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Looking for a diagnosis

Posted by Missy D on 12/26/02 at 08:32 (104017)

I have been to several drs over more than a year for constant numbness of my foot. Minor symptoms in the other foot. I have pain but it varies much from one day to the next and only rarely is it severe. It was thought to be due to a lower back problem (I do have a degenerative lower back problem) but an MRI does'nt support this. The last dr, a neurologist seems to think i'm crazy but did offer EMG testing. My questions-
1. Do repetative ankle sprains as a child predispose a person, as a adult,(48 years old in my case) to this condition?
3. Can this problem be responsible for any of the following symptoms- feet too hot or cold, tightness and twitching and cramping of the calf muscles, minor balance problems, feet falling asleep while driving a car, feet falling asleep very quickly when sitting on ones heels(when I had lower back symptoms I would sit on my heels to take clothes out of my clothes dryer as I could not bend well)
4. Does a dr have to have a suspicion for this to find it on an EMG or in nerve conduction velosity testing? If the dr things the problem is something else will he test the wrong area? I don't feel I have the relationship with the neurologist to suggest he test specifically for this. Any suggestions on how to approach the dr.?
5. I have carpel tunnel syndrome. Dose this make for a predisposition to TTS?
6.What type of a specialist is most likely to diagnose this(or rule it out)?
Much thanks to anyone reading this and responding
Missy

Re: Looking for a diagnosis

wendyn on 12/26/02 at 10:53 (104023)

Missy - what types of tests has your doctor done to rule out systemic causes like diabetes, low b12 etc?

Did you have the EMG testing? The testing looks for conduction problems at various points - it would help determine if the nerves are 'firing' correctly all the way along - or slowing down in a particular spot.

TTS itself (to the best of my knowledge) does not cause hot or cold feet, or balance problems. Have you mentioned the balance problems to your doctor?

In response to your specific questions:

1. The ankle sprains - I don't know....what happened when you were a child?

2. There is no number 2?!

3. Hmmm - doesn't sound like TTS - what happens if you firmly tap your inner ankle (do you get an electric shock feeling like bashing your elbow?)

4. I don't think a doctor would have to suspect TTS to find it on an EMG. It would help determine if the problem is coming from your back or your ankle. Maybe. A lot of us who have been diagnosed with TTS have normal nerve conduction tests.

5. Some people have CTS and TTS - I've read that there may be a connection, HOWEVER - I would be much more suspicious of a possible systemic cause if you have both.

6. TTS is generally a diagnoses made after everything else has been ruled out....you may want to seen an orthpedic surgeon for a second opinion....but I'd be more inclined to seek a second opinion from a different neurologist in your case.

Re: Looking for a diagnosis

Lara T on 12/26/02 at 14:04 (104037)

What type of a specialist is most likely to diagnose this(or rule it out)?

I would suggest an orthopedic surgeon or podiatrist. Whichever one you choose, I'd try to find one that does a lot of sports injuries. TTS is relatively new (only recognized for a few decades now) so many (good, competent) doctors aren't familiar with it. Doctors that deal with sports (even if yours isn't a sports injury) are in my experience more likely to be familiar with this type of problem.

I even went to one of the guys who was doing research on tarsal tunnel and didn't find him as helpful (but did find him incredibly arrogant) as some others! His solution was live with it or surgery, and he turned his nose up at compression socks as a quick and dirty solution for those looking for an easy out (my interpretation of various events).

Re: Looking for a diagnosis

BrianG on 12/26/02 at 20:01 (104071)

Hi Missy,

Some of your symptoms resemble Peripheral Neuropathy. You can find a lot of information on the search engines, like http://www.google.com It might be worth a look.

Good luck
BrianG

Re: Looking for a diagnosis

Lara T on 12/26/02 at 23:06 (104080)

Tarsal Tunnel Symdrome can have a lot of the same symptoms as peripheral neuropathy, I think. In fact I think TTS has been described as one kind of peripheral neuropathy, although I don't think it is what people are generally referring to when they refer to PN. I agree that checking out perhipheral neuropathy might be worth it - just realize there are variations to watch out for.

Re: Looking for a diagnosis

Sharon W on 12/26/02 at 23:55 (104081)

Lara,

Good point. IF I understand correctly, most of the time when people refer to PN, they are talking about a condition (like diabetic neuropathy, for example) where the smaller nerve fibers are affected first, then larger nerves are affected as it gets worse. If the problem is really TTS then it is actually a LARGE nerve that's affected first (the posterior tibial nerve), a nerve that is being trapped and compressed at the ankle -- and then smaller fibers are affected as a result.

Sharon

Re: Looking for a diagnosis

Missy D on 12/27/02 at 13:02 (104108)

Thank You for all the quick responces to my questions. As far as your questions- I have had a lot of blood tests to rule out systemic disease such as diabeties, B12, and others. All are negative. As a kid I was very athletic.I survived this with few injuries except many twisted ankle injuries. All were sprains with no broken bones ever found. I have no problems with increase in symtpoms when tapping on my inner ankle. I also have no symptoms with tapping on my inner wrist and the diagnosis of CTS was confirmed by nerve conduction testing a few years ago. I will probably go ahead with the nerve conduction tests to try to get to the bottom of the symptoms Thank you all for your help
Missy

Re: Looking for a diagnosis

Lara T on 12/27/02 at 15:58 (104123)

Much of what you say sounds similar to my circumstances. Blood work came back negative for systemic causes. I have no pain with tapping on my ankle. As a kid I was reasonably atheletic, although I didn't have numerous sprains. Could just be that being athletic set you up. As Scott says 'Lazy people don't get TTS'. In any case, you're right - the NCV test is the one that counts although it is unlikely to tell you 'why'.

Re: Looking for a diagnosis

wendyn on 12/26/02 at 10:53 (104023)

Missy - what types of tests has your doctor done to rule out systemic causes like diabetes, low b12 etc?

Did you have the EMG testing? The testing looks for conduction problems at various points - it would help determine if the nerves are 'firing' correctly all the way along - or slowing down in a particular spot.

TTS itself (to the best of my knowledge) does not cause hot or cold feet, or balance problems. Have you mentioned the balance problems to your doctor?

In response to your specific questions:

1. The ankle sprains - I don't know....what happened when you were a child?

2. There is no number 2?!

3. Hmmm - doesn't sound like TTS - what happens if you firmly tap your inner ankle (do you get an electric shock feeling like bashing your elbow?)

4. I don't think a doctor would have to suspect TTS to find it on an EMG. It would help determine if the problem is coming from your back or your ankle. Maybe. A lot of us who have been diagnosed with TTS have normal nerve conduction tests.

5. Some people have CTS and TTS - I've read that there may be a connection, HOWEVER - I would be much more suspicious of a possible systemic cause if you have both.

6. TTS is generally a diagnoses made after everything else has been ruled out....you may want to seen an orthpedic surgeon for a second opinion....but I'd be more inclined to seek a second opinion from a different neurologist in your case.

Re: Looking for a diagnosis

Lara T on 12/26/02 at 14:04 (104037)

What type of a specialist is most likely to diagnose this(or rule it out)?

I would suggest an orthopedic surgeon or podiatrist. Whichever one you choose, I'd try to find one that does a lot of sports injuries. TTS is relatively new (only recognized for a few decades now) so many (good, competent) doctors aren't familiar with it. Doctors that deal with sports (even if yours isn't a sports injury) are in my experience more likely to be familiar with this type of problem.

I even went to one of the guys who was doing research on tarsal tunnel and didn't find him as helpful (but did find him incredibly arrogant) as some others! His solution was live with it or surgery, and he turned his nose up at compression socks as a quick and dirty solution for those looking for an easy out (my interpretation of various events).

Re: Looking for a diagnosis

BrianG on 12/26/02 at 20:01 (104071)

Hi Missy,

Some of your symptoms resemble Peripheral Neuropathy. You can find a lot of information on the search engines, like http://www.google.com It might be worth a look.

Good luck
BrianG

Re: Looking for a diagnosis

Lara T on 12/26/02 at 23:06 (104080)

Tarsal Tunnel Symdrome can have a lot of the same symptoms as peripheral neuropathy, I think. In fact I think TTS has been described as one kind of peripheral neuropathy, although I don't think it is what people are generally referring to when they refer to PN. I agree that checking out perhipheral neuropathy might be worth it - just realize there are variations to watch out for.

Re: Looking for a diagnosis

Sharon W on 12/26/02 at 23:55 (104081)

Lara,

Good point. IF I understand correctly, most of the time when people refer to PN, they are talking about a condition (like diabetic neuropathy, for example) where the smaller nerve fibers are affected first, then larger nerves are affected as it gets worse. If the problem is really TTS then it is actually a LARGE nerve that's affected first (the posterior tibial nerve), a nerve that is being trapped and compressed at the ankle -- and then smaller fibers are affected as a result.

Sharon

Re: Looking for a diagnosis

Missy D on 12/27/02 at 13:02 (104108)

Thank You for all the quick responces to my questions. As far as your questions- I have had a lot of blood tests to rule out systemic disease such as diabeties, B12, and others. All are negative. As a kid I was very athletic.I survived this with few injuries except many twisted ankle injuries. All were sprains with no broken bones ever found. I have no problems with increase in symtpoms when tapping on my inner ankle. I also have no symptoms with tapping on my inner wrist and the diagnosis of CTS was confirmed by nerve conduction testing a few years ago. I will probably go ahead with the nerve conduction tests to try to get to the bottom of the symptoms Thank you all for your help
Missy

Re: Looking for a diagnosis

Lara T on 12/27/02 at 15:58 (104123)

Much of what you say sounds similar to my circumstances. Blood work came back negative for systemic causes. I have no pain with tapping on my ankle. As a kid I was reasonably atheletic, although I didn't have numerous sprains. Could just be that being athletic set you up. As Scott says 'Lazy people don't get TTS'. In any case, you're right - the NCV test is the one that counts although it is unlikely to tell you 'why'.