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TTS symptoms and treatment?

Posted by kellys on 6/06/02 at 13:58 (086549)

I have had heel pain for two years now, but didn't see a doctor for the first 8 months. Last year, I was diagnosed with PF and went through all the standard protocols (orthotics, though I swear a bad pair made everything worse, ice, rest, NSAIDs, shots, stretching, etc) and finally had two treatments of ESWT. Seems as though the PF concentrated heel pain is gone now, though the burning sensation I had beforehand flares up here and there. Now the burning pain is back with a vengeance.

My symptoms are: burning sensation, sometimes shooting, focused mostly on inner ankle below the spherical bump on foot, with burning and tingling down into foot and up into calf. The pain gets worse during the day (as opposed to starting off bad with morning PF heel pain - that's gone), and it does NOT get relieved by sitting down or resting.

It is burning pretty badly, the pain is sometimes unbearable and drives me to great distraction in my personal and professional life. I still believe it is caused by biomechanics as it can sometimes be relieved by different shoes/orthotics/etc. Though recently the pain has become constant and more intense. We are continuing to try to treat it conservatively.

The burning part seems indicative of nerve problems, but what do you do about that? Is this TTS?

Comments appreciated.

Re: TTS symptoms and treatment?

Missy B on 6/06/02 at 20:00 (086602)

Kelly,
The burning sensations you descibe sound very much like those that I was experiencing when I was diagnosed with TT/PF. My pain/burning often extended from the bottom of my heel to the bend behind my knee.
Has your doctor sent you for a nerve conduction study? I tried all the non-invasive treatments and when I got only minimal relief after many months, my pod sent me to a neurologist to have this test done. The results confirmed that I was suffering from nerve entrapment in the tarsal tunnel. Missy B.

Re: TTS symptoms and treatment?

wendyn on 6/06/02 at 20:24 (086604)

kellys, if you have not already had the following you need them

a nerve conduction test
full blood work including B12, thyroid and diabetes

Many of us have had TTS begin after wearing improperly made hard orthotics - do you still wear them?

Do your feet ever change colors? And when you say they burn - do they burn just to you or are they also hot to touch

Re: TTS symptoms and treatment?

Helen on 6/06/02 at 20:58 (086608)

I must have nerve entrapment because my pain got worse after bad hard orthotics a number of years ago. I am ok for a while and the thing that flairs up my feet is lifting heavy things ie my daughter, groceries, etc., etc. I never run. I have had this condition for at least six or seven years. What are the treatments for nerve entrapment?

Thanks!

Helen

Re: TTS symptoms and treatment - result of orthotics?

kellys on 6/06/02 at 21:14 (086609)

So it's interesting to see that someone else thinks the orthotics made them worse. My pod kept saying - oh, keep wearing them even if they hurt, you'll break them in. And I kept thinking - hurt this much? You must be kidding!! I switched pods, went through a bunch more fussing about with orthotics and finally found some relief. WIth the ESWT, that seems to have cleared up the PF (or given me significant improvement with respect to PF), but the orthotics wore down and now I'm back to fussing about, this time with burning heels. I continue to wear orthotics but seem to end up switching around between old ones and new ones and whatever seems to relieve some pain for that day. Admittedly probably not the best strategy..

So if a nerve conduction test shows TTS, then what?
Why a B12 test? Or diabetes?

Re: TTS symptoms and treatment - result of orthotics?

Missy B on 6/06/02 at 22:50 (086623)

Kellys,
Blood test work-ups can often pinpoint other conditions in the body which may affect circulation or nerve response and lead to subsequent pain in the feet and legs. Since you have found some relief from your PF, the next step may be for your doctor to check out these conditions as well as send you for a nerve conduction study. Ask him/her.
My blood work-ups were all normal, but my nerve conduction study was positive for TTS. After my pod got these results, he made the first mention of surgery. Since I was still suffering from the pain even though we had tried all the non-invasive treatments (ESWT was not an option for me), he basically gave me 3 choices - live with the pain and try to learn how to manage it, change my lifestyle (including my job), or try to gain relief thru the surgical release. He did not push me into surgery in any way - he told me that I would know if and when that was the choice for me and to let him know at that time. He was very honest about there being no guarantees with this surgery and what the complications could be afterwards. In the end, I chose the surgery and had it last January.
I hope your doctor is able to find some answers for your pain. If not, consider looking again for a new doctor. If you subsequently find that you have TT, please research all your options before jumping into surgery - it is not a step to be taken lightly (pardon my pun). You need to be well informed and find the best possible surgeon. If you have the time to search back thru many of the posts here, you will see that some of us have had favorable outcomes, but that other have not and are still suffering with their pain. There is a wealth of information here which may better prepare you to deal with a diagnosis of TT if you find that you have this condition.
Good Luck to you and keep us posted. We will all be here for you with lots of support. Missy B.

Re: TTS symptoms and treatment - result of orthotics?

Ed Davis, DPM on 6/08/02 at 12:54 (086776)

An orthotic that is made from an oversupinated cast may place pressure on the porta pedis -- the area in the back part of the arch where the branches of the posterior tibial nerve enter the foot. This variant is sometimes referred to as distal tarsal tunnel syndrome.

If the NCV confirms TTS then you may benefit from a tarsal tunnel release. The release is not a conventional release vbut is focused on the area of entrapment about the porta pedis.
Ed

Re: TTS symptoms and treatment?

Missy B on 6/06/02 at 20:00 (086602)

Kelly,
The burning sensations you descibe sound very much like those that I was experiencing when I was diagnosed with TT/PF. My pain/burning often extended from the bottom of my heel to the bend behind my knee.
Has your doctor sent you for a nerve conduction study? I tried all the non-invasive treatments and when I got only minimal relief after many months, my pod sent me to a neurologist to have this test done. The results confirmed that I was suffering from nerve entrapment in the tarsal tunnel. Missy B.

Re: TTS symptoms and treatment?

wendyn on 6/06/02 at 20:24 (086604)

kellys, if you have not already had the following you need them

a nerve conduction test
full blood work including B12, thyroid and diabetes

Many of us have had TTS begin after wearing improperly made hard orthotics - do you still wear them?

Do your feet ever change colors? And when you say they burn - do they burn just to you or are they also hot to touch

Re: TTS symptoms and treatment?

Helen on 6/06/02 at 20:58 (086608)

I must have nerve entrapment because my pain got worse after bad hard orthotics a number of years ago. I am ok for a while and the thing that flairs up my feet is lifting heavy things ie my daughter, groceries, etc., etc. I never run. I have had this condition for at least six or seven years. What are the treatments for nerve entrapment?

Thanks!

Helen

Re: TTS symptoms and treatment - result of orthotics?

kellys on 6/06/02 at 21:14 (086609)

So it's interesting to see that someone else thinks the orthotics made them worse. My pod kept saying - oh, keep wearing them even if they hurt, you'll break them in. And I kept thinking - hurt this much? You must be kidding!! I switched pods, went through a bunch more fussing about with orthotics and finally found some relief. WIth the ESWT, that seems to have cleared up the PF (or given me significant improvement with respect to PF), but the orthotics wore down and now I'm back to fussing about, this time with burning heels. I continue to wear orthotics but seem to end up switching around between old ones and new ones and whatever seems to relieve some pain for that day. Admittedly probably not the best strategy..

So if a nerve conduction test shows TTS, then what?
Why a B12 test? Or diabetes?

Re: TTS symptoms and treatment - result of orthotics?

Missy B on 6/06/02 at 22:50 (086623)

Kellys,
Blood test work-ups can often pinpoint other conditions in the body which may affect circulation or nerve response and lead to subsequent pain in the feet and legs. Since you have found some relief from your PF, the next step may be for your doctor to check out these conditions as well as send you for a nerve conduction study. Ask him/her.
My blood work-ups were all normal, but my nerve conduction study was positive for TTS. After my pod got these results, he made the first mention of surgery. Since I was still suffering from the pain even though we had tried all the non-invasive treatments (ESWT was not an option for me), he basically gave me 3 choices - live with the pain and try to learn how to manage it, change my lifestyle (including my job), or try to gain relief thru the surgical release. He did not push me into surgery in any way - he told me that I would know if and when that was the choice for me and to let him know at that time. He was very honest about there being no guarantees with this surgery and what the complications could be afterwards. In the end, I chose the surgery and had it last January.
I hope your doctor is able to find some answers for your pain. If not, consider looking again for a new doctor. If you subsequently find that you have TT, please research all your options before jumping into surgery - it is not a step to be taken lightly (pardon my pun). You need to be well informed and find the best possible surgeon. If you have the time to search back thru many of the posts here, you will see that some of us have had favorable outcomes, but that other have not and are still suffering with their pain. There is a wealth of information here which may better prepare you to deal with a diagnosis of TT if you find that you have this condition.
Good Luck to you and keep us posted. We will all be here for you with lots of support. Missy B.

Re: TTS symptoms and treatment - result of orthotics?

Ed Davis, DPM on 6/08/02 at 12:54 (086776)

An orthotic that is made from an oversupinated cast may place pressure on the porta pedis -- the area in the back part of the arch where the branches of the posterior tibial nerve enter the foot. This variant is sometimes referred to as distal tarsal tunnel syndrome.

If the NCV confirms TTS then you may benefit from a tarsal tunnel release. The release is not a conventional release vbut is focused on the area of entrapment about the porta pedis.
Ed