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Dynamics of foot cramps & the not-so-funny bone...

Posted by Sheila S on 11/30/02 at 18:43 (101521)

(copied from Surgery page)
I hate to bother the doctors with this one... does anyone here know the dynamics of what happens when your toe(s)/foot cramps?? Specifically, are tendons invovled? Do tendons and/or ligaments feel pain?

).....I'm still trying to figure out WHAT it is that hurts so bad in my foot since no one else seems to know).

I can feel something move on the bone and it hurts real bad. Once it starts hurting, if I don't get my shoe off and spread my foot out pretty soon, it gets worse and worse, similar to a cramping affect only worse - burns and stings. The piece of whatever in your elbow (funny bone) that you can move and it stings and pings (especially when smacked on something), what is that - the actual nerve or tendon? That's what my foot feels like...

Self-diagnosis is the pits. Unfortunately, I've nowhere else to turn at the moment. =( Several different test have been recommended by the doctors when they read my story, but I guess now I'm trying to figure out what test would be the best, based on what 'might' be the problem.

Thanks!
Sheila S.

Re: Dynamics of foot cramps & the not-so-funny bone...

Carole C in NOLA on 11/30/02 at 19:59 (101523)

You're right... you can't really diagnose yourself, and the best you can probably get here is some ideas of what it might be. I hope you get some that are helpful!

My best guess (and I am not in the medical field) is that since the funny bone is really a nerve (as I recall), maybe the cramping muscle in your foot is tightening really hard on a nerve and causing your nerve symptoms. It sounds so painful! I wish I could give you a better answer. In order to get a competent diagnosis, and in order to get medical tests performed, you would need to see a foot professional.

If cramping is the cause, as I suspect, it may help to figure out the cause of the cramping so you can eliminate it. Have you done anything different lately, like wearing different shoes, or walking or standing more, that could cause your foot to cramp up? Are you eating a well rounded diet with plenty of calcium, sodium, and potassium, and drinking plenty of water? Or, [GIRLS ONLY PLEASE] is it near that time of the month when everything in your body seems to want to cramp up?

You are smart to take your shoe off and work out the cramp when this happens. There are some other things you can do if that's not enough. Icing your foot might help to alleviate any minor after-effects of tingling and stinging, because it reduces inflammation and pressure on the tissues. Gentle stretching can help when you are working out the cramp. Try rotating your foot at the ankle, and other gentle stretching. Massaging your feet might help, too.

Carole C

Re: Dynamics of foot cramps & the not-so-funny bone...

Julie on 12/01/02 at 03:36 (101533)

Good ideas from Carole, Sheila. Here's another suggestion. There's a pressure point to relieve cramp. Press with your thumb into the 'webbed' bit between the big toe and second toe. The pressure should be steady and strong.

This will usually relieve 'normal' cramp. I don't know if it will help you, but could try it.

It works on cramp anywhere, incidentally, not just foot cramp.

Re: Dynamics of foot cramps & the not-so-funny bone...

Sheila S on 12/01/02 at 10:50 (101543)

Thanks Carol and Julie for your responses. I wrote a little too quickly though (not explaining well enough!). It's not an actual cramp that occurs in my foot, but I feel certain parts of my foot involved that are also involved in a cramp. So, I'm wondering, when a cramp occurs, and I've always assumed it was muscle that cramped, does it then pull on ligaments and tendons which DO feel pain? If so, this piece I feel in my foot may well be tendon. If it's tendon, what tests show tendons and where they are located and if they aren't in the right place?? (see my line of thinking??)

Unfortunately, the doctors on this site don't agree on tests or type of tests and what the results are worth; and my doctor doesn't feel tests will add to anything..... thus the self-diagnosing. If I can perhaps narrow it down to some degree, I can push my doctor into at least a couple of the tests that have been recommended.

I would like to make an appt. somewhere on the East Coast with a 'world-renowned and well-respected' foot surgeon of some sort, that has a clue. There aren't any such physicians here. But I need to have all the information I can possibly gather beforehand.... Meanwhile, no matter the research, I find no answers to my problem - but I feel certain I'm not the only one suffering like this. (btw - this is a problem arising from neuroma surgery and not a PF issue.)

As an aside, here's my suspicion... during the 1st neuroma surgery (thru the top) when my foot was spread apart: either it caused a tendon to be shifted toward, and somewhat under, the 4th met; or another nerve branch in that area, unseen, got pushed to that area. And so, every time I take a step and my foot rolls off that area it is rather like tweaking your funny bone very hard. And if I don't get the shoe off soon and spread those bones out it worsens until it's almost a cramping affect too. Shoe inserts with met pads, help - but they don't help 100%. They help only if I'm not on my feet for long, and only if I'm still careful about how I walk. Which is hurting my back.... ugh. Needless to say I'm much like the gal that posted a day or so ago (and any other chronic pain sufferer), utterly frustrated and feel hopeless and wonder if my life will be 'normal' and pain-free again. And I've gained 15 pounds because I can't even do any exercise that will burn any calories of use, nor have I been able to ride my horses.

Enough...you know the 'woe is me' part.... every PF sufferer here has been there done that.

Thanks again!
Sheila

Re: Dynamics of foot cramps & the not-so-funny bone...

Julie on 12/01/02 at 12:00 (101549)

Not much use then, was it?! Sheila, post your question with the full explanation on the Ask the Doctor board. That's where it belongs, not on this one, which I don't think the doctors read.

Re: Dynamics of foot cramps & the not-so-funny bone...

Carole C in NOLA on 12/01/02 at 12:17 (101552)

A cramping muscle can pull on tendons and perhaps indirectly on ligaments. Pain is transmitted from tissues by your peripheral nerves. From your description of the sensation as feeling like the 'funny bone' sensation, it sounds likely that there is a large nerve that follows the tissues being pulled and which is being affected directly.

Hopefully some of our prior suggestions will help you to deal with the cramp itself, to find some comfort for it, and to prevent this cramping from happening so often (and perhaps to prevent it from happening at all).

You didn't say how long it has been since the surgery, but it sounds like it's probably time for a follow-up visit to the doctor who performed your neuroma surgery. He knows your foot and has examined it inside and out, which gives him a big advantage over any online doctors when it comes to making a diagnosis.

If he's the doctor that doesn't feel anything can be done, then it seems to me you really have few options. You can try our suggestions, or you can go ahead and get another opinion, even if that does involve travel.

Carole C

Re: Dynamics of foot cramps & the not-so-funny bone...

Sheila S on 12/01/02 at 16:28 (101562)

Thanks Carol! Unfortunately my doctor is part of the problem, he doesn't have a clue. The first doctor did the first surgery in Nov. 2000, the pain began immediately after (too soon for it to be a stump neuroma or scar tissue); so I went to another doc and that surgery was done again Jan. 2002. Still same pain - no change at all. I'm looking for another doctor, but I want to find the best of the best. How to find them, is the problem.

I will post my question on the doctor's page...just hated to bother them again, they've been very kind and answered a few questions already.

Many thanks!
Sheila

Re: Dynamics of foot cramps & the not-so-funny bone...

Julie on 12/02/02 at 03:12 (101579)

Hi Sheila, have you seen Dr Ed Davis's response to you on the Foot Surgery page? He says it sounds like a neuroma.

Don't worry about 'bothering' the doctors. They're giving their time because they want to help people.

Re: Dynamics of foot cramps & the not-so-funny bone...

Sheila S on 12/03/02 at 04:14 (101633)

Hi Julie, thanks for keeping an eye out for me. I've seen it. Dr. Davis has said several times he thinks it's a neuroma, maybe even in an adjacent space. I don't agree though. (if I find out otherwise, I owe him a big apology!!) The pain is too specific (I mean I can actually feel the whatever sliding on the bone, even from the outside of my foot) and I feel PRECISELY where it is. Which can't be a neuroma - because the exact spot is where I've had surgery twice and the last doc, in Jan. of this year, said he looked extremely thoroughly to see if he could see ANYthing else in there and did not see a thing. The pain began immed. after 1st surgery, and is no better after 2nd, maybe even worse....began way too soon for it to be scar tissue or stump neuroma. That's why I'm leaning toward tendon/ligament or nerve displacement... in any case, I need to find out what, if any, test can show that sort of thing. Dr. Z. doesn't really think it's a neuroma either. Ugh - my whole history is on this web site somewhere. LOL

I will keep digging.... I'm thinking about going to an Orthopod...but I went 10 years ago about my knee (after I fell hard on it in the gravel and continued having problems). The Ortho said it's just tendonitis he thot, I've been living with it ever since. Hmmmm. I guess some folks are just hard to diagnose, huh? I'm always the 'one in a million'. =)

Oh - by the way, a very interesting discussion about Chiropractics is going on in the Treatment room.....

Re: Chiropractics

Julie on 12/03/02 at 10:27 (101649)

I've seen it, Sheila, but I'm not getting involved. I've said what I think about the benefits of chiropractics and osteopathy two zillion times, and I don't want to get into any more arguments with anyone who cites 'lack of scientific evidence'. You're doing awfully well - keep it up.

Re: Dynamics of foot cramps & the not-so-funny bone...

Sheila S on 12/03/02 at 14:45 (101668)

Hey Julie, I meant to ask you about pressure points for cramps. Sometimes I have leg cramps at night (most particularly out horse camping) and my daughter (a gymnist) said I needed to drink more water...she was exactly right.

But on the occasion that I do get calf and foot cramps, can you explain where to apply pressure (I know it's difficult typing it sometimes)? The cramps are usually in my calves, and draw my entire foot over which continues on into horrible bottom-of-foot cramps that draw my toes over.... ugh. (or vise versa, sometimes it starts in foot and creeps up calf).

I got stuck one time, cramps SO bad I thought if I got up and walked outside around camp it would ease them, I got up then cramped REALLY bad and couldn't move to get out of the trailer, nor sit back down. It was awful.

Thanks! Sheila

Re: Dynamics of foot cramps & the not-so-funny bone...

Julie on 12/03/02 at 16:38 (101692)

Sheila, the pressure point that I described in my other post (in the webbed bit between the big toe and second toe) will work for cramp anywhere in the leg.

Your daughter is spot on about the water. You may also find calcium and magnesium tablets helpful.

Re: Dynamics of foot cramps & the not-so-funny bone...

Sheila S on 12/03/02 at 18:39 (101705)

Thank you thank you! You have alot of knowledge about these things...

=)

Re: very limted information

Ed Davis, DPM on 12/03/02 at 19:23 (101709)

Sheila:

You provided a very brief description of the problem on the doctor's board and I provided an answer based on that information only. I use only the information you provide on a specific post as I do not have the time to run a search on all of your prior posts.

Your 'funny bone' description implies nerve pain and you stated that you feel something moving around.

Again, I have very limited information from you but you seem to be implying that you had neuroma surgery and then the doctor went back in a second time. Many of us feel that when neuroma surgery is repeated that the second surgery should be done through a plantar incision. Most neuromas follow a fairly typical patttern but a small percentage are anomalous, that is, have an unusual shape and/or pattern of innervation. If that is your case and the doctor did the second surgery via a dorsal approach, he/she would not be likely to find anything. It does not matter how thoroughly one looks via a dorsal incision -- the neuroma is a plantar lesion. The dorsal incisons are used as they are more comfortable for the patient. A plantar incision allows inspection of the plantar nerve stump with COMPLETE visualization of the pattern of nerves. I have seen bilobed and even once a tri-lobed neuroma with part of the neruoma hidden beneath the metatarsal head.
Ed

Re: Dynamics of foot cramps & the not-so-funny bone...

Ed Davis, DPM on 12/03/02 at 19:35 (101711)

Sheila:
You stated that the first surgery wa 'through the top' but did not state what approach was taken on the second surgery.
Ed

Re: Dr. Davis.......

Sheila S on 12/04/02 at 05:55 (101733)

I'm sorry Dr. Davis, please realize I DO appreciate any information received here! Both surgeries were through the top of my foot. Your recent explanation helps me to understand better why you think there's a possibility of an unseen neuroma. No knot can be felt, the pain is in the left foot exactly at the joints in ball of foot (is that met heads?) and up against the left edge of the 3rd met. I feel it about the length and width of a toothpick. It doesn't radiate out until it's bad (at which point it isn't so easily pin-pointed). [It truly feels exactly like when you twang your funny bone, both the pain and the 'piece' of whatever I feel moving.]

It seems the Sclerosing injections should have helped - but didn't. Although, when each injection was first done while the long-acting pain med. was working I felt GREAT for about 3 hours or so.

If you are interested, I can copy the whole 'foot story' and paste it in one big post if you want to read it all and try to put together a complete picture. Let me know.

Assuming it might be a neuroma as you've mentioned, what would be the best tests to check for that? The gandolinium MRI? what would be the best to check for tendon or nerve displacement? I was going to try to force my doctor to order some tests, I've mentioned them twice and he just doesn't seem to feel they will add to anything. But I decided, instead, to schedule an appt. with an Orthopaedic Doc who specializes in foot & ankle surgeries. I want to compare what tests he thinks should be done, etc.

I wrote Dr. Fenton and he recommended a Dr. Banks in Georgia. I may contact him after I get some tests done here. (I certainly won't have surgery again without visiting some other docs - even if I have to drive 8 hours!)

Thanks again..... and if the tests show you were spot-on, I'll post a huge apology! =)

Sheila

Re: for Dr. Davis... (and thanks!)

Sheila S on 12/05/02 at 04:54 (101816)

I'm sorry Dr. Davis, please realize I DO appreciate any information received here! Both surgeries were through the top of my foot. Your recent explanation helps me to understand better why you think there's a possibility of an unseen neuroma. No knot can be felt, the pain is in the left foot exactly at the joints in ball of foot (is that met heads?) and up against the left edge of the 3rd met. I feel it about the length and width of a toothpick. It doesn't radiate out until it's bad (at which point it isn't so easily pin-pointed). [It truly feels exactly like when you twang your funny bone, both the pain and the 'piece' of whatever I feel moving.]

It seems the Sclerosing injections should have helped - but didn't. Although, when each injection was first done while the long-acting pain med. was working I felt GREAT for about 3 hours or so.

If you are interested, I can copy the whole 'foot story' and paste it in one big post if you want to read it all and try to put together a complete picture. Let me know.

Assuming it might be a neuroma as you've mentioned, what would be the best tests to check for that? The gandolinium MRI? what would be the best to check for tendon or nerve displacement? I was going to try to force my doctor to order some tests, I've mentioned them twice and he just doesn't seem to feel they will add to anything. But I decided, instead, to schedule an appt. with an Orthopaedic Doc who specializes in foot & ankle surgeries. I want to compare what tests he thinks should be done, etc.

I wrote Dr. Fenton and he recommended a Dr. Banks in Georgia. I may contact him after I get some tests done here. (I certainly won't have surgery again without visiting some other docs - even if I have to drive 8 hours!)

Thanks again..... and if the tests show you were spot-on, I'll post a huge apology! =)

Sheila

Re: for Dr. Davis... (and thanks!)

Sheila S on 12/05/02 at 09:49 (101841)

by the way, I've been doing a bunch of research since your last post, using some of the words in your post. It appears, like you said, the preferred method for a second surgery is plantar AND the preferred test is the gado.mri you once recommended a few posts back. (which makes me somewhat more frustrated that neither of my surgeons did any tests and don't feel they're worthwhile and the 2nd surgeon did dorsal incision instead of plantar...).

I think I'm making headway though. I have found at least somewhat of an expert in this area, Dr. James T. Chandler at Roanoke Orthopedic Center. At the very least, he should run some tests.

MY thinking is, even tho the MRI is the most expensive, it sounds like it will show the most/best. I can press for that test rather than a bunch of other tests (which may eventually lead to having to have the MRI anyway). Would you agree? I see no point or difference in spending $2k for 3 tests or spending $2k for the MRI, might as well get the best first and once?

Oh yes, ONE other questions. I've been reading about endoscopic surgery for neuroma; but nothing says where the 3 small incisions are. Is this a possibility with a plantar approach? Some sites say studies show the plantar approach causes very little scar tissue and very few, if any, problems from the incision. Other sites say that's the worst place and causes problems with major scar tissue. (sheesh, search 10 sites, get 10 answers!)

Thanks! Sheila

Re: Dr. Davis.......

Ed Davis, DPM on 12/05/02 at 16:07 (101872)

Sheila:
Unfortunately, there are no tests for intermetatarsal neuromas. Occasionally a very good MRI can pick them up BUT, if the neuroma is not in the interspace, but beneath a metatarsal head it may be hard for an MRI to do so. An MRI could be done to rule something else out but your description of the problem strongly suggests a neuroma.

Dr. Banks would be a good choice if you live in Georgia. Dr. John Ruch is another good doc in that area.

Again, I am not sure where you have posted other information on this site but if you can consolidate and re-present it, I would be happy to read it.

Understandably, you are frustrated, but I suspect that the diagnosis and treatment may be far simpler than you expect. A plantar incision will lead the surgeon right to the area for visual inspection--- that is still the 'gold standard' for which no test can substitute.
Ed

Re: for Dr. Davis... (and thanks!)

Ed Davis, DPM on 12/05/02 at 16:38 (101876)

Sheila:
Definitely DO NOT consider endoscopic neuroma surgery. That procedure leaves the neuroma intact but involves the cutting of the transverse metatarsal ligament which is the ligament which holds the metatarsal heads together. The theory is that if the metatarsal heads are allowed to spread apart further then less pressure will exist on the neuroma. I believe that there is some merit to that concept. Your situation MAY involve a neuroma with an anomalous location so that technique is very unlikely to lead to success for you.

You seem to be focused on doing tests. Quite frankly, the potential benefit of the tests is limited but something you may want to do just to rule out the presence of anything unusual. There just is no substitute for visualization of the area. You should have that done by someone who is very familiar with the anatomy of the area. Most podiatric physicians spend a big chunk of their career looking at that area and I feel could offer you the most expertise.

The potential for scarring with plantar incisions is much greater than with dorsal incisions--period. No 'ifs ands of buts' about that. If anyone contradicts this statement, head for the door ASAP. That being said; the most problematic plantar incisons are beneath metatarsal heads. The plantar incison used for neuromas is IN BETWEEN the metatarsal heads and is much less prone to scar tissue or painful scars. It is best to remove neuromas via the dorsal incision for this purpose. The dorsal incision only allows visualization of a portion of the interspace-- enough to remove any garden variety neuroma. Now, if neuroma surgery fails, we need to assume that you have pathology that may not be seen through the limited dorsal view. The plantar view is much broader, more direct and is often extended more proximally. The plantar approach is less ideal from the standpoint of scaring but is a 'neccessary evil' when adequate exposure is needed.
Ed

Re: for Dr. Davis... (and thanks!)

Sheila S on 12/05/02 at 17:43 (101891)

Thanks Dr. Davis. I seem focused on tests only because 2 surgeries have already failed and I just hate the idea of having yet another 'maybe it's this' surgery. But, if no tests will help, then that's what it'll have to be. As you say, I feel the thing SO close to the surface of the skin that I feel pretty certain a plantar incision will definitely expose it. It doesn't feel like it's directly under the met head, but pushed very close against it. Actually, the best way to feel the clicking is when I curl my toes UP and ball of foot is rounded, and push directly in between the met heads. (From pictures, it looks likes I'm pushing up directly on the ligament that crosses between the met heads.) It will ping some using the normal 'squeeze and rotate' routine, but not as bad as the one's did before, it feels lower than the others did. This one hurts more by just pushing across it towards the bone (like pushing across your 'funny bone').

What about...would sclerosing be an option through the plantar area, directly into that spot? As a last ditch effort to avoid another surgery (oh pleeeez, anything but another surgery....)

I'm not in Georgia, I'm in Virginia, but willing to travel some to find a really knowledgeable doctor. The two that did my surgeries are the BEST here! So.... I am also close enough to travel to Duke or MCV or even Baltimore, but don't know who to contact. No names from those places were given to me.

Re: for Dr. Davis... (and thanks!)

Ed Davis, DPM on 12/05/02 at 19:22 (101898)

Sheila:

It may be difficult perform the sclerosing injection through the top but possible. Injecting through the bottom is painful.

A lot of good docs come to mind in your area: Marc A. Platt, DPM and Paul Shoenfeld, DPM of Roanoke (540-343-5517), Barry Saffran, DPM of Fairfax (703-425-3338).
Ed

Re: Dr. Davis.......

pala on 12/05/02 at 21:33 (101910)

sheila, i live in georgia too.

Re: for Dr. Davis... (and thanks!)

Sheila S on 12/06/02 at 05:07 (101934)

My doctor tried the Sclerosing from the top. I went through 7 injections. (He's quite frustrated, he has not done a single surgery since he's been doing the injections.) If the swelling and pain afterwards for a couple days is the direct indication that the nerve was hit as needed, then the nerve was only hit once.

That's why I asked about the possibility of injecting it from the bottom. If it were possible to do this - I think it could be pretty easily targeted by inserting the needle behind my toes (in the edge of the fat pad) at a vertical angle (instead of straight in) and straight to the nerve, and I wouldn't be walking on the point of injection. I didn't know if it would cause other complications. More painful than the dorsal shot? Even using the (um, skin freeze spray) and a long acting pain killer?

I will run ALL these ideas and suggestions from the doctors here by my doc and other docs. I will see what the Orthopod. foot specialist says, and also go to one of the doctors you listed. (sorry, I'm just not willing to undergo surgery until I have a concensus).

I talked to my current doctor yesterday and let him know what I was doing. I offered to keep him posted on everything, if he wants to stay involved since it's been such a puzzle/frustration for him too. I'm a little concerned about causing hard feelings - which I don't want to do, I think he's done the best he can and is a good doc. (Any suggestions THERE??)

Sheila

Re: for Dr. Davis... (and thanks!)

Sheila S on 12/06/02 at 05:10 (101935)

And oh yeah, I am in Roanoke. So I can easily see Platt or Shoenfeld. Do you know them personally? Shall I say you recommended me?

Re: for Dr. Davis... (and thanks!)

Ed Davis, DPM on 12/06/02 at 10:52 (101971)

Sheila:
You could try having sclerosing agents through the bottom. The idea is to progressively shrink and deaden the nerve. If it is underneath a metatarsal head, it may be difficult to deaden and shrink enough as there is a lot of weight bearing pressure there.
Ed

Re: for Dr. Davis... (and thanks!)

Ed Davis, DPM on 12/06/02 at 10:53 (101972)

I don't know them personally. I started years ago with the National Health Service Corps. in WV, so they may or may not recognize my name.
Ed

Re: Dynamics of foot cramps & the not-so-funny bone...

Carole C in NOLA on 11/30/02 at 19:59 (101523)

You're right... you can't really diagnose yourself, and the best you can probably get here is some ideas of what it might be. I hope you get some that are helpful!

My best guess (and I am not in the medical field) is that since the funny bone is really a nerve (as I recall), maybe the cramping muscle in your foot is tightening really hard on a nerve and causing your nerve symptoms. It sounds so painful! I wish I could give you a better answer. In order to get a competent diagnosis, and in order to get medical tests performed, you would need to see a foot professional.

If cramping is the cause, as I suspect, it may help to figure out the cause of the cramping so you can eliminate it. Have you done anything different lately, like wearing different shoes, or walking or standing more, that could cause your foot to cramp up? Are you eating a well rounded diet with plenty of calcium, sodium, and potassium, and drinking plenty of water? Or, [GIRLS ONLY PLEASE] is it near that time of the month when everything in your body seems to want to cramp up?

You are smart to take your shoe off and work out the cramp when this happens. There are some other things you can do if that's not enough. Icing your foot might help to alleviate any minor after-effects of tingling and stinging, because it reduces inflammation and pressure on the tissues. Gentle stretching can help when you are working out the cramp. Try rotating your foot at the ankle, and other gentle stretching. Massaging your feet might help, too.

Carole C

Re: Dynamics of foot cramps & the not-so-funny bone...

Julie on 12/01/02 at 03:36 (101533)

Good ideas from Carole, Sheila. Here's another suggestion. There's a pressure point to relieve cramp. Press with your thumb into the 'webbed' bit between the big toe and second toe. The pressure should be steady and strong.

This will usually relieve 'normal' cramp. I don't know if it will help you, but could try it.

It works on cramp anywhere, incidentally, not just foot cramp.

Re: Dynamics of foot cramps & the not-so-funny bone...

Sheila S on 12/01/02 at 10:50 (101543)

Thanks Carol and Julie for your responses. I wrote a little too quickly though (not explaining well enough!). It's not an actual cramp that occurs in my foot, but I feel certain parts of my foot involved that are also involved in a cramp. So, I'm wondering, when a cramp occurs, and I've always assumed it was muscle that cramped, does it then pull on ligaments and tendons which DO feel pain? If so, this piece I feel in my foot may well be tendon. If it's tendon, what tests show tendons and where they are located and if they aren't in the right place?? (see my line of thinking??)

Unfortunately, the doctors on this site don't agree on tests or type of tests and what the results are worth; and my doctor doesn't feel tests will add to anything..... thus the self-diagnosing. If I can perhaps narrow it down to some degree, I can push my doctor into at least a couple of the tests that have been recommended.

I would like to make an appt. somewhere on the East Coast with a 'world-renowned and well-respected' foot surgeon of some sort, that has a clue. There aren't any such physicians here. But I need to have all the information I can possibly gather beforehand.... Meanwhile, no matter the research, I find no answers to my problem - but I feel certain I'm not the only one suffering like this. (btw - this is a problem arising from neuroma surgery and not a PF issue.)

As an aside, here's my suspicion... during the 1st neuroma surgery (thru the top) when my foot was spread apart: either it caused a tendon to be shifted toward, and somewhat under, the 4th met; or another nerve branch in that area, unseen, got pushed to that area. And so, every time I take a step and my foot rolls off that area it is rather like tweaking your funny bone very hard. And if I don't get the shoe off soon and spread those bones out it worsens until it's almost a cramping affect too. Shoe inserts with met pads, help - but they don't help 100%. They help only if I'm not on my feet for long, and only if I'm still careful about how I walk. Which is hurting my back.... ugh. Needless to say I'm much like the gal that posted a day or so ago (and any other chronic pain sufferer), utterly frustrated and feel hopeless and wonder if my life will be 'normal' and pain-free again. And I've gained 15 pounds because I can't even do any exercise that will burn any calories of use, nor have I been able to ride my horses.

Enough...you know the 'woe is me' part.... every PF sufferer here has been there done that.

Thanks again!
Sheila

Re: Dynamics of foot cramps & the not-so-funny bone...

Julie on 12/01/02 at 12:00 (101549)

Not much use then, was it?! Sheila, post your question with the full explanation on the Ask the Doctor board. That's where it belongs, not on this one, which I don't think the doctors read.

Re: Dynamics of foot cramps & the not-so-funny bone...

Carole C in NOLA on 12/01/02 at 12:17 (101552)

A cramping muscle can pull on tendons and perhaps indirectly on ligaments. Pain is transmitted from tissues by your peripheral nerves. From your description of the sensation as feeling like the 'funny bone' sensation, it sounds likely that there is a large nerve that follows the tissues being pulled and which is being affected directly.

Hopefully some of our prior suggestions will help you to deal with the cramp itself, to find some comfort for it, and to prevent this cramping from happening so often (and perhaps to prevent it from happening at all).

You didn't say how long it has been since the surgery, but it sounds like it's probably time for a follow-up visit to the doctor who performed your neuroma surgery. He knows your foot and has examined it inside and out, which gives him a big advantage over any online doctors when it comes to making a diagnosis.

If he's the doctor that doesn't feel anything can be done, then it seems to me you really have few options. You can try our suggestions, or you can go ahead and get another opinion, even if that does involve travel.

Carole C

Re: Dynamics of foot cramps & the not-so-funny bone...

Sheila S on 12/01/02 at 16:28 (101562)

Thanks Carol! Unfortunately my doctor is part of the problem, he doesn't have a clue. The first doctor did the first surgery in Nov. 2000, the pain began immediately after (too soon for it to be a stump neuroma or scar tissue); so I went to another doc and that surgery was done again Jan. 2002. Still same pain - no change at all. I'm looking for another doctor, but I want to find the best of the best. How to find them, is the problem.

I will post my question on the doctor's page...just hated to bother them again, they've been very kind and answered a few questions already.

Many thanks!
Sheila

Re: Dynamics of foot cramps & the not-so-funny bone...

Julie on 12/02/02 at 03:12 (101579)

Hi Sheila, have you seen Dr Ed Davis's response to you on the Foot Surgery page? He says it sounds like a neuroma.

Don't worry about 'bothering' the doctors. They're giving their time because they want to help people.

Re: Dynamics of foot cramps & the not-so-funny bone...

Sheila S on 12/03/02 at 04:14 (101633)

Hi Julie, thanks for keeping an eye out for me. I've seen it. Dr. Davis has said several times he thinks it's a neuroma, maybe even in an adjacent space. I don't agree though. (if I find out otherwise, I owe him a big apology!!) The pain is too specific (I mean I can actually feel the whatever sliding on the bone, even from the outside of my foot) and I feel PRECISELY where it is. Which can't be a neuroma - because the exact spot is where I've had surgery twice and the last doc, in Jan. of this year, said he looked extremely thoroughly to see if he could see ANYthing else in there and did not see a thing. The pain began immed. after 1st surgery, and is no better after 2nd, maybe even worse....began way too soon for it to be scar tissue or stump neuroma. That's why I'm leaning toward tendon/ligament or nerve displacement... in any case, I need to find out what, if any, test can show that sort of thing. Dr. Z. doesn't really think it's a neuroma either. Ugh - my whole history is on this web site somewhere. LOL

I will keep digging.... I'm thinking about going to an Orthopod...but I went 10 years ago about my knee (after I fell hard on it in the gravel and continued having problems). The Ortho said it's just tendonitis he thot, I've been living with it ever since. Hmmmm. I guess some folks are just hard to diagnose, huh? I'm always the 'one in a million'. =)

Oh - by the way, a very interesting discussion about Chiropractics is going on in the Treatment room.....

Re: Chiropractics

Julie on 12/03/02 at 10:27 (101649)

I've seen it, Sheila, but I'm not getting involved. I've said what I think about the benefits of chiropractics and osteopathy two zillion times, and I don't want to get into any more arguments with anyone who cites 'lack of scientific evidence'. You're doing awfully well - keep it up.

Re: Dynamics of foot cramps & the not-so-funny bone...

Sheila S on 12/03/02 at 14:45 (101668)

Hey Julie, I meant to ask you about pressure points for cramps. Sometimes I have leg cramps at night (most particularly out horse camping) and my daughter (a gymnist) said I needed to drink more water...she was exactly right.

But on the occasion that I do get calf and foot cramps, can you explain where to apply pressure (I know it's difficult typing it sometimes)? The cramps are usually in my calves, and draw my entire foot over which continues on into horrible bottom-of-foot cramps that draw my toes over.... ugh. (or vise versa, sometimes it starts in foot and creeps up calf).

I got stuck one time, cramps SO bad I thought if I got up and walked outside around camp it would ease them, I got up then cramped REALLY bad and couldn't move to get out of the trailer, nor sit back down. It was awful.

Thanks! Sheila

Re: Dynamics of foot cramps & the not-so-funny bone...

Julie on 12/03/02 at 16:38 (101692)

Sheila, the pressure point that I described in my other post (in the webbed bit between the big toe and second toe) will work for cramp anywhere in the leg.

Your daughter is spot on about the water. You may also find calcium and magnesium tablets helpful.

Re: Dynamics of foot cramps & the not-so-funny bone...

Sheila S on 12/03/02 at 18:39 (101705)

Thank you thank you! You have alot of knowledge about these things...

=)

Re: very limted information

Ed Davis, DPM on 12/03/02 at 19:23 (101709)

Sheila:

You provided a very brief description of the problem on the doctor's board and I provided an answer based on that information only. I use only the information you provide on a specific post as I do not have the time to run a search on all of your prior posts.

Your 'funny bone' description implies nerve pain and you stated that you feel something moving around.

Again, I have very limited information from you but you seem to be implying that you had neuroma surgery and then the doctor went back in a second time. Many of us feel that when neuroma surgery is repeated that the second surgery should be done through a plantar incision. Most neuromas follow a fairly typical patttern but a small percentage are anomalous, that is, have an unusual shape and/or pattern of innervation. If that is your case and the doctor did the second surgery via a dorsal approach, he/she would not be likely to find anything. It does not matter how thoroughly one looks via a dorsal incision -- the neuroma is a plantar lesion. The dorsal incisons are used as they are more comfortable for the patient. A plantar incision allows inspection of the plantar nerve stump with COMPLETE visualization of the pattern of nerves. I have seen bilobed and even once a tri-lobed neuroma with part of the neruoma hidden beneath the metatarsal head.
Ed

Re: Dynamics of foot cramps & the not-so-funny bone...

Ed Davis, DPM on 12/03/02 at 19:35 (101711)

Sheila:
You stated that the first surgery wa 'through the top' but did not state what approach was taken on the second surgery.
Ed

Re: Dr. Davis.......

Sheila S on 12/04/02 at 05:55 (101733)

I'm sorry Dr. Davis, please realize I DO appreciate any information received here! Both surgeries were through the top of my foot. Your recent explanation helps me to understand better why you think there's a possibility of an unseen neuroma. No knot can be felt, the pain is in the left foot exactly at the joints in ball of foot (is that met heads?) and up against the left edge of the 3rd met. I feel it about the length and width of a toothpick. It doesn't radiate out until it's bad (at which point it isn't so easily pin-pointed). [It truly feels exactly like when you twang your funny bone, both the pain and the 'piece' of whatever I feel moving.]

It seems the Sclerosing injections should have helped - but didn't. Although, when each injection was first done while the long-acting pain med. was working I felt GREAT for about 3 hours or so.

If you are interested, I can copy the whole 'foot story' and paste it in one big post if you want to read it all and try to put together a complete picture. Let me know.

Assuming it might be a neuroma as you've mentioned, what would be the best tests to check for that? The gandolinium MRI? what would be the best to check for tendon or nerve displacement? I was going to try to force my doctor to order some tests, I've mentioned them twice and he just doesn't seem to feel they will add to anything. But I decided, instead, to schedule an appt. with an Orthopaedic Doc who specializes in foot & ankle surgeries. I want to compare what tests he thinks should be done, etc.

I wrote Dr. Fenton and he recommended a Dr. Banks in Georgia. I may contact him after I get some tests done here. (I certainly won't have surgery again without visiting some other docs - even if I have to drive 8 hours!)

Thanks again..... and if the tests show you were spot-on, I'll post a huge apology! =)

Sheila

Re: for Dr. Davis... (and thanks!)

Sheila S on 12/05/02 at 04:54 (101816)

I'm sorry Dr. Davis, please realize I DO appreciate any information received here! Both surgeries were through the top of my foot. Your recent explanation helps me to understand better why you think there's a possibility of an unseen neuroma. No knot can be felt, the pain is in the left foot exactly at the joints in ball of foot (is that met heads?) and up against the left edge of the 3rd met. I feel it about the length and width of a toothpick. It doesn't radiate out until it's bad (at which point it isn't so easily pin-pointed). [It truly feels exactly like when you twang your funny bone, both the pain and the 'piece' of whatever I feel moving.]

It seems the Sclerosing injections should have helped - but didn't. Although, when each injection was first done while the long-acting pain med. was working I felt GREAT for about 3 hours or so.

If you are interested, I can copy the whole 'foot story' and paste it in one big post if you want to read it all and try to put together a complete picture. Let me know.

Assuming it might be a neuroma as you've mentioned, what would be the best tests to check for that? The gandolinium MRI? what would be the best to check for tendon or nerve displacement? I was going to try to force my doctor to order some tests, I've mentioned them twice and he just doesn't seem to feel they will add to anything. But I decided, instead, to schedule an appt. with an Orthopaedic Doc who specializes in foot & ankle surgeries. I want to compare what tests he thinks should be done, etc.

I wrote Dr. Fenton and he recommended a Dr. Banks in Georgia. I may contact him after I get some tests done here. (I certainly won't have surgery again without visiting some other docs - even if I have to drive 8 hours!)

Thanks again..... and if the tests show you were spot-on, I'll post a huge apology! =)

Sheila

Re: for Dr. Davis... (and thanks!)

Sheila S on 12/05/02 at 09:49 (101841)

by the way, I've been doing a bunch of research since your last post, using some of the words in your post. It appears, like you said, the preferred method for a second surgery is plantar AND the preferred test is the gado.mri you once recommended a few posts back. (which makes me somewhat more frustrated that neither of my surgeons did any tests and don't feel they're worthwhile and the 2nd surgeon did dorsal incision instead of plantar...).

I think I'm making headway though. I have found at least somewhat of an expert in this area, Dr. James T. Chandler at Roanoke Orthopedic Center. At the very least, he should run some tests.

MY thinking is, even tho the MRI is the most expensive, it sounds like it will show the most/best. I can press for that test rather than a bunch of other tests (which may eventually lead to having to have the MRI anyway). Would you agree? I see no point or difference in spending $2k for 3 tests or spending $2k for the MRI, might as well get the best first and once?

Oh yes, ONE other questions. I've been reading about endoscopic surgery for neuroma; but nothing says where the 3 small incisions are. Is this a possibility with a plantar approach? Some sites say studies show the plantar approach causes very little scar tissue and very few, if any, problems from the incision. Other sites say that's the worst place and causes problems with major scar tissue. (sheesh, search 10 sites, get 10 answers!)

Thanks! Sheila

Re: Dr. Davis.......

Ed Davis, DPM on 12/05/02 at 16:07 (101872)

Sheila:
Unfortunately, there are no tests for intermetatarsal neuromas. Occasionally a very good MRI can pick them up BUT, if the neuroma is not in the interspace, but beneath a metatarsal head it may be hard for an MRI to do so. An MRI could be done to rule something else out but your description of the problem strongly suggests a neuroma.

Dr. Banks would be a good choice if you live in Georgia. Dr. John Ruch is another good doc in that area.

Again, I am not sure where you have posted other information on this site but if you can consolidate and re-present it, I would be happy to read it.

Understandably, you are frustrated, but I suspect that the diagnosis and treatment may be far simpler than you expect. A plantar incision will lead the surgeon right to the area for visual inspection--- that is still the 'gold standard' for which no test can substitute.
Ed

Re: for Dr. Davis... (and thanks!)

Ed Davis, DPM on 12/05/02 at 16:38 (101876)

Sheila:
Definitely DO NOT consider endoscopic neuroma surgery. That procedure leaves the neuroma intact but involves the cutting of the transverse metatarsal ligament which is the ligament which holds the metatarsal heads together. The theory is that if the metatarsal heads are allowed to spread apart further then less pressure will exist on the neuroma. I believe that there is some merit to that concept. Your situation MAY involve a neuroma with an anomalous location so that technique is very unlikely to lead to success for you.

You seem to be focused on doing tests. Quite frankly, the potential benefit of the tests is limited but something you may want to do just to rule out the presence of anything unusual. There just is no substitute for visualization of the area. You should have that done by someone who is very familiar with the anatomy of the area. Most podiatric physicians spend a big chunk of their career looking at that area and I feel could offer you the most expertise.

The potential for scarring with plantar incisions is much greater than with dorsal incisions--period. No 'ifs ands of buts' about that. If anyone contradicts this statement, head for the door ASAP. That being said; the most problematic plantar incisons are beneath metatarsal heads. The plantar incison used for neuromas is IN BETWEEN the metatarsal heads and is much less prone to scar tissue or painful scars. It is best to remove neuromas via the dorsal incision for this purpose. The dorsal incision only allows visualization of a portion of the interspace-- enough to remove any garden variety neuroma. Now, if neuroma surgery fails, we need to assume that you have pathology that may not be seen through the limited dorsal view. The plantar view is much broader, more direct and is often extended more proximally. The plantar approach is less ideal from the standpoint of scaring but is a 'neccessary evil' when adequate exposure is needed.
Ed

Re: for Dr. Davis... (and thanks!)

Sheila S on 12/05/02 at 17:43 (101891)

Thanks Dr. Davis. I seem focused on tests only because 2 surgeries have already failed and I just hate the idea of having yet another 'maybe it's this' surgery. But, if no tests will help, then that's what it'll have to be. As you say, I feel the thing SO close to the surface of the skin that I feel pretty certain a plantar incision will definitely expose it. It doesn't feel like it's directly under the met head, but pushed very close against it. Actually, the best way to feel the clicking is when I curl my toes UP and ball of foot is rounded, and push directly in between the met heads. (From pictures, it looks likes I'm pushing up directly on the ligament that crosses between the met heads.) It will ping some using the normal 'squeeze and rotate' routine, but not as bad as the one's did before, it feels lower than the others did. This one hurts more by just pushing across it towards the bone (like pushing across your 'funny bone').

What about...would sclerosing be an option through the plantar area, directly into that spot? As a last ditch effort to avoid another surgery (oh pleeeez, anything but another surgery....)

I'm not in Georgia, I'm in Virginia, but willing to travel some to find a really knowledgeable doctor. The two that did my surgeries are the BEST here! So.... I am also close enough to travel to Duke or MCV or even Baltimore, but don't know who to contact. No names from those places were given to me.

Re: for Dr. Davis... (and thanks!)

Ed Davis, DPM on 12/05/02 at 19:22 (101898)

Sheila:

It may be difficult perform the sclerosing injection through the top but possible. Injecting through the bottom is painful.

A lot of good docs come to mind in your area: Marc A. Platt, DPM and Paul Shoenfeld, DPM of Roanoke (540-343-5517), Barry Saffran, DPM of Fairfax (703-425-3338).
Ed

Re: Dr. Davis.......

pala on 12/05/02 at 21:33 (101910)

sheila, i live in georgia too.

Re: for Dr. Davis... (and thanks!)

Sheila S on 12/06/02 at 05:07 (101934)

My doctor tried the Sclerosing from the top. I went through 7 injections. (He's quite frustrated, he has not done a single surgery since he's been doing the injections.) If the swelling and pain afterwards for a couple days is the direct indication that the nerve was hit as needed, then the nerve was only hit once.

That's why I asked about the possibility of injecting it from the bottom. If it were possible to do this - I think it could be pretty easily targeted by inserting the needle behind my toes (in the edge of the fat pad) at a vertical angle (instead of straight in) and straight to the nerve, and I wouldn't be walking on the point of injection. I didn't know if it would cause other complications. More painful than the dorsal shot? Even using the (um, skin freeze spray) and a long acting pain killer?

I will run ALL these ideas and suggestions from the doctors here by my doc and other docs. I will see what the Orthopod. foot specialist says, and also go to one of the doctors you listed. (sorry, I'm just not willing to undergo surgery until I have a concensus).

I talked to my current doctor yesterday and let him know what I was doing. I offered to keep him posted on everything, if he wants to stay involved since it's been such a puzzle/frustration for him too. I'm a little concerned about causing hard feelings - which I don't want to do, I think he's done the best he can and is a good doc. (Any suggestions THERE??)

Sheila

Re: for Dr. Davis... (and thanks!)

Sheila S on 12/06/02 at 05:10 (101935)

And oh yeah, I am in Roanoke. So I can easily see Platt or Shoenfeld. Do you know them personally? Shall I say you recommended me?

Re: for Dr. Davis... (and thanks!)

Ed Davis, DPM on 12/06/02 at 10:52 (101971)

Sheila:
You could try having sclerosing agents through the bottom. The idea is to progressively shrink and deaden the nerve. If it is underneath a metatarsal head, it may be difficult to deaden and shrink enough as there is a lot of weight bearing pressure there.
Ed

Re: for Dr. Davis... (and thanks!)

Ed Davis, DPM on 12/06/02 at 10:53 (101972)

I don't know them personally. I started years ago with the National Health Service Corps. in WV, so they may or may not recognize my name.
Ed