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Do I have TTS?

Posted by David J on 1/23/03 at 16:16 (106505)

I was referred to a podiatrist who put me through a Pressure-Sensitive Sensory Device (PSSD) that was to check my sense of feeling in a variety of places on my feet. The PSSD test concluded TTS was my problem with both feet.

After that the podiatrist had me go through a series of attempts to make things better: L-arginine and vitamin E, taping the feet, strong non-steroidal anti-inflammatory (Bextra), steroidal anti-inflammatory (medrol 6 day pack), steroid shot in left foot, and 7 visits of physical therapy. He now recommends surgery.

The steroid shot helped for about 3 hours and then faded away totally over another hour and a half. The physical therapy actually made my feet more sensitive to the discomfort. Taping the feet drove me nuts since it continually applied pressure to my heels. None of the other items had any noticeable effect.

Now my question: 'Do I really have TTS?'

I see a lot of inconsistent things with what appears to be the norm for TTS people (according to my web-surfing):

1) My pain is not made better by rest, nor worse by activity: I just beat my soccer playing 13 year old tomboy daughter in a 100 yard dash (I'm 44) with no foot pain at all.

2) The pain is worst when something is pressing against the heels - bottom, sides, or back. Standing more than a half a minute is very annoying - I will almost always sit down - even on the floor at work if need be. I take off my shoes at every opportunity. Even laying on my back in bed at night will wake me up in less than 15 minutes due to becomes a throbbing pain due to the pressure on the back of my heels.

3) I rarely exercise, though I have been a unicyclist since I was 10 but haven't ridden much in the last 15 years (my foot pain seems to have started about 4 or 5 years ago).

4) I don't think I lack anything on range of motion in my feet at all.

Do I really have TTS?

Re: Do I have TTS?

wendyn on 1/23/03 at 22:50 (106571)

David - it does not sound like TTS to me.

You must must must must must get another opinion before going for surgery.

Have you had any blood tests or other types of tests done? (In four years here I've never heard of this PSSD)

Re: Do I have TTS?

Julie on 1/24/03 at 01:55 (106575)

David, I agree with Wendy. It doesn't sound like TTS, and the PSSD test is news to me too.

This is a guess, but from your description of your pain, I would suspect nerve involvement and would be looking at the possibility of the pain coming from my back - impingement, perhaps, of the sciatic nerve, one of whose branches ends in the heel. A chiropractor or osteopath should be able to tell, and treat.

Re: Do I have TTS?

David J on 1/24/03 at 09:07 (106608)

Yes, I keep having this nagging feeling that the symptoms aren't quite lining up with TTS, and rather than having an unsuccessful surgery and then thinking it through, it seemed wiser to check into it now (duh! - but I almost just went ahead!). This message board has been quite interesting and informative.

I talked to a friend who has had several foot surgeries in his family and he recommended his orthopedic surgeon as a source for a second opinion. Does that sound reasonable? I'm starting to think that multiple 'second' opinions might be good.

I have had no blood tests at all on this. What do they test for? All of the tests I have had are what were listed in my original note.

Re: Do I have TTS?

David J on 1/24/03 at 09:44 (106612)

The PSSD was a test that had two parts.

First, by hand the technician would lightly touch something like a pin to my foot and slowly but continually press harder and harder. As soon as I could feel it, I would push a button and the computer would record how hard he had been pushing at the time that I first sensed it. As I recall, this was done on 4 major areas of my foot.

Second, on the same four major areas, he repeated the exercise, but this time it was with two pins very close together (maybe 1/8') and I was to push the button as soon as I could detect two separate points of pressure.

I will take a look at getting other opinions on nerve involvement as you suggest. I don't know how many 'second' opinions my insurance will pay for, but it makes sense to be certain the diagnosis is right before anyone starts cutting into me. Thanks!

Re: Do I have TTS?

Henry C on 1/24/03 at 09:54 (106616)

David,

I think that it is a very good idea to get a second opinion about your foot. You should see several doctors before making any type of decision.

Where are you located? I have several excellant doctors with whom I would sugest you see.

Henry

Re: Do I have TTS?

Amy on 1/24/03 at 10:08 (106620)

I agree with Wendy, also. Those symptoms are almost the opposite of what everyone seems to experience. Definately go for another opinion and good luck! (I am glad to hear someone else will sit on the floor, though, just to get off of their feet!)

Amy

Re: Do I have TTS?

Julie on 1/24/03 at 10:12 (106621)

This may sound cynical, but if you ask a surgeon for an opinion you are more likely than not to get the opinion 'surgery'.

I'd be looking for another podiatrist. And I would certainly consult a chiro or an osteopath.

As I understand it the MRI is the test used to diagnose TTS - if it's positive. But a negative MRI does not rule it out.

Blood tests are usually performed to rule out things you don't have.

Re: Do I have TTS?

David J on 1/24/03 at 10:31 (106622)

I'm in the Austin, Texas area.

Re: Do I have TTS?

David J on 1/24/03 at 10:39 (106623)

Getting the opinion 'surgery' from a surgeon: Good point. I guess that underscores the value of several opinions. Though I think I will still talk to this guy just to be safe.

And if you're saying that the MRI is 'the' test to diagnose TTS, I'll be sure to get one before any surgery. Thanks.

Re: Do I have TTS?

lara t on 1/24/03 at 13:10 (106635)

The NCV is 'the' test to diagnose TTS. HOwever, the MRI is routine prior to surgery to help the surgeon predict what they will see when they get inside. My podiatrist recommended against an MRI recently because she said that even if she found something, given that I have a nice life she would recommend against surgery even if she found something - but if I was going to have surgery she would do an MRI before as part of pre-op procedures. Some docs may do an MRI even without surgery to see if they can see anything - particularly when they are exploring various diagnosis and trying to rule out things.

Re: Do I have TTS?

David J on 1/24/03 at 13:34 (106641)

Well I just did some web research to find out about NCV and I must say that it is very interesting. It's nice to be better educated about the situation. I would like to get some of these tests done on my feet.

Re: Do I have TTS?

wendyn on 1/25/03 at 18:51 (106788)

David - before doing surgery, most doctors will do blood test that will ensure you don't have diabetes, thyroid problems, lupus, rhematoid arthritis, or low b12.

All of them can cause similar symptoms - that may manifest themselves first as an unexplained foot pain.

Re: Do I have TTS?

wendyn on 1/23/03 at 22:50 (106571)

David - it does not sound like TTS to me.

You must must must must must get another opinion before going for surgery.

Have you had any blood tests or other types of tests done? (In four years here I've never heard of this PSSD)

Re: Do I have TTS?

Julie on 1/24/03 at 01:55 (106575)

David, I agree with Wendy. It doesn't sound like TTS, and the PSSD test is news to me too.

This is a guess, but from your description of your pain, I would suspect nerve involvement and would be looking at the possibility of the pain coming from my back - impingement, perhaps, of the sciatic nerve, one of whose branches ends in the heel. A chiropractor or osteopath should be able to tell, and treat.

Re: Do I have TTS?

David J on 1/24/03 at 09:07 (106608)

Yes, I keep having this nagging feeling that the symptoms aren't quite lining up with TTS, and rather than having an unsuccessful surgery and then thinking it through, it seemed wiser to check into it now (duh! - but I almost just went ahead!). This message board has been quite interesting and informative.

I talked to a friend who has had several foot surgeries in his family and he recommended his orthopedic surgeon as a source for a second opinion. Does that sound reasonable? I'm starting to think that multiple 'second' opinions might be good.

I have had no blood tests at all on this. What do they test for? All of the tests I have had are what were listed in my original note.

Re: Do I have TTS?

David J on 1/24/03 at 09:44 (106612)

The PSSD was a test that had two parts.

First, by hand the technician would lightly touch something like a pin to my foot and slowly but continually press harder and harder. As soon as I could feel it, I would push a button and the computer would record how hard he had been pushing at the time that I first sensed it. As I recall, this was done on 4 major areas of my foot.

Second, on the same four major areas, he repeated the exercise, but this time it was with two pins very close together (maybe 1/8') and I was to push the button as soon as I could detect two separate points of pressure.

I will take a look at getting other opinions on nerve involvement as you suggest. I don't know how many 'second' opinions my insurance will pay for, but it makes sense to be certain the diagnosis is right before anyone starts cutting into me. Thanks!

Re: Do I have TTS?

Henry C on 1/24/03 at 09:54 (106616)

David,

I think that it is a very good idea to get a second opinion about your foot. You should see several doctors before making any type of decision.

Where are you located? I have several excellant doctors with whom I would sugest you see.

Henry

Re: Do I have TTS?

Amy on 1/24/03 at 10:08 (106620)

I agree with Wendy, also. Those symptoms are almost the opposite of what everyone seems to experience. Definately go for another opinion and good luck! (I am glad to hear someone else will sit on the floor, though, just to get off of their feet!)

Amy

Re: Do I have TTS?

Julie on 1/24/03 at 10:12 (106621)

This may sound cynical, but if you ask a surgeon for an opinion you are more likely than not to get the opinion 'surgery'.

I'd be looking for another podiatrist. And I would certainly consult a chiro or an osteopath.

As I understand it the MRI is the test used to diagnose TTS - if it's positive. But a negative MRI does not rule it out.

Blood tests are usually performed to rule out things you don't have.

Re: Do I have TTS?

David J on 1/24/03 at 10:31 (106622)

I'm in the Austin, Texas area.

Re: Do I have TTS?

David J on 1/24/03 at 10:39 (106623)

Getting the opinion 'surgery' from a surgeon: Good point. I guess that underscores the value of several opinions. Though I think I will still talk to this guy just to be safe.

And if you're saying that the MRI is 'the' test to diagnose TTS, I'll be sure to get one before any surgery. Thanks.

Re: Do I have TTS?

lara t on 1/24/03 at 13:10 (106635)

The NCV is 'the' test to diagnose TTS. HOwever, the MRI is routine prior to surgery to help the surgeon predict what they will see when they get inside. My podiatrist recommended against an MRI recently because she said that even if she found something, given that I have a nice life she would recommend against surgery even if she found something - but if I was going to have surgery she would do an MRI before as part of pre-op procedures. Some docs may do an MRI even without surgery to see if they can see anything - particularly when they are exploring various diagnosis and trying to rule out things.

Re: Do I have TTS?

David J on 1/24/03 at 13:34 (106641)

Well I just did some web research to find out about NCV and I must say that it is very interesting. It's nice to be better educated about the situation. I would like to get some of these tests done on my feet.

Re: Do I have TTS?

wendyn on 1/25/03 at 18:51 (106788)

David - before doing surgery, most doctors will do blood test that will ensure you don't have diabetes, thyroid problems, lupus, rhematoid arthritis, or low b12.

All of them can cause similar symptoms - that may manifest themselves first as an unexplained foot pain.