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Conservative Treatment Success

Posted by Carl on 12/04/02 at 09:57 (101752)

Hi All, I have been recently diagnosed with TTS (had the blood work and the EMG, etc.). My neurologist has prescribed the 'industrial strength' (800 mg) ibuprofen and physcial therapy. Having read through a lot of the previous postings, I don't find anybody who has had success with this line of treatment. I am only going to consider surgery as a last result (especially since a lot of you haven't been happy with the results), so I'd like to hear from anyone who has had success with a 'conservative' course of treatment. In other words, can anyone tell me about how they have minimized the pain and numbness and been successful at this long term?

Thanks,
Carl

Re: Conservative Treatment Success

Lara T on 12/04/02 at 11:01 (101765)

Ibuprofen helps with the discomfort, but not TTS. I took large doses until my stomach rebelled (known side-effect of ibuprofen).

My TTS got under control when I got prescrition compression socks. ('Under control' means I have a nice life where I don't bite off people's heads anymore, and in fact live reasonably discomfort-free- but I have had to give up certain activities. However, changing my activities wasn't sufficient before the c.socks). A lot of people haven't had success with C.socks, but have liked night splints or other things. There is a list you can find by searching the archives. I believe the title of the thread is 'possible treatments' - it includes things from relatively conservative, non-invasive treatments, to surgery. The list isn't from medical personnel - just from what people on this message board have talked about. Some of the people have PF, some have TTS, and some probably wrote while in the process of determining which they had (or if it was something else). Undoubtedly, some people were misdiagnosed too. So everything on the list may not be appropriate, nothing worked for everyone, and all of it worked for someone.

Good luck.

Re: Conservative Treatment Success

Carl on 12/04/02 at 13:24 (101791)

Thanks for responding Lara. I have seen the list you mention, but I was hoping to get personal success stories (like yours). At least it sounds like you found something that works for you. I'm hoping I don't have to give up any of the many outdoor activities I enjoy, and that ibuprofen and ultrasound will calm down the nerves. What do the compression socks actually do for you? Do they hold your foot in place while sleeping? Sounds uncomfortable, as regular socks sometimes feel constricting.

Carl

Re: Conservative Treatment Success

Lara T on 12/04/02 at 14:54 (101792)

No one knows why the compression socks work for me. I've had some of the doctor's I consulted poo-poo the socks (since it's not clear why they work!). But I figure it's tough to argue with success. There is a hypothesis, given the confluence of various factors, that they might be squeezing water out and thereby relieving pressure on the nerve in the tarsal tunnel.

It took me months to figure out that I would have to give up tennis (and before this moment came I swore that I wouldn't give up tennis). HOwever, I've taken up art (I'm not particularly talented, but I enjoy it), and have a nice life.

I don't think the ibuprofen calms down the nerves - it just reduces the pain/discomfort.

The socks aren't particularly uncomfortable, although there is a difference and they aren't as comfortable as regular socks. I don't mind them. Lots of people wear them, including people with diabetes or varicose veins (although they may use the OTC ones, I'm not sure). It sure beats the Tarsal Tunnel pain. It took awhile to get used to putting them on - takes a little bit more muscle in the fingers, but it didn't take long to learn. I got some relief immediately, but it was several weeks before I plataeued (sp?) at the level at which I live my life. I don't wear the socks when sleeping (usually, although sometimes when I have had a flare-up - which I haven't had since I've learned what causes flare-ups - I have worn them when sleeping). I figure my feet are like a bank account with a reserve fund. I have so many steps a day (which allow me to live a normal life, but not active life - although it does include about 20-30 of exercise if I choose the right exercises-things that don't require a lot of flexing of the foot). If I overdue it one day it isn't that bad and I can make it up the next day with a little less use (which seems to monitor itself intuitively). HOwever, I can't be active day after day after day.

Good luck.

Re: Conservative Treatment Success

Ed Davis, DPM on 12/05/02 at 19:32 (101900)

Lara:

There are no secrets as to why compression hose can benefit some with TTS.
Compression socks are effective for TTS under a couple of circumstances.
First- edema (which has many causes) can place additonal pressure on the nerve and the compression hose can decrease that edema. If edema is an issue-- try to find the cause of it.
Second--varicosities within the tarsal tunnel can place a lot of pressure on the nerve. Some estimate that up to 30% of TTS is due to vricose veins in the tarsal tunnel. Compression hose helps to control the varicosities.

I would be a bit concerned if you are seeing a doc who does not understand this fundamental knowledge. You need assistance and that means a practitioner who understands your problem.
Ed

Re: Conservative Treatment Success

elliott on 12/06/02 at 10:03 (101960)

Dr. Ed, the reason a compression sock might work is also the reason it might not work: it induces further pressure on the nerve as well. In my left foot, I had the largest vein (and nothing else) my surgeon had ever observed in his career, yet the compression sock made things worse. I tried it for about two weeks and said forget it. (I guess one can ask what might have happened if I'd stuck it out for a few months, but that's a tough sell when the pain level is being increased.) If one's TTS happens to be such that even a shoe touching the area causes discomfort, it's probably a good bet that the compression sock won't work. Regardless, it's certainly worth a brief try.

Carl, for serious TTS cases, not many have had success without surgery. I sometimes wonder if waiting it out several years has merit (maybe it depends somewhat on the likely cause and whether it might be at least somewhat reversible). But when the pain is just about unbearable after already waiting a long time, you start losing confidence that it will get better waiting forever.

[]

Re: Conservative Treatment Success

Carl D. on 12/06/02 at 10:17 (101962)

Elliot, Yes the 'how long do I wait' question seems to be the $64 million question. I reading through a lot of postings on this board, however, I don't see many people who are totally or even mostly happy with the success of their surgeries. I do see a number of postings indicating that they regret having had the surgery because their condition got no better and sometimes got worse. Maybe that's just the nature of the motivation to post to this board (meaning people who are upset are more likely to post as a way to vent their frustration). Anyway, thanks for your thoughts.

Re: Conservative Treatment Success

elliott on 12/06/02 at 10:28 (101965)

Carl, I don't recall if you stated how you (believe you) got TTS, but if you've waited long enough and tried what little is available, I guess what you have to ask yourself is how bad your pain is and can you live with it forever given the surgical uncertainties. I'd put eventual success of a TTS release when done by someone skilled at it at about 70%, a figure quoted by some doctors with hands-on experience whose opinions I respect. I'm certainly happy with the TTS release I had on my left foot--two rocky years later, that is. But yes, you can get worse, and things get murky if you need additional surgery. Good luck.

[]

Re: Conservative Treatment Success

Carl D. on 12/06/02 at 10:37 (101968)

Elliot, I'm glad to get positive feedback on surgery for TTS. I think I've had it for at least two years (probably from over activity), but I've just recently started dealing with it (both through Western medicine and Eastern). I want to give the conservative treatments their full due before talking to my doctor about surgery. Anyway, thanks for your thoughts.

Re: Conservative Treatment Success

Lara T on 12/06/02 at 12:18 (101988)

Thanks for the information. If that is the case, is there any danger in continuing symptomatic treatment with compression socks.

Could it be edema if there are no other signs. I assume there is a degree of difference between water retention and edema. AT least one doctor mused that water retention might be invovled as it came on at a time that I went on a hormone medication (as well as when I started tennis & karate lessons, which is what I always focused on). I have since stopped the hormone medication (as well as tennis & karate), although the TTS didn't not go away.

If it's a varicose vein, is there a danger to jsut leaving things as they are as I am happy with the life I have. Several opinions have advised against surgery if I can manage without it. I know of no history of varicose veins in any of my parents, grandparents, siblings, or aunts/uncles (we have other bad genes in the family, but not varicose veins. NOw, if you want to talk about arthritis. . . ). I assume this doesn't rule out varicose veins but makes it less likely with no other signs of varicose veins.

Could it just be a confluence of events (narrower than average tunnel, with very active lifestyle, changes with menopause, and perhaps medication causing water retention). I suspect I was vulnerable to TTS. From family stories I suspect my mother and grandmother had symptoms - but much later in life, and they did not lead as active a lifestyle either before or after the symptoms showed up. They were older, and just rested when it started to flare up, which they could do since not only were the kids out of the house, their husbands were retired with decent pensions.

Re: Conservative Treatment Success

wendyn on 12/06/02 at 12:21 (101989)

Carl - you're wise to try both the western and eastern medicine.

I have RSD now which resulted from TTS - but I have improved greatly with a combination of orthotics, birks, time, yoga, time, acupuncture, time, B12 supplements, physio, and time.

I'm not a surgical candidate - so I just make do the best I can.

Keep in touch and let us know how you're doing!

Re: Conservative Treatment Success

Carl D. on 12/06/02 at 12:57 (101992)

Wendyn, Thanks for your 'recipe'. I'd like to do yoga too, but a lot of the poses are hard on the feet--how do you do it? The acupuncture seems to help with the pain, but hasn't done much for the cause of the pain and I don't want to get acupuncture every week. I read on Dr. Weil's site that he recommends B vitamin supplements, so I think I add that to the mix.
It's good to know that time is a big factor too!

Re: Conservative Treatment Success

Julie on 12/06/02 at 16:33 (102006)

Carl, there is much to yoga that does not involve standing poses. In fact, in the classical literature, there is not a single standing pose: the styles of yoga that have made them popular have developed rather recently. If you are interested, just look around for a teacher who does not focus primarily on the standing postures. There must be some - I'm one, but I'm in England, but you'll find one if you search.

The breathing exercises, relaxation and meditation, plus simple movements that you can do sitting (well!) in a chair, would be of great benefit to you.

Re: Conservative Treatment Success

Ed Davis, DPM on 12/06/02 at 18:58 (102017)

Elliott:
A compression sock can place direct pressure on the nerve causing pain. Never underestimate the power of hydraulic pressure though -- I believe that with use of compression stockings, there is a net decrease in pressure on the nerve (would be an interesting study). The counter of shoes can be quite rigid and that can be potentially more traumatic than the pressure caused by stockings.
Ed

Re: Conservative Treatment Success

wendyn on 12/06/02 at 19:44 (102032)

Carl - I have a very good teacher who helps with suggestions.

I wear my birks for all standing poses, and if my feet are really bad - I kneel or do an alternate pose.

Like Julie said - there's A LOT of yoga that can be done OFF the feet.

Have you been tested for B12 deficiency?

Re: Conservative Treatment Success

Carl D. on 12/09/02 at 10:04 (102339)

Julie and Wendy, Thanks for the encouragement on the yoga practices. I didn't know that the standing positions were recent developments--the teachers I've had (both live and on tv) have used them a lot. I'll try using my Birks and see how I feel. I have been tested for B12 def., which was a concern since I'm a vegetarian, but I checked out fine metabolically. I think my TTS has developed from overactivity (biking, hiking, snowboarding, rollerblading, landscaping, etc.). It would be nice to know which, if any, of these activities are specifically responsible for my nerve compression, but it may just be a combination of all of them.
Yoga may be a good alternative for exercise while I'm trying to recover.
Thanks again for your thoughts.

Re: Conservative Treatment Success

Julie on 12/09/02 at 16:49 (102397)

Carl, have a look at any of the classical Hatha Yoga texts - the Hatha Yoga Pradipika or the Gheranda Samhita. Not a single standing posture. We need standing postures now because we might otherwise get little weight-bearing exercise, unlike the forest-dwellers of old - this is presumably why they were developed. Not sure when this began - probably over the last century or so.

I taught in my Birks for several months while my PF was at its worst. And encouraged my PF students to do likewise.

Re: Conservative Treatment Success

Lara T on 12/04/02 at 11:01 (101765)

Ibuprofen helps with the discomfort, but not TTS. I took large doses until my stomach rebelled (known side-effect of ibuprofen).

My TTS got under control when I got prescrition compression socks. ('Under control' means I have a nice life where I don't bite off people's heads anymore, and in fact live reasonably discomfort-free- but I have had to give up certain activities. However, changing my activities wasn't sufficient before the c.socks). A lot of people haven't had success with C.socks, but have liked night splints or other things. There is a list you can find by searching the archives. I believe the title of the thread is 'possible treatments' - it includes things from relatively conservative, non-invasive treatments, to surgery. The list isn't from medical personnel - just from what people on this message board have talked about. Some of the people have PF, some have TTS, and some probably wrote while in the process of determining which they had (or if it was something else). Undoubtedly, some people were misdiagnosed too. So everything on the list may not be appropriate, nothing worked for everyone, and all of it worked for someone.

Good luck.

Re: Conservative Treatment Success

Carl on 12/04/02 at 13:24 (101791)

Thanks for responding Lara. I have seen the list you mention, but I was hoping to get personal success stories (like yours). At least it sounds like you found something that works for you. I'm hoping I don't have to give up any of the many outdoor activities I enjoy, and that ibuprofen and ultrasound will calm down the nerves. What do the compression socks actually do for you? Do they hold your foot in place while sleeping? Sounds uncomfortable, as regular socks sometimes feel constricting.

Carl

Re: Conservative Treatment Success

Lara T on 12/04/02 at 14:54 (101792)

No one knows why the compression socks work for me. I've had some of the doctor's I consulted poo-poo the socks (since it's not clear why they work!). But I figure it's tough to argue with success. There is a hypothesis, given the confluence of various factors, that they might be squeezing water out and thereby relieving pressure on the nerve in the tarsal tunnel.

It took me months to figure out that I would have to give up tennis (and before this moment came I swore that I wouldn't give up tennis). HOwever, I've taken up art (I'm not particularly talented, but I enjoy it), and have a nice life.

I don't think the ibuprofen calms down the nerves - it just reduces the pain/discomfort.

The socks aren't particularly uncomfortable, although there is a difference and they aren't as comfortable as regular socks. I don't mind them. Lots of people wear them, including people with diabetes or varicose veins (although they may use the OTC ones, I'm not sure). It sure beats the Tarsal Tunnel pain. It took awhile to get used to putting them on - takes a little bit more muscle in the fingers, but it didn't take long to learn. I got some relief immediately, but it was several weeks before I plataeued (sp?) at the level at which I live my life. I don't wear the socks when sleeping (usually, although sometimes when I have had a flare-up - which I haven't had since I've learned what causes flare-ups - I have worn them when sleeping). I figure my feet are like a bank account with a reserve fund. I have so many steps a day (which allow me to live a normal life, but not active life - although it does include about 20-30 of exercise if I choose the right exercises-things that don't require a lot of flexing of the foot). If I overdue it one day it isn't that bad and I can make it up the next day with a little less use (which seems to monitor itself intuitively). HOwever, I can't be active day after day after day.

Good luck.

Re: Conservative Treatment Success

Ed Davis, DPM on 12/05/02 at 19:32 (101900)

Lara:

There are no secrets as to why compression hose can benefit some with TTS.
Compression socks are effective for TTS under a couple of circumstances.
First- edema (which has many causes) can place additonal pressure on the nerve and the compression hose can decrease that edema. If edema is an issue-- try to find the cause of it.
Second--varicosities within the tarsal tunnel can place a lot of pressure on the nerve. Some estimate that up to 30% of TTS is due to vricose veins in the tarsal tunnel. Compression hose helps to control the varicosities.

I would be a bit concerned if you are seeing a doc who does not understand this fundamental knowledge. You need assistance and that means a practitioner who understands your problem.
Ed

Re: Conservative Treatment Success

elliott on 12/06/02 at 10:03 (101960)

Dr. Ed, the reason a compression sock might work is also the reason it might not work: it induces further pressure on the nerve as well. In my left foot, I had the largest vein (and nothing else) my surgeon had ever observed in his career, yet the compression sock made things worse. I tried it for about two weeks and said forget it. (I guess one can ask what might have happened if I'd stuck it out for a few months, but that's a tough sell when the pain level is being increased.) If one's TTS happens to be such that even a shoe touching the area causes discomfort, it's probably a good bet that the compression sock won't work. Regardless, it's certainly worth a brief try.

Carl, for serious TTS cases, not many have had success without surgery. I sometimes wonder if waiting it out several years has merit (maybe it depends somewhat on the likely cause and whether it might be at least somewhat reversible). But when the pain is just about unbearable after already waiting a long time, you start losing confidence that it will get better waiting forever.

[]

Re: Conservative Treatment Success

Carl D. on 12/06/02 at 10:17 (101962)

Elliot, Yes the 'how long do I wait' question seems to be the $64 million question. I reading through a lot of postings on this board, however, I don't see many people who are totally or even mostly happy with the success of their surgeries. I do see a number of postings indicating that they regret having had the surgery because their condition got no better and sometimes got worse. Maybe that's just the nature of the motivation to post to this board (meaning people who are upset are more likely to post as a way to vent their frustration). Anyway, thanks for your thoughts.

Re: Conservative Treatment Success

elliott on 12/06/02 at 10:28 (101965)

Carl, I don't recall if you stated how you (believe you) got TTS, but if you've waited long enough and tried what little is available, I guess what you have to ask yourself is how bad your pain is and can you live with it forever given the surgical uncertainties. I'd put eventual success of a TTS release when done by someone skilled at it at about 70%, a figure quoted by some doctors with hands-on experience whose opinions I respect. I'm certainly happy with the TTS release I had on my left foot--two rocky years later, that is. But yes, you can get worse, and things get murky if you need additional surgery. Good luck.

[]

Re: Conservative Treatment Success

Carl D. on 12/06/02 at 10:37 (101968)

Elliot, I'm glad to get positive feedback on surgery for TTS. I think I've had it for at least two years (probably from over activity), but I've just recently started dealing with it (both through Western medicine and Eastern). I want to give the conservative treatments their full due before talking to my doctor about surgery. Anyway, thanks for your thoughts.

Re: Conservative Treatment Success

Lara T on 12/06/02 at 12:18 (101988)

Thanks for the information. If that is the case, is there any danger in continuing symptomatic treatment with compression socks.

Could it be edema if there are no other signs. I assume there is a degree of difference between water retention and edema. AT least one doctor mused that water retention might be invovled as it came on at a time that I went on a hormone medication (as well as when I started tennis & karate lessons, which is what I always focused on). I have since stopped the hormone medication (as well as tennis & karate), although the TTS didn't not go away.

If it's a varicose vein, is there a danger to jsut leaving things as they are as I am happy with the life I have. Several opinions have advised against surgery if I can manage without it. I know of no history of varicose veins in any of my parents, grandparents, siblings, or aunts/uncles (we have other bad genes in the family, but not varicose veins. NOw, if you want to talk about arthritis. . . ). I assume this doesn't rule out varicose veins but makes it less likely with no other signs of varicose veins.

Could it just be a confluence of events (narrower than average tunnel, with very active lifestyle, changes with menopause, and perhaps medication causing water retention). I suspect I was vulnerable to TTS. From family stories I suspect my mother and grandmother had symptoms - but much later in life, and they did not lead as active a lifestyle either before or after the symptoms showed up. They were older, and just rested when it started to flare up, which they could do since not only were the kids out of the house, their husbands were retired with decent pensions.

Re: Conservative Treatment Success

wendyn on 12/06/02 at 12:21 (101989)

Carl - you're wise to try both the western and eastern medicine.

I have RSD now which resulted from TTS - but I have improved greatly with a combination of orthotics, birks, time, yoga, time, acupuncture, time, B12 supplements, physio, and time.

I'm not a surgical candidate - so I just make do the best I can.

Keep in touch and let us know how you're doing!

Re: Conservative Treatment Success

Carl D. on 12/06/02 at 12:57 (101992)

Wendyn, Thanks for your 'recipe'. I'd like to do yoga too, but a lot of the poses are hard on the feet--how do you do it? The acupuncture seems to help with the pain, but hasn't done much for the cause of the pain and I don't want to get acupuncture every week. I read on Dr. Weil's site that he recommends B vitamin supplements, so I think I add that to the mix.
It's good to know that time is a big factor too!

Re: Conservative Treatment Success

Julie on 12/06/02 at 16:33 (102006)

Carl, there is much to yoga that does not involve standing poses. In fact, in the classical literature, there is not a single standing pose: the styles of yoga that have made them popular have developed rather recently. If you are interested, just look around for a teacher who does not focus primarily on the standing postures. There must be some - I'm one, but I'm in England, but you'll find one if you search.

The breathing exercises, relaxation and meditation, plus simple movements that you can do sitting (well!) in a chair, would be of great benefit to you.

Re: Conservative Treatment Success

Ed Davis, DPM on 12/06/02 at 18:58 (102017)

Elliott:
A compression sock can place direct pressure on the nerve causing pain. Never underestimate the power of hydraulic pressure though -- I believe that with use of compression stockings, there is a net decrease in pressure on the nerve (would be an interesting study). The counter of shoes can be quite rigid and that can be potentially more traumatic than the pressure caused by stockings.
Ed

Re: Conservative Treatment Success

wendyn on 12/06/02 at 19:44 (102032)

Carl - I have a very good teacher who helps with suggestions.

I wear my birks for all standing poses, and if my feet are really bad - I kneel or do an alternate pose.

Like Julie said - there's A LOT of yoga that can be done OFF the feet.

Have you been tested for B12 deficiency?

Re: Conservative Treatment Success

Carl D. on 12/09/02 at 10:04 (102339)

Julie and Wendy, Thanks for the encouragement on the yoga practices. I didn't know that the standing positions were recent developments--the teachers I've had (both live and on tv) have used them a lot. I'll try using my Birks and see how I feel. I have been tested for B12 def., which was a concern since I'm a vegetarian, but I checked out fine metabolically. I think my TTS has developed from overactivity (biking, hiking, snowboarding, rollerblading, landscaping, etc.). It would be nice to know which, if any, of these activities are specifically responsible for my nerve compression, but it may just be a combination of all of them.
Yoga may be a good alternative for exercise while I'm trying to recover.
Thanks again for your thoughts.

Re: Conservative Treatment Success

Julie on 12/09/02 at 16:49 (102397)

Carl, have a look at any of the classical Hatha Yoga texts - the Hatha Yoga Pradipika or the Gheranda Samhita. Not a single standing posture. We need standing postures now because we might otherwise get little weight-bearing exercise, unlike the forest-dwellers of old - this is presumably why they were developed. Not sure when this began - probably over the last century or so.

I taught in my Birks for several months while my PF was at its worst. And encouraged my PF students to do likewise.