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Any real treatments for TTS besides surgery?

Posted by JJC on 7/21/02 at 13:23 (090290)

I've read these boards for sometime.
Correct me if I'm wrong, but I don't see any 'treatments'
available for treating Tarsal Tunnel Syndrome.
Am I wrong here? I mean, I read that surgery is a 50/50 crap shoot.
So how does a doctor treat TTS? Is it always drugs? Phsycial Therapy?
What kind of doctor should someone work with? The neurologist
who found the TTS in an NCV study? A podiatrist?

Re: Any real treatments for TTS besides surgery?

DR Zuckerman on 7/21/02 at 16:09 (090300)

This is a very good question. The answer depends on what is causing the problem. For example. excessive pronation that is contributing to the condition needs to be addressed. Orthosis will need to be made and the proper prescription added. If you have lower back disc disease that will have to be addressed. If there is a Flexor tendonitis then phyical therapy, nsaid, restriction of motion by some type of casting. If there is a lesion such as a cyst then surgery is a consideration. In summary almost all of the evaluations and treatments that are involved with heel pain can and should be considered with TTS.

Re: Any real treatments for TTS besides surgery?

JJC on 7/21/02 at 19:53 (090309)

YOur comment '... If there is a lesion such as a cyst '
Would something like that show up on an MRI of the foot/ankle?
What about Flexor tendonitis? HOw is that diagnosed?

Re: Any real treatments for TTS besides surgery?

DR Zuckerman on 7/21/02 at 20:51 (090313)

Hi

A cyst and or tendonitis can be determined by an mri or diagnostic ultrasound evaluation.

Re: Any real treatments for TTS besides surgery?

Lara T on 7/21/02 at 22:09 (090320)

I've mentioned compression socks several times. They apparently don't work for lots of people, but they are magic for me - no one knows why. I assume they work for others as I can't imagine why the doctor would have even tried it if he hadn't seen success previously. If you need more information, goto the Tarsal Tunnel board and look for a thread on 'compression socks'.

Re: Any real treatments for TTS besides surgery?

Ed Davis, DPM on 7/21/02 at 23:43 (090328)

A percentage of TTS is caused by varicose veins within the tarsal tunnel. Compression socks may help such individuals. It is helpful to try to find the cause of TTS as the treatments can vary with the cause.
Ed

Re: Any real treatments for TTS besides surgery?

Barbara S on 7/21/02 at 23:57 (090331)

Hi Lara T. I know you have posted about compression socks many times and how they work for you,but they didn't work for me. When I first had the compression sock fitted my foot was already a little swollen. The lady that fitted me told me to put it on first thing in the morning. Almost immediatly I could feel my foot and ankle begin to swell. The PT that suggested I ask my Doc said stop wearing it. She said it should not make my swelling worse. I had my surgery April 22 2002 and every since the very first day I have had a problem with swelling. I could not wear a cam boot or anything else on my foot. Even when I put on a regular low cut sock I can feel it start to swell. I just had a MRI on Sat,as the Docs can't figure out about the swelling and when I do toe to heel stretches it is very tight the ankle and back of heel up into the back of my leg. Hopefully something will show up on the MRI. GLad they work for you, wish they would have worked for me. Take Care Barbara S.

Re: Any real treatments for TTS besides surgery?

KathyB on 7/22/02 at 17:50 (090374)

I think it does make a difference what is causing your TTS, for me it is being caused by something that happened during my posterior tibial tendon. I am doing well on drug thepary and since it isn't broke my doctor does not see why he should do surgery. I do PT on my own, after having been in it for a year, I will be going on a new exercise program tomorrow. I have a good Podiatrist that I would trade for the world. I trust him and he has brought me from living in daily all consuming pain to 90% pain free 90% of the time. My advise: Get a good doctor that you trust and start from there. Do you reserach so you know what is going on, and what is the newest treatments and drugs out there. I am on Neurontin and Topamax. Topamax is not well known, but it is working very well on me. Good Luck, it is not an easy road.

Re: Any real treatments for TTS besides surgery?

Lara T on 7/23/02 at 09:34 (090422)

I wonder whether I should post this on the 'treatment' board (probably will also), but hte question came up here.
What are all the options for treatments, and how would the cause effect the treatment. It seems that 90% of what is mentioned has been mentioned before. I've tried to make a list of everything I've heard of.

NON INVASIVE
compression socks
Vitamin B
ESWT (for PF, not TTS?)

MINIMALLY INVASIVE (but not necessarily without significant side effects)
Cortisone shots
Medications: NSAIDS
Medications: Neurontin, Elavil

INVASIVE
PF release surgery
TTS release surgery

Re: Any real treatments for TTS besides surgery?

Lanny on 7/24/02 at 20:03 (090531)

...For really chronic TTS try the fluid silicone orthotic that Dr Kiper (www.drkiper.com) prescribes,,,it helped me when nothing else worked. He will consult over the phone & if you pass he'll even give u a guarantee...worth a shot...Good Luck

Re: Any real treatments for TTS besides surgery?

Don S. on 7/30/02 at 19:37 (091035)

I was diagnosed with bilateral TTS about 18 months ago. Was put on a low dose of neurontin (gabapentin) before being diagnosed. Was ready for surgery but my doc went back to his home in Georgia so started anew with his partner. He takes things maore coservatively. He increased the neurontin and am now up to 600mg 3 times a day. It helped but I still had my bad days. He then added vioxx (25mg once daily) about 6 weeks ago and the relief has been tremendous. I went from a pain level of 6 to 7 down to a 3. Give it a try.

Re: Any real treatments for TTS besides surgery?

sue m on 8/08/02 at 08:07 (091919)

neurontin made me very dizzy so my dr gave me topomax-- haven't taken it yet because I'm affraid it will make me dizzy too. Do you ahve any side effects from the topomax?

Re: Any real treatments for TTS besides surgery?

DR Zuckerman on 7/21/02 at 16:09 (090300)

This is a very good question. The answer depends on what is causing the problem. For example. excessive pronation that is contributing to the condition needs to be addressed. Orthosis will need to be made and the proper prescription added. If you have lower back disc disease that will have to be addressed. If there is a Flexor tendonitis then phyical therapy, nsaid, restriction of motion by some type of casting. If there is a lesion such as a cyst then surgery is a consideration. In summary almost all of the evaluations and treatments that are involved with heel pain can and should be considered with TTS.

Re: Any real treatments for TTS besides surgery?

JJC on 7/21/02 at 19:53 (090309)

YOur comment '... If there is a lesion such as a cyst '
Would something like that show up on an MRI of the foot/ankle?
What about Flexor tendonitis? HOw is that diagnosed?

Re: Any real treatments for TTS besides surgery?

DR Zuckerman on 7/21/02 at 20:51 (090313)

Hi

A cyst and or tendonitis can be determined by an mri or diagnostic ultrasound evaluation.

Re: Any real treatments for TTS besides surgery?

Lara T on 7/21/02 at 22:09 (090320)

I've mentioned compression socks several times. They apparently don't work for lots of people, but they are magic for me - no one knows why. I assume they work for others as I can't imagine why the doctor would have even tried it if he hadn't seen success previously. If you need more information, goto the Tarsal Tunnel board and look for a thread on 'compression socks'.

Re: Any real treatments for TTS besides surgery?

Ed Davis, DPM on 7/21/02 at 23:43 (090328)

A percentage of TTS is caused by varicose veins within the tarsal tunnel. Compression socks may help such individuals. It is helpful to try to find the cause of TTS as the treatments can vary with the cause.
Ed

Re: Any real treatments for TTS besides surgery?

Barbara S on 7/21/02 at 23:57 (090331)

Hi Lara T. I know you have posted about compression socks many times and how they work for you,but they didn't work for me. When I first had the compression sock fitted my foot was already a little swollen. The lady that fitted me told me to put it on first thing in the morning. Almost immediatly I could feel my foot and ankle begin to swell. The PT that suggested I ask my Doc said stop wearing it. She said it should not make my swelling worse. I had my surgery April 22 2002 and every since the very first day I have had a problem with swelling. I could not wear a cam boot or anything else on my foot. Even when I put on a regular low cut sock I can feel it start to swell. I just had a MRI on Sat,as the Docs can't figure out about the swelling and when I do toe to heel stretches it is very tight the ankle and back of heel up into the back of my leg. Hopefully something will show up on the MRI. GLad they work for you, wish they would have worked for me. Take Care Barbara S.

Re: Any real treatments for TTS besides surgery?

KathyB on 7/22/02 at 17:50 (090374)

I think it does make a difference what is causing your TTS, for me it is being caused by something that happened during my posterior tibial tendon. I am doing well on drug thepary and since it isn't broke my doctor does not see why he should do surgery. I do PT on my own, after having been in it for a year, I will be going on a new exercise program tomorrow. I have a good Podiatrist that I would trade for the world. I trust him and he has brought me from living in daily all consuming pain to 90% pain free 90% of the time. My advise: Get a good doctor that you trust and start from there. Do you reserach so you know what is going on, and what is the newest treatments and drugs out there. I am on Neurontin and Topamax. Topamax is not well known, but it is working very well on me. Good Luck, it is not an easy road.

Re: Any real treatments for TTS besides surgery?

Lara T on 7/23/02 at 09:34 (090422)

I wonder whether I should post this on the 'treatment' board (probably will also), but hte question came up here.
What are all the options for treatments, and how would the cause effect the treatment. It seems that 90% of what is mentioned has been mentioned before. I've tried to make a list of everything I've heard of.

NON INVASIVE
compression socks
Vitamin B
ESWT (for PF, not TTS?)

MINIMALLY INVASIVE (but not necessarily without significant side effects)
Cortisone shots
Medications: NSAIDS
Medications: Neurontin, Elavil

INVASIVE
PF release surgery
TTS release surgery

Re: Any real treatments for TTS besides surgery?

Lanny on 7/24/02 at 20:03 (090531)

...For really chronic TTS try the fluid silicone orthotic that Dr Kiper (www.drkiper.com) prescribes,,,it helped me when nothing else worked. He will consult over the phone & if you pass he'll even give u a guarantee...worth a shot...Good Luck

Re: Any real treatments for TTS besides surgery?

Don S. on 7/30/02 at 19:37 (091035)

I was diagnosed with bilateral TTS about 18 months ago. Was put on a low dose of neurontin (gabapentin) before being diagnosed. Was ready for surgery but my doc went back to his home in Georgia so started anew with his partner. He takes things maore coservatively. He increased the neurontin and am now up to 600mg 3 times a day. It helped but I still had my bad days. He then added vioxx (25mg once daily) about 6 weeks ago and the relief has been tremendous. I went from a pain level of 6 to 7 down to a 3. Give it a try.

Re: Any real treatments for TTS besides surgery?

sue m on 8/08/02 at 08:07 (091919)

neurontin made me very dizzy so my dr gave me topomax-- haven't taken it yet because I'm affraid it will make me dizzy too. Do you ahve any side effects from the topomax?