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TTS help

Posted by Rich S on 7/29/02 at 17:37 (090928)

Hi, I have been experiencing severe heel pain for the last 10 years.
It all started with severe burning pain in my heels. I was sent to
an orthopedic doctor. I was then sent for an EMG which did show a
delay in my nerve. I opted to have my right foot operated on, and there was no releive. If anything it was worse. I suffered threw it for a few years and now its getting worse. Ive been seeing a podiatrist who treated me conservly for TTS. I tried stretching, Ice, which did nothing. I recently had another EMG which doesnt show TTS. My doctor said that most of the time, patients with TTS dont show it on the test. I do experience a burning pain in my heels which gets really bad if I stand for 30 mins or so on hard surface. If I tap on my ankle area, my toes do go numb.
Its so bad now, just the pressure of my feet on the floor while sitting causes pain.

Anybody have some good remedies for this crippling pain?

Re: TTS help

Sharon W on 7/29/02 at 19:02 (090934)

Rich,

You might try to find a podiatrist who is board certified for orthopedic podiatry, and have him/her make you orthotics for TTS. I realize that since you say you've already had 'conservative treatments,' chances are you've probably had orthotics made for you at least once already, but it DOES matter how knowledgable and skillful the doctor who designs your orthotics is. And you've probably already tried SOME kind of anti-inflammatory medicine, like ibuprofen or Aleve... Have you tried iontophoresis, or a special massage technique called ART? Some patients, including myself, have found contrast baths to be helpful. Others have found relief from wearing compression hose. And of course, your doctor may attempt to relieve your symptoms with steroid injections; have you had those yet, as part of your 'conservative treatment'?

Sharon

Re: TTS help

Rich S on 7/30/02 at 16:51 (091021)

Yes I did have custom made orthotics, which did no good. I was taking ibufrofen for a while.

What is iontophoresis?

When you say contrast baths? do you mean soaking feet in hot water then cold, or Vis vera??

I did have 3 corizone injections which did nothing.

My doctor thinks I have both TTS, and PF. Im doing strecthing exercises
to help loosen up my Fascia. My calf muscles are very tight and im working on this.

Sincerly,
Rich

Re: TTS help

Sharon W on 7/30/02 at 17:04 (091024)

Rich,

Your situation sounds quite a bit like mine; I have both PF and TTS, and it sounds like we've been through pretty much all the same 'conservative treatments'. They didn't work very well for me, either. I've just had TTS release surgery on my right foot, and a number (6) of extra varicose veins (venules, actually), some of them hardened and inflamed ('phlebosclerotic') were removed from my tarsal tunnel. I am optimistic, but I know it is really too early to tell the results.

You might talk to your Dr. about taking Vioxx, or Celebrex.

Iontophoresis is electrical stimulation to the tarsal tunnel area that is used to instill topical medications deeper into the tissues of your foot and ankles. Many doctors seem to find it effective for their patients. I didn't try it because my insurance wouldn't pay for it.

Stretching DID help me, I think. I think the best stretches are the yoga stretches that Julie posted a few months ago. They will not over-stress your PF or TTS. Try doing a search for 'Julie's Stretches'.

Good luck to you! I know what you are dealing with, and how very difficult it can be.

Sharon

Re: PS

Sharon W on 7/30/02 at 20:57 (091051)

Yes, contrast baths are soaking in hot, then cold. Another version is a hot (very warm), then apply a bag of ice -- kind of like Scandanavians go roll in the snow after a sauna!

Sharon

Re: TTS help

Rich S on 7/31/02 at 08:00 (091105)

Best of luck to you on your recent surgery. I hope it works for you.
I had my right foot done 10 years ago, and still to this day its worse than my left. I have a lot of scare tissue that gives me a problem.

My foot doctor now wants to operate on my left foot. Im very hesitant to do this.

Ive been stretching my feet pretty agressivly and I notice it does make my
feet more sensitive and painful. trying to find julies stretches

Thanks for all your info, and hope everything works out for you.

Rich S

Re: To find Julie's stretches, see the treatments board

Sharon W on 7/31/02 at 08:19 (091111)

Rich,

Sorry, I thought it would work to find her stretches with a search. But Julie is a terrific lady; she saw these posts and she re-posted her stretches for you (and everyone) on the treatments message board.

I did notice your comment earlier that the surgery on your right foot was unsuccessful. Scar tissue is the worst enemy of TTS surgery; my pod was hesitant to do the surgery on me for exactly that reason. But now that you know you have a problem with scar tissue buildup, there ARE things your doctor can do that can help to avoid excessive buildup of scar tissue. Promptly beginning to do ultrasound and other PT techniques is perhaps the most important thing. But the Dr. can inject Kenalog and Wydase to reduce scar tissue formation. And for scarring at the skin level, some patients (not to mention Dr. Ed) have had good things to say about a product called Cica-Care. I have brought up all of this to my pod because I want to do everything possible to prevent that happening in my case.

Sharon

Re: scar tissue

elliott on 7/31/02 at 08:40 (091115)

Ever wonder how the docs even know when scar tissue is the culprit? I think they often say that for lack of a better reason. Looking at post-surgical MRIs is tricky (successful releases also generate scar tissue) and probably far from definitive, as well as impractical: you'd have to compare them to MRIs taken on successful post-surgical releases (yeah, sure). Sometimes you can see and feel scar tissue (and then try and do something about it, e.g. tissue massage), but I don't think that's what happens in the majority of cases.

I think the docs in the know consider scar tissue to be the likely culprit when one gets initial relief and then a return of symptoms within around 4 months to a year following surgery. Even then there are other possibilities to consider.

---

Re: Elliott

Sharon W on 7/31/02 at 15:54 (091174)

Elliott,

You said that even when symptoms return within about 4 months, 'there are other possibilities to consider' besides scar tissue. What other possibilities did you have in mind?

Sharon

Re: Sharon

elliott on 7/31/02 at 23:15 (091225)

Other possibilities include

1) the same biomechanical problems that led to TTS in the first place

2) strange nerve flairups such as neuralgias or neuromas resulting from the surgery

3) systemic diseases

Temporary relief from surgery can still come in the face of 1) or 3) since the release gives the nerve more room to move, at least temporarily.

I believe you posted before your surgery that your suspected cause was 1), but that enlarged veins were found; me also. But I firmly believe that veins could become enlarged due to the stresses of biomechanical problems. In surgery, they cut away your veins, release the laciniate ligament and give your nerve more room to move, but if you have a weird biomechanical gait or physical structure that contributed and which has not been addressed or corrected, what's stopping something from happening again? If not from veins, then from the bone or tissue structure re-tugging on the nerve or continuing to weaken in some way. What may well have been the real cause of my first foot's TTS wasn't diagnosed until a few months ago, almost three years after my TTS surgery. With hindsight, I might have done some things differently on this foot. Hindsight is 100%, they say. Anyway, this reasoning suggests why good orthotics may be appropriate even after a successful release.

But enough of this. For now, positive thoughts only. Your surgery went great, you *will* get better.

---

Re: Elliott: Other possibilities

Sharon W on 8/03/02 at 12:37 (091483)

As far as biomechanical problems are concerned, those have (I believe) been adequately resolved (in my case) by orthotics. You may be correct that poor biomechanics can lead to varicosities, but in my case there is a strong family history of varicose veins, as well, and I actually have venous insufficiency. I DO believe that it was necessary to remove all those small, hardened and/or varicose venules that were wrapped around (and strangling) the PT nerve. (Certainly, I worry about the problem reoccuring -- it is unfortunately a serious possibility.) Neuralgias, or neuromas, are also a possibillity, and one that my pod has discussed with me alreaady. We will deal with those types of problems when, and if, they occur. Systemic diseases have been pretty well ruled out by blood tests, etc. except that I already had a known problem with hardening of blood vessels, and, as I mentioned before, with venous insufficiency in that leg. I will not ignore these other problems, and I certainly don't expect this TTS surgery release to somehow miraculously cure them.

Thanks for your concern.

Sharon

Re: TTS help

Sharon W on 7/29/02 at 19:02 (090934)

Rich,

You might try to find a podiatrist who is board certified for orthopedic podiatry, and have him/her make you orthotics for TTS. I realize that since you say you've already had 'conservative treatments,' chances are you've probably had orthotics made for you at least once already, but it DOES matter how knowledgable and skillful the doctor who designs your orthotics is. And you've probably already tried SOME kind of anti-inflammatory medicine, like ibuprofen or Aleve... Have you tried iontophoresis, or a special massage technique called ART? Some patients, including myself, have found contrast baths to be helpful. Others have found relief from wearing compression hose. And of course, your doctor may attempt to relieve your symptoms with steroid injections; have you had those yet, as part of your 'conservative treatment'?

Sharon

Re: TTS help

Rich S on 7/30/02 at 16:51 (091021)

Yes I did have custom made orthotics, which did no good. I was taking ibufrofen for a while.

What is iontophoresis?

When you say contrast baths? do you mean soaking feet in hot water then cold, or Vis vera??

I did have 3 corizone injections which did nothing.

My doctor thinks I have both TTS, and PF. Im doing strecthing exercises
to help loosen up my Fascia. My calf muscles are very tight and im working on this.

Sincerly,
Rich

Re: TTS help

Sharon W on 7/30/02 at 17:04 (091024)

Rich,

Your situation sounds quite a bit like mine; I have both PF and TTS, and it sounds like we've been through pretty much all the same 'conservative treatments'. They didn't work very well for me, either. I've just had TTS release surgery on my right foot, and a number (6) of extra varicose veins (venules, actually), some of them hardened and inflamed ('phlebosclerotic') were removed from my tarsal tunnel. I am optimistic, but I know it is really too early to tell the results.

You might talk to your Dr. about taking Vioxx, or Celebrex.

Iontophoresis is electrical stimulation to the tarsal tunnel area that is used to instill topical medications deeper into the tissues of your foot and ankles. Many doctors seem to find it effective for their patients. I didn't try it because my insurance wouldn't pay for it.

Stretching DID help me, I think. I think the best stretches are the yoga stretches that Julie posted a few months ago. They will not over-stress your PF or TTS. Try doing a search for 'Julie's Stretches'.

Good luck to you! I know what you are dealing with, and how very difficult it can be.

Sharon

Re: PS

Sharon W on 7/30/02 at 20:57 (091051)

Yes, contrast baths are soaking in hot, then cold. Another version is a hot (very warm), then apply a bag of ice -- kind of like Scandanavians go roll in the snow after a sauna!

Sharon

Re: TTS help

Rich S on 7/31/02 at 08:00 (091105)

Best of luck to you on your recent surgery. I hope it works for you.
I had my right foot done 10 years ago, and still to this day its worse than my left. I have a lot of scare tissue that gives me a problem.

My foot doctor now wants to operate on my left foot. Im very hesitant to do this.

Ive been stretching my feet pretty agressivly and I notice it does make my
feet more sensitive and painful. trying to find julies stretches

Thanks for all your info, and hope everything works out for you.

Rich S

Re: To find Julie's stretches, see the treatments board

Sharon W on 7/31/02 at 08:19 (091111)

Rich,

Sorry, I thought it would work to find her stretches with a search. But Julie is a terrific lady; she saw these posts and she re-posted her stretches for you (and everyone) on the treatments message board.

I did notice your comment earlier that the surgery on your right foot was unsuccessful. Scar tissue is the worst enemy of TTS surgery; my pod was hesitant to do the surgery on me for exactly that reason. But now that you know you have a problem with scar tissue buildup, there ARE things your doctor can do that can help to avoid excessive buildup of scar tissue. Promptly beginning to do ultrasound and other PT techniques is perhaps the most important thing. But the Dr. can inject Kenalog and Wydase to reduce scar tissue formation. And for scarring at the skin level, some patients (not to mention Dr. Ed) have had good things to say about a product called Cica-Care. I have brought up all of this to my pod because I want to do everything possible to prevent that happening in my case.

Sharon

Re: scar tissue

elliott on 7/31/02 at 08:40 (091115)

Ever wonder how the docs even know when scar tissue is the culprit? I think they often say that for lack of a better reason. Looking at post-surgical MRIs is tricky (successful releases also generate scar tissue) and probably far from definitive, as well as impractical: you'd have to compare them to MRIs taken on successful post-surgical releases (yeah, sure). Sometimes you can see and feel scar tissue (and then try and do something about it, e.g. tissue massage), but I don't think that's what happens in the majority of cases.

I think the docs in the know consider scar tissue to be the likely culprit when one gets initial relief and then a return of symptoms within around 4 months to a year following surgery. Even then there are other possibilities to consider.

---

Re: Elliott

Sharon W on 7/31/02 at 15:54 (091174)

Elliott,

You said that even when symptoms return within about 4 months, 'there are other possibilities to consider' besides scar tissue. What other possibilities did you have in mind?

Sharon

Re: Sharon

elliott on 7/31/02 at 23:15 (091225)

Other possibilities include

1) the same biomechanical problems that led to TTS in the first place

2) strange nerve flairups such as neuralgias or neuromas resulting from the surgery

3) systemic diseases

Temporary relief from surgery can still come in the face of 1) or 3) since the release gives the nerve more room to move, at least temporarily.

I believe you posted before your surgery that your suspected cause was 1), but that enlarged veins were found; me also. But I firmly believe that veins could become enlarged due to the stresses of biomechanical problems. In surgery, they cut away your veins, release the laciniate ligament and give your nerve more room to move, but if you have a weird biomechanical gait or physical structure that contributed and which has not been addressed or corrected, what's stopping something from happening again? If not from veins, then from the bone or tissue structure re-tugging on the nerve or continuing to weaken in some way. What may well have been the real cause of my first foot's TTS wasn't diagnosed until a few months ago, almost three years after my TTS surgery. With hindsight, I might have done some things differently on this foot. Hindsight is 100%, they say. Anyway, this reasoning suggests why good orthotics may be appropriate even after a successful release.

But enough of this. For now, positive thoughts only. Your surgery went great, you *will* get better.

---

Re: Elliott: Other possibilities

Sharon W on 8/03/02 at 12:37 (091483)

As far as biomechanical problems are concerned, those have (I believe) been adequately resolved (in my case) by orthotics. You may be correct that poor biomechanics can lead to varicosities, but in my case there is a strong family history of varicose veins, as well, and I actually have venous insufficiency. I DO believe that it was necessary to remove all those small, hardened and/or varicose venules that were wrapped around (and strangling) the PT nerve. (Certainly, I worry about the problem reoccuring -- it is unfortunately a serious possibility.) Neuralgias, or neuromas, are also a possibillity, and one that my pod has discussed with me alreaady. We will deal with those types of problems when, and if, they occur. Systemic diseases have been pretty well ruled out by blood tests, etc. except that I already had a known problem with hardening of blood vessels, and, as I mentioned before, with venous insufficiency in that leg. I will not ignore these other problems, and I certainly don't expect this TTS surgery release to somehow miraculously cure them.

Thanks for your concern.

Sharon