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HAVE QUESTION ON ASK THE FOOT DOCTORS

Posted by Bruce M. on 7/14/02 at 10:41 (089628)

PLEASE LET ME KNOW WHAT HAS WORKED AND WHAT HAS NOT TO TARSAL TUNNEL SYNDROME. THANKS, BRUCE

Re: HAVE QUESTION ON ASK THE FOOT DOCTORS

wendyn on 7/14/02 at 11:07 (089633)

Bruce - your post from the doctor's board:

HI,I WAS JUST DIAGNOSED WITH TARSAL TUNNEL SYNDROME AND I AM WONDERING WHAT THE NORMAL TREATMENT PLAN IS? THE DOCTOR HAS PUT ME ON MOBIC-AN ANTI-INFLAMMATORY AND IS SUGGESTING AN CORTISONE INJECTION, MAYBE SOME PHYSICAL THERAPY AND ORTHOSIS. DOES THIS SOUND LIKE THE USUAL? I WOULDN'T MIND SOME ADVICE FROM OTHERS WHO HAVE THIS PROBLEM. THANKS, BRUCE

Bruce, how was your TTS diagnosed? Did your doctor run some tests on you?

A normal course of treatment would include, rest, orthotics, anti inflammatories, physio and possibly coritsone. The cortisone injection does carry some risk - so discuss that with your doctor.

Surgery is a last resort, and seems to be best left to cases where there is an identifiable mass in the tunnel that can be removed. Many of the people who post here have had lousy results with the surgery.

Re: All to True Wendyn(eom)

Tammie on 7/14/02 at 18:39 (089640)

sorry, I agree with all that wendyn has said, I had the surgery.

Re: What works

Ed Davis, DPM on 7/15/02 at 13:48 (089691)

One important question to consider is if there is an identifiable mass placing pressure on the nerve as Wendyn pointed out. Such masses include varicose veins, synovial cysts, extra muscle bellies, spurs....etc. Cases that involve removal of an identifiable mass often have a good success rate surgically. Scar tissue is assumed to be the culprit if no mass is identified. Surgery which involves a scar tissue release around the nerve works from 40 to 80% of the time depending on who and what you read. It is worthwhile to try conservative treatment including PT, cortisone injections, orthotics in such cases before considering surgery.
Ed

Re: What works

Bruce M. on 7/15/02 at 16:09 (089702)

I was diagnosed with tts when the podiatrist tapped on my ankle and asked what I felt and I told him that I felt prickly sensations in my toes. I had twisted my ankle about a week before seeing the doctor. He didn't mention the nerve conduction test, but he did say that a cortisone shot might help or having some physical therapy- are there stretches you do for tts? He starte

Re: What works

Bruce M. on 7/15/02 at 16:09 (089703)

I was diagnosed with tts when the podiatrist tapped on my ankle and asked what I felt and I told him that I felt prickly sensations in my toes. I had twisted my ankle about a week before seeing the doctor. He didn't mention the nerve conduction test, but he did say that a cortisone shot might help or having some physical therapy- are there stretches you do for tts? He started me on anti-inflammatories which haven't helped so far. After reading the posts - do I ask for cortisone next week or ask to have the nct first? Bruce

Re: HAVE QUESTION ON ASK THE FOOT DOCTORS

Lara T on 7/15/02 at 22:49 (089740)

The treatment that worked wonders for me (and apparently not as well for anyone else, so don't hold your breath) are compression socks. I have Rx socks - not just the ones you can get OTC. For more information, check the archives of this board for a thread on compression socks. No one has given me a reasonable explanation on why it works. I keep bringing it up (on previous threads on this board) because it is a relatively inexpensive (expensive socks, inexpensive treatment), non-invasive treatment to try. If it doesn't work you haven't lost much time or money - I noticed improvement quickly. If it makes things worse (a few people I think reported that) they just took the socks off. For me, it gave me a life back (albeit a life without my tennis & karate and malling and long walks in the park - but I can clean my house and go to classes, and care for my kids and don't have to fantasize about amputation and crawl around on the floor, or stay put on the couch all evening and have people bring things to me, and now I take art classes instead of tennis.

Re: What works

wendyn on 7/15/02 at 23:20 (089741)

Bruce, if this is fairly recent and it happened from twisting your ankle, I wouldn't worry about it too much. I would suspect that if you ice, rest, elevate, take your anti-inflams - I guess you'll heal quickly.

The test you describe checks for Tinel's sign. A nerve conduction test should be done prior to considering surgery, and many doctors also do an MRI to see exactly what is going on. You are a long way from having to even consider that though.

Keep in touch and let us know how you do!!!!

Re: What works

Sharon W on 7/16/02 at 08:21 (089755)

Bruce,

If I were you, I would ask for nerve conduction tests first, and also ask your Dr. if orthotics or some sort of cast or brace might be appropriate for you. Since you twisted your ankle right before this happened, I agree with Wendy that it may simply heal as your injury heals -- but if the position of your foot and the way you walk contributed to twisting your ankle, that may be something that needs correcting.

About the nerve conduction tests: they may confirm tarsal tunnel syndrome but a positive result on those tests for TTS indicates a fairly serious case, one in which the nerves of your foot have begun to show damage in terms of how fast your nerve impulses are firing. Some doctors prefer to wait until they are almost at the point of considering surgery, before doing those tests -- so you may find that your Dr. wants to wait a while on that. But, you can always ASK!

-- Sharon

Re: HAVE QUESTION ON ASK THE FOOT DOCTORS

mike l on 7/16/02 at 17:49 (089800)

been diagnosed with tts ,heel have had cortisone,plantar release{surgery} walking cast, nite splint,physical therapy,several ortos made.........no help. Dr. says tts ,no pain in morn but over course of day or hard surfacews pain is bad. prolonged standing also hurts. removing shoes ,ioce and rest help. sound like tts? pain on inside of foot and radiates to bottom of feet.

Re: HAVE QUESTION ON ASK THE FOOT DOCTORS

wendyn on 7/16/02 at 18:54 (089802)

Mike - when was your surgery?

Is this the same doctor (diagnosing your TTS) who did your PF release?

Re: HAVE QUESTION ON ASK THE FOOT DOCTORS

mike l on 7/17/02 at 16:33 (089892)

It's a different doctor{same clinic} Dr. named POJMAN, Dr. who has diagnosed me with TTS has been doing TTS surgery 21 years,said has only had one that failed,redid it and successfull. PF was 5 years ago with no change.

Re: then your doc has by far the best TTS record in the world

elliott on 7/19/02 at 06:58 (090076)

i.e., his words are completely unbelievable unless, perhaps, he did just two TTS surgeries over those 21 years:

1) the one that failed
2) a re-doing of the one that failed.

---

Re: then your doc has by far the best TTS record in the world

mike l on 7/19/02 at 17:09 (090150)

guess i'm a lucky guy..............enlighten me please

Re: What damage?

Lara T on 7/20/02 at 07:41 (090196)

Why do you say '. . .one in which the nerves of your foot have begun to show damage in terms of how fast your nerve impulses are firing' I'm concerned I'm missing something.

I've been told that while walking may be uncomfortable (depending on how well I've managed it that day/week/month), I'm not doing any damage to anything by continuing my life. My experience has been to that the ebbing and flowing of my symptoms correlates to how I treat my feet and there has not been an overall deterioration. IN fact, it took about two years to diagnose it, and once I got my 'magic socks' things became very manageable - indicating to me no overall damage, just better control of symptoms.

Am I missing something I should be aware of.

Re: What damage?

Sharon W on 7/21/02 at 08:57 (090271)

Lara,

Continued and/or daily compression (squeezing) of an entrapped nerve can cause damage to it, particulary to the myellin sheath which helps it to conduct nerve impusles properly. Since you have experienced so much relief after beginning to use compression socks, your nerve has probably been HEALING, not getting worse. If I recall correctly, you did have nerve conduction tests done at one time? I imagine that repeating the tests at some point would help to determine whether, and how much, your nerve has been healing. (Then again, nobody really enjoys those tests...)

Sharon

Re: HAVE QUESTION ON ASK THE FOOT DOCTORS

wendyn on 7/14/02 at 11:07 (089633)

Bruce - your post from the doctor's board:

HI,I WAS JUST DIAGNOSED WITH TARSAL TUNNEL SYNDROME AND I AM WONDERING WHAT THE NORMAL TREATMENT PLAN IS? THE DOCTOR HAS PUT ME ON MOBIC-AN ANTI-INFLAMMATORY AND IS SUGGESTING AN CORTISONE INJECTION, MAYBE SOME PHYSICAL THERAPY AND ORTHOSIS. DOES THIS SOUND LIKE THE USUAL? I WOULDN'T MIND SOME ADVICE FROM OTHERS WHO HAVE THIS PROBLEM. THANKS, BRUCE

Bruce, how was your TTS diagnosed? Did your doctor run some tests on you?

A normal course of treatment would include, rest, orthotics, anti inflammatories, physio and possibly coritsone. The cortisone injection does carry some risk - so discuss that with your doctor.

Surgery is a last resort, and seems to be best left to cases where there is an identifiable mass in the tunnel that can be removed. Many of the people who post here have had lousy results with the surgery.

Re: All to True Wendyn(eom)

Tammie on 7/14/02 at 18:39 (089640)

sorry, I agree with all that wendyn has said, I had the surgery.

Re: What works

Ed Davis, DPM on 7/15/02 at 13:48 (089691)

One important question to consider is if there is an identifiable mass placing pressure on the nerve as Wendyn pointed out. Such masses include varicose veins, synovial cysts, extra muscle bellies, spurs....etc. Cases that involve removal of an identifiable mass often have a good success rate surgically. Scar tissue is assumed to be the culprit if no mass is identified. Surgery which involves a scar tissue release around the nerve works from 40 to 80% of the time depending on who and what you read. It is worthwhile to try conservative treatment including PT, cortisone injections, orthotics in such cases before considering surgery.
Ed

Re: What works

Bruce M. on 7/15/02 at 16:09 (089702)

I was diagnosed with tts when the podiatrist tapped on my ankle and asked what I felt and I told him that I felt prickly sensations in my toes. I had twisted my ankle about a week before seeing the doctor. He didn't mention the nerve conduction test, but he did say that a cortisone shot might help or having some physical therapy- are there stretches you do for tts? He starte

Re: What works

Bruce M. on 7/15/02 at 16:09 (089703)

I was diagnosed with tts when the podiatrist tapped on my ankle and asked what I felt and I told him that I felt prickly sensations in my toes. I had twisted my ankle about a week before seeing the doctor. He didn't mention the nerve conduction test, but he did say that a cortisone shot might help or having some physical therapy- are there stretches you do for tts? He started me on anti-inflammatories which haven't helped so far. After reading the posts - do I ask for cortisone next week or ask to have the nct first? Bruce

Re: HAVE QUESTION ON ASK THE FOOT DOCTORS

Lara T on 7/15/02 at 22:49 (089740)

The treatment that worked wonders for me (and apparently not as well for anyone else, so don't hold your breath) are compression socks. I have Rx socks - not just the ones you can get OTC. For more information, check the archives of this board for a thread on compression socks. No one has given me a reasonable explanation on why it works. I keep bringing it up (on previous threads on this board) because it is a relatively inexpensive (expensive socks, inexpensive treatment), non-invasive treatment to try. If it doesn't work you haven't lost much time or money - I noticed improvement quickly. If it makes things worse (a few people I think reported that) they just took the socks off. For me, it gave me a life back (albeit a life without my tennis & karate and malling and long walks in the park - but I can clean my house and go to classes, and care for my kids and don't have to fantasize about amputation and crawl around on the floor, or stay put on the couch all evening and have people bring things to me, and now I take art classes instead of tennis.

Re: What works

wendyn on 7/15/02 at 23:20 (089741)

Bruce, if this is fairly recent and it happened from twisting your ankle, I wouldn't worry about it too much. I would suspect that if you ice, rest, elevate, take your anti-inflams - I guess you'll heal quickly.

The test you describe checks for Tinel's sign. A nerve conduction test should be done prior to considering surgery, and many doctors also do an MRI to see exactly what is going on. You are a long way from having to even consider that though.

Keep in touch and let us know how you do!!!!

Re: What works

Sharon W on 7/16/02 at 08:21 (089755)

Bruce,

If I were you, I would ask for nerve conduction tests first, and also ask your Dr. if orthotics or some sort of cast or brace might be appropriate for you. Since you twisted your ankle right before this happened, I agree with Wendy that it may simply heal as your injury heals -- but if the position of your foot and the way you walk contributed to twisting your ankle, that may be something that needs correcting.

About the nerve conduction tests: they may confirm tarsal tunnel syndrome but a positive result on those tests for TTS indicates a fairly serious case, one in which the nerves of your foot have begun to show damage in terms of how fast your nerve impulses are firing. Some doctors prefer to wait until they are almost at the point of considering surgery, before doing those tests -- so you may find that your Dr. wants to wait a while on that. But, you can always ASK!

-- Sharon

Re: HAVE QUESTION ON ASK THE FOOT DOCTORS

mike l on 7/16/02 at 17:49 (089800)

been diagnosed with tts ,heel have had cortisone,plantar release{surgery} walking cast, nite splint,physical therapy,several ortos made.........no help. Dr. says tts ,no pain in morn but over course of day or hard surfacews pain is bad. prolonged standing also hurts. removing shoes ,ioce and rest help. sound like tts? pain on inside of foot and radiates to bottom of feet.

Re: HAVE QUESTION ON ASK THE FOOT DOCTORS

wendyn on 7/16/02 at 18:54 (089802)

Mike - when was your surgery?

Is this the same doctor (diagnosing your TTS) who did your PF release?

Re: HAVE QUESTION ON ASK THE FOOT DOCTORS

mike l on 7/17/02 at 16:33 (089892)

It's a different doctor{same clinic} Dr. named POJMAN, Dr. who has diagnosed me with TTS has been doing TTS surgery 21 years,said has only had one that failed,redid it and successfull. PF was 5 years ago with no change.

Re: then your doc has by far the best TTS record in the world

elliott on 7/19/02 at 06:58 (090076)

i.e., his words are completely unbelievable unless, perhaps, he did just two TTS surgeries over those 21 years:

1) the one that failed
2) a re-doing of the one that failed.

---

Re: then your doc has by far the best TTS record in the world

mike l on 7/19/02 at 17:09 (090150)

guess i'm a lucky guy..............enlighten me please

Re: What damage?

Lara T on 7/20/02 at 07:41 (090196)

Why do you say '. . .one in which the nerves of your foot have begun to show damage in terms of how fast your nerve impulses are firing' I'm concerned I'm missing something.

I've been told that while walking may be uncomfortable (depending on how well I've managed it that day/week/month), I'm not doing any damage to anything by continuing my life. My experience has been to that the ebbing and flowing of my symptoms correlates to how I treat my feet and there has not been an overall deterioration. IN fact, it took about two years to diagnose it, and once I got my 'magic socks' things became very manageable - indicating to me no overall damage, just better control of symptoms.

Am I missing something I should be aware of.

Re: What damage?

Sharon W on 7/21/02 at 08:57 (090271)

Lara,

Continued and/or daily compression (squeezing) of an entrapped nerve can cause damage to it, particulary to the myellin sheath which helps it to conduct nerve impusles properly. Since you have experienced so much relief after beginning to use compression socks, your nerve has probably been HEALING, not getting worse. If I recall correctly, you did have nerve conduction tests done at one time? I imagine that repeating the tests at some point would help to determine whether, and how much, your nerve has been healing. (Then again, nobody really enjoys those tests...)

Sharon