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Foot Surgery in NOV 2002

Posted by Tim H on 10/17/02 at 10:24 (097731)

My foot doctor is highly recommending foot surgery to correct my tarsal tunnel.

He made it sound like a simple operation to relieve the nerve pinching, then 'about 3 weeks later I'm healed and the nerves will fine'.

I agreed, so surgery is planned, but THEN, I fought this web site. Now things seem diferent. The surgery sounds not so simple, and not so guaranteed, as I am reading your posts.

I know every foot is different, but my case was described as classic tarsel tunnel, (I did have the nerve testing) and the nerves are being pinched near the ankle and causing numbness on the right side of my foot. The cortisone shots provided temporary, deminishing relief.

HELP - In your experiences, my million dollar question is: is it possible that the surgery may actually make my foot worse or not help ? If I get my ligiaments cut up, and take the risk of those 'unusual' situations occuring, I would like to know that the doctor is correct when he says the operation has a 95%+ chance of success.

Thanks,
Tim

Re: Foot Surgery in NOV 2002

Tim H on 10/17/02 at 11:03 (097733)

I just read more posts AFTER posting the above. And after learning more from your posts, I understand the wide spectrum of issues and I also see I better start taking this more seriously ! I hope your foot conditions improve ! What a card to be dealt.

I had a pulled/torn planter facsiitis, thus the foot adventure and treatment began.
The torn planter facsiitis healed after 6 months.
But then I 'felt' numbness in my little toe and the outside part of my foot.
Some PT helped, but when I was on feet a lot, little toe became numb again.
Then little toe AND second toe became numb.
Then outside of foot and little toe started hurting, (burning).
Cortosone shot in ankle provided GREAT help at first, now it only helps for 5 days.
Now the outside half of my foot and toes are mostly numb and burning. The ankle and heal do not hurt at all.

Locating the entrapment area seems to be the key BEFORE surgery. I would really hope to 'release' the suspect nerve in ONE surgery !
Where do you get this cream to try and locate the entrapment area ?

Re: Foot Surgery in NOV 2002

elliott on 10/17/02 at 11:21 (097738)

Regarding surgery, you have to ask yourself questions like how much pain you're in, can you live with it the rest of your life, might it get better with time and other conservative means. If the answer's No, the surgery may be worth considering. Odds are more like 70%, even with the best surgeons.

A competent doc giving you a good exam should be able to distinguish between standard TTS and a more distal entrapment. The various nerves branch off the main one at the inner ankle, the lateral plantar nerve heading to the outer part of the sole of the foot and the last two toes. If the source of entrapment is at the inner ankle (always a possibility and the most likely in general), a standard TTS release may be warranted. Suggest you read a lot of earlier posts regarding surgical outcomes, other sources of pain such as your back and diseases for which bloodwork may help, etc.

Not sure how valuable it is in your case, but if you want to try a topical cream, click on Message Boards at top, then do a search on 'Formula 5'. It will bring up the info you need. You still need a doc to write a script.

[]

Re: Foot Surgery in NOV 2002

chris on 10/17/02 at 12:14 (097746)

I had pf and tts surgery Nov '00. You will find some very knowledgable folks here. I actually found this site after I had my surgery and if I had found it before surgery, I might not have had the surgery.

There are many non-surgical treatments that should be tried first. I'm sure someone else can list them better than I could. As Elliott mentioned you should consider how much pain you are in now...I was in so much pain I would have preferred having my foot cut off!

I am happy to say that my surgery was successful and 2 years later, I continue to be pain free. I will say that 3 weeks after surgery I was not pain free and that it was more like 3-4 months and more phyisical therapy following surgery before I started to feel better.

I also must point out that there are those who were worse off following surgery....I'm sure they will post their stories too.

Good luck to you!

Re: Foot Surgery in NOV 2002

Julie on 10/18/02 at 02:47 (097790)

Tim

I have no experience of TTS and no knowledge of it other than from reading these message boards for a few years. But I think you are right to be cautious. If you read past posts you will find many histories of people who were made worse, some much worse, by TTS surgery. This isn't to say it never works, but the success rate seems, as Elliott told you, not to be as high as your doctor claimed.

I would be sceptical of a doctor who told me that the surgery would be simple and that I (and my nerves!) would be fine in three weeks. NO surgery is simple, particularly not foot surgery, and no nerve in the universe recovers from surgery in three weeks.

The first thing to do, if you are seriously considering surgery, is see at least one more foot specialist for another opinion. If you weren't seriously considering surgery before it was suggested (i.e. if your pain isn't so excruciating that you can live with it for a while longer) then do some more research here and inform yourself about conservative treatments.

And read Wendy's FAQ (link at the top of the home page) for a masterly summary of knowledge of TTS. Wendy doesn't read the boards all the time, but her name in this post will trigger an email to her, and she may talk to you herself. She and Elliott are probably the most knowledgeable people here, TTS-wise.

Re: Apart from the doctors, I should have said!

Julie on 10/18/02 at 02:54 (097791)

.

Re: Foot Surgery in NOV 2002

Sharon W on 10/18/02 at 08:03 (097795)

Tim,

Please listen to Elliott on this one -- I would distrust any Dr. who said that tarsal tunnel release surgery would have a 95% success rate, UNLESS an MRI had shown that there is some kind of a mass inside, or pressing in on, your tarsal tunnel -- something that could be removed during surgery to relieve the pressure on the nerve.

Also, the recovery time (before you feel significant relief from nerve pain) is usually reported to be more like 2 to 6 months, NOT 3 weeks! (Sometimes it takes even longer than that.) If your nerve is ALREADY DAMAGED enough to show up as abnormal on nerve conduction tests, you may indeed need this surgery to relieve the pressure on that nerve so it can BEGIN to heal. But nerves take a long time to heal -- it is a very slow (and painful) process. For that reason, TTS surgery usually doesn't bring that much IMMEDIATE relief. It takes a while, because you are not just recovering from the surgery itself, you also have to recover from the damage done by the nerve entrapment that made the surgery necessary in the first place!

By the way, I have had TTS surgery myself (2 1/2 months ago), and I am quite satisfied with the results so far.

Sharon

Re: Foot Surgery in NOV 2002

Ellen F. on 10/18/02 at 09:22 (097802)

Does the nerve become 'more' damaged if already damaged and you wait longer for the surgery? Do you think it is better to have the surgery when you are not in bad pain, or wait until the pain is worse? see my pain is not like some described by people here. So far i have been able to tolerate it, so i'm wondering if i should just continue to get maybe 2 or so other opinions from other drs. also i am getting the feeling that podiatrist vs othopedic is more the way to go as far as the surgery part. I guess mostly what i have read is 'experience' with this type of surgery by the dr. is of utmost importance. the podiatrist that wants to do my surgery has done 20 in the past yr., he also said success rate is 80%.

Re: How long is too long to wait for a TTS release?

Sharon W on 10/18/02 at 11:23 (097809)

Ellen,

The question you asked was rather throroughly discussed last March, in this thread (I hope the link works):

bbt.cgi?n=76792

Perhaps the most interesting comments made on the subject in the thread I just mentioned were made by one of the podiatrists, Ed Davis, DPM (I cut and pasted his message, below):

How Long Is Too Long To Wait For TT Release?
Posted by Ed Davis, DPM on 3/21/02 at 19:22 View Thread

I wish we had more concrete information from which to give you an answer with the force of statistical backup. My experience is that individuals who wait too long to treat TTS have a much poorer prognosis.

How long is too long? Again, not a lot of concrete information. I would certainly be inclined to move forward with surgical treatment if the NCV shows significant changes confirming TTS. My feeling is that the risks of surgical treatment outweigh the risks of allowing disease progression.

I have some individuals with abnormal NCV in my office who do not want surgery. I am repeating the NCV on a yearly basis in an attempt to give them an accurate assessment of the course of their disease and if delaying surgery is causing potential damage. I am lucky to have a highly skilled electromyographer in my area.
Ed

Re: How long is too long to wait for a TTS release?

elliott on 10/18/02 at 12:59 (097815)

Check out this link to the abstract of such a study, namely of those who waited over 5 years before surgery (I think I posted it once before a long time ago):

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9345220&dopt=Abstract

The results should not be taken as gospel, especially given the small sample size, but it showed around 60% success. If you think about it, that's not unreasonably lower than what I've been told is the true figure for the population at large, more like 70% (and you even could argue, counterintuitively, that it's higher than the results of that thorough study which claimed only 44%, so maybe waiting actually increases your chances :-) :-)). There's probably a distinction between the case where the nerve is getting more and more crushed as time goes on (call it Stage 2) vs. just being touched and irritated (Stage 1). I'd bet symptoms would worsen a lot anyway if things were deteriorating. I don't think waiting a year or possibly even two in Stage 1 to see if things will clear is such a bad thing. Note: some might remain in Stage 1 the rest of their lives, while some might actually start in Stage 2.)

Speaking of success rates, even though I accept the 70% figure I gave before, if one is in serious pain just about all the time and has trouble coping, the surgery, when done by someone competent, is worth a try. I'll break the mold by saying this even in the absence of a visible obstruction in the tarsal tunnel, since sometimes the nerve gets tugged and stretched, and simply needs a bit more room to move, which the surgery provides. To me the real danger with no visible structure in the tarsal tunnel is that often they have not figured out what really caused the TTS, and then the surgery often doesn't help or gives only temporary relief or makes one worse in some way, with the true culprit showing itself only years down the road. In that case, waiting might have picked that up. I'm not really basing all these comments on any studies or facts; just some thoughts and intuition from someone who has had a bilateral release.

[]

Re: How long is too long to wait for a TTS release?

Ellen F. on 10/18/02 at 13:31 (097816)

Elliott, thanks for the info. Also, just how do you find out what 'stage' you are in? The Dr. that did my nerve studies, said 'moderate in the left and mild in the right'. am i to assume that is stage 1, possibly a 2 in the left? Would my Dr. know this if i asked him? also got phone call today about my surgery schedule date and i did inform them i was going to get a second opinion. I am really willing to even have more injections if that would help, and try casts, splints anything really but surgery at this point in time. The information you sent was very good, thanks again. The Dr. that did the studies also said I didn't need surgery, is that common for them to make a call like that? Also are you aware of any Pods/Ortho. Drs in the Columbus, Oh area where I could go for 2nd opinion. I would still like to see the Dr. in the Baltimore area, but locally for me right now might be better. thanks so much again.

Re: How long is too long to wait for a TTS release?

Ellen F. on 10/18/02 at 13:35 (097817)

thanks very informative. You must have a great memory.

Re: How long is too long to wait for a TTS release?

elliott on 10/18/02 at 14:08 (097818)

I'd base the stage more on what caused it and how you feel than anything else. For example, if it's trauma such as arising from an ankle fracture, that's probably much more likely to be Stage 2. Or perhaps if you start feeling progressively worse than you used to in previous months, with substantial discomfort by day's end. No hard and fast rules. Very high latency readings on an NCV may be something to ponder too. But how bad it is, how much it's radiating, etc., are the key. I'd say it has less to do with your doctor and more to do with you; the doc can't know exactly how you feel.

It's not common for the doc who did the studies to make such a call. The test isn't as definitive as they'd like to believe. However, if you have a copy of your results, a latency of 7.0 and over is usually a clear sign of trouble.

Given the risk of thinning tissue and even rupture, numerous mindless injections are not a good thing. If properly spaced out, and thought to offer a chance of permanently relieving symptoms or as an aid in diagnosis or location, they can be a good thing. I woudn't get more than 3 or 4 well spaced-out shots in total. You can try casting, although I don't put much faith in it for 'real' TTS.

You're in Columbus Ohio? Would you like to visit Tammie and exchange stories? I think she's near you and could use some support and cheer. Anyway, there's G James Sammarco in Cincinnati:

http://www.orthopedicexcellence.com/GJS.html

He is another big name, has published on nerve problems, and is yet another member of the Fearsome Foursome. Note: not to be confused with his son, V James Sammarco, also an orthopedist in the same practice.

Then there's Stephen F. Conti in Pittsburgh, a big-name ortho.

If it's a pod you want, I believe it's Dr. Yu in Cleveland that is held in high regard.

[]

Re: How long is too long to wait for a TTS release?

Ellen F. on 10/18/02 at 15:17 (097821)

Elliott,
Yes i definetly would like to visit with Tammi as you suggest. I will check with insurance re Dr. James Sammarco. Orothopod is not totally necessary, i would base more on experience, esp. with the surgery end. I thought as you did about the opinion of Dr. doing the study, I was a little taken back that he said 'you don't need surgery'. The pod that i'm going to has great confidence in the group that did my studies, he has tried others with not so good results. I will try and communicate with the Pod that i'm going to re: latency times to find out #'s. I am assuming that they are probably better than the 7.0 as the Dr. performing the study indicated to me terms such as 'mild and moderate', but i would like to know the #'s and see the actual written results and will need them to take to another dr. at the 2nd opinion. A funny thing is happening, i have been on my feet less since yest. because i was in bed most of day yest. as i have a sinus infection and today my feet feel worse?? yest. when i got up out of bed and walked every time i put my right foot down i received a shock at the tip of the big toe on the right foot(the mild one).Today shoes feel aweful on my feet and i'm getting a pulsating feeling in the sides of my arches on both feet? Not a 'zinger' type pain just an odd sensation. i know you have probably heard all this before, but i am also wanting to 'vent' some today. I am just concerned about the whole situation and am worried about the other foot too, thinking that if i need surgery on the one the other will consequently pay the price. thinking about the stats of positive outcomes, etc. seems there is so much to digest, doesn't it? I had such a great outcome with my hand, and i'm so very thankful, but it took much searcing and weighing out the good and bad, but i will say it was worth it. it isn't over with the hand as my dr. said someday he may have to take the bone out completely, but new procedures are always coming into play, so now i wait it out with that one. I was also told by dr. doing nerve conduction with the hand that it was RSD, which i hear alot about with the reading i'm doing on this message board, that can be rather tricky. it turned out i didn't have RSD, or carpal tunnel, but AVN. But, this study was definetly + for the TTS, i guess in the back of my mind i'm rehashing the wrist and still can't help but wondering if it is AVN in the heels. I will keep pursuing till i get the answers i need to make a good decision, that is all i can do with a little help from my friends here.

Re: Foot Surgery in NOV 2002

wendyn on 10/18/02 at 20:49 (097844)

Thanks Julie!

Tim, I can't add anything to what Elliott and Sharon have already said.

Be skeptical of a doctor promising you those type of results.

Please keep in touch!

Re: Foot Surgery in NOV 2002

kellys on 10/19/02 at 10:39 (097884)

Tim,

I had pretty bad symptoms of TTS this summer although an NCV did not show nerve damage. The diagnosis was still classic TTS. But the burning, shooting pains and severe tightness in the calf area were nearly unbearable - I'd wake up wondering how much longer I could really live with this. I got two cortisone shots in my TT area (both feet) this summer, kept doing non-weight-bearing exercise (cycling) as much as I could, started phys therapy in the TT area, and found a terrific neuromuscular therapist (NMT)/bodyworker. I've been seeing her weekly for 2.5 months and although in June I might have begged for surgery, I have had only minimal TT pain in the past month. My PF came back slightly just before I starting seeing the neuromuscular therapist, but it's not paralyzing like it used to be and I'm managing it reasonably well with all the conservative therapies (NSAIDS, ice, careful stretching, orthotics, night splint,etc.).

I know everyone's different, but some of the worst TT pain I had seemed to come along with unbearable pain and muscular tightness in the posterior tibial region. My NMT really digs in and gets some of that tightness out and it has made a truly dramatic difference in my overall pain level. My guess is everything is connected and when the foot/ankle area hurts, I walk funny, screw up my calf muscles, and that affects the foot/ankle area. My NMT seems to be helping me break that cycle, though she's careful not to push too hard since she had debilitating PF some time ago and knows that overworking can also be a problem. The downsides are that the sessions can be temporarily painful (temporarily being the key - my TTS was NOT temporary so I can put up with temporary) and expensive. But avoiding surgery and being able to go through the day without constant pain is worth a lot of $ to me. If I am not in too much pain, activity also seems to help by stimulating blood flow to the area. In my experience, total rest doesn't necessarily make me better and often makes me worse. Hence my efforts to keep up some level of non-weight-bearing exercise. I still walk only very minimally.

Good luck. Everyone is different and the quoted success rates sure vary. My only point is that maybe you'll stumble upon some treatment that helps you the way I did. I'm not 100% better, that's for sure, but I'm making slow progress and enjoying that my general pain level is hovering bewteen 1 and 4 out of 10 rather than 7-9 as is was!

Re: Foot Surgery in NOV 2002

Tim H on 10/21/02 at 11:07 (098028)

Thank you all for your responses ! They have all been helpful. I believe I will need to get a second opinion for peace of mind. I completely trust and like the doctor I have been going to, however, if anything would seem to require a 'second opinion', surgery would be it. I'm sure he won't like it.

The TT has NOT gotten bad enough that I have changed any daily activities, (walking wise), although the numbness / slight pain-burning is slowly increasing.

Two items regarding my doctor:
(1) he completes about 8 TT surgeries a year.
(2) I misquoted him, he was conveying to me that I can get around and get back to my 'normal' foot activity in 3 weeks, NOT that the nerves would be fine in 3 weeks.

Thanks again and I will keep you posted !

Re: Foot Surgery in NOV 2002

Judy H. on 10/21/02 at 17:40 (098037)

Has anyone out there had tarsal tunnel release because of diabetes? My neuropathy was labeled idiopathic until 2 days before surgery when I had a gluclose test that put me in diabetic class.

My doctor is only one in Tulsa who performs this procedure and not many docs here have heard of it.

I am 6 weeks out and still have so much pain. New pain where none before. Tight bands of pain across arch and around heel. Physical therapy is hell. After first workout I have not been able to walk very much. I also had neuroplasty on top of foot. Is there hope for this pain to end?

Re: Tim

Julie on 10/22/02 at 01:57 (098067)

Two observations.

In over two years I can't recall anyone on these boards reporting that they got back to 'normal activities' in three weeks after any foot surgery.

Good doctor generally do not object to a patient getting a second opinion. Many would encourage them to do so. If your doctor 'doesn't like' your getting one, maybe you should rethink your complete trust! But you may be wrong and he may be perfectly happy for you to investigate further. He should be: they're YOUR feet.

Anyway, I'm glad you're going to go for the second opinion.

Let us know how you get on.

Re: Foot Surgery in NOV 2002

Melanie E on 10/30/02 at 19:22 (098706)

Hi I was told I would be on crutches for at least two weeks non-weight bearing after the TTS surgery. The way the dr snorted and said AT LEAST....I know that is the minimum time. I just got off crutches after 9 weeks for a talar dome fracture. I am going to work tomorrow on Halloween as a cripple wearing a blonde wig instead of my black hair. Do you think they will recognize me?

Re: Foot Surgery in NOV 2002

c. myerly on 11/04/02 at 15:09 (099310)

Hey Sharon -

Did you have any major problems occur with the surgery and the heeling process? From your surgery day on, what was the heeling process?

I am to have surgery this month too.

Thanks.

Please email me personally.

Re: Foot Surgery in NOV 2002

Tim H on 10/17/02 at 11:03 (097733)

I just read more posts AFTER posting the above. And after learning more from your posts, I understand the wide spectrum of issues and I also see I better start taking this more seriously ! I hope your foot conditions improve ! What a card to be dealt.

I had a pulled/torn planter facsiitis, thus the foot adventure and treatment began.
The torn planter facsiitis healed after 6 months.
But then I 'felt' numbness in my little toe and the outside part of my foot.
Some PT helped, but when I was on feet a lot, little toe became numb again.
Then little toe AND second toe became numb.
Then outside of foot and little toe started hurting, (burning).
Cortosone shot in ankle provided GREAT help at first, now it only helps for 5 days.
Now the outside half of my foot and toes are mostly numb and burning. The ankle and heal do not hurt at all.

Locating the entrapment area seems to be the key BEFORE surgery. I would really hope to 'release' the suspect nerve in ONE surgery !
Where do you get this cream to try and locate the entrapment area ?

Re: Foot Surgery in NOV 2002

elliott on 10/17/02 at 11:21 (097738)

Regarding surgery, you have to ask yourself questions like how much pain you're in, can you live with it the rest of your life, might it get better with time and other conservative means. If the answer's No, the surgery may be worth considering. Odds are more like 70%, even with the best surgeons.

A competent doc giving you a good exam should be able to distinguish between standard TTS and a more distal entrapment. The various nerves branch off the main one at the inner ankle, the lateral plantar nerve heading to the outer part of the sole of the foot and the last two toes. If the source of entrapment is at the inner ankle (always a possibility and the most likely in general), a standard TTS release may be warranted. Suggest you read a lot of earlier posts regarding surgical outcomes, other sources of pain such as your back and diseases for which bloodwork may help, etc.

Not sure how valuable it is in your case, but if you want to try a topical cream, click on Message Boards at top, then do a search on 'Formula 5'. It will bring up the info you need. You still need a doc to write a script.

[]

Re: Foot Surgery in NOV 2002

chris on 10/17/02 at 12:14 (097746)

I had pf and tts surgery Nov '00. You will find some very knowledgable folks here. I actually found this site after I had my surgery and if I had found it before surgery, I might not have had the surgery.

There are many non-surgical treatments that should be tried first. I'm sure someone else can list them better than I could. As Elliott mentioned you should consider how much pain you are in now...I was in so much pain I would have preferred having my foot cut off!

I am happy to say that my surgery was successful and 2 years later, I continue to be pain free. I will say that 3 weeks after surgery I was not pain free and that it was more like 3-4 months and more phyisical therapy following surgery before I started to feel better.

I also must point out that there are those who were worse off following surgery....I'm sure they will post their stories too.

Good luck to you!

Re: Foot Surgery in NOV 2002

Julie on 10/18/02 at 02:47 (097790)

Tim

I have no experience of TTS and no knowledge of it other than from reading these message boards for a few years. But I think you are right to be cautious. If you read past posts you will find many histories of people who were made worse, some much worse, by TTS surgery. This isn't to say it never works, but the success rate seems, as Elliott told you, not to be as high as your doctor claimed.

I would be sceptical of a doctor who told me that the surgery would be simple and that I (and my nerves!) would be fine in three weeks. NO surgery is simple, particularly not foot surgery, and no nerve in the universe recovers from surgery in three weeks.

The first thing to do, if you are seriously considering surgery, is see at least one more foot specialist for another opinion. If you weren't seriously considering surgery before it was suggested (i.e. if your pain isn't so excruciating that you can live with it for a while longer) then do some more research here and inform yourself about conservative treatments.

And read Wendy's FAQ (link at the top of the home page) for a masterly summary of knowledge of TTS. Wendy doesn't read the boards all the time, but her name in this post will trigger an email to her, and she may talk to you herself. She and Elliott are probably the most knowledgeable people here, TTS-wise.

Re: Apart from the doctors, I should have said!

Julie on 10/18/02 at 02:54 (097791)

.

Re: Foot Surgery in NOV 2002

Sharon W on 10/18/02 at 08:03 (097795)

Tim,

Please listen to Elliott on this one -- I would distrust any Dr. who said that tarsal tunnel release surgery would have a 95% success rate, UNLESS an MRI had shown that there is some kind of a mass inside, or pressing in on, your tarsal tunnel -- something that could be removed during surgery to relieve the pressure on the nerve.

Also, the recovery time (before you feel significant relief from nerve pain) is usually reported to be more like 2 to 6 months, NOT 3 weeks! (Sometimes it takes even longer than that.) If your nerve is ALREADY DAMAGED enough to show up as abnormal on nerve conduction tests, you may indeed need this surgery to relieve the pressure on that nerve so it can BEGIN to heal. But nerves take a long time to heal -- it is a very slow (and painful) process. For that reason, TTS surgery usually doesn't bring that much IMMEDIATE relief. It takes a while, because you are not just recovering from the surgery itself, you also have to recover from the damage done by the nerve entrapment that made the surgery necessary in the first place!

By the way, I have had TTS surgery myself (2 1/2 months ago), and I am quite satisfied with the results so far.

Sharon

Re: Foot Surgery in NOV 2002

Ellen F. on 10/18/02 at 09:22 (097802)

Does the nerve become 'more' damaged if already damaged and you wait longer for the surgery? Do you think it is better to have the surgery when you are not in bad pain, or wait until the pain is worse? see my pain is not like some described by people here. So far i have been able to tolerate it, so i'm wondering if i should just continue to get maybe 2 or so other opinions from other drs. also i am getting the feeling that podiatrist vs othopedic is more the way to go as far as the surgery part. I guess mostly what i have read is 'experience' with this type of surgery by the dr. is of utmost importance. the podiatrist that wants to do my surgery has done 20 in the past yr., he also said success rate is 80%.

Re: How long is too long to wait for a TTS release?

Sharon W on 10/18/02 at 11:23 (097809)

Ellen,

The question you asked was rather throroughly discussed last March, in this thread (I hope the link works):

bbt.cgi?n=76792

Perhaps the most interesting comments made on the subject in the thread I just mentioned were made by one of the podiatrists, Ed Davis, DPM (I cut and pasted his message, below):

How Long Is Too Long To Wait For TT Release?
Posted by Ed Davis, DPM on 3/21/02 at 19:22 View Thread

I wish we had more concrete information from which to give you an answer with the force of statistical backup. My experience is that individuals who wait too long to treat TTS have a much poorer prognosis.

How long is too long? Again, not a lot of concrete information. I would certainly be inclined to move forward with surgical treatment if the NCV shows significant changes confirming TTS. My feeling is that the risks of surgical treatment outweigh the risks of allowing disease progression.

I have some individuals with abnormal NCV in my office who do not want surgery. I am repeating the NCV on a yearly basis in an attempt to give them an accurate assessment of the course of their disease and if delaying surgery is causing potential damage. I am lucky to have a highly skilled electromyographer in my area.
Ed

Re: How long is too long to wait for a TTS release?

elliott on 10/18/02 at 12:59 (097815)

Check out this link to the abstract of such a study, namely of those who waited over 5 years before surgery (I think I posted it once before a long time ago):

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9345220&dopt=Abstract

The results should not be taken as gospel, especially given the small sample size, but it showed around 60% success. If you think about it, that's not unreasonably lower than what I've been told is the true figure for the population at large, more like 70% (and you even could argue, counterintuitively, that it's higher than the results of that thorough study which claimed only 44%, so maybe waiting actually increases your chances :-) :-)). There's probably a distinction between the case where the nerve is getting more and more crushed as time goes on (call it Stage 2) vs. just being touched and irritated (Stage 1). I'd bet symptoms would worsen a lot anyway if things were deteriorating. I don't think waiting a year or possibly even two in Stage 1 to see if things will clear is such a bad thing. Note: some might remain in Stage 1 the rest of their lives, while some might actually start in Stage 2.)

Speaking of success rates, even though I accept the 70% figure I gave before, if one is in serious pain just about all the time and has trouble coping, the surgery, when done by someone competent, is worth a try. I'll break the mold by saying this even in the absence of a visible obstruction in the tarsal tunnel, since sometimes the nerve gets tugged and stretched, and simply needs a bit more room to move, which the surgery provides. To me the real danger with no visible structure in the tarsal tunnel is that often they have not figured out what really caused the TTS, and then the surgery often doesn't help or gives only temporary relief or makes one worse in some way, with the true culprit showing itself only years down the road. In that case, waiting might have picked that up. I'm not really basing all these comments on any studies or facts; just some thoughts and intuition from someone who has had a bilateral release.

[]

Re: How long is too long to wait for a TTS release?

Ellen F. on 10/18/02 at 13:31 (097816)

Elliott, thanks for the info. Also, just how do you find out what 'stage' you are in? The Dr. that did my nerve studies, said 'moderate in the left and mild in the right'. am i to assume that is stage 1, possibly a 2 in the left? Would my Dr. know this if i asked him? also got phone call today about my surgery schedule date and i did inform them i was going to get a second opinion. I am really willing to even have more injections if that would help, and try casts, splints anything really but surgery at this point in time. The information you sent was very good, thanks again. The Dr. that did the studies also said I didn't need surgery, is that common for them to make a call like that? Also are you aware of any Pods/Ortho. Drs in the Columbus, Oh area where I could go for 2nd opinion. I would still like to see the Dr. in the Baltimore area, but locally for me right now might be better. thanks so much again.

Re: How long is too long to wait for a TTS release?

Ellen F. on 10/18/02 at 13:35 (097817)

thanks very informative. You must have a great memory.

Re: How long is too long to wait for a TTS release?

elliott on 10/18/02 at 14:08 (097818)

I'd base the stage more on what caused it and how you feel than anything else. For example, if it's trauma such as arising from an ankle fracture, that's probably much more likely to be Stage 2. Or perhaps if you start feeling progressively worse than you used to in previous months, with substantial discomfort by day's end. No hard and fast rules. Very high latency readings on an NCV may be something to ponder too. But how bad it is, how much it's radiating, etc., are the key. I'd say it has less to do with your doctor and more to do with you; the doc can't know exactly how you feel.

It's not common for the doc who did the studies to make such a call. The test isn't as definitive as they'd like to believe. However, if you have a copy of your results, a latency of 7.0 and over is usually a clear sign of trouble.

Given the risk of thinning tissue and even rupture, numerous mindless injections are not a good thing. If properly spaced out, and thought to offer a chance of permanently relieving symptoms or as an aid in diagnosis or location, they can be a good thing. I woudn't get more than 3 or 4 well spaced-out shots in total. You can try casting, although I don't put much faith in it for 'real' TTS.

You're in Columbus Ohio? Would you like to visit Tammie and exchange stories? I think she's near you and could use some support and cheer. Anyway, there's G James Sammarco in Cincinnati:

http://www.orthopedicexcellence.com/GJS.html

He is another big name, has published on nerve problems, and is yet another member of the Fearsome Foursome. Note: not to be confused with his son, V James Sammarco, also an orthopedist in the same practice.

Then there's Stephen F. Conti in Pittsburgh, a big-name ortho.

If it's a pod you want, I believe it's Dr. Yu in Cleveland that is held in high regard.

[]

Re: How long is too long to wait for a TTS release?

Ellen F. on 10/18/02 at 15:17 (097821)

Elliott,
Yes i definetly would like to visit with Tammi as you suggest. I will check with insurance re Dr. James Sammarco. Orothopod is not totally necessary, i would base more on experience, esp. with the surgery end. I thought as you did about the opinion of Dr. doing the study, I was a little taken back that he said 'you don't need surgery'. The pod that i'm going to has great confidence in the group that did my studies, he has tried others with not so good results. I will try and communicate with the Pod that i'm going to re: latency times to find out #'s. I am assuming that they are probably better than the 7.0 as the Dr. performing the study indicated to me terms such as 'mild and moderate', but i would like to know the #'s and see the actual written results and will need them to take to another dr. at the 2nd opinion. A funny thing is happening, i have been on my feet less since yest. because i was in bed most of day yest. as i have a sinus infection and today my feet feel worse?? yest. when i got up out of bed and walked every time i put my right foot down i received a shock at the tip of the big toe on the right foot(the mild one).Today shoes feel aweful on my feet and i'm getting a pulsating feeling in the sides of my arches on both feet? Not a 'zinger' type pain just an odd sensation. i know you have probably heard all this before, but i am also wanting to 'vent' some today. I am just concerned about the whole situation and am worried about the other foot too, thinking that if i need surgery on the one the other will consequently pay the price. thinking about the stats of positive outcomes, etc. seems there is so much to digest, doesn't it? I had such a great outcome with my hand, and i'm so very thankful, but it took much searcing and weighing out the good and bad, but i will say it was worth it. it isn't over with the hand as my dr. said someday he may have to take the bone out completely, but new procedures are always coming into play, so now i wait it out with that one. I was also told by dr. doing nerve conduction with the hand that it was RSD, which i hear alot about with the reading i'm doing on this message board, that can be rather tricky. it turned out i didn't have RSD, or carpal tunnel, but AVN. But, this study was definetly + for the TTS, i guess in the back of my mind i'm rehashing the wrist and still can't help but wondering if it is AVN in the heels. I will keep pursuing till i get the answers i need to make a good decision, that is all i can do with a little help from my friends here.

Re: Foot Surgery in NOV 2002

wendyn on 10/18/02 at 20:49 (097844)

Thanks Julie!

Tim, I can't add anything to what Elliott and Sharon have already said.

Be skeptical of a doctor promising you those type of results.

Please keep in touch!

Re: Foot Surgery in NOV 2002

kellys on 10/19/02 at 10:39 (097884)

Tim,

I had pretty bad symptoms of TTS this summer although an NCV did not show nerve damage. The diagnosis was still classic TTS. But the burning, shooting pains and severe tightness in the calf area were nearly unbearable - I'd wake up wondering how much longer I could really live with this. I got two cortisone shots in my TT area (both feet) this summer, kept doing non-weight-bearing exercise (cycling) as much as I could, started phys therapy in the TT area, and found a terrific neuromuscular therapist (NMT)/bodyworker. I've been seeing her weekly for 2.5 months and although in June I might have begged for surgery, I have had only minimal TT pain in the past month. My PF came back slightly just before I starting seeing the neuromuscular therapist, but it's not paralyzing like it used to be and I'm managing it reasonably well with all the conservative therapies (NSAIDS, ice, careful stretching, orthotics, night splint,etc.).

I know everyone's different, but some of the worst TT pain I had seemed to come along with unbearable pain and muscular tightness in the posterior tibial region. My NMT really digs in and gets some of that tightness out and it has made a truly dramatic difference in my overall pain level. My guess is everything is connected and when the foot/ankle area hurts, I walk funny, screw up my calf muscles, and that affects the foot/ankle area. My NMT seems to be helping me break that cycle, though she's careful not to push too hard since she had debilitating PF some time ago and knows that overworking can also be a problem. The downsides are that the sessions can be temporarily painful (temporarily being the key - my TTS was NOT temporary so I can put up with temporary) and expensive. But avoiding surgery and being able to go through the day without constant pain is worth a lot of $ to me. If I am not in too much pain, activity also seems to help by stimulating blood flow to the area. In my experience, total rest doesn't necessarily make me better and often makes me worse. Hence my efforts to keep up some level of non-weight-bearing exercise. I still walk only very minimally.

Good luck. Everyone is different and the quoted success rates sure vary. My only point is that maybe you'll stumble upon some treatment that helps you the way I did. I'm not 100% better, that's for sure, but I'm making slow progress and enjoying that my general pain level is hovering bewteen 1 and 4 out of 10 rather than 7-9 as is was!

Re: Foot Surgery in NOV 2002

Tim H on 10/21/02 at 11:07 (098028)

Thank you all for your responses ! They have all been helpful. I believe I will need to get a second opinion for peace of mind. I completely trust and like the doctor I have been going to, however, if anything would seem to require a 'second opinion', surgery would be it. I'm sure he won't like it.

The TT has NOT gotten bad enough that I have changed any daily activities, (walking wise), although the numbness / slight pain-burning is slowly increasing.

Two items regarding my doctor:
(1) he completes about 8 TT surgeries a year.
(2) I misquoted him, he was conveying to me that I can get around and get back to my 'normal' foot activity in 3 weeks, NOT that the nerves would be fine in 3 weeks.

Thanks again and I will keep you posted !

Re: Foot Surgery in NOV 2002

Judy H. on 10/21/02 at 17:40 (098037)

Has anyone out there had tarsal tunnel release because of diabetes? My neuropathy was labeled idiopathic until 2 days before surgery when I had a gluclose test that put me in diabetic class.

My doctor is only one in Tulsa who performs this procedure and not many docs here have heard of it.

I am 6 weeks out and still have so much pain. New pain where none before. Tight bands of pain across arch and around heel. Physical therapy is hell. After first workout I have not been able to walk very much. I also had neuroplasty on top of foot. Is there hope for this pain to end?

Re: Tim

Julie on 10/22/02 at 01:57 (098067)

Two observations.

In over two years I can't recall anyone on these boards reporting that they got back to 'normal activities' in three weeks after any foot surgery.

Good doctor generally do not object to a patient getting a second opinion. Many would encourage them to do so. If your doctor 'doesn't like' your getting one, maybe you should rethink your complete trust! But you may be wrong and he may be perfectly happy for you to investigate further. He should be: they're YOUR feet.

Anyway, I'm glad you're going to go for the second opinion.

Let us know how you get on.

Re: Foot Surgery in NOV 2002

Melanie E on 10/30/02 at 19:22 (098706)

Hi I was told I would be on crutches for at least two weeks non-weight bearing after the TTS surgery. The way the dr snorted and said AT LEAST....I know that is the minimum time. I just got off crutches after 9 weeks for a talar dome fracture. I am going to work tomorrow on Halloween as a cripple wearing a blonde wig instead of my black hair. Do you think they will recognize me?

Re: Foot Surgery in NOV 2002

c. myerly on 11/04/02 at 15:09 (099310)

Hey Sharon -

Did you have any major problems occur with the surgery and the heeling process? From your surgery day on, what was the heeling process?

I am to have surgery this month too.

Thanks.

Please email me personally.