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Nerve Conduction Test

Posted by Kori E on 1/09/02 at 13:29 (069356)

I went to the surgeon today and he is pretty sure it's bilateral TTS but he wants me to get a Nerve Conduction Test first. I've already had cortisone shots, physical therapy, orthotics, and 6 weeks in a walking cast so we're pretty sure I'm going to have the surgery. Can someone explain what exactly this test will show, how they do it, and of course does it hurt? Thank you.

Re: Nerve Conduction Test

elliott on 1/09/02 at 13:56 (069363)

I think you said your second foot has pain and swelling, but you didn't say it was nervy. I'd be cautious before rushing into anything, at least on that foot. Is it nervy in the other foot? Can you describe the symptoms (exactly where and what the pain is)? Also, when it's bilateral, I'd be especially cautious to check for diseases (did you have bloodwork done?) and neck/back possiblities.

Your question about the nerve conduction test has been asked a lot. I cropped and pasted below the answer I gave to another from an older post. I am assuming you are getting the standard NCV rather than a more experimental type of device (which will hurt even less or not at all). You can also page back a page or two on this board and see several relevant threads on this topic. Here it is:

----

First, the NCV (nerve conduction velocity) test: Some kind of cream is applied to a two-pronged shocker, which is then placed on your skin, and you receive an electric shock. Knowing what they're doing and why helps. What they're doing is not so mysterious: it's measuring the time it takes for the nerve being tested to conduct the electricity from shocker to where it's recorded by the metal disc placed lower down on your foot. If there is nerve entrapment and the test picks it up, the time it takes to get from one end to the other--called distal latency--will be slower than normal (if you see the tester write down a number in the single digits plus one decimal place of around 7.0 or higher, start worrying). The shocks are focused on the nerves of interest, so can vary depending on the patient's targeted problem. Mehodology can vary from tester to tester too; mine is very well respected. For TTS, they concentrate on the conductivity of the medial and lateral plantar nerves, but they usually quickly test the main nerves on the other side of the foot too. The shocker is placed most of the time on your middle and lower calf/shin area, both medially and laterally (I don't recall any shocks, or needles for that matter, placed directly on or in the ankle). The shocker may be placed higher up, i.e. on the thigh, for a few shocks, especially if it is suspected that the thigh or back might be involved. I think there were around 20 shocks in all. All but the last few are no big deal at all. The last few in each series, when they seem to turn up the volume, will make your leg jump a bit and will feel somewhat more uncomfortable than the rest. But each shock is felt just for a second or so. In fact, consider it to be around 20 shocks x 1.5 seconds/shock = 30 total seconds of 'pain', with the pain neither continuous nor of the same severity. If you insist on your pain scale, on a scale of 1 to 10, I'd rate the worst few shocks a 7, but overall the test gets perhaps a 4. Again, the 'pain' is so short that it's not a big deal, and I'm tempted to lower that number further because of this.

Next, the EMG: This is the needle part of the test, which is searching for muscle atrophy as connected to nerve entrapment. I was stuck me with a very small needle (no permanent marks) maybe 6 times. Locations I recall were bottom of big toe, maybe fourth toe, top of foot, and shin (the last probably sightly 'worse' than the others, I think due to the feeling of it pressing on your bone). You barely feel the prick, although you get this slightly uncomfortable feeling while it's in there that you've lost range of motion. It's kept in for a few, call it 3, seconds. Total duration of 'pain' is 6 x 3 = 18 seconds. On a scale of 1 to 10, this test gets a 1.

Total duration of 'pain' for entire exam is 30 + 18 = 48 seconds, not all continuous. The total test, with the pain levels appropriately weighted by pain time, gets a 3. Elapsed time for entire test (including dead time, but not including pre-test interview) is around 35 minutes. Hope this is enough detail for you.

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Re: Nerve Conduction Test

Kori E on 1/09/02 at 14:13 (069365)

That information was great and helped me alot, thank you very much!

My second foot is also 'nervy'. If you tap on the Tarsal Tunnel area my big toe becomes numb and tingly, and is becoming worse every day. The area is very swollen, tender and painful and looking more like my right foot all the time. My right foot is definitely worse though, more swelling, numbness and shooting pains.

I did have bloodwork and an MRI done, both which came back negative. I haven't had or have any history of neck/back problems.

The doctor wants to do surgery one foot at a time. I've read varying things about recovery time and procedure and was wondering if there was a typical recovery process. I'm trying to figure out how much time I will miss from work.

Thanks again!

Re: Nerve Conduction Test

elliott on 1/09/02 at 14:39 (069367)

If all goes textbook well (simple release, done right, no complications), you could be back to work in two weeks. But it often doesn't. They may find something in there (e.g. inflamed tendon) they have to fix prompting a longer recovery. And the chances of recurrence and failure are higher for TTS than for many other ailments (which is why you want to be sure you'll willing to risk it). Many here have had failed releases. I assume your doc is familiar with this surgery.

Do you have any idea of what brought on your symptoms?

----

Re: Nerve Conduction Test

Kori E on 1/09/02 at 16:21 (069381)

My doc is familiar and has done this surgery before. I know people that have gone to him for other orthopedic surgeries and all have been extremely happy with him.

We can't figure out what brought on my symptoms. I haven't injured myself or had any trauma to the area and I'm not sure what else would cause it.

Re: Nerve Conduction Test

elliott on 1/09/02 at 22:35 (069432)

What's your pain level? Can you wait it out a while? It's only been two weeks since your latest foot; that's nothing. Sometimes things not seen before start showing up, giving clues. This is especially true in your case, bilateral and with no clear culprit. Again, the chances of surgery in both feet going well are just not as high as you might think.

A few other things to ponder. Given the bilateral, you may want to consider trying a chiro (not that I've ever gone), as there may be a back/gait connection. You may want to try a few different pairs of shoes, preferably more supportive ones; it could just be you've subtly been walking a certain way over the years that caused it.

---

Re: Nerve Conduction Test

cindyp on 1/10/02 at 11:17 (069507)

Why not an mri? So they can get a good picture of what's going on?

Re: Nerve Conduction Test

Kori E on 1/10/02 at 11:32 (069508)

My pain level is anywhere from a 3 to an 8. Last night it was really bad I had to take 2 Vicadin and I really try to not take them unless I absolutely have to. The pain is never completely gone, it's always there, just sometimes is worse than others. I work full-time and have 5 children at home, ages 8 to 17, and this had affected my life immensely. I'm not able to do things with them like I used to because of the pain. I have read how some people here are being treated for depression and I could see how that could easily happen. I've had this since August and I'm ready to do whatever I need to do to get back to how life used to be, if that's possible. I know that the surgery is definitely not a 100% sure thing, but I feel I have tried everything else and even when I did the physical therapy, the shots, and everything else, I didn't get even the slightest relief. I'm having the surgery on my right foot first, not both feet at the same time. I guess we'll see if my left gets better or if I'll need surgery on that one also.

Re: Nerve Conduction Test

Kori E on 1/10/02 at 11:33 (069509)

I did have an MRI and it came back negative. It showed there was no cyst or anything else that might be putting pressure on that nerve.

Re: Nerve Conduction Test

cindyp on 1/10/02 at 20:35 (069587)

I don't know I never had a nerve conduction. Had the mri but if you have had other's tests like tinnel sign and is positive i would say it's a good bet. Just get the best surgeon you can afford, preferably specialist in foot and ankle reconstruction.

Re: ask yourself two questions

elliott on 1/12/02 at 21:33 (069823)

How did you get TTS if you did nothing to traumatize your feet?

How did you get it bilaterally?

The second question is particularly troublesome.

Rhetorical answer: it likely came from some as yet undiagnosed disease, or it is coming from your back, gait or shoes.

Look around on this board at the typical surgical results. Those likely to do better are those who had a traumatic injury or an observed mass pressing on the nerve. Even if your surgeon does a textbook-perfect surgery, and even if it initially goes well, how would you like it if a short while afterwards you get a return of symptoms, and/or you get nerve-related back pain, and/or tingling in your hands, and the list goes on. Because that is what I suspect will happen, given the bilateral mystery.

You're speaking here to someone who had bilateral TTS surgery and who has now done more research than would care to admit. If there's one area they don't seem to know enough about, it's the connection of the back to the feet. With both this and some of the diseases, there's often a lag between feet symptoms and the others to come out. This may be because nerve symptoms are usually felt in the extremities first. Sure, keep surgery open as an option, especially if the pain is unbearable. And hey, I can assure you I know about the pain and discomfort. But as someone who's been there already, had I had it to do all over again, I might have first tried things like back alignments, aggressive yoga, maybe a second pair of orthotics, etc., first. You're still relatively recent; it might clear up.

---

---

Re: Nerve Conduction Test

elliott on 1/09/02 at 13:56 (069363)

I think you said your second foot has pain and swelling, but you didn't say it was nervy. I'd be cautious before rushing into anything, at least on that foot. Is it nervy in the other foot? Can you describe the symptoms (exactly where and what the pain is)? Also, when it's bilateral, I'd be especially cautious to check for diseases (did you have bloodwork done?) and neck/back possiblities.

Your question about the nerve conduction test has been asked a lot. I cropped and pasted below the answer I gave to another from an older post. I am assuming you are getting the standard NCV rather than a more experimental type of device (which will hurt even less or not at all). You can also page back a page or two on this board and see several relevant threads on this topic. Here it is:

----

First, the NCV (nerve conduction velocity) test: Some kind of cream is applied to a two-pronged shocker, which is then placed on your skin, and you receive an electric shock. Knowing what they're doing and why helps. What they're doing is not so mysterious: it's measuring the time it takes for the nerve being tested to conduct the electricity from shocker to where it's recorded by the metal disc placed lower down on your foot. If there is nerve entrapment and the test picks it up, the time it takes to get from one end to the other--called distal latency--will be slower than normal (if you see the tester write down a number in the single digits plus one decimal place of around 7.0 or higher, start worrying). The shocks are focused on the nerves of interest, so can vary depending on the patient's targeted problem. Mehodology can vary from tester to tester too; mine is very well respected. For TTS, they concentrate on the conductivity of the medial and lateral plantar nerves, but they usually quickly test the main nerves on the other side of the foot too. The shocker is placed most of the time on your middle and lower calf/shin area, both medially and laterally (I don't recall any shocks, or needles for that matter, placed directly on or in the ankle). The shocker may be placed higher up, i.e. on the thigh, for a few shocks, especially if it is suspected that the thigh or back might be involved. I think there were around 20 shocks in all. All but the last few are no big deal at all. The last few in each series, when they seem to turn up the volume, will make your leg jump a bit and will feel somewhat more uncomfortable than the rest. But each shock is felt just for a second or so. In fact, consider it to be around 20 shocks x 1.5 seconds/shock = 30 total seconds of 'pain', with the pain neither continuous nor of the same severity. If you insist on your pain scale, on a scale of 1 to 10, I'd rate the worst few shocks a 7, but overall the test gets perhaps a 4. Again, the 'pain' is so short that it's not a big deal, and I'm tempted to lower that number further because of this.

Next, the EMG: This is the needle part of the test, which is searching for muscle atrophy as connected to nerve entrapment. I was stuck me with a very small needle (no permanent marks) maybe 6 times. Locations I recall were bottom of big toe, maybe fourth toe, top of foot, and shin (the last probably sightly 'worse' than the others, I think due to the feeling of it pressing on your bone). You barely feel the prick, although you get this slightly uncomfortable feeling while it's in there that you've lost range of motion. It's kept in for a few, call it 3, seconds. Total duration of 'pain' is 6 x 3 = 18 seconds. On a scale of 1 to 10, this test gets a 1.

Total duration of 'pain' for entire exam is 30 + 18 = 48 seconds, not all continuous. The total test, with the pain levels appropriately weighted by pain time, gets a 3. Elapsed time for entire test (including dead time, but not including pre-test interview) is around 35 minutes. Hope this is enough detail for you.

----

Re: Nerve Conduction Test

Kori E on 1/09/02 at 14:13 (069365)

That information was great and helped me alot, thank you very much!

My second foot is also 'nervy'. If you tap on the Tarsal Tunnel area my big toe becomes numb and tingly, and is becoming worse every day. The area is very swollen, tender and painful and looking more like my right foot all the time. My right foot is definitely worse though, more swelling, numbness and shooting pains.

I did have bloodwork and an MRI done, both which came back negative. I haven't had or have any history of neck/back problems.

The doctor wants to do surgery one foot at a time. I've read varying things about recovery time and procedure and was wondering if there was a typical recovery process. I'm trying to figure out how much time I will miss from work.

Thanks again!

Re: Nerve Conduction Test

elliott on 1/09/02 at 14:39 (069367)

If all goes textbook well (simple release, done right, no complications), you could be back to work in two weeks. But it often doesn't. They may find something in there (e.g. inflamed tendon) they have to fix prompting a longer recovery. And the chances of recurrence and failure are higher for TTS than for many other ailments (which is why you want to be sure you'll willing to risk it). Many here have had failed releases. I assume your doc is familiar with this surgery.

Do you have any idea of what brought on your symptoms?

----

Re: Nerve Conduction Test

Kori E on 1/09/02 at 16:21 (069381)

My doc is familiar and has done this surgery before. I know people that have gone to him for other orthopedic surgeries and all have been extremely happy with him.

We can't figure out what brought on my symptoms. I haven't injured myself or had any trauma to the area and I'm not sure what else would cause it.

Re: Nerve Conduction Test

elliott on 1/09/02 at 22:35 (069432)

What's your pain level? Can you wait it out a while? It's only been two weeks since your latest foot; that's nothing. Sometimes things not seen before start showing up, giving clues. This is especially true in your case, bilateral and with no clear culprit. Again, the chances of surgery in both feet going well are just not as high as you might think.

A few other things to ponder. Given the bilateral, you may want to consider trying a chiro (not that I've ever gone), as there may be a back/gait connection. You may want to try a few different pairs of shoes, preferably more supportive ones; it could just be you've subtly been walking a certain way over the years that caused it.

---

Re: Nerve Conduction Test

cindyp on 1/10/02 at 11:17 (069507)

Why not an mri? So they can get a good picture of what's going on?

Re: Nerve Conduction Test

Kori E on 1/10/02 at 11:32 (069508)

My pain level is anywhere from a 3 to an 8. Last night it was really bad I had to take 2 Vicadin and I really try to not take them unless I absolutely have to. The pain is never completely gone, it's always there, just sometimes is worse than others. I work full-time and have 5 children at home, ages 8 to 17, and this had affected my life immensely. I'm not able to do things with them like I used to because of the pain. I have read how some people here are being treated for depression and I could see how that could easily happen. I've had this since August and I'm ready to do whatever I need to do to get back to how life used to be, if that's possible. I know that the surgery is definitely not a 100% sure thing, but I feel I have tried everything else and even when I did the physical therapy, the shots, and everything else, I didn't get even the slightest relief. I'm having the surgery on my right foot first, not both feet at the same time. I guess we'll see if my left gets better or if I'll need surgery on that one also.

Re: Nerve Conduction Test

Kori E on 1/10/02 at 11:33 (069509)

I did have an MRI and it came back negative. It showed there was no cyst or anything else that might be putting pressure on that nerve.

Re: Nerve Conduction Test

cindyp on 1/10/02 at 20:35 (069587)

I don't know I never had a nerve conduction. Had the mri but if you have had other's tests like tinnel sign and is positive i would say it's a good bet. Just get the best surgeon you can afford, preferably specialist in foot and ankle reconstruction.

Re: ask yourself two questions

elliott on 1/12/02 at 21:33 (069823)

How did you get TTS if you did nothing to traumatize your feet?

How did you get it bilaterally?

The second question is particularly troublesome.

Rhetorical answer: it likely came from some as yet undiagnosed disease, or it is coming from your back, gait or shoes.

Look around on this board at the typical surgical results. Those likely to do better are those who had a traumatic injury or an observed mass pressing on the nerve. Even if your surgeon does a textbook-perfect surgery, and even if it initially goes well, how would you like it if a short while afterwards you get a return of symptoms, and/or you get nerve-related back pain, and/or tingling in your hands, and the list goes on. Because that is what I suspect will happen, given the bilateral mystery.

You're speaking here to someone who had bilateral TTS surgery and who has now done more research than would care to admit. If there's one area they don't seem to know enough about, it's the connection of the back to the feet. With both this and some of the diseases, there's often a lag between feet symptoms and the others to come out. This may be because nerve symptoms are usually felt in the extremities first. Sure, keep surgery open as an option, especially if the pain is unbearable. And hey, I can assure you I know about the pain and discomfort. But as someone who's been there already, had I had it to do all over again, I might have first tried things like back alignments, aggressive yoga, maybe a second pair of orthotics, etc., first. You're still relatively recent; it might clear up.

---

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