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distal TTS question for Dr. Davis

Posted by kellys on 6/09/02 at 13:56 (086847)

I have a quick follow-up Q to your post in the TTS category. First off, you are the first and only doctor that's given me a plausible explanation as to why the orthotics caused pressure and pain in that location. The orthotics caused pressure and significant pain in just that spot (which I thought was more PF) and when I continued wearing them through the pain, I started getting the bad burning through foot/ankle/up into leg. Now I have more consistent burning.

My question:

How do I find a specialist who could help me with this and even discuss the appropriate surgical options? My current podiatrist does not have much experience with nerve problems - probably because I am in a small town. I would love to solve this without surgery, assuming the NCV is positive, but even talking to a doctor about possibilities/success rates/recovery/etc. would help me be more informed.
Also, would an MRI show anything such as where the nerve is inflamed?

Thanks much.

>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: Hi, just a thought Id share

Tammie on 6/09/02 at 18:35 (086875)

Hello Kelly, I was just wondering if you have ever seen a pain management Dr.? I am not really sure about this I thought I would throw it on the table and see what others thought. I had a very lot of problems and alot of pain . The best thing I have done so far I say this with hesitant words so I dont jinx this lol Is get a Dr. in the pain management clinic!!!

He not only helps with my pain he also has been very quick to get some testing done that my former Dr.s never thought needed done! Now I am still new to his care but so far I have had nerve testing and tomorrow am I will get a mri both tests were never done and te other dr.s did not see a need to it. Funny how this dr. seemed to think it was ver needed and seemed horified neither was done before the surgeries! I do think this dr. is on a positive roll and if nothing else I will feel better that thease tests which are so important are being done , and I didnt have to ask!!!!

Just a story that might interest you ! I am not trying to tell you what to do just offer a bit of what I have learned so far! I only wish I had done this sooner. Take care and in any decision yu make I hope for the best for you! Hugs to you Kelly

Re: distal TTS question for Dr. Davis

Ed Davis, DPM on 6/10/02 at 13:55 (086959)

Kelly:

Where do you live? Close to a larger city?
One source of referrals is http://www.acfas.org
Ed

Re: referral?

kellys on 6/10/02 at 16:37 (086990)

I live in PA. Have scheduled an appt with Dr. Cozzarelli in NJ but it's a long drive. Harrisburg, Hershey, or York would be significantly closer. I really want to find someone who has experience with nerve problems in the foot/ankle and has access to the diagnostic equipment. Suggestions appreciated.

Re: referral?

Sharon W on 6/10/02 at 17:12 (086992)

Kelly,

Of course I'm sure you would get the very best of care from Dr. Cozz but I understand your problem. So I thought I'd mention that Dr. David Wander is in Philadelphia. (He used to post here regularly, but he seems to have stopped... or perhaps he's just taking a break from it.) Anyway, if you have access to a Philadelphia phone book, you can probably reach his office.

-- Sharon

Re: PS

Sharon W on 6/10/02 at 17:17 (086995)

Kelly,

I should add that I don't know what diagnostic equipment Dr. Wander has, so if you do decide to call his office, perhaps you should ASK.

-- Sharon

Re: referral?

Ed Davis, DPM on 6/10/02 at 18:39 (087011)

I went to school in Philadelphia so I am more familiar with practitioners in that area. Your appointment with Dr. Cozzarelli may be valuable in that he can give you good diagnostic and treatment insights even if you don't follow through with him due to the distance. See what names you come up with from the ACFAS sight. How far are you from Pittsburgh? Dr. Guido LaPorta of Pittsburgh has a lot of experience with TTS.
Ed

Re: Hi, just a thought Id share

Tammie on 6/09/02 at 18:35 (086875)

Hello Kelly, I was just wondering if you have ever seen a pain management Dr.? I am not really sure about this I thought I would throw it on the table and see what others thought. I had a very lot of problems and alot of pain . The best thing I have done so far I say this with hesitant words so I dont jinx this lol Is get a Dr. in the pain management clinic!!!

He not only helps with my pain he also has been very quick to get some testing done that my former Dr.s never thought needed done! Now I am still new to his care but so far I have had nerve testing and tomorrow am I will get a mri both tests were never done and te other dr.s did not see a need to it. Funny how this dr. seemed to think it was ver needed and seemed horified neither was done before the surgeries! I do think this dr. is on a positive roll and if nothing else I will feel better that thease tests which are so important are being done , and I didnt have to ask!!!!

Just a story that might interest you ! I am not trying to tell you what to do just offer a bit of what I have learned so far! I only wish I had done this sooner. Take care and in any decision yu make I hope for the best for you! Hugs to you Kelly

Re: distal TTS question for Dr. Davis

Ed Davis, DPM on 6/10/02 at 13:55 (086959)

Kelly:

Where do you live? Close to a larger city?
One source of referrals is http://www.acfas.org
Ed

Re: referral?

kellys on 6/10/02 at 16:37 (086990)

I live in PA. Have scheduled an appt with Dr. Cozzarelli in NJ but it's a long drive. Harrisburg, Hershey, or York would be significantly closer. I really want to find someone who has experience with nerve problems in the foot/ankle and has access to the diagnostic equipment. Suggestions appreciated.

Re: referral?

Sharon W on 6/10/02 at 17:12 (086992)

Kelly,

Of course I'm sure you would get the very best of care from Dr. Cozz but I understand your problem. So I thought I'd mention that Dr. David Wander is in Philadelphia. (He used to post here regularly, but he seems to have stopped... or perhaps he's just taking a break from it.) Anyway, if you have access to a Philadelphia phone book, you can probably reach his office.

-- Sharon

Re: PS

Sharon W on 6/10/02 at 17:17 (086995)

Kelly,

I should add that I don't know what diagnostic equipment Dr. Wander has, so if you do decide to call his office, perhaps you should ASK.

-- Sharon

Re: referral?

Ed Davis, DPM on 6/10/02 at 18:39 (087011)

I went to school in Philadelphia so I am more familiar with practitioners in that area. Your appointment with Dr. Cozzarelli may be valuable in that he can give you good diagnostic and treatment insights even if you don't follow through with him due to the distance. See what names you come up with from the ACFAS sight. How far are you from Pittsburgh? Dr. Guido LaPorta of Pittsburgh has a lot of experience with TTS.
Ed