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PF,TTS, Diagnostic tools, treatment , prognosis

Posted by Jane T on 9/04/02 at 22:28 (094489)

I am an emergency physician with PF and now TTS. I have had PF for 20 years, with left PF release 18 years ago.
My Right foot (non surgical) became worse 2 years ago (related to pregnancy, I think) but calmed down.
In March my R. foot again became worse but this time in a debilitating way. I developed TTS in that R foot in July. I worked very little in July, none in August and have no shifts for September. My TTS is not one bit better since the end of July.
I had eswt (Siemons low intensity , Canada) early August. I have tried: ice, contrast baths, celebrex 800 neurontin 1800, rest, night splints, good shoes (PD minor with heel) orthotics, taping, massage, stretching, acupunture (no help, done before TTS developed), homeopathy . Stretching seems to make the nerve worse.
I am swimming.
Dr Roger Mann said 'I don't know' and recommended anEMG to r/o TTS and a bone scan.
My Kaiser Podiatrist ( Dr Ford) has an MRI scheduled for Sept 13th and is considering surgery. He doesn't think I need an EMG.
Clinically in my opinion and in the opinion of Dr Ford I have TTS.
Do I need the EMG? Bone Scan (wouldn't this duplicate the mri?)
What is my prognosis? I can change to psychiatry (my other field) but I love my work and I don't want to give up prematurely.
It does seem hopeless, however. If the TTS does not go away I can't imagine working one shift, and I have been told that I could 'permanently damage things' if I 'toughed it out' and worked anyway. I actually think that I have already permanently damaged things and that I may be disabled from this neuropathy.

Re: PF,TTS, Diagnostic tools, treatment , prognosis

Dr. John Cozzarelli on 9/05/02 at 05:38 (094508)

Hi Jane:

I would recommend the EMG and or NCV and see what is going on with the posterior tibial nerve.

Dr. John Cozzarelli

Re: PF,TTS, Diagnostic tools, treatment , prognosis

Carmen H on 9/05/02 at 13:30 (094529)

I am not a doctor but in my opinion I would get the EMG an NCV...those tests are done for TTS and any type of nerve involvement...I wonder why your doctor wouldn't want it done? I would also do the scheduled MRI ....MRI's can rule out compressiona neuropathies and fluid around the tendon etc. I would also (If this were me) for now quit swimming and see if this helps calm things down. If it doesn't calm things down go back to it as exercise is good for your mood as you know.
Sounds like you have really run the gammet on the treatments and doctors....this is a tough thing to deal with as we all know. You have a couple things on your side....your medical knowledge and your other profession can be a 'sit down' profession. Which may turn out to be exactly what you need.
If you tried all the homepathic remedies BEFORE the TTS developed perhaps you ought to give them another shot geared toward treating the TTS?
Of course after the tests are run to confirm your suspected nerve problem...so you know what you are dealing with.
Many people discourage surgery....and use it as a last resort if necessary. Many people have great success from it and some none at all. You have to do what's best for your individual case..but I would definitely not rush into it and tell your doctor up front how you feel. That you want to take time for that important of a decision.
If you decide to go with the surgery option you will want to completely check out the person who does the surgery. As you know...making sure he has a success rate that's within your comfort zone etc.
Aslo what type of shoes are considered good shoes? Like what brand are you wearing and have you experimented with many kinds?
I wish you best the best of luck.....hang in there!!!!

Re: PF,TTS, Diagnostic tools, treatment , prognosis

Jane T on 9/05/02 at 15:36 (094533)

Thanks for your comments. I will ask my doctor about the emg when I see him on tuesday. I'm trying to research outcomes of surgery for PF complicated by TTS. I am assuming that I have an overpronation biomechanical problem causing both, and if the surgery helped the PF would it by default help the TTS. The other problem is that I am not sure how much of the pain is PF any more. A lot of it is TTS.
Shoes: PD Minor with a heel which I highly recommend. Orthotics are still confusing. I have had several pair of custom made.
Three pairs of rigid (which is recommended for PF) did not work--I could not tolerate them. Last June I had a pedorthoist (specialty making shoes and orthotics) make some foam type. They have been criticized by some of my doctors, but I am reluctan to spend more money. Taping really helps--I do this daily.

Re: PF,TTS, Diagnostic tools, treatment , prognosis

Jane T on 9/05/02 at 15:48 (094534)

Thank you for your comments. Jane

Re: PF,TTS, Diagnostic tools, treatment , prognosis

Carmen H on 9/05/02 at 17:16 (094547)

I understand your reluctance to spend more money and at the risk of talking like a commercial and spammer you may want to think about the silicone dynamic orthotics Scott advertises on the heel pain book site.
I just realized they are advertised here and I have had these for weeks now. A friend referred me to Dr. kiper. I got them (after MANY failed orthotics rigid (couldn't tolerate them for long either, foam, blue goo, and amfit) these have by far been the most comfortable and tolerable orthotics I have ever had.
Even in the midst of a pf flare up (from overdoing it) these are like walking on pillows with support.
He offers a money back guarantee and that was the only way hubby would let me get them. So far..so good.
Dr. Kiper can lend personal insight into your situation over the phone too if you contact him. He's very knowledgable and takes his time to talk to you.

Well if your symptoms are confusing...'what's TTS and what's PF' perhaps you ask the doc how would he know how to differentiate?
I have never heard of PD minor shoes...? What type of shoes is that?
Have you tried others to relieve the pressure on the nerves?
Well like I said I am no doctor or spammer either...just letting you know what has worked for me for PF so far.

Re: PF,TTS, Diagnostic tools, treatment , prognosis

Jane T on 9/05/02 at 18:16 (094548)

Thanks for your comments. PD Minor shoes are expensive, well made great shoes for PF. They were about $150. M y podiatrist looked at them and agreed that they were really good. They also have a bit of a heel which I understand is important for PF.
The pedorthist who made my orthotics in W.Va. a year ago had recommended them as well. They have a stiff heel counter.
I have been tempted to try the silicone orthotics, but I have been weary due to my previous attempts and also getting the right fit long distance. Maybe I'll try them. thanks Jane

Re: PF,TTS, Diagnostic tools, treatment , prognosis

Carole C in NOLA on 9/05/02 at 18:18 (094549)

Jane, I am not a foot professional, nor do I have TTS, but I am almost completely recovered from my PF. I attribute this to my soft custom orthotics (made by my pedorthist) and rest as much as anything. My orthotics are mostly foam, custom molded for my feet and very thick.

If your soft foam orthotics seem to help and do not increase your pain, I would suggest that you wear them. Many people have reported on these message boards that they too could not tolerate rigid orthotics during the time when their PF was very painful. Later on, when your pain is less, perhaps you will be able to more easily tolerate your rigid orthotics.

I'd suggest that you never stand or take one step without your PD Minors (with foam orthotics if they are comfortable), or else Birkenstock 'Arizonas' around the house. These have an orthotic footbed and many of us find them to be very comfortable at home and convenient to slip into in the middle of the night, and so on.

I hope this helps. The heel pain book, which you can read on this website, is very helpful in understanding PF. It discusses icing, taping, and other helpful treatments. Also helpful are very very gentle non-weighbearing stretches, such as Julie's stretches. Here is a link to a description of her stretches: bbv.cgi?n=91080

Carole C

Re: PF,TTS, Diagnostic tools, treatment , prognosis

Ed Davis, DPM on 9/06/02 at 21:04 (094649)

Did you have the series of 3 ESWT? When did you complete the series? It does take up to 12 weeks to see the results although you may want to consider repeat of the ESWT before considering surgery.

NCV/EMG is valuable for diagnosis of TTS but there is a lot of variability in diagnostic technique. It sounds like you may be on the west coast. If so, Dr. Mohammed Saeed of Tacoma, WA is one of the best diagnosticians for TTS in the country.

The fact that taping helps provides an important clue that biomechanical control is helpful. Your orthotics should, ideally, provide the same or better level of relief as the taping.
Ed

Re: PF,TTS, Diagnostic tools, treatment , prognosis

Jane T on 9/10/02 at 23:04 (094974)

Clinically I have TTS. I am scheduled for an MRI on Friday, possible surgery in November to release the PF not the TTS. Any opinion on surgical approach? I had the Siemons 3 treatments over 4 days with laser afterwards in Toronto. The last one was August 6th.
I have had no ED shifts since late July. I wear a cam boot and an orthotic made for me by a Pedorthist (sp?) in West Virginia about one year ago. It is foam type, and most podiatrists I see don't approve of it. I have had 3 rigid orthotics that did not seem to help.
I am wondering whether I should try yet another orthotic (custom). Taping is imperative.
I am thin, overpronate, high arches, occupational disaster.

Re: PF,TTS, Diagnostic tools, treatment , prognosis

Dr. John Cozzarelli on 9/05/02 at 05:38 (094508)

Hi Jane:

I would recommend the EMG and or NCV and see what is going on with the posterior tibial nerve.

Dr. John Cozzarelli

Re: PF,TTS, Diagnostic tools, treatment , prognosis

Carmen H on 9/05/02 at 13:30 (094529)

I am not a doctor but in my opinion I would get the EMG an NCV...those tests are done for TTS and any type of nerve involvement...I wonder why your doctor wouldn't want it done? I would also do the scheduled MRI ....MRI's can rule out compressiona neuropathies and fluid around the tendon etc. I would also (If this were me) for now quit swimming and see if this helps calm things down. If it doesn't calm things down go back to it as exercise is good for your mood as you know.
Sounds like you have really run the gammet on the treatments and doctors....this is a tough thing to deal with as we all know. You have a couple things on your side....your medical knowledge and your other profession can be a 'sit down' profession. Which may turn out to be exactly what you need.
If you tried all the homepathic remedies BEFORE the TTS developed perhaps you ought to give them another shot geared toward treating the TTS?
Of course after the tests are run to confirm your suspected nerve problem...so you know what you are dealing with.
Many people discourage surgery....and use it as a last resort if necessary. Many people have great success from it and some none at all. You have to do what's best for your individual case..but I would definitely not rush into it and tell your doctor up front how you feel. That you want to take time for that important of a decision.
If you decide to go with the surgery option you will want to completely check out the person who does the surgery. As you know...making sure he has a success rate that's within your comfort zone etc.
Aslo what type of shoes are considered good shoes? Like what brand are you wearing and have you experimented with many kinds?
I wish you best the best of luck.....hang in there!!!!

Re: PF,TTS, Diagnostic tools, treatment , prognosis

Jane T on 9/05/02 at 15:36 (094533)

Thanks for your comments. I will ask my doctor about the emg when I see him on tuesday. I'm trying to research outcomes of surgery for PF complicated by TTS. I am assuming that I have an overpronation biomechanical problem causing both, and if the surgery helped the PF would it by default help the TTS. The other problem is that I am not sure how much of the pain is PF any more. A lot of it is TTS.
Shoes: PD Minor with a heel which I highly recommend. Orthotics are still confusing. I have had several pair of custom made.
Three pairs of rigid (which is recommended for PF) did not work--I could not tolerate them. Last June I had a pedorthoist (specialty making shoes and orthotics) make some foam type. They have been criticized by some of my doctors, but I am reluctan to spend more money. Taping really helps--I do this daily.

Re: PF,TTS, Diagnostic tools, treatment , prognosis

Jane T on 9/05/02 at 15:48 (094534)

Thank you for your comments. Jane

Re: PF,TTS, Diagnostic tools, treatment , prognosis

Carmen H on 9/05/02 at 17:16 (094547)

I understand your reluctance to spend more money and at the risk of talking like a commercial and spammer you may want to think about the silicone dynamic orthotics Scott advertises on the heel pain book site.
I just realized they are advertised here and I have had these for weeks now. A friend referred me to Dr. kiper. I got them (after MANY failed orthotics rigid (couldn't tolerate them for long either, foam, blue goo, and amfit) these have by far been the most comfortable and tolerable orthotics I have ever had.
Even in the midst of a pf flare up (from overdoing it) these are like walking on pillows with support.
He offers a money back guarantee and that was the only way hubby would let me get them. So far..so good.
Dr. Kiper can lend personal insight into your situation over the phone too if you contact him. He's very knowledgable and takes his time to talk to you.

Well if your symptoms are confusing...'what's TTS and what's PF' perhaps you ask the doc how would he know how to differentiate?
I have never heard of PD minor shoes...? What type of shoes is that?
Have you tried others to relieve the pressure on the nerves?
Well like I said I am no doctor or spammer either...just letting you know what has worked for me for PF so far.

Re: PF,TTS, Diagnostic tools, treatment , prognosis

Jane T on 9/05/02 at 18:16 (094548)

Thanks for your comments. PD Minor shoes are expensive, well made great shoes for PF. They were about $150. M y podiatrist looked at them and agreed that they were really good. They also have a bit of a heel which I understand is important for PF.
The pedorthist who made my orthotics in W.Va. a year ago had recommended them as well. They have a stiff heel counter.
I have been tempted to try the silicone orthotics, but I have been weary due to my previous attempts and also getting the right fit long distance. Maybe I'll try them. thanks Jane

Re: PF,TTS, Diagnostic tools, treatment , prognosis

Carole C in NOLA on 9/05/02 at 18:18 (094549)

Jane, I am not a foot professional, nor do I have TTS, but I am almost completely recovered from my PF. I attribute this to my soft custom orthotics (made by my pedorthist) and rest as much as anything. My orthotics are mostly foam, custom molded for my feet and very thick.

If your soft foam orthotics seem to help and do not increase your pain, I would suggest that you wear them. Many people have reported on these message boards that they too could not tolerate rigid orthotics during the time when their PF was very painful. Later on, when your pain is less, perhaps you will be able to more easily tolerate your rigid orthotics.

I'd suggest that you never stand or take one step without your PD Minors (with foam orthotics if they are comfortable), or else Birkenstock 'Arizonas' around the house. These have an orthotic footbed and many of us find them to be very comfortable at home and convenient to slip into in the middle of the night, and so on.

I hope this helps. The heel pain book, which you can read on this website, is very helpful in understanding PF. It discusses icing, taping, and other helpful treatments. Also helpful are very very gentle non-weighbearing stretches, such as Julie's stretches. Here is a link to a description of her stretches: bbv.cgi?n=91080

Carole C

Re: PF,TTS, Diagnostic tools, treatment , prognosis

Ed Davis, DPM on 9/06/02 at 21:04 (094649)

Did you have the series of 3 ESWT? When did you complete the series? It does take up to 12 weeks to see the results although you may want to consider repeat of the ESWT before considering surgery.

NCV/EMG is valuable for diagnosis of TTS but there is a lot of variability in diagnostic technique. It sounds like you may be on the west coast. If so, Dr. Mohammed Saeed of Tacoma, WA is one of the best diagnosticians for TTS in the country.

The fact that taping helps provides an important clue that biomechanical control is helpful. Your orthotics should, ideally, provide the same or better level of relief as the taping.
Ed

Re: PF,TTS, Diagnostic tools, treatment , prognosis

Jane T on 9/10/02 at 23:04 (094974)

Clinically I have TTS. I am scheduled for an MRI on Friday, possible surgery in November to release the PF not the TTS. Any opinion on surgical approach? I had the Siemons 3 treatments over 4 days with laser afterwards in Toronto. The last one was August 6th.
I have had no ED shifts since late July. I wear a cam boot and an orthotic made for me by a Pedorthist (sp?) in West Virginia about one year ago. It is foam type, and most podiatrists I see don't approve of it. I have had 3 rigid orthotics that did not seem to help.
I am wondering whether I should try yet another orthotic (custom). Taping is imperative.
I am thin, overpronate, high arches, occupational disaster.