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Will this nightmare ever end?

Posted by Cheri A on 6/21/02 at 17:53 (088236)

Today, a POD told me that I still had nerve entrapment below the area where TTS surgery was done. He said the nerve divides, and that there are tunnels for the divisions, and that a surgery would open the tunnel area up to relieve the pressure.
I wonder why the surgeon didn't look there while he had me on the table? Has anyone had TTS release, then another one in a different area?
I don't feel I can face another surgery, butI can't help but wonder if maybe THIS is the cure I have been praying for. Has anyone had a similar experience?

Re: Will this nightmare ever end?

KathyB on 6/21/02 at 18:41 (088243)

I have not had your problem, but I wanted to tell you that I will keep you in my prayers. I have had three surgeries on my ankles to fix ruptured tendons and crushed sub-talar joints in both ankles. They now think I have an entrapment or TTS or some combination there of. I feel like it will never end, but there an end and will support and research you will find the answer you are seeking. Good luck to you and good health.

Re: Will this nightmare ever end?

Ed Davis, DPM on 6/21/02 at 18:44 (088244)

The area referred to as the tarsal tunnel is not the area where all entrapment of the posterior tibial nerve occurs. We now believe that a percentage of entrapment occurs in the area where the branches of the post. tib. nerves enter the foot, called the porta pedis. This has been referred to sometimes as the distal tarsal tunnel. Some feel that the surgery should include 'opening' up both areas. The advantage of doing so would be to potentially free all potential areas of entrapment. The disadvantage is potentially more traumatic surgery with more potential scar tissue formation. Tarsal tunnel syndrome is more rare that carpal tunnel so we don't have the numbers yet to make a good judgement on which approach is better. I feel, personally, that opening both areas will be the predominant method in the future.
Ed

Re: porta pedis

JR1 on 6/22/02 at 13:03 (088305)

How does a doctor (neurologist, I assume??) determine which
branches are entrapped?

Re: porta pedis

Cheri A on 6/22/02 at 14:30 (088306)

It is my understanding that there is a new method of testing. I had this test done on the 20th. I am not sure exactly how it works, but it is not painful like NCV, and doesn't take as long.
I don't know that this test tells which branch is trapped or not, but I believe the tunnels are side by side and the surgey not only enlarges the tunnels but also removes the dividing tissue between them so that there is lots of room.

Re: porta pedis

Sharon W on 6/22/02 at 15:07 (088307)

Cheri,

Do you remember the NAME of the test you took?

-- Sharon

Re: porta pedis

Cheri A on 6/22/02 at 15:34 (088308)

My letter of referral states: 'Neuromuscular junction testing (repetitive stimulation, paired stimuli), each nerve, any one method'.
So there you have it! I didn't ask if there was a common name for the test. If I get a chance to, I will. I will post it here when I find out.

Re: Lettter of referral

Sharon W on 6/22/02 at 17:40 (088310)

Cheri,

OH. Sounds like whoever referred you didn't know what test would be used, either! Well, maybe one of the doctors here would know about such tests...

-- Sharon

Re: Will this nightmare ever end?

eileenc on 6/23/02 at 09:13 (088332)

That is what happened to me after my TT release. I now have swelling (and I am sure that means scar tissue) below the original scar. It causes swelling in the arch and, with certain movements, numbness in the outer 3 toes.
Wish I had a solution. I use lots of ice, low cut tennis shoes which do not touch the scar, and Neurontin.

Re: they're supposed to listen real closely to your symptoms

elliott on 7/16/02 at 09:39 (089768)

but this usually gets short shrift.

Re: Hi, Eileen. Did your SI joint problem ever resolve? (nm)

elliott on 7/16/02 at 09:41 (089770)

.

Re: Will this nightmare ever end?

Phill C on 7/25/02 at 02:41 (090544)

The symptoms you mention are very familiar to me. I am 9 month post op. I have found that I still feel almost like screaming when there is presure from a shoe on any part of the foot any where near the arch, inside of the ankle, or the scar.

I have found that it helps to ware an over sized (length [one full size min] and width [atleast one last wider min]) shoe; to pull the shoe open to it's fullest and just put a granny knot in the strings.

I have looked at several hundres shoes and have not found a slip on of any kind that I can wear for more that just a few minutes.

Berkinstock sandles (pre-op) used to help a little, but just make it worse now.

I often use a cold water foot bath (with those blue ice things rotated in to it ,then back into the freezer) in a semi continous cycle. It's great on hot days.

I try to keep the water temp at around 45 degrees (so as not to actually freeze the feet).

Phill

Re: Will this nightmare ever end?

KathyB on 6/21/02 at 18:41 (088243)

I have not had your problem, but I wanted to tell you that I will keep you in my prayers. I have had three surgeries on my ankles to fix ruptured tendons and crushed sub-talar joints in both ankles. They now think I have an entrapment or TTS or some combination there of. I feel like it will never end, but there an end and will support and research you will find the answer you are seeking. Good luck to you and good health.

Re: Will this nightmare ever end?

Ed Davis, DPM on 6/21/02 at 18:44 (088244)

The area referred to as the tarsal tunnel is not the area where all entrapment of the posterior tibial nerve occurs. We now believe that a percentage of entrapment occurs in the area where the branches of the post. tib. nerves enter the foot, called the porta pedis. This has been referred to sometimes as the distal tarsal tunnel. Some feel that the surgery should include 'opening' up both areas. The advantage of doing so would be to potentially free all potential areas of entrapment. The disadvantage is potentially more traumatic surgery with more potential scar tissue formation. Tarsal tunnel syndrome is more rare that carpal tunnel so we don't have the numbers yet to make a good judgement on which approach is better. I feel, personally, that opening both areas will be the predominant method in the future.
Ed

Re: porta pedis

JR1 on 6/22/02 at 13:03 (088305)

How does a doctor (neurologist, I assume??) determine which
branches are entrapped?

Re: porta pedis

Cheri A on 6/22/02 at 14:30 (088306)

It is my understanding that there is a new method of testing. I had this test done on the 20th. I am not sure exactly how it works, but it is not painful like NCV, and doesn't take as long.
I don't know that this test tells which branch is trapped or not, but I believe the tunnels are side by side and the surgey not only enlarges the tunnels but also removes the dividing tissue between them so that there is lots of room.

Re: porta pedis

Sharon W on 6/22/02 at 15:07 (088307)

Cheri,

Do you remember the NAME of the test you took?

-- Sharon

Re: porta pedis

Cheri A on 6/22/02 at 15:34 (088308)

My letter of referral states: 'Neuromuscular junction testing (repetitive stimulation, paired stimuli), each nerve, any one method'.
So there you have it! I didn't ask if there was a common name for the test. If I get a chance to, I will. I will post it here when I find out.

Re: Lettter of referral

Sharon W on 6/22/02 at 17:40 (088310)

Cheri,

OH. Sounds like whoever referred you didn't know what test would be used, either! Well, maybe one of the doctors here would know about such tests...

-- Sharon

Re: Will this nightmare ever end?

eileenc on 6/23/02 at 09:13 (088332)

That is what happened to me after my TT release. I now have swelling (and I am sure that means scar tissue) below the original scar. It causes swelling in the arch and, with certain movements, numbness in the outer 3 toes.
Wish I had a solution. I use lots of ice, low cut tennis shoes which do not touch the scar, and Neurontin.

Re: they're supposed to listen real closely to your symptoms

elliott on 7/16/02 at 09:39 (089768)

but this usually gets short shrift.

Re: Hi, Eileen. Did your SI joint problem ever resolve? (nm)

elliott on 7/16/02 at 09:41 (089770)

.

Re: Will this nightmare ever end?

Phill C on 7/25/02 at 02:41 (090544)

The symptoms you mention are very familiar to me. I am 9 month post op. I have found that I still feel almost like screaming when there is presure from a shoe on any part of the foot any where near the arch, inside of the ankle, or the scar.

I have found that it helps to ware an over sized (length [one full size min] and width [atleast one last wider min]) shoe; to pull the shoe open to it's fullest and just put a granny knot in the strings.

I have looked at several hundres shoes and have not found a slip on of any kind that I can wear for more that just a few minutes.

Berkinstock sandles (pre-op) used to help a little, but just make it worse now.

I often use a cold water foot bath (with those blue ice things rotated in to it ,then back into the freezer) in a semi continous cycle. It's great on hot days.

I try to keep the water temp at around 45 degrees (so as not to actually freeze the feet).

Phill