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Dr WAnder

Posted by sammy p on 2/11/04 at 06:21 (144074)

Dr Wander,

Thanks for all your help. I was wondering if you would consider if the FHL and the FDL tendons which have tenosynovitis in my case would be considered space occupying lesions for tarsal tunnel sugery? It seems to be on this forum that unless one has a tumor , cyst, ganglia then tts surgery is not reccommneded? What is your view on this as in my case?

Re: Dr WAnder

Nancie H on 2/11/04 at 10:30 (144088)

I have TTS and would like more spacific information on surgery.

Re: Dr WAnder

Dr. David S. Wander on 2/11/04 at 17:57 (144125)

Sam,

Often MRI findings can be misleading. On more than one ocassion I've performed surgery and intra-operatively the actual clinical picture differed from the MRI reading. As I stated in my prior postings, I understand that your MRI was read as tenosynovitis of the FHL and FDL, with a 'normal' posterior tibial tendon. I would not get too hung up on the MRI findings, but would follow the clinical presentation. If there is fluid around the FHL and FDL tendons I would not call that a space occupying lesion, but the fluid may be causing increased pressure in the tarsal tunnel, therefore causing increased symtpoms. If a cyst or ganglion is present, surgery is recommeded, not to necessarily decompress the tarsal tunnel, but to remove the lesion. If there was a space occupying lesion, it should have been evident on the MRI. Once again, I would focus on the tarsal tunnel and discuss this with your doctor. Additionally, diagnostic ultrasound can show 'real time' imaging of the FHL and FDL tendons and can aid in determining if a true pathology of these tendons exists. Have you had any blood work in addition to other tests??

Re: Dr WAnder

sammy p on 2/12/04 at 07:33 (144155)

Dr Wander,

Thank you for yout time in these posts, it is greatly appreciated. I wish i lived in your area as i would choose to have you manage my problem.

In response to blood work I've had tests for diabetes, thyroid, lupus, and all turned out normal. I have not had any other tests except MRI. Since I have fluid in the FHL & FDL tendons , what is the best way to get rid of this fluid, AS this as you mentioned could be causing increased pressure in the tarsal tunnel. Elevation? Heat? ICE? I haven't tried ultrasould in physical therapy yet could this help? I am currently trying iontophoreseis patch which is slighlty takilng the edge off , but it is still present. I will discuss with my doctor the tarsal tunnel issue.

Another dilemma, is i've been out of work as a mail carrier for 3 months, yet never reported my problem because it gradually developed and got more persistent and worse as i continued to walk my rouote which is 5 solid hours of walking and 2 hours standing in one spot in the morning.I honestly thought that this would not persist. I do think my job caused my problem, but how do i go about having my podiatrist support me in this. There was no traumatic injury it just came on. I know he is busy but he would have to write a medical narrative, on findings and has to correlate the job to my injury. The post office will not accomadate me unless it is accepted by workers comp and then they will meet my restrctions. Do you think I have a chance in my podiatrist helping me with workers comp after three months of not reporting it? What is your expreince with mail carriers as i know you have mentioned before that you have seen many.

Thanks for your advice, Sammy p

Re: Dr WAnder

Dr. David S. Wander on 2/12/04 at 18:41 (144214)

Sam,

On several ocassions I've given you my opinion that the fluid around the FHL and FDL tendons may simply be an MRI finding with little clinical correlation. This is not abundant amounts of liquid, it simply means that on MRI there was an increased signal and a small amount of fluid around the tendons. This isn't something you can actively 'remove'. If it is due to an injury or trauma it may resolve over time, or as stated previously, it may be of absolutely no significance. I've given you my opinion 3 times, and each time I've stated my feelings about the MRI findings. Once again, MRI findings do NOT always clinically correlate. It is up to YOUR treating doctor to determine if the positive findings on the MRI are of any clinical significance. Once again, I would place my attention to the tarsal tunnel. Physical therapy, iontophoresis, etc., may all help your discomfort, but first it would be nice to have an actual diagnosis.

I don't know you're doctor, but it is certainly reasonable to have a job related injury or disability. I can not think of any logical reason why your doctor would not help you, ....IF he/she believes that the problem is work related. He/she may charge you for filling out any papers or writing any letters, since it does involve time. If he/she doesn't believe it's work related, then you may have a problem.