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Complications following unnecessary TTS release surgery?

Posted by Shelley G on 2/17/02 at 00:26 (073963)

Has anyone experienced an unnecessary TTS release surgery? If so, were there problems that surfaced because of the surgery? What were they, were they resolved, and how? Thanks for any and all information.

Re: Take a look at this web site

BrianG on 2/17/02 at 19:40 (074062)

Hi Shelley,

Sorry, I can't answer your questions. But, when I see 'unnecessary TTS release surgery', it makes me think of http://www.footlaw.com Good luck

BrianG

Re: Thanks, Brian

Shelley G. on 2/17/02 at 21:47 (074073)

Very interesting site. I've bookmarked it for future reference. :+)

Re: Complications following unnecessary TTS release surgery?

Ed Davis, DPM on 2/20/02 at 22:45 (074460)

Shelly:

If you take the time to go through the archives of this site you will see numerous posts concerning patients who have had both tarsal tunnel release surgery and plantar fascia release surgery either simultaneously or in proximity. I had posted my concerns about this several months ago.
I remain astonished by the numbers of additional posters since that time. Individuals undergoing a combination of procedures that should be extremely rare, in my opinion.

Ed

Re: Take a look at this web site-- ADVERTISEMENT?

Ed Davis, DPM on 2/20/02 at 22:49 (074461)

Brian:

You make take offense at this but would you please tell us if you work for
or on behalf of the people at footlaw.com?
Ed

Re: Complications following unnecessary TTS release surgery?

Shelley G on 2/21/02 at 08:00 (074493)

Dr. Davis,
Thank you for your comments. I realize I wasn't very clear with my quesetion. My husband's feet are such at this time that it's hard to know if there are any repercussions from what may have been unnecessary surgeries...vitamin deficiencies vs. TTS. He may have both. It was a premature question on my part as his feet are still numb and painful and we are still in the process of insolating the cause of the malabsorption he seems to have. I guess I was wondering if a person had TT release surgery, but didn't really have the condition, was is possible to have complications that would then cause foot pain. We're knee-deep in trying to figure all of this out...it's somewhat a mystery to my husband's many doctors, but we're getting there. I read your reply to Brian and want to assure you that my(our) purpose in asking the original question was not to suggest malpractice. My husband's surgeon made it very plain to us before the surgeries that there were no guarantees with this and often a TTS diagnosis was difficult to make. We have no hard feelings about the surgical treatment (did have 3 opinions)just trying to be prepared for any future problems that might make us think the vitamin deficiency problem was not resolving based on some continuing (new) pain. Thanks, again.
Shelley

Re: Complications following ....Brian and Footlaw

Ed Davis, DPM on 2/21/02 at 18:19 (074581)

Shelly:
I understand the nature of your post. My response was solely directed at Brian since he has appeared to attempt to solicit business for the law firm before on this website. I could be wrong about that so I am hoping to hear his response.

I did not realize that you were the same poster from a while back who described the malabsorbtion problem/beriberi. I generally do not go back more than about a page so may miss the connection. Continuing in the same string would enable us to see who you are but, unfortunatley, may place your response a few pages back and thus get missed. Some forums will move an older string forward when there is a new post in that string----perhaps something for Scott to consider.

There is no question that TTS surgery performed in the absence of TT could actualy cause TTS via formation of scar tissue. It appears, based on the NCV, that it was likely that your husband had both the malaborbtion problem plus TTS though.

It may take up to 6 to 8 months of supplementation with B1 and B12 to see the final effects of that treatment. Hopefully, that will be all that is needed. If there is residual symptoms after that time, I think it would be reasonable to assume that the deficiency/malabsorbtion state is no longer a culprit and the NCV should be repeated.
Ed

Re: Thread

Ed Davis, DPM on 2/21/02 at 18:22 (074582)

I should have used the term 'thread' instead of 'string.'
Ed

Re: Complications following ....Brian and Footlaw

Shelley G on 2/21/02 at 19:47 (074598)

Thank you, Dr. Davis, for your comments; thread suggestion noted. Thanks. I also appreciate your response re TT surgery. It looks as if, for us, we're in a wait and see mode, and will continue hoping for the best! I'll keep you informed as to whether the vitamin deficiency thing turns out to be the culprit. Thanks again.
Shelley

Re: Complications following ....Brian and Footlaw

Mike S. on 2/23/02 at 20:55 (074879)

Would any podiatrist do a release with out a positive NCS/EMG? How does an 'unnecessary release happen? I have 'significant delay' in my tests, but I don't have vitamin deficiency tests???

Re: Yes, they did advertise.

BrianG on 2/23/02 at 21:44 (074882)

No Offence at all Dr. Ed. Last I knew they were adverising on this forum. It is where I first found out about them. I did talk with them about a possible suit, but there were honest enough to tell me they thought it would be a very hard win. I suppose you could check with Scott, as I certainly wouldn't want to be breaking any of his rules.

BrianG

PS To answer your question, no. I have nothing to do with them.

Re: Positive NCS/EMG

Shelley G on 2/23/02 at 22:38 (074887)

Hi, Mike. I can't speak for anyone else, but in my husband's case the release surgery was done by an orthopedic surgeon, not a podiatrist. He did have a positive NCS for delay and was diagnosed with TTS, but following both of his surgeries he was told that the area wasn't that tight.

You may be wondering why in the heck he had the second surgery! The first release became severely infected, caused a lot of scar tissue, and was considered a failure. His feet were only getting worse so the decision was made to try the release on the other ankle, assuming that it would respond more favorably than the one with the scar tissue.

As it turns out, neither surgery may have been needed. It was after the 'failure' of the second surgery that the surgeon referred him to yet another neurologist (3rd one) and this doctor was the first to order lab tests other than those done to rule out diabetes and lupus. It was at that time the deficiencies were documented.

I have seen considerable counseling on this site to seek and research before having surgery. I don't know what your situation is doctor-wise, but here's an example of what we were up against: One of the neurologist Lloyd saw referred him to another neurologist who specializes in nerve stuff relating to TTS. This guy is located out of state and out of our insurance network so would have been quite an expense, but were willing to work it out. The only way this doctor would see my husband was for us to send all of his medical records (which was hell to get collected and frankly several of his doctors were not very cooperative in this effort), along with a letter from the referring doctor. He would review the material and then determine if he would see my husband. Well, he passed the test and the doctor called the referring doctor to say that he would see him as a second opinion; however, from the records he felt that his treatment was on the right track and he would probably do the same thing. With this piece of information, from a noted specialist, published no less, what should we have done? We thought we had done the right thing.

I wish I would have found this board before the surgeries. Don't know if it would have changed anything, but it might have. :+(

Shelley

Re: TTS surgery

wendyn on 2/23/02 at 23:41 (074889)

I have heard of many cases of where doctors have operated after a normal nerve conduction test. Even my own pod claimed that the tests are often inconclusive. Some doctors refuse to even do them based on the fact that they don't consider them reliable.

Re: TTS surgery

Ed Davis, DPM on 2/25/02 at 19:01 (075044)

The reliability of NCV testing is, indeed, a dilemna. I happen to be lucky in having excellent testers nearby, Electrodiagnostic Associate of Tacoma -- Dr. Mohammed Saeed is their lead tester and his results are impeccable. One reason for performing a TT release without testing is if there is an identifiable mass growing over the tarsal tunnel, placing pressure on the nerve. Otherwise I would proceed with caution.
Ed

Re: NCV vs EMG Testing

Mike S. on 2/25/02 at 22:42 (075058)

I am 43 & am willing to try the release since my quality of life is (&^$#*!!! with TTS. I have had several studies done, the last one exclusivly EMG, well maybe a few NCV ZAPS. Findings seem to be c/w distal tibial neuropathies bilaterally. Distal to Soleus/Flex Dig Longus/Post Tib. Primarily appears to involve FDIP/AH though unable to find insertional activity of left FDIP. Previous conduction studies showed significant slowing of medial & lateral plantar studies.

The $1,000,000 question is 'could this be related to a HORRIFFIC job I had in 93/94 where my feet were in such terrible pain from 12/7 for two 4 month periods running/walking on concrete.' The pain was excrutiating. Could symptoms be delayed 5 years?

Re: Take a look at this web site

BrianG on 2/17/02 at 19:40 (074062)

Hi Shelley,

Sorry, I can't answer your questions. But, when I see 'unnecessary TTS release surgery', it makes me think of http://www.footlaw.com Good luck

BrianG

Re: Thanks, Brian

Shelley G. on 2/17/02 at 21:47 (074073)

Very interesting site. I've bookmarked it for future reference. :+)

Re: Complications following unnecessary TTS release surgery?

Ed Davis, DPM on 2/20/02 at 22:45 (074460)

Shelly:

If you take the time to go through the archives of this site you will see numerous posts concerning patients who have had both tarsal tunnel release surgery and plantar fascia release surgery either simultaneously or in proximity. I had posted my concerns about this several months ago.
I remain astonished by the numbers of additional posters since that time. Individuals undergoing a combination of procedures that should be extremely rare, in my opinion.

Ed

Re: Take a look at this web site-- ADVERTISEMENT?

Ed Davis, DPM on 2/20/02 at 22:49 (074461)

Brian:

You make take offense at this but would you please tell us if you work for
or on behalf of the people at footlaw.com?
Ed

Re: Complications following unnecessary TTS release surgery?

Shelley G on 2/21/02 at 08:00 (074493)

Dr. Davis,
Thank you for your comments. I realize I wasn't very clear with my quesetion. My husband's feet are such at this time that it's hard to know if there are any repercussions from what may have been unnecessary surgeries...vitamin deficiencies vs. TTS. He may have both. It was a premature question on my part as his feet are still numb and painful and we are still in the process of insolating the cause of the malabsorption he seems to have. I guess I was wondering if a person had TT release surgery, but didn't really have the condition, was is possible to have complications that would then cause foot pain. We're knee-deep in trying to figure all of this out...it's somewhat a mystery to my husband's many doctors, but we're getting there. I read your reply to Brian and want to assure you that my(our) purpose in asking the original question was not to suggest malpractice. My husband's surgeon made it very plain to us before the surgeries that there were no guarantees with this and often a TTS diagnosis was difficult to make. We have no hard feelings about the surgical treatment (did have 3 opinions)just trying to be prepared for any future problems that might make us think the vitamin deficiency problem was not resolving based on some continuing (new) pain. Thanks, again.
Shelley

Re: Complications following ....Brian and Footlaw

Ed Davis, DPM on 2/21/02 at 18:19 (074581)

Shelly:
I understand the nature of your post. My response was solely directed at Brian since he has appeared to attempt to solicit business for the law firm before on this website. I could be wrong about that so I am hoping to hear his response.

I did not realize that you were the same poster from a while back who described the malabsorbtion problem/beriberi. I generally do not go back more than about a page so may miss the connection. Continuing in the same string would enable us to see who you are but, unfortunatley, may place your response a few pages back and thus get missed. Some forums will move an older string forward when there is a new post in that string----perhaps something for Scott to consider.

There is no question that TTS surgery performed in the absence of TT could actualy cause TTS via formation of scar tissue. It appears, based on the NCV, that it was likely that your husband had both the malaborbtion problem plus TTS though.

It may take up to 6 to 8 months of supplementation with B1 and B12 to see the final effects of that treatment. Hopefully, that will be all that is needed. If there is residual symptoms after that time, I think it would be reasonable to assume that the deficiency/malabsorbtion state is no longer a culprit and the NCV should be repeated.
Ed

Re: Thread

Ed Davis, DPM on 2/21/02 at 18:22 (074582)

I should have used the term 'thread' instead of 'string.'
Ed

Re: Complications following ....Brian and Footlaw

Shelley G on 2/21/02 at 19:47 (074598)

Thank you, Dr. Davis, for your comments; thread suggestion noted. Thanks. I also appreciate your response re TT surgery. It looks as if, for us, we're in a wait and see mode, and will continue hoping for the best! I'll keep you informed as to whether the vitamin deficiency thing turns out to be the culprit. Thanks again.
Shelley

Re: Complications following ....Brian and Footlaw

Mike S. on 2/23/02 at 20:55 (074879)

Would any podiatrist do a release with out a positive NCS/EMG? How does an 'unnecessary release happen? I have 'significant delay' in my tests, but I don't have vitamin deficiency tests???

Re: Yes, they did advertise.

BrianG on 2/23/02 at 21:44 (074882)

No Offence at all Dr. Ed. Last I knew they were adverising on this forum. It is where I first found out about them. I did talk with them about a possible suit, but there were honest enough to tell me they thought it would be a very hard win. I suppose you could check with Scott, as I certainly wouldn't want to be breaking any of his rules.

BrianG

PS To answer your question, no. I have nothing to do with them.

Re: Positive NCS/EMG

Shelley G on 2/23/02 at 22:38 (074887)

Hi, Mike. I can't speak for anyone else, but in my husband's case the release surgery was done by an orthopedic surgeon, not a podiatrist. He did have a positive NCS for delay and was diagnosed with TTS, but following both of his surgeries he was told that the area wasn't that tight.

You may be wondering why in the heck he had the second surgery! The first release became severely infected, caused a lot of scar tissue, and was considered a failure. His feet were only getting worse so the decision was made to try the release on the other ankle, assuming that it would respond more favorably than the one with the scar tissue.

As it turns out, neither surgery may have been needed. It was after the 'failure' of the second surgery that the surgeon referred him to yet another neurologist (3rd one) and this doctor was the first to order lab tests other than those done to rule out diabetes and lupus. It was at that time the deficiencies were documented.

I have seen considerable counseling on this site to seek and research before having surgery. I don't know what your situation is doctor-wise, but here's an example of what we were up against: One of the neurologist Lloyd saw referred him to another neurologist who specializes in nerve stuff relating to TTS. This guy is located out of state and out of our insurance network so would have been quite an expense, but were willing to work it out. The only way this doctor would see my husband was for us to send all of his medical records (which was hell to get collected and frankly several of his doctors were not very cooperative in this effort), along with a letter from the referring doctor. He would review the material and then determine if he would see my husband. Well, he passed the test and the doctor called the referring doctor to say that he would see him as a second opinion; however, from the records he felt that his treatment was on the right track and he would probably do the same thing. With this piece of information, from a noted specialist, published no less, what should we have done? We thought we had done the right thing.

I wish I would have found this board before the surgeries. Don't know if it would have changed anything, but it might have. :+(

Shelley

Re: TTS surgery

wendyn on 2/23/02 at 23:41 (074889)

I have heard of many cases of where doctors have operated after a normal nerve conduction test. Even my own pod claimed that the tests are often inconclusive. Some doctors refuse to even do them based on the fact that they don't consider them reliable.

Re: TTS surgery

Ed Davis, DPM on 2/25/02 at 19:01 (075044)

The reliability of NCV testing is, indeed, a dilemna. I happen to be lucky in having excellent testers nearby, Electrodiagnostic Associate of Tacoma -- Dr. Mohammed Saeed is their lead tester and his results are impeccable. One reason for performing a TT release without testing is if there is an identifiable mass growing over the tarsal tunnel, placing pressure on the nerve. Otherwise I would proceed with caution.
Ed

Re: NCV vs EMG Testing

Mike S. on 2/25/02 at 22:42 (075058)

I am 43 & am willing to try the release since my quality of life is (&^$#*!!! with TTS. I have had several studies done, the last one exclusivly EMG, well maybe a few NCV ZAPS. Findings seem to be c/w distal tibial neuropathies bilaterally. Distal to Soleus/Flex Dig Longus/Post Tib. Primarily appears to involve FDIP/AH though unable to find insertional activity of left FDIP. Previous conduction studies showed significant slowing of medial & lateral plantar studies.

The $1,000,000 question is 'could this be related to a HORRIFFIC job I had in 93/94 where my feet were in such terrible pain from 12/7 for two 4 month periods running/walking on concrete.' The pain was excrutiating. Could symptoms be delayed 5 years?