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do i have tarsal tunnel syndrome?

Posted by frank c. on 2/12/03 at 18:36 (108957)

Two different aliments afflict me.
1. A pain in lower right leg and foot that occurs and increases with walking.

2. A lack of sensitivity, warmth, and lividity in right foot centering about the 2nd thru 5th toes after awakening from sleep.

For the first aliment, the pain has increased over the last several months. Initially I thought that the problem was a result of a muscle strain from exercise or mowing the lawn. However, even with rest the problem has persisted, and in fact, has gotten much worse.

The pain occurs only after walking. There is no pain when sitting or lying down. Initially, when I walk, I feel no pain until I have walked for 100 strides (approx. 100 yards). Then, a cramping begins on the outside of the right foot, about 1-2 inches from the juncture of the small toes and foot. This pain can best be described as the feeling one has when wearing shoes that are too tight. After about another 25 strides, the pain traverses the underside and ball of the foot with an increasing burning sensation. Taking another 25 strides produces a pain moving to the Achilles tendon and the lower calf muscle that resembles a pulled muscle or sprain. Eventually, at about 200 strides, the pain moves up the calf muscle behind the leg, to the back of the knee. At 250 strides a much more severe pain begins in the muscle on the outside of the shinbone, about midway between the kneecap and ankle. If I push off with my toes while striding, the pain occurs more rapidly.

The pain is so severe by 300 strides that I can hardly walk. When I rest (even standing) or sit, the pain gradually diminishes in about 5 minutes and disappears entirely within 15 minutes. When I begin walking again, the same scenario is played out over approximately the same distance.

I can reduce, but not totally prevent the onset of the severe pain in the outer calf muscle. If I walk on my foot and move it on a flat surface as if I were stepping up a flight of stairs, it takes longer for the pain to occur throughout the foot and leg. Mechanically, this means that I am not flexing my toes to push off them as I stride. Instead, I am pushing off with my heel.

If I sit with my foot flat on the floor and simply flex my foot 50 times by raising my toes off the floor and maintain contact with the floor with my heel, I can produce the same pain in the muscles on the outside of the shinbone that occurs when I stride 250 paces. However, the pain usually found in the rest of my leg and foot when I walk does not occur.

The problem occurs regardless of the shoes (or lack thereof).

I am able to stand stationary on my right leg and do a deep knee bend while lifting my left leg and holding onto a kitchen counter, with no resultant pain. There seems to be no lose of strength in my leg.

I can ride an exercise bike with medium resistance, and pedal at 15 miles an hour for over one hour and feel no pain in my right leg or foot.

For the second aliment, I awoke one morning 2 months ago with a lack of sensation in my right foot. I thought that I had merely slept on it the wrong way and that it had 'fallen asleep.' When I rubbed it for a minute or two and walked on it, the numbing/tingling sensation disappeared. However, the foot itself felt cold to the touch and appeared to lack the lividity found in my other foot.

Gradually this situation occurred more often when I woke from sleep, and now regularly I find that if I lay down on my right side (but not my left side) a tingling sensation occurs in my foot and toes within about 10 minutes, followed by a loss of sensation of the 2nd thru 5th toes of the foot. This sensation is NOT the same as that afore described after I walk for 125 strides. In fact, walking for a few strides seems to cause the feeling (without pain) to return to the toes and foot.

I have seen a physician and he thought it was tendonitis, and prescribed a 10mg daily dose of valdecoxib (bextra) for 14 days. It has not worked.

So help? If you can? from what i have read about TTS it seems that what i have described fits well with what symptoms TTS has been described as.

thanks.

frank

Re: do i have tarsal tunnel syndrome?

Dr. Z on 2/12/03 at 23:44 (108974)

You can have TTS. I would make an appointment with a neurologist or orthopedic surgeon who knows lower back problems. You may need a nerve conduction test

Re: thanks!

frank c. on 2/13/03 at 00:28 (108978)

the more i read about TTS the more it fit my symptoms.

your remark is much appreciated. but i am bewildered about the pain on the outside of my shinbone, thinking that it was a tendon being irritated because i was favoring walking a certain way and caused it to be mis-aligned under stress.

nonetheless, to the doc i go!!

thanks.
frank

Re: do i have tarsal tunnel syndrome?

Dr. Z on 2/12/03 at 23:44 (108974)

You can have TTS. I would make an appointment with a neurologist or orthopedic surgeon who knows lower back problems. You may need a nerve conduction test

Re: thanks!

frank c. on 2/13/03 at 00:28 (108978)

the more i read about TTS the more it fit my symptoms.

your remark is much appreciated. but i am bewildered about the pain on the outside of my shinbone, thinking that it was a tendon being irritated because i was favoring walking a certain way and caused it to be mis-aligned under stress.

nonetheless, to the doc i go!!

thanks.
frank

Re: thanks!

Dr. Z on 2/14/03 at 20:40 (109192)

Could be but only an examination consisting of neurological and muscle testing by examination will you know the diagnosis

Re: do i have tarsal tunnel syndrome?

Dr. David S. Wander on 2/14/03 at 20:42 (109193)

In addition to Dr. Z's suggestion, you may want to have your circulation tested. Intermittent claudication is pain secondary to a vascular problem and often begins after walking for a set distance. The pain often begins distally (toward the toes) and then moves proximal (up the calf). Classic intermittent claudication pain is relieved almost completely after a few minutes of rest and recurs upon resuming the walking. I would certainly consider having the circulation tested in addition to the suggestions Dr. Z made.

Re: do i have tarsal tunnel syndrome?

Dr. Z on 2/14/03 at 21:53 (109195)

Good point Dr. Wander Is there a history of circulatory problems or diabetes in your family? Do you smoke? Did your family doctor examinate your pulses in your feet or do any type of circulatory testing?

Re: doctors, thank you for your important comments

frank c. on 2/15/03 at 00:43 (109199)

The physician i saw tested my blood pressure below and above my knee and said the readings were normal. i smoke a couple of cigarettes a day after dinner, maybe 3 packets in a month's time. i am right handed and as normal have a left leg slightly larger then my right one, and i would have thought that claudication, vascular contraction, and retention of blood/fluids would enlarge the right one, which it has not. however, the 'burning' sensation i feel upon walking 300 yards does feel exactly like that which occurs from lactic acid build-up in a muscle.

I am setting a date for an examination by my physician and will ask for the testing that each of you recommended.

i note that it is possible that i have the problems both of you mentioned. the claudication from a more sendentary lifestyle this past year (6 hours at work on a pc) and the way in which i position my legs at the pc, viz., cross legged ankle turned out, exacerbating any pinching of the tarsal tunnel at the ankle, or as i note today, on my toes, pushing up with the ball of my foot.

i mention these for you to see if before you have come across such descriptions of behavior that caused the same symptoms i described earlier.

again, i wish to thank you for your time and efforts on site.

frank