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Back to see the Doctor

Posted by Chad H on 6/11/02 at 12:41 (087118)

I have an appointment scheduled for this Thursday to discuss my options with my orthopedic again. The last time I saw him he recommended a gastroc reccession to lengthen my achilles. TTS has caused me to completely loss all range of motion in my right ankle. I have had two unsuccessful TTS releases (performed by different docs from who I am currently seeing) and arthroscopic surgery to repair a damaged tendon the outside of my ankle caused by not walking properly (similar to a really bad sprain. This too was relatively unsuccessful.

At this point, my tight achilles and the sprained area are a major source of the pain I experience in my ankle. The TTS pain is still very evident, especially if I am touched in that area, but the other pain actually overshadows the TTS pain. The loss of range of motion is causing major atrophy in the muscles, tendons and ligament in my entire lower right leg. What was once confined to the tarsal tunnel area is spreading all the way up to my knee. Has anyone else experienced this type of loss of range of motion due to TTS?

So this is the thinking...In an attempt to reduce the pain in the achilles and increase my range of motion, my doctor would like to try to lengthen the achilles via a gastroc reccession. I posted this on the board about 6 months ago when he first recommended it. If I decide to go forward with this, I would like him to also work on the sprain area again while I am down and under the knife. After my time in a cast, this would be followed by agressive PT to increase and maintain range of motion.

Assuming all of this actually works, the next step we have discussed would be a vien wrap. The plan would be to have my current ortho perform a release and clean the entire area of scar tissue and free the nerve, and then have a microvascular surgeon with vein wrap experience perform the wrap.

At 29 years of age, the TTS and ankle pain continues to be a major drag in my life. It is not going to get better on its own. My ankle keeps degrading, and the pain and loss of range of motion continues to worsen.

I am not sure how to proceed and appreciate the opportunity to vent with all of you. Let me know your thoughts on all of this. Am I crazy?

Re: Back to see the Doctor

Sharon W on 6/12/02 at 08:55 (087267)

Chad,

You are not crazy. In fact it sounds like you are really 'on top of things,' and very well informed about your medical conditions and the procedures that have been done, the sources of your current pain, and the procedures that are planned for you. I applaud your for being so proactive in your own care!

It is my hope that all your surgeries and treatments from now on will work out exactly as intended, and you will soon find considerable relief from what is obviously excruciating pain. (After all, you've ALREADY had enough BAD luck to last a lifetime!)

-- Sharon

Re: Back to see the Doctor

Ed Davis, DPM on 6/12/02 at 16:16 (087337)

Chad:

There are 3 potential procedures that you may need but am not sure why your doc wants to stage the procedures, that is perform them sequentially.

The vein wrap procedure (make sure you are dealing with an individual experienced in this area), achilles lengthening and possibly a lateral ankle stabilization could all be performed at the same time, saving you a lot of down time. Arthroscopic procedures would be unlikely to repair a damaged tendon on the side of your ankle. Is it possible that the arthroscopy was for a damaged lateral ankle ligament?
Ed

Re: Response to Dr. Davis

Chad H on 6/13/02 at 11:58 (087467)

Dr. Davis,

Thank you for the reply. I always value your input.

I am afraid to say that I can't remember if it was a damaged tendon or ligament. I believe one connects muscle to bone and the other connects muscle to muscle. With that in mind, I don't remember what the arthroscopic was for. The painful area is located directly above the outside ankle bone and resembles a sprain. Now that you mention it, I beleive it was ligament damage. I don't know if you can diagnose with that information or not. I will be seeing the doctor tonight, so I will get more information.

How would you go about lateral ankle stabilization?

In response to the idea of the procedures all taking place at once: the thinking behind having them done sequentially is due to the fact that my doctor told me that if we perform a vien wrap, he would want me up and working the ankle as soon as possible to keep the nerve moving freely. He feels that if we preform the wrap and then I spend 4 - 6 weeks in a cast, the vein wrap will not be successful due to the nerve become 're-trapped' as the area heals and scar tissue reforms.

Is there anyway to keep the scar tissue for reforming?

This brings up a good question. Which is better following a tts release and a vien wrap: 4-6 weeks of cast time for healing or 1 week of cast time and then PT to keep the nerve and ankle moving freely? I believe it could be argued both ways as to which allows the scar tissue to build back up around the nerve and the tarsal tunnel.

Re: Response to Dr. Davis

Chad H on 6/13/02 at 12:07 (087471)

Opps, I meant muscle to bone and bone to bone. Muscle to bone being tendons, right? With that in mind, it was (is) ligament damage that the arthroscopic was for.

One other question. Is there any other known conditions that can cause the tineal sign? I have an outrageous amount of pain in the tarsal tunnel area, but I don't have many of the other symptoms (burning, hot, cold, tingling, numbness). EMG's have been inconclusive on me.

Re: I AM SO FRUSTRATED

Chad H on 6/13/02 at 19:32 (087503)

I hope you all don't mind if I just keep responding to my own posts!

I went to my doctor appointment. Doctor has not changed his mindset. He wants to ONLY do the gastroc recession to lengthen the achilles and he thinks this will relieve the majority of my other pain. In his words, if I still have the nerve pain after the procedure, we will talk about that then.

Let's see, I first had the nerve pain, then the problem with my achilles, so now, fixing the achilles is also going to cure my nerve pain??

He also doesn't want to fix the ligament pain on the outside of my ankle. In my opinion, he believes that since he as already worked on that area, if he were to work on it again it would be like admiting he failed the first time.

I AM SO TICKED OFF!!

So I am once again in search of a new doctor. It is so frustrating to know that I know more than my doctor, and I can't get him to listen.

I don't know where to turn and what to do next. Surgery? Medicine? Some type of pain relief? The Celebrex just isn't cutting it. He showed absolutely no compassion for the sleepless nights I experiece in agonizing pain.

I feel like crying...

Re: I AM SO FRUSTRATED

Carmen on 6/13/02 at 20:10 (087513)

What's your email Chad?

Re: I AM SO FRUSTRATED

Chad H on 6/14/02 at 12:19 (087595)

Carmen,

You can email me at (email removed)

Re: I AM SO FRUSTRATED

Ed Davis, DPM on 6/14/02 at 18:16 (087631)

Chad:

Your frustration is understandable but don't give up. You need a solid treatment plan and then go for it. Your doc does not sound like he has a clear plan and that you definitely need a second opinion.

Where do you live -- I will see if I know anyone in your area.
Ed

Re: I AM SO FRUSTRATED

Chad H on 6/15/02 at 13:27 (087684)

Dr. Davis,

You have recommended I go see Dr. Yu (I think) up near Cleveland. I am in Columbus, Ohio. There isn't any reason I haven't called him yet, just been trying to figure out the best plan.

I set up an appointment with a foot and ankle orthopedic at the Cleveland Clinic for the Monday after next. His bio says he has interested in nerve disorders as well as other ankle issues. His name is Dr. Christopher Tisdel.

I will keep you posted and would love to hear about recommended doctors.

Re: I AM SO FRUSTRATED

Rolanda P. on 6/16/02 at 05:35 (087722)

Please let me know how satisfied with Dr. Tisdel you are. The pain in my left foot has kept me up most of the night and I am looking for someone to work with to try and get some relief.
Thank you.

Re: I AM SO FRUSTRATED

eileenc on 6/16/02 at 11:40 (087735)

I went to Cleveland Clinic in September of 1997. The head of the foot and ankle department 'did not believe in tarsal tunnel' (the resident doctor who listened to my story before the head honcho came in said this). As a result I was diagnosed with Plantar Fascitis and given an excrutiating 'night splint' to wear and horribly painful orthotics. When I protested that I could not even bear the weight of a sheet on my ankle and how was I going to bear this plastic boot touching it; Dr.(can't remember his name) head of the department replied, ' People who want to get well will do these things. What can I say? I tried it. Ended up in agony, and called the doctor back to try to get any earlier appointment (he had given me an appointment 10 weeks in the future). No one EVER called me back. A month later a local podiatric surgeon opened up my ankle and remarked that I had twice as much scar tissue as he had ever seen in the tarsal tunnel. My surgery was a resounding failure.
I hope your experience will be better because the name of the docotor you are seeing is not the guy I saw. I will be interested to see what happens with you. Good Luck!!

Re: I AM SO FRUSTRATED

Matt L on 6/17/02 at 14:31 (087816)

Chad,
I'm assuming you've seen Dr. Lee at OSU- he's supposed to know a lot about TTS. And I believe you seen Dr. Schon in Baltimore concerning the vein wrap?

Re: I AM SO FRUSTRATED

Chad H on 6/18/02 at 19:29 (087937)

Dr. Lee has actually been my doctor for the past few years. He is the one I am talking about up above.

He is a great doctor, but doesn't spend enough time and doesn't actually listen to what I am saying. I swear he makes his diagnoses before he even walks into the room.

Never been to Dr. Schon.

Re: I AM SO FRUSTRATED

Henry C on 6/19/02 at 08:53 (087988)

Chad,

I suggest that you make a trip over to Baltimore and see Dr. Schon. I have been a patient of his for several years now and am very pleased with him. I also had him perform a vein wrap procedure on me. Although it did not completely remove all my pain, it did help a good bit.

Unlike other doctors, he seems to really take time with his patients. I know what you are talking about when you say your doctor makes his diagnoses before he even sees you. Most doctors are in such a rush to see everyone, that you only see him for a minute if you are lucky. This has not been my experience with Dr. Schon. I have found that he takes as much time as I need and he seems to actually listen to what I have to say. Imagine that from a doctor, I know it's hard to believe!

Dr. Schon's phone number is 800-571-9820 and his office has a web site at http://www.gcoa.net . I know it may be a long trip to Baltimore, but I really believe he should be able to help you. At least I hope so.

Henry C

Re: Back to see the Doctor

Sharon W on 6/12/02 at 08:55 (087267)

Chad,

You are not crazy. In fact it sounds like you are really 'on top of things,' and very well informed about your medical conditions and the procedures that have been done, the sources of your current pain, and the procedures that are planned for you. I applaud your for being so proactive in your own care!

It is my hope that all your surgeries and treatments from now on will work out exactly as intended, and you will soon find considerable relief from what is obviously excruciating pain. (After all, you've ALREADY had enough BAD luck to last a lifetime!)

-- Sharon

Re: Back to see the Doctor

Ed Davis, DPM on 6/12/02 at 16:16 (087337)

Chad:

There are 3 potential procedures that you may need but am not sure why your doc wants to stage the procedures, that is perform them sequentially.

The vein wrap procedure (make sure you are dealing with an individual experienced in this area), achilles lengthening and possibly a lateral ankle stabilization could all be performed at the same time, saving you a lot of down time. Arthroscopic procedures would be unlikely to repair a damaged tendon on the side of your ankle. Is it possible that the arthroscopy was for a damaged lateral ankle ligament?
Ed

Re: Response to Dr. Davis

Chad H on 6/13/02 at 11:58 (087467)

Dr. Davis,

Thank you for the reply. I always value your input.

I am afraid to say that I can't remember if it was a damaged tendon or ligament. I believe one connects muscle to bone and the other connects muscle to muscle. With that in mind, I don't remember what the arthroscopic was for. The painful area is located directly above the outside ankle bone and resembles a sprain. Now that you mention it, I beleive it was ligament damage. I don't know if you can diagnose with that information or not. I will be seeing the doctor tonight, so I will get more information.

How would you go about lateral ankle stabilization?

In response to the idea of the procedures all taking place at once: the thinking behind having them done sequentially is due to the fact that my doctor told me that if we perform a vien wrap, he would want me up and working the ankle as soon as possible to keep the nerve moving freely. He feels that if we preform the wrap and then I spend 4 - 6 weeks in a cast, the vein wrap will not be successful due to the nerve become 're-trapped' as the area heals and scar tissue reforms.

Is there anyway to keep the scar tissue for reforming?

This brings up a good question. Which is better following a tts release and a vien wrap: 4-6 weeks of cast time for healing or 1 week of cast time and then PT to keep the nerve and ankle moving freely? I believe it could be argued both ways as to which allows the scar tissue to build back up around the nerve and the tarsal tunnel.

Re: Response to Dr. Davis

Chad H on 6/13/02 at 12:07 (087471)

Opps, I meant muscle to bone and bone to bone. Muscle to bone being tendons, right? With that in mind, it was (is) ligament damage that the arthroscopic was for.

One other question. Is there any other known conditions that can cause the tineal sign? I have an outrageous amount of pain in the tarsal tunnel area, but I don't have many of the other symptoms (burning, hot, cold, tingling, numbness). EMG's have been inconclusive on me.

Re: I AM SO FRUSTRATED

Chad H on 6/13/02 at 19:32 (087503)

I hope you all don't mind if I just keep responding to my own posts!

I went to my doctor appointment. Doctor has not changed his mindset. He wants to ONLY do the gastroc recession to lengthen the achilles and he thinks this will relieve the majority of my other pain. In his words, if I still have the nerve pain after the procedure, we will talk about that then.

Let's see, I first had the nerve pain, then the problem with my achilles, so now, fixing the achilles is also going to cure my nerve pain??

He also doesn't want to fix the ligament pain on the outside of my ankle. In my opinion, he believes that since he as already worked on that area, if he were to work on it again it would be like admiting he failed the first time.

I AM SO TICKED OFF!!

So I am once again in search of a new doctor. It is so frustrating to know that I know more than my doctor, and I can't get him to listen.

I don't know where to turn and what to do next. Surgery? Medicine? Some type of pain relief? The Celebrex just isn't cutting it. He showed absolutely no compassion for the sleepless nights I experiece in agonizing pain.

I feel like crying...

Re: I AM SO FRUSTRATED

Carmen on 6/13/02 at 20:10 (087513)

What's your email Chad?

Re: I AM SO FRUSTRATED

Chad H on 6/14/02 at 12:19 (087595)

Carmen,

You can email me at (email removed)

Re: I AM SO FRUSTRATED

Ed Davis, DPM on 6/14/02 at 18:16 (087631)

Chad:

Your frustration is understandable but don't give up. You need a solid treatment plan and then go for it. Your doc does not sound like he has a clear plan and that you definitely need a second opinion.

Where do you live -- I will see if I know anyone in your area.
Ed

Re: I AM SO FRUSTRATED

Chad H on 6/15/02 at 13:27 (087684)

Dr. Davis,

You have recommended I go see Dr. Yu (I think) up near Cleveland. I am in Columbus, Ohio. There isn't any reason I haven't called him yet, just been trying to figure out the best plan.

I set up an appointment with a foot and ankle orthopedic at the Cleveland Clinic for the Monday after next. His bio says he has interested in nerve disorders as well as other ankle issues. His name is Dr. Christopher Tisdel.

I will keep you posted and would love to hear about recommended doctors.

Re: I AM SO FRUSTRATED

Rolanda P. on 6/16/02 at 05:35 (087722)

Please let me know how satisfied with Dr. Tisdel you are. The pain in my left foot has kept me up most of the night and I am looking for someone to work with to try and get some relief.
Thank you.

Re: I AM SO FRUSTRATED

eileenc on 6/16/02 at 11:40 (087735)

I went to Cleveland Clinic in September of 1997. The head of the foot and ankle department 'did not believe in tarsal tunnel' (the resident doctor who listened to my story before the head honcho came in said this). As a result I was diagnosed with Plantar Fascitis and given an excrutiating 'night splint' to wear and horribly painful orthotics. When I protested that I could not even bear the weight of a sheet on my ankle and how was I going to bear this plastic boot touching it; Dr.(can't remember his name) head of the department replied, ' People who want to get well will do these things. What can I say? I tried it. Ended up in agony, and called the doctor back to try to get any earlier appointment (he had given me an appointment 10 weeks in the future). No one EVER called me back. A month later a local podiatric surgeon opened up my ankle and remarked that I had twice as much scar tissue as he had ever seen in the tarsal tunnel. My surgery was a resounding failure.
I hope your experience will be better because the name of the docotor you are seeing is not the guy I saw. I will be interested to see what happens with you. Good Luck!!

Re: I AM SO FRUSTRATED

Matt L on 6/17/02 at 14:31 (087816)

Chad,
I'm assuming you've seen Dr. Lee at OSU- he's supposed to know a lot about TTS. And I believe you seen Dr. Schon in Baltimore concerning the vein wrap?

Re: I AM SO FRUSTRATED

Chad H on 6/18/02 at 19:29 (087937)

Dr. Lee has actually been my doctor for the past few years. He is the one I am talking about up above.

He is a great doctor, but doesn't spend enough time and doesn't actually listen to what I am saying. I swear he makes his diagnoses before he even walks into the room.

Never been to Dr. Schon.

Re: I AM SO FRUSTRATED

Henry C on 6/19/02 at 08:53 (087988)

Chad,

I suggest that you make a trip over to Baltimore and see Dr. Schon. I have been a patient of his for several years now and am very pleased with him. I also had him perform a vein wrap procedure on me. Although it did not completely remove all my pain, it did help a good bit.

Unlike other doctors, he seems to really take time with his patients. I know what you are talking about when you say your doctor makes his diagnoses before he even sees you. Most doctors are in such a rush to see everyone, that you only see him for a minute if you are lucky. This has not been my experience with Dr. Schon. I have found that he takes as much time as I need and he seems to actually listen to what I have to say. Imagine that from a doctor, I know it's hard to believe!

Dr. Schon's phone number is 800-571-9820 and his office has a web site at http://www.gcoa.net . I know it may be a long trip to Baltimore, but I really believe he should be able to help you. At least I hope so.

Henry C