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a 2nd tarsal tunnel surgery ?

Posted by William S on 11/12/02 at 18:33 (099941)

The first surgery did not help. I am told I should try a second operation. Anyone have luck with operation #2 ?

Re: a 2nd tarsal tunnel surgery ?

elliott on 11/12/02 at 18:53 (099950)

William S, why don't you tell us the details of the first one (original symptoms, cause, test results, any obstructions detected, how surgery went, current symptoms) and maybe we can help you.

[]

Re: a 2nd tarsal tunnel surgery ?

William S on 11/12/02 at 21:13 (099975)

HAd 1st surgery 2 years ago. Several neurologists and foot doctors concluded it was TTS. Surgeon never said there was an obstruction but he had to move the nerve. End result-- no improvement. I have gone to another foot surgeon and he thinks we should try it again. Maybe the 1st doctor didn't extent far enough to free the nerve.

Re: a 2nd tarsal tunnel surgery ?

Henry C on 11/13/02 at 06:52 (099998)

William,

Operation #2 did not provide that much more relief then failed operation #1. In both operations, the surgen did not find anything applying pressure to the nerve. My TTS was a side effect of another surgery to repair a broken Talar Dome. They believe that the nerve was streched during that initial operation.

For my first surgery, I went to Dr. Mark Myerson in Baltimore, MD. He is suposed to be one of the top foot and ankle doctors in the country. He told me that a small simple surgery would be required to repair the nerve runnig behind my ankle. Well that simple surgery did not work. After complications, he referred me to Dr. Lew Schon also of Baltimore.

Dr. Schon was a technique (vein wrap) where he removes the vein from your leg and wraps it around the injured nerve. The vein acts like an insulator protecting the nerve from further scare tissue damage. I had this surgery in March of 2000 and still have pain everyday.

I hope you have better luck then mine. I'm still hoping that there is someone out there who can help me, so don't give up.

Henry C

Re: a 2nd tarsal tunnel surgery ?

elliott on 11/13/02 at 09:03 (100008)

William S:

1. Exactly what and where were your original symptoms?
2. Exactly what and where are your current symptoms?

And no, 'nervy pain on the foot' is not a good enough answer. :-) More questions:

3. Did you have any of an MRI, nerve conduction test, xray, and if so, what did they show?

4. Any idea as to the cause?

5. Did you have any temporary or partial improvement from surgery?

6. What exactly was done at surgery?

7. How experienced in TTS was your surgeon?

8. When you say 'move the nerve', what do you mean? Transsection?

[]

Re: a 2nd tarsal tunnel surgery ?

William S on 11/13/02 at 12:14 (100031)

original symtoms-- numbness on the ball of my right foot. Then painful episodes. When I walked or stood, pain keep getting worse.

current conditions- same. I teach. After a few minutes on my feet, pain develops. I need to sit for awhile. Numbness is always there.

I never had a MRI Doctors said it would be a waste of time.. I had 3 nerve conduction test. They said it appears that it was TTS. They would never say for sure. They said it is not exact but most likely it was TTS.

No idea of the cause. I first noticed the numbness after a week long strenuous lifting of cement blocks. I helped a friend moving hundreds of these blocks. I believe that is when I first noticed something wrong. I even have gone to a back surgeon, thinking it might be a disc problem. Had an MRI on my back. There is a bulging disc but he feels it is a strech to think it is causing pain in my foot.

The surgeon that operated on my foot has done several. He opened a 4 inch area near my ankle and 'thought to have freed up the nerve ' he said he 'moved' the nerve away from something to keep it away from being obstructed. That's all he told me.

The surgery has not improved things. I have since gone to another foot doctor who has suggested I try the operation again with him. He thinks maybe the 1st doctor didn't open up the area far enough to get at the nerve where it most likely is pinched.

Re: a 2nd tarsal tunnel surgery ?

elliott on 11/13/02 at 12:51 (100036)

The week of long strenuous lifting of cement blocks may well be the cause.

Which side of the ball, medial or lateral? Between or on what ball joints? Does it radiate to the toes, and if so, which ones?

Have you tried any other treatments (cortisone, orthotics, pads, etc.)?

[]

Re: a 2nd tarsal tunnel surgery ?

William S on 11/13/02 at 14:06 (100045)

It's hard to pinpoint an exact spot on the ball of my foot. Most of the ball of my foot in numb and aches. It does radiate to the first 2 toes, starting from the big toe.
I had cortisone shots 3 times, I tried orthotics for 2 years. No help with either of these attempts.

Re: a 2nd tarsal tunnel surgery ?

elliott on 11/13/02 at 14:32 (100049)

Where were the cortisone shots given, in the ball or the ankle? Also, did you have any nerve pain at the ankle?

Re: a 2nd tarsal tunnel surgery ?

William S on 11/13/02 at 15:04 (100056)

The shots were all in the ankle area. I have very little pain in the ankle area.

Re: a 2nd tarsal tunnel surgery ?

elliott on 11/13/02 at 15:33 (100061)

OK, here's what I have to say. Usually, when there is insufficient release in a standard case of TTS (is there such a thing? :-)), it's due to not releasing the first branch of the lateral plantar nerve, and sometimes medial calcaneal nerves. These nerves would give you pain in locations not compatible with where you're complaining about it. Are they suggesting entrapment outside the tarsal tunnel further along the medial plantar nerve? It doesn't sound like you have this, but you may want to ask them this, where they'd be cutting, and would they be opening the old area again. The risks go way up for a second TTS release--especially with no clear objective--due to things like excess scar tissue, collapse of the nerve bed, etc.

If pre- first surgery you didn't have clear discomfort at the ankle area, I'd look at the long list of possible causes at the ball itself before rushing into a second release.

[]

Re: a 2nd tarsal tunnel surgery ?

William S on 11/13/02 at 15:49 (100063)

Thanks Elliott

Re: a 2nd tarsal tunnel surgery ?

elliott on 11/12/02 at 18:53 (099950)

William S, why don't you tell us the details of the first one (original symptoms, cause, test results, any obstructions detected, how surgery went, current symptoms) and maybe we can help you.

[]

Re: a 2nd tarsal tunnel surgery ?

William S on 11/12/02 at 21:13 (099975)

HAd 1st surgery 2 years ago. Several neurologists and foot doctors concluded it was TTS. Surgeon never said there was an obstruction but he had to move the nerve. End result-- no improvement. I have gone to another foot surgeon and he thinks we should try it again. Maybe the 1st doctor didn't extent far enough to free the nerve.

Re: a 2nd tarsal tunnel surgery ?

Henry C on 11/13/02 at 06:52 (099998)

William,

Operation #2 did not provide that much more relief then failed operation #1. In both operations, the surgen did not find anything applying pressure to the nerve. My TTS was a side effect of another surgery to repair a broken Talar Dome. They believe that the nerve was streched during that initial operation.

For my first surgery, I went to Dr. Mark Myerson in Baltimore, MD. He is suposed to be one of the top foot and ankle doctors in the country. He told me that a small simple surgery would be required to repair the nerve runnig behind my ankle. Well that simple surgery did not work. After complications, he referred me to Dr. Lew Schon also of Baltimore.

Dr. Schon was a technique (vein wrap) where he removes the vein from your leg and wraps it around the injured nerve. The vein acts like an insulator protecting the nerve from further scare tissue damage. I had this surgery in March of 2000 and still have pain everyday.

I hope you have better luck then mine. I'm still hoping that there is someone out there who can help me, so don't give up.

Henry C

Re: a 2nd tarsal tunnel surgery ?

elliott on 11/13/02 at 09:03 (100008)

William S:

1. Exactly what and where were your original symptoms?
2. Exactly what and where are your current symptoms?

And no, 'nervy pain on the foot' is not a good enough answer. :-) More questions:

3. Did you have any of an MRI, nerve conduction test, xray, and if so, what did they show?

4. Any idea as to the cause?

5. Did you have any temporary or partial improvement from surgery?

6. What exactly was done at surgery?

7. How experienced in TTS was your surgeon?

8. When you say 'move the nerve', what do you mean? Transsection?

[]

Re: a 2nd tarsal tunnel surgery ?

William S on 11/13/02 at 12:14 (100031)

original symtoms-- numbness on the ball of my right foot. Then painful episodes. When I walked or stood, pain keep getting worse.

current conditions- same. I teach. After a few minutes on my feet, pain develops. I need to sit for awhile. Numbness is always there.

I never had a MRI Doctors said it would be a waste of time.. I had 3 nerve conduction test. They said it appears that it was TTS. They would never say for sure. They said it is not exact but most likely it was TTS.

No idea of the cause. I first noticed the numbness after a week long strenuous lifting of cement blocks. I helped a friend moving hundreds of these blocks. I believe that is when I first noticed something wrong. I even have gone to a back surgeon, thinking it might be a disc problem. Had an MRI on my back. There is a bulging disc but he feels it is a strech to think it is causing pain in my foot.

The surgeon that operated on my foot has done several. He opened a 4 inch area near my ankle and 'thought to have freed up the nerve ' he said he 'moved' the nerve away from something to keep it away from being obstructed. That's all he told me.

The surgery has not improved things. I have since gone to another foot doctor who has suggested I try the operation again with him. He thinks maybe the 1st doctor didn't open up the area far enough to get at the nerve where it most likely is pinched.

Re: a 2nd tarsal tunnel surgery ?

elliott on 11/13/02 at 12:51 (100036)

The week of long strenuous lifting of cement blocks may well be the cause.

Which side of the ball, medial or lateral? Between or on what ball joints? Does it radiate to the toes, and if so, which ones?

Have you tried any other treatments (cortisone, orthotics, pads, etc.)?

[]

Re: a 2nd tarsal tunnel surgery ?

William S on 11/13/02 at 14:06 (100045)

It's hard to pinpoint an exact spot on the ball of my foot. Most of the ball of my foot in numb and aches. It does radiate to the first 2 toes, starting from the big toe.
I had cortisone shots 3 times, I tried orthotics for 2 years. No help with either of these attempts.

Re: a 2nd tarsal tunnel surgery ?

elliott on 11/13/02 at 14:32 (100049)

Where were the cortisone shots given, in the ball or the ankle? Also, did you have any nerve pain at the ankle?

Re: a 2nd tarsal tunnel surgery ?

William S on 11/13/02 at 15:04 (100056)

The shots were all in the ankle area. I have very little pain in the ankle area.

Re: a 2nd tarsal tunnel surgery ?

elliott on 11/13/02 at 15:33 (100061)

OK, here's what I have to say. Usually, when there is insufficient release in a standard case of TTS (is there such a thing? :-)), it's due to not releasing the first branch of the lateral plantar nerve, and sometimes medial calcaneal nerves. These nerves would give you pain in locations not compatible with where you're complaining about it. Are they suggesting entrapment outside the tarsal tunnel further along the medial plantar nerve? It doesn't sound like you have this, but you may want to ask them this, where they'd be cutting, and would they be opening the old area again. The risks go way up for a second TTS release--especially with no clear objective--due to things like excess scar tissue, collapse of the nerve bed, etc.

If pre- first surgery you didn't have clear discomfort at the ankle area, I'd look at the long list of possible causes at the ball itself before rushing into a second release.

[]

Re: a 2nd tarsal tunnel surgery ?

William S on 11/13/02 at 15:49 (100063)

Thanks Elliott