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"you're so vein"

Posted by elliott on 7/26/02 at 08:48 (090649)

Based on comments here of your surgeries, it seems a given for just about all of you that large veins in the tarsal tunnel are automatically removed (ligated) at surgery without a second thought.

The surgeon who did my left foot, one of the bigger TTS names, found during its release a very large vein pressing on my nerve in the tarsal tunnel but did not ligate since, as he claims and has written in his journal articles, the vein provides support for the whole artery/vein/nerve structure, acts as a natural buffer against scar tissue, and avoids risks associated with too much tampering. His may well be a minority viewpoint (although the surgeon who did my right foot didn't ligate the observed engorged veins either). In addition, I keep hearing (as I did with regard to my father, who just had heart bypass surgery a few days ago) that whenever they take out a vein, there is always the possibility (but what's the probability?) of leaving one with permanent swelling and pain due to buildup where the cut vein is knotted.

While no one debates not ligating a varicose vein strangling or wrapped around the nerve, there seems to be a gray area when there's a large vein just touching it (with the idea of those espousing not ligating being that the release of the flexor retinaculum and separation of vein from nerve at surgery will suffice). While I did have some great initial relief from the surgery, given my post-surgical problems (almost unbearable tingling especially with shoes on for any length of time), I couldn't stop wondering what could have been if only that vein had been ligated. But now, two years later, this foot seems to be settling down somewhat (less irritation, and I can keep at least some shoes on for a few hours), possibly in part due to the occasional massaging/stretching I've been doing. I actually have hope that maybe this foot will one day return to normal (I can't say the same for my other foot, which, although the nervy symptoms disappeared through surgery, was left severely weakened by it (it was a more complicated foot, though, and had another thing besides the release done to it). If it does return to normal, perhaps it was for the better that the vein was not ligated. I presume that if the vein were indeed a dangerous ballooning varicose vein, I should be getting worse with time not better, but who knows?

Any thoughts on this vein thing? How many of you have had trouble due to ligating the vein?

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Re: "you're so vein"

Sharon W on 7/26/02 at 10:40 (090666)

Elliott,

As you know, I just had surgery to remove the varicose vein in my right tarsal tunnel. Turns out, things weren't the way they appeared on the MRI -- instead of having just the (one) normal vain in there -- the posterior tibial vein, which was thought to be varicose -- I had SIX somewhat smaller ones running through there, which were entwined around the nerve and were clearly malformed and varicose. My pod ended up leaving the PT vein alone, but removed all the others. It is very early to tell, only 2 days after surgery and still on painkillers, but based on comparing how the foot with the incision compares with my other foot (which also has PF and TTS)I THINK I already feel a reduction in pain!!

Sharon

Re: best wishes for a full recovery (nm)

elliott on 7/26/02 at 14:10 (090686)

.

Re: "you're so vein" "I bet you thought this song was about you"

Ed Davis, DPM on 7/26/02 at 16:21 (090701)

Elliott:

The vein as 'buffer' theory has some merit. The tunnel is a closed space and 'hydraulic' (fluid) pressure can be a powerful force. I hope that we eventually have an accurate way to measure pressures in the tunnel -- that would give us better insight.
Ed

Re: "you're so vein"

Sharon W on 7/26/02 at 10:40 (090666)

Elliott,

As you know, I just had surgery to remove the varicose vein in my right tarsal tunnel. Turns out, things weren't the way they appeared on the MRI -- instead of having just the (one) normal vain in there -- the posterior tibial vein, which was thought to be varicose -- I had SIX somewhat smaller ones running through there, which were entwined around the nerve and were clearly malformed and varicose. My pod ended up leaving the PT vein alone, but removed all the others. It is very early to tell, only 2 days after surgery and still on painkillers, but based on comparing how the foot with the incision compares with my other foot (which also has PF and TTS)I THINK I already feel a reduction in pain!!

Sharon

Re: best wishes for a full recovery (nm)

elliott on 7/26/02 at 14:10 (090686)

.

Re: "you're so vein" "I bet you thought this song was about you"

Ed Davis, DPM on 7/26/02 at 16:21 (090701)

Elliott:

The vein as 'buffer' theory has some merit. The tunnel is a closed space and 'hydraulic' (fluid) pressure can be a powerful force. I hope that we eventually have an accurate way to measure pressures in the tunnel -- that would give us better insight.
Ed