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for Dr. Davis (and thanks!)

Posted by Sheila S on 12/05/02 at 09:54 (101843)

Hi Dr. Davis - I copied our recent posts and my answers here, from the Social page, since I imagine you visit this section more often.... I appreciate your assistance! and am actually making some headway now...more at the end....

very limted information
Posted by Ed Davis, DPM on 12/03/02 at 19:23
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...
Posted by Ed Davis, DPM on 12/03/02 at 19:35
Sheila:
You stated that the first surgery wa 'through the top' but did not state what approach was taken on the second surgery.
Ed

Dr. Davis.......
Posted by Sheila S on 12/04/02 at 05:55
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!)
Posted by Sheila S on 12/05/02 at 09:49

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: for Dr. Davis (and thanks!)

Ed Davis, DPM on 12/05/02 at 16:44 (101878)

See my responses on the 'social' board.
Ed

Re: for Dr. Davis (and thanks!)

Sheila S on 12/05/02 at 17:46 (101894)

LOL okay, see mine there too! =)

Re: for Dr. Davis (and thanks!)

D.Thomas on 12/05/02 at 20:57 (101908)

I actually used a wheelchair last year off and on for over 3 months.

Re: for Dr. Davis (and thanks!)

Ed Davis, DPM on 12/05/02 at 16:44 (101878)

See my responses on the 'social' board.
Ed

Re: for Dr. Davis (and thanks!)

Sheila S on 12/05/02 at 17:46 (101894)

LOL okay, see mine there too! =)

Re: for Dr. Davis (and thanks!)

D.Thomas on 12/05/02 at 20:57 (101908)

I actually used a wheelchair last year off and on for over 3 months.