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HELP!!! very frustrated!!

Posted by gayle on 10/31/02 at 02:40 (098768)

Hi Doctors,

If a person had been suffering from a foot disorder for a year and received only a little pain relief from physical therapy, would you have to consider the pain to be psychogenic. I have been diagnosed with PF and several months later with tarsal tunnel syndrome following an NCV exam. I have had only some relief with iontophoresis and now my physical therapist feels that my illness may be psychogenic. I feel it is not. I must have tarsal tunnel syndrome, if my NCV exam displays it.

I have not tried custom made orthotics yet. Is it worth the try? Any opinions?

Thanks a million.

Re: HELP!!! very frustrated!!

Lara % on 10/31/02 at 08:00 (098778)

The following treatments have been tried and passed on by someone (meaning they probably worked for someone). Some are controversial, most aren't. The list may not flow - it's a cut and paste job. Most of us keep trying stuff until we find what works, rest for awhile, and then look again to see if something can help even more.

My understanding is an NCV test is the gold-standard for diagnosing TTS. A negative test isn't definitive, but a positive test is unlikely to be a false-negative. However, even with a diagnosis, many doctors aren't familiar with all the treatment options - it's a relatively new diagnosis (last few decades, but that's new in medical history).

NON INVASIVE
-compression socks
- taping (see Scotts heelbook, online)
-nighsplints
-ice (daily and/or after activities. YOu can get ice packs that fit -nicely to the foot). I've heard reports of this being much more successful than would be anticipated, even 15 min/day at the end of the day
-aggressive stretching
-contrast baths
-pilates, strengthening, and balance exercises, etc.
-boot cast, cam walker, etc. to immobilize foot
-massage sandals
-Vitamin B/B12 (some people take mega doses - be careful as to which vitamins can cause toxic reactions)

-ESWT (for PF, not TTS?)
-ART (type of massage)
-Trigger Point Massage Therapy

-Capsazin cream
- Ibuprofen cream
-Glucosamine & Chondroitin (In the past I experimented with different brands. SOLGAR is the one that works on me. When I first started taking G/C I started with SCHIFF brand from a neighbor who had it (she bought it from Costco). I tried getting a cheaper brand at my health food store, other than Solgar, but it didn't work.)
Oral dose packs of cortisone have helped some. Also there are much more powerful topical creams that can be compounded by a pharmacist at the request of a doctor that can be much more effective than otc ibuprophen cream. They may contain ingredients like ketamine, ketaprophen, gahapentin, etc. A lot of these medications are much better at not only killing pain, but preventing the nerves from over firing. Even simple ibuprofen cream could be compounded by your local pharmacist.

MINIMALLY INVASIVE (but not necessarily without significant side effects)
-Cortisone shots
-Medications: NSAIDS
-Medications: Neurontin, Elavil
-PT like iontophoresis (sp)? with a steroid
orthotics

INVASIVE
-PF release surgery
-TT release surgery

Posted by john h on 3/02/2000
i was thinking today of some possible treatments for PF that no one has tried:
1. Faith healer
2. In some societies they beat your feet with a cane if you do something bad. Might help?
3. Witch Doctor? Hey! Why not it beats a cortisone shot!
4. Radiation. Tie a rod of plutonium 238 around your foot.
5. Bio-feedback. good luck!
5. Break both legs which will force you into bed for 4 or 5 months. (something less drastic which I tried unintentionally but very effectively - get a fungal infection requiring soaking 6x day for a week, or have knee surgery).
6. Psycharisit. some idiots think the pain is in our head.
7. I once had a wart on my hand. my grandmother had me rub it with a dirty wash cloth and then bury the cloth. For real- the wart went away. Unfortunately, my wife does not keep any dirty dishcloths around.
8. Get a boyfriend like Brad Pitt or girlfriend like Julia Roberts and forget your pain.

Re: HELP!!! very frustrated!!

Sharon W on 10/31/02 at 13:52 (098816)

Gayle,

I am not a Dr., just a TTS patient who is VERY tired of the attitude you described!! Very few medical professionals can understand what it is like to have TTS, becuase very few of them HAVE it! If they could feel the pain themselves for a day, if they had to live with the changes TTS makes to a person's lifestyle for JUST ONE DAY, they would NOT have such a smug and disbelieving attitude.

You said that nerve conduction studies have confirmed that you have TTS. Unless the person who did the test was INEXPERIENCED with TTS, you probably do have it. TTS can have many different causes, but I have researched this subject quite extensively and as far as I know, TTS CANNOT be 'psychogenic'. It is NOT 'all in your head'!!

One of the podiatrists who posts on these boards has explained that there are many doctors, EVEN some PODIATRISTS, who do not believe that TTS exists. They are WRONG. But I think you may have come across a physical therapist who has that attitude.

Sharon

Re: HELP!!! very frustrated!!

gayle on 11/01/02 at 04:12 (098872)

Thank you very much Lara% I will try some of these methods. I appreciate your help!!!

Thanks again
gayle

Re: HELP!!! very frustrated!!

Lara T on 11/02/02 at 08:25 (098991)

For more information on any of these things (and there is much behind each sort listing) there is a lot more information in the archives. I'm also willing to add comments to each entry if people send them along.

Re: HELP!!! very frustrated!!

Ed Davis, DPM on 11/02/02 at 16:18 (099074)

Gayle:
Here is the way I look at NCV evidence. NCVs are not very sensitive for TTS-- in other words, they will miss a lot of patients who have TTS. On the other hand, they can be very specific, meaning that if the test is positive, then the likelihood is very high that you have TTS.

You need to see a practitioner who has experience in the treatment of TTS.
I would really consider leaving any practitioner who states that the pain is psychogenic when an NCV is positive.
Ed

Re: HELP!!! very frustrated!!

Lara % on 10/31/02 at 08:00 (098778)

The following treatments have been tried and passed on by someone (meaning they probably worked for someone). Some are controversial, most aren't. The list may not flow - it's a cut and paste job. Most of us keep trying stuff until we find what works, rest for awhile, and then look again to see if something can help even more.

My understanding is an NCV test is the gold-standard for diagnosing TTS. A negative test isn't definitive, but a positive test is unlikely to be a false-negative. However, even with a diagnosis, many doctors aren't familiar with all the treatment options - it's a relatively new diagnosis (last few decades, but that's new in medical history).

NON INVASIVE
-compression socks
- taping (see Scotts heelbook, online)
-nighsplints
-ice (daily and/or after activities. YOu can get ice packs that fit -nicely to the foot). I've heard reports of this being much more successful than would be anticipated, even 15 min/day at the end of the day
-aggressive stretching
-contrast baths
-pilates, strengthening, and balance exercises, etc.
-boot cast, cam walker, etc. to immobilize foot
-massage sandals
-Vitamin B/B12 (some people take mega doses - be careful as to which vitamins can cause toxic reactions)

-ESWT (for PF, not TTS?)
-ART (type of massage)
-Trigger Point Massage Therapy

-Capsazin cream
- Ibuprofen cream
-Glucosamine & Chondroitin (In the past I experimented with different brands. SOLGAR is the one that works on me. When I first started taking G/C I started with SCHIFF brand from a neighbor who had it (she bought it from Costco). I tried getting a cheaper brand at my health food store, other than Solgar, but it didn't work.)
Oral dose packs of cortisone have helped some. Also there are much more powerful topical creams that can be compounded by a pharmacist at the request of a doctor that can be much more effective than otc ibuprophen cream. They may contain ingredients like ketamine, ketaprophen, gahapentin, etc. A lot of these medications are much better at not only killing pain, but preventing the nerves from over firing. Even simple ibuprofen cream could be compounded by your local pharmacist.

MINIMALLY INVASIVE (but not necessarily without significant side effects)
-Cortisone shots
-Medications: NSAIDS
-Medications: Neurontin, Elavil
-PT like iontophoresis (sp)? with a steroid
orthotics

INVASIVE
-PF release surgery
-TT release surgery

Posted by john h on 3/02/2000
i was thinking today of some possible treatments for PF that no one has tried:
1. Faith healer
2. In some societies they beat your feet with a cane if you do something bad. Might help?
3. Witch Doctor? Hey! Why not it beats a cortisone shot!
4. Radiation. Tie a rod of plutonium 238 around your foot.
5. Bio-feedback. good luck!
5. Break both legs which will force you into bed for 4 or 5 months. (something less drastic which I tried unintentionally but very effectively - get a fungal infection requiring soaking 6x day for a week, or have knee surgery).
6. Psycharisit. some idiots think the pain is in our head.
7. I once had a wart on my hand. my grandmother had me rub it with a dirty wash cloth and then bury the cloth. For real- the wart went away. Unfortunately, my wife does not keep any dirty dishcloths around.
8. Get a boyfriend like Brad Pitt or girlfriend like Julia Roberts and forget your pain.

Re: HELP!!! very frustrated!!

Sharon W on 10/31/02 at 13:52 (098816)

Gayle,

I am not a Dr., just a TTS patient who is VERY tired of the attitude you described!! Very few medical professionals can understand what it is like to have TTS, becuase very few of them HAVE it! If they could feel the pain themselves for a day, if they had to live with the changes TTS makes to a person's lifestyle for JUST ONE DAY, they would NOT have such a smug and disbelieving attitude.

You said that nerve conduction studies have confirmed that you have TTS. Unless the person who did the test was INEXPERIENCED with TTS, you probably do have it. TTS can have many different causes, but I have researched this subject quite extensively and as far as I know, TTS CANNOT be 'psychogenic'. It is NOT 'all in your head'!!

One of the podiatrists who posts on these boards has explained that there are many doctors, EVEN some PODIATRISTS, who do not believe that TTS exists. They are WRONG. But I think you may have come across a physical therapist who has that attitude.

Sharon

Re: HELP!!! very frustrated!!

gayle on 11/01/02 at 04:12 (098872)

Thank you very much Lara% I will try some of these methods. I appreciate your help!!!

Thanks again
gayle

Re: HELP!!! very frustrated!!

Lara T on 11/02/02 at 08:25 (098991)

For more information on any of these things (and there is much behind each sort listing) there is a lot more information in the archives. I'm also willing to add comments to each entry if people send them along.

Re: HELP!!! very frustrated!!

Ed Davis, DPM on 11/02/02 at 16:18 (099074)

Gayle:
Here is the way I look at NCV evidence. NCVs are not very sensitive for TTS-- in other words, they will miss a lot of patients who have TTS. On the other hand, they can be very specific, meaning that if the test is positive, then the likelihood is very high that you have TTS.

You need to see a practitioner who has experience in the treatment of TTS.
I would really consider leaving any practitioner who states that the pain is psychogenic when an NCV is positive.
Ed