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Have thoughts on cause of new onset TTS type symptoms. Also need shoe suggestions.

Posted by GaryZ on 10/27/01 at 00:34 (063668)

This message board has been great ! Elliott, Dr Ed Davis ,Dr Zuckerman, Wendy & Stephanie all have given me diagnostic information and thoughts regarding TTS.

I am an interesting thought on possible causation.

Elliott brought up a good point, why both feet at the same time ?
Perhaps the answer is in the shoes. I have used the same brand of 'walking' shoes for 2 years (11.5 4E) as my work shoes. I replace the shoes every few months and have a several pairs that I rotate. A few weeks prior to onset of symtoms I replaced my shoes and purchased a few new pairs. I noted the fit was slightly different (same shoe model) . I had some mild discomfort that I attributed to breaking in . Sometime after, the TTS like symptoms occured with burning on the bottom of BOTH feet and then tingling up my inner calf. This problem has persisted since with only improvement when I was on vacation (lots of walking on pavement) and wore sandals. The pain resolved after several days. When I returned home the problem again occurred and has persisted in spite of orthotics (in these same shoes). I have just about completed a course of prednisone and on near max dose of neurontin without improvement. Today after being at work I noted that these shoes (which I have a few pair) have an angulated pointy protuberances, although cushioned, on both sides of the back of the shoe. The medial side points into the posterior aspect of the medial maleolus along the track of the posterior tibial nerve. I have now noticed localized tingling and discomfort at this point of contact ( a positive localized Tinels test).

Could this part of the shoe be causing direct pressure on the nerve and causing irritation on it and TTS symptoms ?

What brands of shoes for folks with wide feet should I try that will not put pressure on this part of my ankle ? Both comfortable work and gym shoes for TTS irritation ?

Since this area is now irritated and tender, what do you suggest to 'cool' it down to limit and protect it from further exacerbation ? I just completed a course of, antiiflammatories, Prednisone, but this was before I thought of this possible cause.

Thanks,

Gary

Re: Have thoughts on cause of new onset TTS type symptoms. Also need shoe suggestions.

wendyn on 10/27/01 at 10:03 (063680)

Gary - forgive me - my memory fails me. I've had one day off in the last 14. Have you tried Birkenstock They don't put any pressure on the ankle.

Re: try this

elliott on 10/27/01 at 20:10 (063692)

Needless to say, stop wearing those shoes immediately and try other types of shoes. I think I suggested that early on. Some might postulate that prolonged use over years of the same model shoe, even one that has been working great for years, might anyway increase the chances for TTS since your feet keep striking the ground in exactly the same way for years. Proof would be tough to come by, but given the problems you already have, suggest stop wearing your current shoes right away. Finding another pair that won't aggravate the ankle once you have symptoms may be tough; there's a lot of hit or miss involved. Aside from the Birkenstock Wendy recommends (you may not like sandals, but the worse your condition gets, the more you're willing to compromise on your previous dress standards; I have a pair at home and another at work, and they help), if you have no ankle weakness or any other support problems, perhaps try boots, as you should be able to find a quality model that does not hit at the sensitive area. Wear them for months and see if things settle down.

Not sure if you're using the Tinel's terminology correctly or whether you've satisfied the test. Everyone uses the expression 'Tinel's sign test' to mean that when tapping at the medial malleolus, the nerve pain (such as tingling) radiates, into the arch, toes, and/or calf. Its technically correct meaning is the shooting pain felt post-surgery during the healing process.

Re: Have thoughts on cause of new onset TTS type symptoms. Also need shoe suggestions.

GaryZ on 11/01/01 at 10:18 (063928)

Update, repeat EMG negative ( by an experienced examiner at a highly respected academic center). MRI overead positive ( L4-L5, L5-S1 ) stenosis and herniation. Lab work all normal. Had epidural steroids with some improvement already.

Elliott your intuition was correct.

I am amazed that isolated plantar foot burning can be radicular with out any back pain and initially no other symptomolgy.

I can see how back problems and foot problems can look very similar and be at times tough to diferentiate. Interesting though that the foot burning improved with orthotics. I would encourage a thorough and complete evaluation prior to any surgery to be sure the correct condition is being treated.

Thanks for everyones input and suggestions !

Gary

Re: glad you're improving

elliott on 11/01/01 at 15:12 (063946)

The bulging disc thing would probably explain only one side, not both, unless you mean to say you have bulging discs on both sides? Also, detecting them and being sure that they are the cause of foot problems is not always clear; a large segment of the population has detectable back problems.

Epidurals seem usually to provide only temporary relief--like a couple of months. Typically there's a three-strikes-and-you're-out rule: no more shots. Hope you got lucky, both with the shot and in avoiding future back pain (there often is a delay). Keep us informed.

It is not that suprising that back-initiated foot burning would be alleviated with orthotics. Orthotics alter how your back stresses your feet. Orthotics often are prescribed for pure back problems.

Re: shoes and TTS

Ed Davis, DPM on 11/01/01 at 16:23 (063954)

What factors could cause a shoe to irritate the PT nerve? Excess rubbing or pressure over the laciniate ligament possibly. The one thing of significance is overpronation----a foot that rolls inward excessively allows the inside (medial) side of the foot and ankle to place excess pressure against the medial counter of the shoe.
Ed

Re: glad you're improving

wendyn on 11/01/01 at 22:57 (063987)

Good to hear they found the root of your problem.

Before I got into orthotics and custom Birkenstock full time - I had significantly more lower back pain than I have had since. Significantly. Huge difference. Can't believe how much things have changed.

I still get some lower back pain - but a lot of the SI joint pain and muscle trigger point pain is gone.

Re: glad you're improving

GaryZ on 11/02/01 at 19:09 (064027)

Elliott,

I have a central disc herniation and stenosis at L4-L5 & L5-S1.
This helps explain the burning pain in both feet.
Apparently nerve impingement can cause 'hyperesthesia' or exagerated
pain senation in the feet.

Gary

Re: Have thoughts on cause of new onset TTS type symptoms. Also need shoe suggestions.

wendyn on 10/27/01 at 10:03 (063680)

Gary - forgive me - my memory fails me. I've had one day off in the last 14. Have you tried Birkenstock They don't put any pressure on the ankle.

Re: try this

elliott on 10/27/01 at 20:10 (063692)

Needless to say, stop wearing those shoes immediately and try other types of shoes. I think I suggested that early on. Some might postulate that prolonged use over years of the same model shoe, even one that has been working great for years, might anyway increase the chances for TTS since your feet keep striking the ground in exactly the same way for years. Proof would be tough to come by, but given the problems you already have, suggest stop wearing your current shoes right away. Finding another pair that won't aggravate the ankle once you have symptoms may be tough; there's a lot of hit or miss involved. Aside from the Birkenstock Wendy recommends (you may not like sandals, but the worse your condition gets, the more you're willing to compromise on your previous dress standards; I have a pair at home and another at work, and they help), if you have no ankle weakness or any other support problems, perhaps try boots, as you should be able to find a quality model that does not hit at the sensitive area. Wear them for months and see if things settle down.

Not sure if you're using the Tinel's terminology correctly or whether you've satisfied the test. Everyone uses the expression 'Tinel's sign test' to mean that when tapping at the medial malleolus, the nerve pain (such as tingling) radiates, into the arch, toes, and/or calf. Its technically correct meaning is the shooting pain felt post-surgery during the healing process.

Re: Have thoughts on cause of new onset TTS type symptoms. Also need shoe suggestions.

GaryZ on 11/01/01 at 10:18 (063928)

Update, repeat EMG negative ( by an experienced examiner at a highly respected academic center). MRI overead positive ( L4-L5, L5-S1 ) stenosis and herniation. Lab work all normal. Had epidural steroids with some improvement already.

Elliott your intuition was correct.

I am amazed that isolated plantar foot burning can be radicular with out any back pain and initially no other symptomolgy.

I can see how back problems and foot problems can look very similar and be at times tough to diferentiate. Interesting though that the foot burning improved with orthotics. I would encourage a thorough and complete evaluation prior to any surgery to be sure the correct condition is being treated.

Thanks for everyones input and suggestions !

Gary

Re: glad you're improving

elliott on 11/01/01 at 15:12 (063946)

The bulging disc thing would probably explain only one side, not both, unless you mean to say you have bulging discs on both sides? Also, detecting them and being sure that they are the cause of foot problems is not always clear; a large segment of the population has detectable back problems.

Epidurals seem usually to provide only temporary relief--like a couple of months. Typically there's a three-strikes-and-you're-out rule: no more shots. Hope you got lucky, both with the shot and in avoiding future back pain (there often is a delay). Keep us informed.

It is not that suprising that back-initiated foot burning would be alleviated with orthotics. Orthotics alter how your back stresses your feet. Orthotics often are prescribed for pure back problems.

Re: shoes and TTS

Ed Davis, DPM on 11/01/01 at 16:23 (063954)

What factors could cause a shoe to irritate the PT nerve? Excess rubbing or pressure over the laciniate ligament possibly. The one thing of significance is overpronation----a foot that rolls inward excessively allows the inside (medial) side of the foot and ankle to place excess pressure against the medial counter of the shoe.
Ed

Re: glad you're improving

wendyn on 11/01/01 at 22:57 (063987)

Good to hear they found the root of your problem.

Before I got into orthotics and custom Birkenstock full time - I had significantly more lower back pain than I have had since. Significantly. Huge difference. Can't believe how much things have changed.

I still get some lower back pain - but a lot of the SI joint pain and muscle trigger point pain is gone.

Re: glad you're improving

GaryZ on 11/02/01 at 19:09 (064027)

Elliott,

I have a central disc herniation and stenosis at L4-L5 & L5-S1.
This helps explain the burning pain in both feet.
Apparently nerve impingement can cause 'hyperesthesia' or exagerated
pain senation in the feet.

Gary