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Tarsal Tunnel Surgery

Posted by Jill on 3/06/03 at 17:33 (112049)

I have recently been diagnosed with TTS after having NCS. My podiatrist is trying steroid shots for the next two weeks. If that is unsuccesful he said we would try surgery. Besides being terified of the pain and recovering of the surgery and I am worrying about paying for it also. My insurance will cover 90% of the cost of the surgery. I would be resposible for the other 10%. I was curious how much the surgery will cost?

Thanks for any help you can give me.

Re: Tarsal Tunnel Surgery

lauriel on 3/06/03 at 17:40 (112050)

I had surgery in December and I think the original total cost was about $3000, but because I have a PPO , I made sure I went with a preferred provider facility and anethesiologist which brought the cost down, they have to accept what the insurance co says I will check and get back to you, there are also various levels of surgery, depending on the complexity of what they are doing - mine was fairly simple.
Laurie

Re: Tarsal Tunnel Surgery

wendyn on 3/06/03 at 22:14 (112076)

Jill - how long have you had TTS?

It's always a good idea to get a second opinion before going with surgery of any kind.

Re: Tarsal Tunnel Surgery

Jill on 3/06/03 at 22:34 (112079)

I've had the pain since January. I've had several doctors tell me it is TTS.

Re: Tarsal Tunnel Surgery

Ed Davis, DPM on 3/06/03 at 23:06 (112083)

Jill:

That is not a long time to have had TTS. Did the pain come on suddenly or was the onset gradual. TTS more often than not, does not have a specific identifiable cause but, in cases where the onset of symptoms was sudden or where exaccerbation was rapid, I would make it a point to look carefully for causes.
Ed

Re: Tarsal Tunnel Surgery

Debra on 3/07/03 at 01:00 (112088)

Hello sorry to hear about your pain, I to suffer from this ,I have had 2 surgeries and am still in severe pain. I have gone to physical therapy, had shots , gone to pain management, none of these things have helped me. This has been with me for 2years , I can walk limited with a cane. My 2 Drs. operated and sent me on my way , Surgery was no help. I hope someday to recover but the drs, say there isnt much hope. I hope you will have a better recovery than I did. Take Care and God Bless, Debra

Re: Tarsal Tunnel Surgery

wendyn on 3/07/03 at 07:56 (112095)

Jill - surgery at 2 months is almost unheard of. Surgery is usually considered a last resort after all conservative methods have failed. Did those other doctors suggest surgery now too?

Before you jump for surgery now - spend some time on this board and talk to some people who have had it (sucessful and not).

Re: Tarsal Tunnel Surgery

eileenc on 3/07/03 at 08:29 (112098)

Please don't have surgery yet. Wendyn said it best when she said to talk to other people and try other things first.
My failed surgery was almost 6 years ago and made my foot worse.
I use Neurontin for the nerve pain and ice-cube water baths for inflammation ( along with an anti-inflammatory).

Re: Tarsal Tunnel Surgery

Sharon W on 3/07/03 at 10:22 (112114)

Wendyn,

Surgery at two months isn't as unheard of as it should be! I was reading another board and someone was preparing for his pre-surgery consult AFTER THE FIRST VISIT with his doctor! Wanted to know what the surgery would be like, what to expect. He didn't say anything about test results and it really didn't sound like any tests had been done. His doctor had told him he would be able to put weight on it after 3 days, and to walk normally wearing a shoe after 2 weeks!

...And the even stranger thing is, someone responded to him saying she'd had the surgery, that it was 90% successful and he should go for it! She figured there was no sense wasting time with other treatments that hadn't worked for her, anyway. She thought it was great that his doctor planned on having him back on his feet right away, too. Said she saw no need for physical therapy, that there was no reason for it if you got back on your feet right away. I guess there really ARE people for whom that kind of approach works... apparently, it did for this woman.

But I do suspect that the ultimate 'success' rate is probably lower with that approach, than with a more careful approach that incorporates physical therapy and good after-care.

Sharon

Re: Tarsal Tunnel Surgery

Marty on 3/07/03 at 11:07 (112125)

Sharon,

Was this the p/n board?

Re: Marty

Sharon W on 3/07/03 at 11:08 (112126)

Yep. I think the guy will go for it.
.

Re: Tarsal Tunnel Surgery

Jill on 3/07/03 at 11:38 (112130)

I woke up SuperBowl Sunday with horrible leg cramps and I could barely walk. I saw my PCP on the 1/29/03 after a night of trouble sleeping because of intense pins and needles in my foot. The only thing that seemed to help was sitting up in bed and resting my foot on the floor. My PCP sent me to have an MRI of my back which came up clear and she tested me for diabetes, also clear. The pain just seemed to get worse and worse. It is intensely painful to walk on my foot. I have pain 24 hours a day. If I try to walk any distance at all, I'm in such pain that I get all sweaty and pale for the pain. The next visit I had with her she prescriped Elavil to me. That was not helping much so she doubled my dosage, which has helped me sleep through the night. She suggested I see a podiatrist and a nuerologist. I have seen two podiatrist and a nuerologist, which have all said that I have Tarsal Tunnel syndrome. After a positive NCS the nuerologist referred me to an orthopeadic surgeon. My podiatrist has given me 2 injections and I am scheduled for another one next Thursday. The steroid shots do not seem to give me any relief. My podiatrist has also scheduled for me to have an MRI on my foot/ankle on Monday. He doesn't seem to want to rush in surgery. I think he was just telling me it is an option, so I began looking at what is covered for my insurance. I am just trying to prepare myself for all situations. I have tried icing it and that doesn't seem to help much. I am 24 years old and I don't want to be in pain for the rest of my life. I am too young. I am willing to try anything the doctors suggest at this point.

Re: Tarsal Tunnel Surgery

Marty on 3/07/03 at 11:39 (112131)

I suffered for 7 years before having the surgery. Don't know at this point if it was a success. Post op, 2-1/2 weeks. I don't have all the bills yet but the out patient bill was $3700 dollars. Don't have bill from anesthesiologist or the doctor yet. I have to pay 20% plus new orthodics. Plus post op visits every week for at least a month and then once a month. Doctor took an x-ray last visit so I'm guessing by the time I'm better on this foot it will be at least $10,000. If you pay 10% you'll possibly need $1,000. Ask your doctor what the cost will be.
I'm under the opinion as some, but not many here that full blown TTS can not be cured without surgery. (Just my option) But first make sure you really have TTS. You should have a Nerve Conduction Test done. How does your doctor know it's TTS? Did he tap on the side of your ankle to confirm TTS? What kind of doctor is he?

Re: Tarsal Tunnel Surgery

lauriel on 3/07/03 at 12:07 (112139)

Jill, I checked my bills last night, it was $3500 for surgery center, $1100 for surgeon and $800 for anethesia - And my post op Dr visits are included in the price of my surgery. I know Marty had more extensive surgery than I did and even if you get a price ahead of time, they may find something that is more complicated that can drive the cost up.

I suffered with TTS for 3 years. It has been 3 months since my surgery, still dont know if it helped, wont know for awhile, I was willing to take the chance on surgery since I did not want to be on drugs for the rest of my life. Orthodics actually helped quite a bit for awhile. I know there are a lot of unsuccesful surgeries out there, I hope mine wasnt one of them. I think some of the failures come from what happens post surgery. Like Sharon said in her post, Getting advised to weightbearing after a few days, no physical therapy. Maybe the Dr not fully aware of procedures and people just plain trying to do too much too fast after surgery. I think the list could go on. I do think you should look at all of the alternatives before you choose surgery. It is my understanding too that the only thing that will cure it is surgery, but there are alternatives that dramatically lesson the severity of pain that you should probabely look at before you take the plunge. The post op recovery is not fun! I feel like I progress 2 steps forward, then one step backward. Any little thing sets me back.
Laurie

Re: Tarsal Tunnel Surgery

Sharon W on 3/07/03 at 14:07 (112154)

Lauriel, Jill,

I DON'T think surgery is the only thing that can ever possibly 'cure' EARLY TTS, but I do think that is true except in a very few rare cases once the condition is advanced. I read a research report once that commented a patient who'd had a diagnosed case of TTS for more than 6 months has probably reached the 'chronic' stage and other treatments (besides surgery) will not be effective.

The other thing to remember is, whatever CAUSED the TTS in the first place, if it isn't taken care of, can cause you to get TTS back again once you go back to your normal lifestyle.

Sharon

Re: Tarsal Tunnel Surgery

lauriel on 3/07/03 at 15:14 (112164)

Sharon, are you saying that you can TTS again even after successful surgery? I dont think anyone has mentioned that, not even my Dr! And since mine is caused by my gait I need to get new orthodics asap. That makes so much sense why people may think the surgery is unsucessful, you made a fix but you have not corrected the cause.

thanks so much for that info
Laurie

Re: Tarsal Tunnel Surgery

Sharon W on 3/07/03 at 15:23 (112166)

Actually, I was referring to when the non-surgical treatments are successful. Surgery is different because, of course, the nerve is no longer inside the tarsal tunnel, it's been 'released'.

But yes, if you get scar tissue buildup in the tarsal tunnel re-entrapping the nerve, or if you re-injure yourself somehow, then I do think you can get it again after surgery -- if fact there have been a couple of posts recently by people that may have happened to. The scar tissue issue is a biggie; it's the main reason why re-surgeries sometimes have to be done.

Sharon
.

Re: Tarsal Tunnel Surgery

wendyn on 3/07/03 at 15:51 (112167)

Jill - the MRI is the next logical step - sounds like you have a good doctor!!

Re: Tarsal Tunnel Surgery

Kristi O. on 3/07/03 at 16:56 (112173)

I think you just have to be prepared for surgery not to work, just as you have to be prepared for conservative treatments not to work. Expect the worst, hope for the best. I am 23, had TTS surgery after similar symptoms for just 2 months also. I felt surgery was the best option for me. To me, my time is most important. I had rather take a chance on surgery possibly fixing it (or not), than invest a year of my life in a conservative treatment that may or may not work. Of course I am still recovering, but I had the surgery 2/24/03 (11 days ago) and I am not even using crutches anymore. So far, no regrets. The feeling is back in my foot and normal -- no pins and needles. Of course, this is solely my experience. It is different for different people and situations. It is always possible that I could have repeats of the injuries that caused TTS in the first place and have TTS come back. I am willing to deal with that when I come to it, and plan to do my best until then to prevent those injuries.

I guess my point is surgery is riskier, but you have to do what is right for you in your situation. To me, surgery was worth the risk. Good luck to you, and I hope whatever you choose that you start feeling better soon!

Kristi

Re: Tarsal Tunnel Surgery

Marty on 3/07/03 at 19:10 (112186)

I sure wish the surgeon wouldn't of put me into a boot right away because there was no way for my to get ice on it until a week later when I went back in, he then said I could take it off to ice. Scare tissue is the biggest reason TTS relapse happens. It's critical to ice 20 to 30 on, 20 to 30 off for the first 24 hours.

I have been getting allot of pretty bad zingers today, seems the nerve is really waken up. I feel like a drag race car, my foot is just sitting there on the starting line revving it's engine to see if it's got all the power ready to explode. LOL

Re: Neurontin

Marty on 3/07/03 at 19:15 (112187)

Jill,

Ask you're Pod about Neurontin, it can really help. Might get enough relief to give yourself some time to think things through. You might be lucky and get this under control with rest, ice etc. But if there's a blockage of some sort then I think surgery in warranted. (my opinion)

Re: Tarsal Tunnel Surgery

Jill on 3/07/03 at 19:45 (112193)

Kristi,

I agree with you totally. I realize that surgery is risker, but to me it is worth the risk.

I keep thinking of things that I'm going to do 'when my foot gets better'. Time is most important to me too. I agree that I'm not sure that I want to invest so much time in pain trying to go through consevative treatments that may or may not work.

One thing is for sure. I will never take my health for granted again. This has made me realize how crucial it is to appreaciate good health and to take care of my body. I will never abuse or push my body to limits it can't handle again. I am thankful that TTS does have treatments that can work.

Thanks for your input.

Re: Whoa -- back up here!

Ed Davis, DPM on 3/08/03 at 11:16 (112247)

Jill:
The history you provided is very atypical for tarsal tunnel. You did not mention if the symptoms occurred in both feet or just one.

Tarsal tunnel does not generally come on overnight without some type of trauma so this needs to be looked at more closely. Any swelling? Any increase or change in physical activity before the onset? Have you been worked up for a compartment syndrome? A compartment syndrome involves an increase in pressure in a section of the leg such that nerves, arteries and veins are squeezed causing pain.
Ed

Re: Tarsal Tunnel Surgery

Lara t on 3/08/03 at 11:45 (112251)

Just a small point of information - the tap on the side of the ankle (with resulting pain of some sort) may confirm TTS (I'm not sure of that), but absence of pain doesn't prove you don't have TTS. I don't have it, never have. But for me, the NCV test proves TTS, and my history of symptoms are pretty classic so that my podiatrist that was very familiar iwth TTS (as opposed to the many doctors that aren't and missed the diagnosis) was pretty confident of my diagnosis before sending me for the NCV test (which is the primary test for diagnosis - although a negative result again, doesn't mean you don't have TTS).

Re: Whoa -- back up here!

Jill on 3/08/03 at 14:59 (112271)

My podiatrist did have some concern that the symptoms started overnight. I only have the symptoms in my left foot. I have had no swelling. I have not increased or changed my activity level before the onset. The only slightly similar symptoms I had before January was sometimes my foot would go a little numb when I was walking distances, i.e. more that a mile. My whole life I have had weak ankles, rolling them a lot. I was born with my left foot turned in and I had a cast to straighten it out. In 1996 I had Bell's Palsy on my left side. I don't know if any of this is relevant, but they are things that my mom and I have thought of when we were brainstorming.

Re: Tarsal Tunnel Surgery

Laurie R on 3/08/03 at 16:17 (112282)

Hi Yes Sharon is right . I am one that had a TTS surgery last May , and now I have it again ...... I have scar tissue on the PT nerve .... I am going to have one more surgery . A vein wrap surgery to try to fix this . I have been dealing with this for almost 4 years... My Pod waited 3 years before he did my first surgery . He won't do my next. I am having it done by a Ortho doc this time......

Before you have surgery , read as much as you can . I have to say , I tend to agree with you guys . If you know you have TTS for sure . It makes no sence at all to wait as I did for three years to have surgery ..... I will say my surgery really helped my PF .... I just got the scar tissue around the PT nerve .....

Some may think I am crazy for having a repeat surgery again , but I really don't have any choices left . I can't deal with this pain . I also got RSD from my foot injury .... But that is a whole other story .

I wish you all the best if you do have surgery . I did not find the recovery that bad at all with my first surgery .....

Laurie R

Re: Tarsal Tunnel Surgery

wendyn on 3/08/03 at 17:11 (112291)

Jill, I don't want to be a pain - and I'm not going to bug you about this again...but I've been on these boards for 4 years now...and a couple of your comments concern me.

You realize that sugery is 'riskier' - but that it's worth the risk. Have you really researched this? Do you fully understand the risks?

Time is most important to you, and you don't want to 'waste time' on things that don't work.

Any idea how long it could take to heal from surgery? Or how long you could be in pain if your surgery makes things worse? Once a foot is operated on, there are all kinds of other things you may have to content with (i.e. scar tissue).

I'm not asking you these questions to second guess your intelligence, but I've seen enough people on this board have devastating consequences from the surgery. True, there are some positive outcomes too and I wish there were more. I'm really concerned that you seem to have your mind set on these - even though you've had this only 2 months.

Please take your time, even if it's hard - and make your choices carefully.

I promise to be quiet now.

Re: Tarsal Tunnel Surgery

Lara t on 3/09/03 at 00:19 (112315)

I'm glad Wendyn spoke up. I was thinking the same thing - but wondered whether to speak up if you really didn't want to hear it. You're question after all wasn't what we thought about surgery, but rather how to handle the cost and what to expect. If you don't want to know more, please stop reading and I wish you well with your surgery.

While still figuring out how to find 4 months to take off for surgery (the length of time my doctor predicted I wouldn't be able to function the way the family relied on - particularly driving/chauffeuring), and living a relatively sendentary life, my doctor gave me compression socks to try = which gave me back a good life - not the same life, but a good life. They don't seem to have helped a lot of people on this board, but I think they do help a lot of people (according to my pod anyway). Other people have found other things that worked.

Foot surgery isn't as easy as most surgeries we are familiar with. Regardless of the particular surgery being performed, I understand feet tend to have lots more problems generally. More infections (which isn't necessarily as easy to get over with no lingering affects as your basic strep throat we are familiar with). TTS hasn't been around all that long - about 40 years I believe - so the level of expertise isn't the same as for many surgeries we are familiar with.

I think I should stop. You didn't ask for this, and if you decide on surgery I wish you well.

Re: Whoa -- back up here!

Ed Davis, DPM on 3/10/03 at 18:39 (112488)

Jill:

The steroid shots may be worth a try but more workup is in order, especially due to the sudden onset. An MRI may be helpful to look for anything that could be placing pressure on the nerve.
Ed