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Differentiating tendonitis and tarsal tunnel syndrome

Posted by Heather W on 1/23/02 at 11:23 (070985)

Hi,

I have had foot pain for 3 years. Five doctors, all sports docs / orthopedic specialists, could not locate a cause. Pain was in sole of foot initially. Rest helped, but every time I took up sport again, pain would return. First a month helped, then I had to wait 2 months, then 3...recently I have stopped sports for a year and in the last 8 mos have literally done nothing, other than perhaps 20 min walking per day. More causes pain.

I have orthotics, and have gone thru 6 wks foot stabilization, OTC anti-inflammatories, rest and ice. The swelling was huge, so I received 3 cortisone shots for the pain

Eventually the pain moved from bottom of foot to medial malleolus. Now it is in inner side of foot.

I recently got diagnosed with 'Tarsal Tunnel Syndrome' by an experienced neurochir. He recommended surgery. I'd like to know what the possible complications of surgery are, and how to differ between TTS and tibial tendonitis? The symptoms of tibial tendonitis sound more apt to my case than TTS - I have no Tinel symptom or burning or tingling or numbness - it is more like an toothache that does not go away. Raising the foot does not lessen pain, as it would were it swollen.

Thanks for your help!

Heather

Re: Differentiating tendonitis and tarsal tunnel syndrome

Ed Davis, DPM on 1/23/02 at 21:26 (071060)

TTS surgery has potential complications so it important to be reasonably certain about that diagnosis before proceeding. Numbness and tingling are common with TTS so the absence of those signs may call the diagnosis into question. Have you had a nerve conduction velocity test (NCV)?
Ed

Re: Differentiating tendonitis and tarsal tunnel syndrome

Heather W. on 2/13/02 at 06:19 (073577)

Dear Ed,

Thanks for your quick response. I regret I was away the past couple weeks. Hopefully you'll see this post.

Yes, I had a NVC. The results came up negative, i.e., there was no reduction in nerve conduction velocity. When i asked why, the doctor said that only occured in late-stage cases - and at that point the nerve would be irreversibly damaged, so even surgery couldn't bring it back to 100% performance. In response to my lack of Tinel's Sign, tingling or numbness, he said not all people show these symptoms and they are likewise late-stage symptoms, and it's necessary to operate before it gets that critical. I was suprised to hear his assessment as 'early,' as I have had these symptoms 3 years! An NMR showed excessive fatty tissue in the Tarsal Tunnel, but originally there was excessive swelling that caused pain - the swelling is all but gone, for the most part due to avoiding all sport for 8 mos.

what I don't understand is the cause of the swelling. Why did it initially arise? From what I was told, the swelling put pressure on the nerve, which then caused pain. Why does the doc say the fatty tissue is the cause? Can fatty tissue suddenly 'appear', or was it there from the beginning - if so, why did it not cause problems the first 23 years of my life?

Thanks in advance,
Heather

Re: Differentiating tendonitis and tarsal tunnel syndrome

Ed Davis, DPM on 1/23/02 at 21:26 (071060)

TTS surgery has potential complications so it important to be reasonably certain about that diagnosis before proceeding. Numbness and tingling are common with TTS so the absence of those signs may call the diagnosis into question. Have you had a nerve conduction velocity test (NCV)?
Ed

Re: Differentiating tendonitis and tarsal tunnel syndrome

Heather W. on 2/13/02 at 06:19 (073577)

Dear Ed,

Thanks for your quick response. I regret I was away the past couple weeks. Hopefully you'll see this post.

Yes, I had a NVC. The results came up negative, i.e., there was no reduction in nerve conduction velocity. When i asked why, the doctor said that only occured in late-stage cases - and at that point the nerve would be irreversibly damaged, so even surgery couldn't bring it back to 100% performance. In response to my lack of Tinel's Sign, tingling or numbness, he said not all people show these symptoms and they are likewise late-stage symptoms, and it's necessary to operate before it gets that critical. I was suprised to hear his assessment as 'early,' as I have had these symptoms 3 years! An NMR showed excessive fatty tissue in the Tarsal Tunnel, but originally there was excessive swelling that caused pain - the swelling is all but gone, for the most part due to avoiding all sport for 8 mos.

what I don't understand is the cause of the swelling. Why did it initially arise? From what I was told, the swelling put pressure on the nerve, which then caused pain. Why does the doc say the fatty tissue is the cause? Can fatty tissue suddenly 'appear', or was it there from the beginning - if so, why did it not cause problems the first 23 years of my life?

Thanks in advance,
Heather