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What Permanent Functional Architectual Changes Does a TT Surgery Cause?

Posted by Mike S. on 4/03/02 at 10:18 (078348)

I had bilateral foot neuroma's surgically removed & that surgery did not seem so invasive. For some reason, I have it in my head that cutting that fiberous tarsal tunnel is a BIG DEAL or a much bigger deal than neuroma surgery. Does the foot behave differently or have architectual or functional limitations?

Re: What Permanent Functional Architectual Changes Does a TT Surgery Cause?

Ed Davis, DPM on 4/03/02 at 22:18 (078442)

Changes in foot structure should be minimal although TT surgery has its share of potential problems.
Ed

Re: What Permanent Functional Architectual Changes Does a TT Surgery Cause?

Mike S. on 4/03/02 at 23:39 (078451)

Is the lionshare of potential problems largely the surgeons skill & patient post-op care or something that can happen after it's well healed.

Re: What Permanent Functional Architectual Changes Does a TT Surgery Cause?

Ed Davis, DPM on 4/04/02 at 20:34 (078533)

I think that formation of scar tissue, something that can return to compress the nerve is probably one of the biggest problems. Scar tissue formation is a function of patient genetics, surgical technique, control of swelling after surgery. Scar tissue can be mitigated after surgery via edema control, physical therapy and possible use of steroids.
Ed

Re: What Permanent Functional Architectual Changes Does a TT Surgery Cause?

cindyp on 4/04/02 at 21:23 (078539)

How weird. Didn't have physical therapy didn't have steroids only put my foot up for a month and have very little if any scar tissue.

Re: What Permanent Functional Architectual Changes Does a TT Surgery Cause?

Michael Trenkel on 4/05/02 at 06:42 (078552)

Hello,
than I think you have much luck! After my TTS-Sugery I had to sit for 3 Month in a wheel-chair, and must go 1 Year with crutches (even today).
Everythings went's wrong with the suggery, there was a big inflammation at the TT-area for 1/2 year after the suggery, and I had much much pain for a year (even in bed). Never again! I'm now 34 and my hole life was changed with that suggery!

Michael Trenkel from 53844 Troisdorf (Germany)
(email removed)

Re: What Permanent Functional Architectual Changes Does a TT Surgery Cause?

Sharon W on 4/05/02 at 09:06 (078565)

Dr. Davis,

This is something I've always wondered: does post-release scar tissue usually 'just' build up in the immediate vicinity of where the flexor retinaculum was cut, or does it typically occur all along the incision? And if it is necessary to release the post. tibial nerve from entrapments or varicosities, does that increase the problem with scar tissue?

-- Sharon

Re: What Permanent Functional Architectual Changes Does a TT Surgery Cause?

cindyp on 4/05/02 at 10:18 (078569)

Sorry that it has been so bad for you. I firmly believe if you have a qualified surgeon then you won't have much of a problem. I am very sorry that it didn't work out for you. You cannot go to different dr. to see if they can fix you up?

Re: What Permanent Functional Architectual Changes Does a TT Surgery Cause?

Ed Davis, DPM on 4/05/02 at 22:30 (078629)

Cindy:

The needs of every patient are different; your experience may be different than that of others who have had the surgery. The need for PT, steroids, etc. is related to an individual's healing process.
Ed

Re: What Permanent Functional Architectual Changes Does a TT Surgery Cause?

Ed Davis, DPM on 4/05/02 at 22:32 (078630)

Cindy:

Glad to hear you had a good experience but a bad experience may have little to do with the surgeon or surgical technique.
Ed

Re: What Permanent Functional Architectual Changes Does a TT Surgery Cause?

Ed Davis, DPM on 4/05/02 at 22:36 (078631)

Sharon:

Excellent question-- you have touched upon an interesting contraversy. We do not agree on how much dissection should be done or how much to release at times. Release more and do more dissection and there is more potential for scar tissue. Limit dissection and there is a concern of an inadequate release.

Scar tissue can occur anywhere in the areas you have mentioned.
Ed

Re: What Permanent Functional Architectual Changes Does a TT Surgery Cause?

Sharon W on 4/06/02 at 07:31 (078650)

Dr. Ed,

Thanks for answering; I always appreciate your precise responses.

How much does genetics (history of keloids, past personal history of adhesions, etc.) seem to influence the amount of scarring after a TTS release? Are those factors taken into consideration when deciding whether a patient is a candidate for surgery, and can they help to predict how a pt. will respond to surgery, as far as scarring is concerned?

-- Sharon

Re: What Permanent Functional Architectual Changes Does a TT Surgery Cause?

Ed Davis, DPM on 4/06/02 at 16:15 (078704)

Yes, such factors are taken into account to the extent that they are known or are predictable.
Ed

Re: What Permanent Functional Architectual Changes Does a TT Surgery Cause?

Sharon W on 4/07/02 at 22:46 (078788)

Dr. Ed,

Thanks:)

-- Sharon

Re: What Permanent Functional Architectual Changes Does a TT Surgery Cause?

Michael T on 4/08/02 at 03:53 (078792)

Hello cindy,
I was in 5 clinic (2 of them where Univerity-Clinics). They all say cause of the bad first suggery, there is no possibility for help in another suggery. Now I'm in a pain-therapy (is this the word in english?) at the anestehtic departement of the university-clinic in Koeln, it helps a little bit to can live withe the pain.

Michael T. (from Germany , 53844 Troisdorf)

Re: What Permanent Functional Architectual Changes Does a TT Surgery Cause?

Ed Davis, DPM on 4/03/02 at 22:18 (078442)

Changes in foot structure should be minimal although TT surgery has its share of potential problems.
Ed

Re: What Permanent Functional Architectual Changes Does a TT Surgery Cause?

Mike S. on 4/03/02 at 23:39 (078451)

Is the lionshare of potential problems largely the surgeons skill & patient post-op care or something that can happen after it's well healed.

Re: What Permanent Functional Architectual Changes Does a TT Surgery Cause?

Ed Davis, DPM on 4/04/02 at 20:34 (078533)

I think that formation of scar tissue, something that can return to compress the nerve is probably one of the biggest problems. Scar tissue formation is a function of patient genetics, surgical technique, control of swelling after surgery. Scar tissue can be mitigated after surgery via edema control, physical therapy and possible use of steroids.
Ed

Re: What Permanent Functional Architectual Changes Does a TT Surgery Cause?

cindyp on 4/04/02 at 21:23 (078539)

How weird. Didn't have physical therapy didn't have steroids only put my foot up for a month and have very little if any scar tissue.

Re: What Permanent Functional Architectual Changes Does a TT Surgery Cause?

Michael Trenkel on 4/05/02 at 06:42 (078552)

Hello,
than I think you have much luck! After my TTS-Sugery I had to sit for 3 Month in a wheel-chair, and must go 1 Year with crutches (even today).
Everythings went's wrong with the suggery, there was a big inflammation at the TT-area for 1/2 year after the suggery, and I had much much pain for a year (even in bed). Never again! I'm now 34 and my hole life was changed with that suggery!

Michael Trenkel from 53844 Troisdorf (Germany)
(email removed)

Re: What Permanent Functional Architectual Changes Does a TT Surgery Cause?

Sharon W on 4/05/02 at 09:06 (078565)

Dr. Davis,

This is something I've always wondered: does post-release scar tissue usually 'just' build up in the immediate vicinity of where the flexor retinaculum was cut, or does it typically occur all along the incision? And if it is necessary to release the post. tibial nerve from entrapments or varicosities, does that increase the problem with scar tissue?

-- Sharon

Re: What Permanent Functional Architectual Changes Does a TT Surgery Cause?

cindyp on 4/05/02 at 10:18 (078569)

Sorry that it has been so bad for you. I firmly believe if you have a qualified surgeon then you won't have much of a problem. I am very sorry that it didn't work out for you. You cannot go to different dr. to see if they can fix you up?

Re: What Permanent Functional Architectual Changes Does a TT Surgery Cause?

Ed Davis, DPM on 4/05/02 at 22:30 (078629)

Cindy:

The needs of every patient are different; your experience may be different than that of others who have had the surgery. The need for PT, steroids, etc. is related to an individual's healing process.
Ed

Re: What Permanent Functional Architectual Changes Does a TT Surgery Cause?

Ed Davis, DPM on 4/05/02 at 22:32 (078630)

Cindy:

Glad to hear you had a good experience but a bad experience may have little to do with the surgeon or surgical technique.
Ed

Re: What Permanent Functional Architectual Changes Does a TT Surgery Cause?

Ed Davis, DPM on 4/05/02 at 22:36 (078631)

Sharon:

Excellent question-- you have touched upon an interesting contraversy. We do not agree on how much dissection should be done or how much to release at times. Release more and do more dissection and there is more potential for scar tissue. Limit dissection and there is a concern of an inadequate release.

Scar tissue can occur anywhere in the areas you have mentioned.
Ed

Re: What Permanent Functional Architectual Changes Does a TT Surgery Cause?

Sharon W on 4/06/02 at 07:31 (078650)

Dr. Ed,

Thanks for answering; I always appreciate your precise responses.

How much does genetics (history of keloids, past personal history of adhesions, etc.) seem to influence the amount of scarring after a TTS release? Are those factors taken into consideration when deciding whether a patient is a candidate for surgery, and can they help to predict how a pt. will respond to surgery, as far as scarring is concerned?

-- Sharon

Re: What Permanent Functional Architectual Changes Does a TT Surgery Cause?

Ed Davis, DPM on 4/06/02 at 16:15 (078704)

Yes, such factors are taken into account to the extent that they are known or are predictable.
Ed

Re: What Permanent Functional Architectual Changes Does a TT Surgery Cause?

Sharon W on 4/07/02 at 22:46 (078788)

Dr. Ed,

Thanks:)

-- Sharon

Re: What Permanent Functional Architectual Changes Does a TT Surgery Cause?

Michael T on 4/08/02 at 03:53 (078792)

Hello cindy,
I was in 5 clinic (2 of them where Univerity-Clinics). They all say cause of the bad first suggery, there is no possibility for help in another suggery. Now I'm in a pain-therapy (is this the word in english?) at the anestehtic departement of the university-clinic in Koeln, it helps a little bit to can live withe the pain.

Michael T. (from Germany , 53844 Troisdorf)