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Post surgery update and info for TTS

Posted by lauriel on 1/21/03 at 14:36 (106161)

I want to let anyone know if you are going to do TTS surgery, take the recuperation slow. I had mine on 12/6 and doing physical therapy now. I overdid it over the week-end, just a little bit of walking without crutches and a lot with one crutch because I felt so good. plus I wore different shoes than I normally do. This combination really brought my symptons back. (I was finally able to get a shoe on 2 weeks ago). My PT wants me to keep using one crutch and to keep my walking to a minimum. He said he doesnt want me undoing his work, not to mention slowing the healing process.

When my Dr gave me the go ahead to walk without crutches at 4 weeks, it was like - well see what you can do and bye. After trying to walk for a week my symptons were worse so he referred my to physical therapy. When I first asked him about therapy right after surgery, he said lets wait and see how you do. I think therapy is a must! In just four visits I have a lot more mobility and range of motion, which I had almost none when I started.

Re: Post surgery update and info for TTS

Sharon W on 1/21/03 at 15:59 (106165)

Laurie,

I agree completely; I don't understand why some surgeons fail to provide the after-care needed to help patients heal successfully from this surgery. I honestly believe that problem has a lot to do with why so many TTS surgeries are unsuccessful.

I had over 4 months of physical therapy after my TTS surgery, and I KNOW it had a lot to do with the fact that I feel a whole lot better now than I did before 'going under the knife'.

Sharon

Re: Post surgery update and info for TTS

Marty on 1/21/03 at 16:02 (106168)

Thanks for the information. Take it slow and Physical therapy. Did you use a wheel chair at first or just crutches? How long were you pretty much bed ridden?

Marty

Re: Post surgery update and info for TTS

Sharon W on 1/21/03 at 16:17 (106170)

Marty,

ASK any doctor you are considering for surgery, what he expects that his plan for after-care will be, how often you will see him for follow-up, how he would deal with a complication such as the development of scare tissue, and whether or not he will send you to PT. (And make sure he recommends you to a physical therapist with experience treating TTS and a reasonably good track record -- PTs are NOT 'all created equal'!)

If he says he doesn't recommend physical therapy after TTS surgery, and will not agree to order it in your case, I would look for a different surgeon, because even the most PERFECT surgery can fail to heal properly without good after-care. (Just my opinion as a patient who's been there.)

Sharon

Re: OOPS!

Sharon W on 1/21/03 at 16:19 (106171)

That would of course be 'scar tissue,' not 'SCARE TISSUE'. LOL!

Sharon

Re: OOPS!

Marty on 1/21/03 at 16:22 (106173)

scare tissue seems more appropriate to me :)

Re: OOPS!

Sharon W on 1/21/03 at 16:24 (106174)

Yes, it may have been a Freudian slip, at that!!

Sharon

Re: Post surgery update and info for TTS

Marty on 1/21/03 at 16:24 (106175)

Man, How in the world am I ever going to remeber all this. LOL. I'm amping up the Neurontin and things are confussing. Wow the rooms spinning Weeeeeeeeeee. Lol it's not that bad ;)

I will print this and reveiw. Well off the the Pod.

Marty

Re: Good luck with the pod visit!

Sharon W on 1/21/03 at 16:30 (106178)

;o)

Re: Post surgery update and info for TTS

lauriel on 1/21/03 at 17:21 (106185)

I was on crutches, if you can get a wheel chair, maybe after the first week, get one. I was Pretty much bedridden the first week, then moved around a little bit the second. Using crutches for the first month makes you totally useless. I did find that by using a plastic grocery bag to carry things around the house helped. You will find like when you open a soda, you have to stay put where you are, or even as simple as making a sandwich is almost impossible until you become weight bearing, that is why I wish I had a wheel chair. I also had a nasty fall ( my crutch got stuck on the tile floor) that totally bruised the palms of my hands, which made it very difficult to use. Thank god my husband was home to help me up or else I dont know what I would have done. I still wish I had one now so I can be more mobile, like just going for a stroll would be nice. As Sharon said in her post, please make sure your Dr is going to refer you to a physical therapist and ask what your recovery plan is going to be to before your surgery.
Laurie

Re: Post surgery update and info for TTS

Sharon W on 1/21/03 at 17:50 (106189)

Marty,

You asked for more info about what it's like AFTER TTS surgery. Well, it's not pretty... This is just MY story, of course but here goes:

I rented a wheelchair to use for the first month after surgery, and was very glad I did. I was not supposed to touch my foot to the ground at all, until she took the stitches out. I had paid a little extra to rent an extender attachment for the wheelchair so that I could sit in it with my foot extended outward and supported. That turned out to be quite useful when I had to visit doctors... Having my foot down below my waist level for ANY amount of time soon got it to swelling and throbbing painfully -- something I preferred to avoid!

After surgery, you can expect to have a very long scar, probably about 6-8 inches long. The incision will be swollen at first, even if it is not infected, and you will no longer see that 'trench' between that bump on the inside of your ankle and the back of your heel, because the swelling will make it look poofy. It should NOT be an angry color of red, and you should NOT start running a fever a couple of days after the surgery -- those are signs of infection.

Most likely, however, you won't get to see it at all that first week, because your doctor will probably put you in a splint and won't want you to take it off yourself. Mine was a posterior splint (supporting the back side of my ankle and keeping it immobile). The splint was lined with several layers of the most incredibly SOFT stuff -- cotton gauze -- and then wrapped in other bandages -- but it still felt constricting and seemed to rub painfully against my incision with the slightest movement. There was lots of sensitivity to anything in contact with the incision, and the slightest contact was painful.

I was not supposed to touch my foot to the ground at all, at that point. I was told to keep my foot elevated above the level of my heart except when I got up to go to the bathroom, and to put ice on over the splint (I actually used a bag of frozen peas) for 20 minutes out of every hour while I was awake. I was careful to keep a towel under the peas, to keep moisture off of the splint.

That first day, I was actually in very little pain; my Dr. had injected my foot with Marcaine to numb it. For the next 10 days, however, my foot burned like fire, and I was VERY glad for the painkillers! I could definitely FEEL that it was swollen up, inside that splint. (Swelling in the area around a nerve can lead to numbness, but of course swelling is a normal part of the healing process.)

Once I stopped taking painkillers all the time, I realized I had LOTS of painful tingling in my toes and forefoot, and lots of burning on the outside bottom of my foot past my heels. I still had painful tingling in my ankle sometimes, and a whole lot of STINGING, but not as much burning or radiating pain there as before the surgery.

12 days after surgery my podiatrist (the one who did the surgery) took the splint off and put me in an inflatable boot cast. She still did not want me beginning to walk on that foot for another week, however.
After 3 weeks I was sent to physical therapy with instructions to gradually begin putting weight on my surgery foot while wearing the air cast, still using crutches at first, and then a cane, and then just walking in the cast. After 6 weeks, I was finally 'allowed' to start wearing shoes again (well, my Birkenstock sandals, anyway!)

I've been lucky. 4 weeks after the surgery, I was already feeling a whole lot (maybe 40%) better than before I went 'under the knife'. After 8 weeks I was in about 70% less pain than before the operation. At this point, it is up to about 80%. I feel incredibly LUCKY to be able to call my surgery a 'success' -- even though not ALL of the pain has gone away. (And I don't expect that it will ever be 100%.)

This is 'risky' surgery because some people (perhaps 10%) end up feeling even WORSE than they did before going under the knife. And for many others, the surgery doesn't really make things worse but it involves considerable pain and a long recovery and doesn't seem to help at all.

I don't know how long you'll be off work, but in my humble opinion it probably shouldn't be less than 6 weeks. You may have a desk job but you will have to WALK from your car to your office -- and even driving will be a problem at first. If you push yourself too hard, you can do damage to those healing tissues and reduce your probability that the surgery will be a success.

Sharon

Re: Post surgery update and info for TTS

lauriel on 1/21/03 at 18:37 (106196)

Dont scare me! your last paragraph of about pushing yourself too hard, which I did over the week-end I promise to be good now. But you are making me nervous on my recovery since your Dr did so much for you regarding what she did with the splint and keeping you off for so long and an air cast. I am reading so many different reactions from surgery and what the Drs did, which I find interesting. I wish I found this board before my surgery I would have had so many more questionsto ask the Dr.

My pain before surgery was when I put pressure on my foot it felt like someone was sending electric shock into my ankle. I have the 6 inch incision on my ankle. My foot was just wrapped, I did not have any supporting devices. I wonder if they do different things for the different types of symptoms. My only problem was when my foot was cold as ice. Other than that I havent had any problems except tingling except in my heel when I first tried to walk which has gone away. Luckily I did not take have to take any medications - Except for the stifness I didnt feel I had surgery until I began to walk which is a different story.

Re: thats great

Marty on 1/21/03 at 19:50 (106203)

oh man i think that great you didn't have to take meds!

Re: thats great

Sharon W on 1/21/03 at 19:58 (106205)

Marty, how did it go with the pod? What did you find out about those nerve conduction tests?

Sharon

Re: Differences in post-surgery plans

Sharon W on 1/21/03 at 20:23 (106208)

Laurie,

There are probably at least as many as many post-surgery plans for TTS as there are doctors performing the surgery. And good doctors do modify their usual post-surgery plans to fit the physical conditions and special needs of each patient. The important thing is that the surgeon you chose does HAVE a plan for you that seems reasonable and well thought out.

I have a serious circulation problem, which was the reason for the strict restrictions about keeping my foot above the level of my heart for so long, and the main reason for using the air cast. (That type of cast puts compression on the lower leg -- and there certainly was no way I could have worn my compression hose, right after surgery!!) And the fact that I am overweight may explain why she wanted me to stay off my foot so long.

Also, my TTS surgery itself was probably a bit more involved than some. It took about 2 hours to do. She carefully 'released' the nerve from entrapments starting a couple of inches ABOVE the tarsal tunnel and then followed the three nerve branches down past the tarsal tunnel as far as she could. (She found areas of entrapment all the way down.) She also had to tie off and remove 6 varicose veins from inside the tarsal tunnel itself.

Speedy healing to you!

Sharon

Re: Differences in post-surgery plans

Julie on 1/22/03 at 02:21 (106237)

Sharon, it's wonderful that you take so much time and thought and care to inform and help people facing the surgery you have had.

As you know, I haven't had foot surgery myself, but from years of reading the different post-surgery experiences of others here, I'd add one little bit to the excellent counsel you've been giving Marty and Laurie and others.

Bodies are different and they heal differently, and there are many factors that influence healing, general health and state of one's immune system before the surgery being significant ones. Also doctors differ in their techniques as well as in their views, and surgeries differ, and taking all this together I would guess that one can't KNOW for sure what one's own healing time is going to be until one is 'there'.

The important thing is not to underestimate the fact that this is major surgery, and to take all the healing time that is necessary, as you did.

Re: Differences in post-surgery plans

Sharon W on 1/22/03 at 09:15 (106274)

Julie,

I agree wholeheartedly. And you just touched on an important consideration that I left out. There ARE many factors that influence healing, and some of them can be quite unforeseen.

When choosing a surgeon, it is important to find someone who is FLEXIBLE in his/her approach so that, when something unforeseen happens, s/he will react promptly and appropriately. And THAT, of course, also implies that s/he should be 'on top of things,' scheduling fairly frequent follow-up visits with you and CONTINUING to follow up for as long as it takes.

Sharon

Re: Post surgery painkillers

Sharon W on 1/22/03 at 09:35 (106276)

Laurie, Marty,

Sounds like your TTS symptoms (before surgery) were probably quite similar to mine. Only for me, the 'electric shock' when putting pressure on the foot had gradually changed into radiating sharp or burning pains most of the time.

Anyway, congratulations on not needing pain meds! Just be sure, if you DO have pain, to use them... there is evidence to suggest that NOT using pain meds when you really NEED them might be a factor in developing serious and incurable pain syndromes. Many people think that 'toughing it out' if you can endure the pain without using any drugs is a good thing, but that is not true. Pain meds are prescribed very carefully by doctors, and it is the doctor's job to make the judgement as to how much is likely to be needed and how much would be 'too much'. As long as you are not taking more painkillers than s/he prescribed, or getting them from someone else, you should be fine.

Sharon

Re: Post surgery painkillers

Sharon W on 1/22/03 at 10:31 (106284)

Obviously, the first part of that previous message was for Laurie, but the comments about 'toughing it out' and not using painkillers was in response to Marty's comment.

Laurie, I had the same feeling of COLD in my foot (especially my toes) after surgery; it was in the middle of a hot Texas summer with the indoor thermometer reading about 78-80 degrees, and the REST of my body was uncomfortably HOT, but my toes felt like ice! This especially happened at NIGHT, when I was sleeping and therefore NOT applying ice to the area.

In fact, strangely enough, I discovered that applying ice over the incision area for 20 minutes of the hour actually helped to make my toes feel WARMER!! I suppose that was probably because it reduced the swelling and returned some ciruculation and/or nerve function to my feet.

Sharon

Re: Post surgery painkillers

lauriel on 1/22/03 at 11:23 (106291)

I am glad you told me about what they found in your entrapment. I have no idea what my Dr found (stupid me for not asking, or maybe even stupider(is that a word) for the Dr not telling me. I am going ask what he found next visit which is week after next. And you are right, there are different recovery instructions for differenct types, since I have never gone through anything even remotely this close to this this before, I feel so niave. Thanks for all your insight, you will be a great help to others who are considering surgery.
Laurie

Re: TTS Surgery: releasing entrapments

Sharon W on 1/22/03 at 11:47 (106302)

Laurie,

How long did your surgery take to do?

From my research, I've discovered that there are actually at least 3 different procedures done for TTS surgery. One procedure is simply to cut down into the flexor retinaculum (also known as the 'lacinate ligament') and 'release' the posterior tibial nerve from that tough band of fibrous tissue. I think that is the classic procedure, but it won't help as much if there is another area below or above the the flexor retinaculum where the nerve is trapped. Another procedure is to begin up ABOVE the tarsal tunnel, following the posterior tibial nerve and releasing it from any entrapments. A third procedure involves following the posterior tibial nerve further down PAST the flexor retinaculum (or 'lacinate ligament')and checking the area where it splits, looking closely for entrapments in the area known as the 'porta pedis'.

My understanding of the anatomy involved is hazy at this level of detail and I may not have it EXACTLY right... But my point is that there is not just ONE type of surgical procedure done for TTS, and which procedure(s) are actually done on you may influence what you need during the recovery process.

Sharon

Re: Post surgery painkillers

Julie on 1/22/03 at 11:51 (106304)

Laurie, please don't feel stupid! You can't possibly know something until you know it, or know what to ask if you haven't thought of it. One of the many great things about this board is that people like Sharon, who have 'been there', share their knowledge and experience so that those who come after get a clearer, fuller idea of what to look for and what to expect. Stay with the boards for all the learning it can give you.

Re: TTS Surgery: releasing entrapments

lauriel on 1/22/03 at 12:33 (106317)

it took about 45 minutes, I think that was what he orginally said before I went in, but think I it took longer from what I remember coming out of anestheisia I hope you dont mind I am going to print what you just said and ask him what he did. I did read some place that one reason TTS surgery is not successful is they dont go up high enough
laurie

Re: TTS Surgery: releasing entrapments

Sharon W on 1/22/03 at 12:50 (106322)

Or, in some cases, don't go DOWN far enough.

I have no problem with you printing what I said -- I 'published' it on the internet, after all, when I posted it -- but it might not be the best idea to bring it in and show it to your doctor.

Some doctors do take a positive attitude toward patients who research for themselves and use the internet to become better informed. But unfortunately there are a LOT of doctors out there who assume ANYTHING posted on some internet message board is completely bogus, and any patient who reads such things is a know-it-all hypochondriac!

So, unless you know that your doctor is open-minded about such things, please don't make that mistake. It would be better just to try to remember as much as you can, ESPECIALLY the questions you wanted to ask --and leave it at that.

Sharon

Re: TTS Surgery: releasing entrapments

lauriel on 1/22/03 at 15:32 (106348)

thanks I will just ask where the entrapment was and have him explain thoroughly what the procedure he used and then compare
Laurie

Re: Post surgery update and info for TTS

Sharon W on 1/21/03 at 15:59 (106165)

Laurie,

I agree completely; I don't understand why some surgeons fail to provide the after-care needed to help patients heal successfully from this surgery. I honestly believe that problem has a lot to do with why so many TTS surgeries are unsuccessful.

I had over 4 months of physical therapy after my TTS surgery, and I KNOW it had a lot to do with the fact that I feel a whole lot better now than I did before 'going under the knife'.

Sharon

Re: Post surgery update and info for TTS

Marty on 1/21/03 at 16:02 (106168)

Thanks for the information. Take it slow and Physical therapy. Did you use a wheel chair at first or just crutches? How long were you pretty much bed ridden?

Marty

Re: Post surgery update and info for TTS

Sharon W on 1/21/03 at 16:17 (106170)

Marty,

ASK any doctor you are considering for surgery, what he expects that his plan for after-care will be, how often you will see him for follow-up, how he would deal with a complication such as the development of scare tissue, and whether or not he will send you to PT. (And make sure he recommends you to a physical therapist with experience treating TTS and a reasonably good track record -- PTs are NOT 'all created equal'!)

If he says he doesn't recommend physical therapy after TTS surgery, and will not agree to order it in your case, I would look for a different surgeon, because even the most PERFECT surgery can fail to heal properly without good after-care. (Just my opinion as a patient who's been there.)

Sharon

Re: OOPS!

Sharon W on 1/21/03 at 16:19 (106171)

That would of course be 'scar tissue,' not 'SCARE TISSUE'. LOL!

Sharon

Re: OOPS!

Marty on 1/21/03 at 16:22 (106173)

scare tissue seems more appropriate to me :)

Re: OOPS!

Sharon W on 1/21/03 at 16:24 (106174)

Yes, it may have been a Freudian slip, at that!!

Sharon

Re: Post surgery update and info for TTS

Marty on 1/21/03 at 16:24 (106175)

Man, How in the world am I ever going to remeber all this. LOL. I'm amping up the Neurontin and things are confussing. Wow the rooms spinning Weeeeeeeeeee. Lol it's not that bad ;)

I will print this and reveiw. Well off the the Pod.

Marty

Re: Good luck with the pod visit!

Sharon W on 1/21/03 at 16:30 (106178)

;o)

Re: Post surgery update and info for TTS

lauriel on 1/21/03 at 17:21 (106185)

I was on crutches, if you can get a wheel chair, maybe after the first week, get one. I was Pretty much bedridden the first week, then moved around a little bit the second. Using crutches for the first month makes you totally useless. I did find that by using a plastic grocery bag to carry things around the house helped. You will find like when you open a soda, you have to stay put where you are, or even as simple as making a sandwich is almost impossible until you become weight bearing, that is why I wish I had a wheel chair. I also had a nasty fall ( my crutch got stuck on the tile floor) that totally bruised the palms of my hands, which made it very difficult to use. Thank god my husband was home to help me up or else I dont know what I would have done. I still wish I had one now so I can be more mobile, like just going for a stroll would be nice. As Sharon said in her post, please make sure your Dr is going to refer you to a physical therapist and ask what your recovery plan is going to be to before your surgery.
Laurie

Re: Post surgery update and info for TTS

Sharon W on 1/21/03 at 17:50 (106189)

Marty,

You asked for more info about what it's like AFTER TTS surgery. Well, it's not pretty... This is just MY story, of course but here goes:

I rented a wheelchair to use for the first month after surgery, and was very glad I did. I was not supposed to touch my foot to the ground at all, until she took the stitches out. I had paid a little extra to rent an extender attachment for the wheelchair so that I could sit in it with my foot extended outward and supported. That turned out to be quite useful when I had to visit doctors... Having my foot down below my waist level for ANY amount of time soon got it to swelling and throbbing painfully -- something I preferred to avoid!

After surgery, you can expect to have a very long scar, probably about 6-8 inches long. The incision will be swollen at first, even if it is not infected, and you will no longer see that 'trench' between that bump on the inside of your ankle and the back of your heel, because the swelling will make it look poofy. It should NOT be an angry color of red, and you should NOT start running a fever a couple of days after the surgery -- those are signs of infection.

Most likely, however, you won't get to see it at all that first week, because your doctor will probably put you in a splint and won't want you to take it off yourself. Mine was a posterior splint (supporting the back side of my ankle and keeping it immobile). The splint was lined with several layers of the most incredibly SOFT stuff -- cotton gauze -- and then wrapped in other bandages -- but it still felt constricting and seemed to rub painfully against my incision with the slightest movement. There was lots of sensitivity to anything in contact with the incision, and the slightest contact was painful.

I was not supposed to touch my foot to the ground at all, at that point. I was told to keep my foot elevated above the level of my heart except when I got up to go to the bathroom, and to put ice on over the splint (I actually used a bag of frozen peas) for 20 minutes out of every hour while I was awake. I was careful to keep a towel under the peas, to keep moisture off of the splint.

That first day, I was actually in very little pain; my Dr. had injected my foot with Marcaine to numb it. For the next 10 days, however, my foot burned like fire, and I was VERY glad for the painkillers! I could definitely FEEL that it was swollen up, inside that splint. (Swelling in the area around a nerve can lead to numbness, but of course swelling is a normal part of the healing process.)

Once I stopped taking painkillers all the time, I realized I had LOTS of painful tingling in my toes and forefoot, and lots of burning on the outside bottom of my foot past my heels. I still had painful tingling in my ankle sometimes, and a whole lot of STINGING, but not as much burning or radiating pain there as before the surgery.

12 days after surgery my podiatrist (the one who did the surgery) took the splint off and put me in an inflatable boot cast. She still did not want me beginning to walk on that foot for another week, however.
After 3 weeks I was sent to physical therapy with instructions to gradually begin putting weight on my surgery foot while wearing the air cast, still using crutches at first, and then a cane, and then just walking in the cast. After 6 weeks, I was finally 'allowed' to start wearing shoes again (well, my Birkenstock sandals, anyway!)

I've been lucky. 4 weeks after the surgery, I was already feeling a whole lot (maybe 40%) better than before I went 'under the knife'. After 8 weeks I was in about 70% less pain than before the operation. At this point, it is up to about 80%. I feel incredibly LUCKY to be able to call my surgery a 'success' -- even though not ALL of the pain has gone away. (And I don't expect that it will ever be 100%.)

This is 'risky' surgery because some people (perhaps 10%) end up feeling even WORSE than they did before going under the knife. And for many others, the surgery doesn't really make things worse but it involves considerable pain and a long recovery and doesn't seem to help at all.

I don't know how long you'll be off work, but in my humble opinion it probably shouldn't be less than 6 weeks. You may have a desk job but you will have to WALK from your car to your office -- and even driving will be a problem at first. If you push yourself too hard, you can do damage to those healing tissues and reduce your probability that the surgery will be a success.

Sharon

Re: Post surgery update and info for TTS

lauriel on 1/21/03 at 18:37 (106196)

Dont scare me! your last paragraph of about pushing yourself too hard, which I did over the week-end I promise to be good now. But you are making me nervous on my recovery since your Dr did so much for you regarding what she did with the splint and keeping you off for so long and an air cast. I am reading so many different reactions from surgery and what the Drs did, which I find interesting. I wish I found this board before my surgery I would have had so many more questionsto ask the Dr.

My pain before surgery was when I put pressure on my foot it felt like someone was sending electric shock into my ankle. I have the 6 inch incision on my ankle. My foot was just wrapped, I did not have any supporting devices. I wonder if they do different things for the different types of symptoms. My only problem was when my foot was cold as ice. Other than that I havent had any problems except tingling except in my heel when I first tried to walk which has gone away. Luckily I did not take have to take any medications - Except for the stifness I didnt feel I had surgery until I began to walk which is a different story.

Re: thats great

Marty on 1/21/03 at 19:50 (106203)

oh man i think that great you didn't have to take meds!

Re: thats great

Sharon W on 1/21/03 at 19:58 (106205)

Marty, how did it go with the pod? What did you find out about those nerve conduction tests?

Sharon

Re: Differences in post-surgery plans

Sharon W on 1/21/03 at 20:23 (106208)

Laurie,

There are probably at least as many as many post-surgery plans for TTS as there are doctors performing the surgery. And good doctors do modify their usual post-surgery plans to fit the physical conditions and special needs of each patient. The important thing is that the surgeon you chose does HAVE a plan for you that seems reasonable and well thought out.

I have a serious circulation problem, which was the reason for the strict restrictions about keeping my foot above the level of my heart for so long, and the main reason for using the air cast. (That type of cast puts compression on the lower leg -- and there certainly was no way I could have worn my compression hose, right after surgery!!) And the fact that I am overweight may explain why she wanted me to stay off my foot so long.

Also, my TTS surgery itself was probably a bit more involved than some. It took about 2 hours to do. She carefully 'released' the nerve from entrapments starting a couple of inches ABOVE the tarsal tunnel and then followed the three nerve branches down past the tarsal tunnel as far as she could. (She found areas of entrapment all the way down.) She also had to tie off and remove 6 varicose veins from inside the tarsal tunnel itself.

Speedy healing to you!

Sharon

Re: Differences in post-surgery plans

Julie on 1/22/03 at 02:21 (106237)

Sharon, it's wonderful that you take so much time and thought and care to inform and help people facing the surgery you have had.

As you know, I haven't had foot surgery myself, but from years of reading the different post-surgery experiences of others here, I'd add one little bit to the excellent counsel you've been giving Marty and Laurie and others.

Bodies are different and they heal differently, and there are many factors that influence healing, general health and state of one's immune system before the surgery being significant ones. Also doctors differ in their techniques as well as in their views, and surgeries differ, and taking all this together I would guess that one can't KNOW for sure what one's own healing time is going to be until one is 'there'.

The important thing is not to underestimate the fact that this is major surgery, and to take all the healing time that is necessary, as you did.

Re: Differences in post-surgery plans

Sharon W on 1/22/03 at 09:15 (106274)

Julie,

I agree wholeheartedly. And you just touched on an important consideration that I left out. There ARE many factors that influence healing, and some of them can be quite unforeseen.

When choosing a surgeon, it is important to find someone who is FLEXIBLE in his/her approach so that, when something unforeseen happens, s/he will react promptly and appropriately. And THAT, of course, also implies that s/he should be 'on top of things,' scheduling fairly frequent follow-up visits with you and CONTINUING to follow up for as long as it takes.

Sharon

Re: Post surgery painkillers

Sharon W on 1/22/03 at 09:35 (106276)

Laurie, Marty,

Sounds like your TTS symptoms (before surgery) were probably quite similar to mine. Only for me, the 'electric shock' when putting pressure on the foot had gradually changed into radiating sharp or burning pains most of the time.

Anyway, congratulations on not needing pain meds! Just be sure, if you DO have pain, to use them... there is evidence to suggest that NOT using pain meds when you really NEED them might be a factor in developing serious and incurable pain syndromes. Many people think that 'toughing it out' if you can endure the pain without using any drugs is a good thing, but that is not true. Pain meds are prescribed very carefully by doctors, and it is the doctor's job to make the judgement as to how much is likely to be needed and how much would be 'too much'. As long as you are not taking more painkillers than s/he prescribed, or getting them from someone else, you should be fine.

Sharon

Re: Post surgery painkillers

Sharon W on 1/22/03 at 10:31 (106284)

Obviously, the first part of that previous message was for Laurie, but the comments about 'toughing it out' and not using painkillers was in response to Marty's comment.

Laurie, I had the same feeling of COLD in my foot (especially my toes) after surgery; it was in the middle of a hot Texas summer with the indoor thermometer reading about 78-80 degrees, and the REST of my body was uncomfortably HOT, but my toes felt like ice! This especially happened at NIGHT, when I was sleeping and therefore NOT applying ice to the area.

In fact, strangely enough, I discovered that applying ice over the incision area for 20 minutes of the hour actually helped to make my toes feel WARMER!! I suppose that was probably because it reduced the swelling and returned some ciruculation and/or nerve function to my feet.

Sharon

Re: Post surgery painkillers

lauriel on 1/22/03 at 11:23 (106291)

I am glad you told me about what they found in your entrapment. I have no idea what my Dr found (stupid me for not asking, or maybe even stupider(is that a word) for the Dr not telling me. I am going ask what he found next visit which is week after next. And you are right, there are different recovery instructions for differenct types, since I have never gone through anything even remotely this close to this this before, I feel so niave. Thanks for all your insight, you will be a great help to others who are considering surgery.
Laurie

Re: TTS Surgery: releasing entrapments

Sharon W on 1/22/03 at 11:47 (106302)

Laurie,

How long did your surgery take to do?

From my research, I've discovered that there are actually at least 3 different procedures done for TTS surgery. One procedure is simply to cut down into the flexor retinaculum (also known as the 'lacinate ligament') and 'release' the posterior tibial nerve from that tough band of fibrous tissue. I think that is the classic procedure, but it won't help as much if there is another area below or above the the flexor retinaculum where the nerve is trapped. Another procedure is to begin up ABOVE the tarsal tunnel, following the posterior tibial nerve and releasing it from any entrapments. A third procedure involves following the posterior tibial nerve further down PAST the flexor retinaculum (or 'lacinate ligament')and checking the area where it splits, looking closely for entrapments in the area known as the 'porta pedis'.

My understanding of the anatomy involved is hazy at this level of detail and I may not have it EXACTLY right... But my point is that there is not just ONE type of surgical procedure done for TTS, and which procedure(s) are actually done on you may influence what you need during the recovery process.

Sharon

Re: Post surgery painkillers

Julie on 1/22/03 at 11:51 (106304)

Laurie, please don't feel stupid! You can't possibly know something until you know it, or know what to ask if you haven't thought of it. One of the many great things about this board is that people like Sharon, who have 'been there', share their knowledge and experience so that those who come after get a clearer, fuller idea of what to look for and what to expect. Stay with the boards for all the learning it can give you.

Re: TTS Surgery: releasing entrapments

lauriel on 1/22/03 at 12:33 (106317)

it took about 45 minutes, I think that was what he orginally said before I went in, but think I it took longer from what I remember coming out of anestheisia I hope you dont mind I am going to print what you just said and ask him what he did. I did read some place that one reason TTS surgery is not successful is they dont go up high enough
laurie

Re: TTS Surgery: releasing entrapments

Sharon W on 1/22/03 at 12:50 (106322)

Or, in some cases, don't go DOWN far enough.

I have no problem with you printing what I said -- I 'published' it on the internet, after all, when I posted it -- but it might not be the best idea to bring it in and show it to your doctor.

Some doctors do take a positive attitude toward patients who research for themselves and use the internet to become better informed. But unfortunately there are a LOT of doctors out there who assume ANYTHING posted on some internet message board is completely bogus, and any patient who reads such things is a know-it-all hypochondriac!

So, unless you know that your doctor is open-minded about such things, please don't make that mistake. It would be better just to try to remember as much as you can, ESPECIALLY the questions you wanted to ask --and leave it at that.

Sharon

Re: TTS Surgery: releasing entrapments

lauriel on 1/22/03 at 15:32 (106348)

thanks I will just ask where the entrapment was and have him explain thoroughly what the procedure he used and then compare
Laurie