surgery.) It can be rented for $25 a week or bought for around $250. Check into it; maybe a medical supplies company can help if your ortho can't.

I recall an earlier post of yours in which you said you have no clearcut nervy sensations in your feet. I would then be real careful before rushing into surgery just yet, especially since it's unclear if it's for PF or TTS or both. Exactly how much pain are you in and how limiting is it? What else have you done for the PF?

You said the tester felt TTS is not the source of your pain regardless of the test. This may not be a contradiction, e.g. if the source of your pain were elsewhere than the tarsal tunnel but still affected the nerves. You may want to phone the tester and ask more questions; you have the right. You could also get tested by another and compare. But the nerve conduction tests are not completely foolproof; view them as supportive (or in this case, muddling :-)) evidence.

Re: well, at least the catch is no catch

Scott R on 10/16/01 at 10:08 (063063)

For a much better option for about the same price, see the video of me using one at https://plus37.safe-order.net/cgi-heelspurs/a/b.cgi?p=iwf

I'm about to no longer stock this item because the sales were zero, so anybody reading this message can buy one for $250 instead of the advertised $350. Just mention in the comments blank that you want it for $250 and you understand that there's no refund at that price.

Re: P.S. Night Splints too

Scott R on 10/16/01 at 10:11 (063064)

I've got a couple more used night splints. $35 each instead of $90. Just say $35 in the comments blank and mention you understand there's no refund.

Re: OK, it may score something for maneuverabilty

elliott on 10/16/01 at 10:46 (063068)

Maybe worth considering, but isn't it real risky down steps? Also, seems to me like the risk of falling is greater and that there would be increased pressure on the knee (and crotch?!?), especially for anything longer than very short distances. Also, every time you get up to go to the bathroom or the kitchen, you have to strap up. I hated that even with my walking boot.

Re: hands-free crutch

Scott R on 10/16/01 at 11:06 (063072)

I've worn it for a few hours and it's like wearing nothing. You can wear it sitting down, but it's really meant for a working or playing environment where you're on your feet a lot. I don't think it would be safe going down stairs but I haven't tried it. Going up would probably be safer. But the other can't be used at all, so you could carry one or the other.

Re: Positive NCS but neurologist discourages surgery

Ed Davis, DPM on 10/17/01 at 16:12 (063171)

Sounds like a tough decision. Nevertheless, plantar fasciitis usually can be cured non-surgically while TTS can be difficult to cure non-surgically.
Study this site with attention to Scott's heel pain book in order to answer the question: 'Have I had all the non-surgical treatment options for plantar fasciitis performed before considering surgery?'
Ed