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DR Z

Posted by Alex Prato on 4/27/04 at 10:58 (149631)

DR Z,

I have been suffering with FHL&FDL Tenosynovitis for 7 months based on MRI and symptoms. I have NO NUMBNESS, TINGLING OR SHOOTING SENSATIONS, STRICTLY PAIN IN THE INNER ANKLEBELOW THE MEDIAL MALLEOUS.

My Tinels sign was negative , but my NCV study only showed slight minimal nerve irritation. My DOC thinks its more tendons than nerve issue based on the NCV results. I have tried PT, 2 cortisone injections, Vioxx, hard short leg cast to immobilize( 1 month) 2 pairs of orthotics both were hard rigid plastic type now using spenco polysorb, but is not helping much either.

My physician wants to do a Tarsal Tunnel Release and Tenosynovectomy and states that the success is only 50%. I feel the pain at rest,and more aggravated when standing for 1/2 hour. Walking will slightly relieve it then when i go sit down it acts up again, but i can sleep through the night.

Have you ever performed this type of surgery and would you reccommend it or is it a bad risky surgery? Could it make me worse? I am 33 and walk normally with no noticeable limp but the pain is there. I am at wits end and not sure if i should give it more time or take a chance with surgery. Can it go away on its own or do i have to live with it?

I thank you for your advice and expertise and professional medical opinion.

Re: DR Z

Dr. Z on 4/27/04 at 18:57 (149652)

I have not performed this surgery or seen any post op cases from this surgery. I use to do alot of post -op care for extensive rearfoot surgery and I have not seen a TTS with a tendon debridment. Not sure what the results would be. If you are in pain and have tried all types of treatment the choice is do it or live with it. If you have confidence in your doctor maybe he will let you talk to one of his patients that had this type of foot surgery

Re: DR Z

Pauline on 4/27/04 at 21:15 (149664)

Dr. Z,
What about a referral for her to that Dr. that is suppose to be the best neurosurgeon for TTS surgery? Is it Dillon or something like that?

Re: DR Z

Dr. Z on 4/27/04 at 21:36 (149669)

Dr. Dellon from Johns Hopkins University in Baltimore Maryland is one of the expert in TTS and nerve entrapment problems. I believe his web site is http://www.dellon.com . If you can't find it let me know by contacting me at (email removed). I have his e-mail address in my office. Also just use the goggles search with his name Dr. Dellon

Re: DR Z

Ed Davis, DPM on 4/27/04 at 22:09 (149674)

Alex:
If the tendons are inflamed, they will irritate the nerve. A tarsal tunnel release may help but it can also be an invitation to trouble so definitely something to think about. I wish I could have seen the orthotics because there are certain characteristics that would make an orthotic more effective: kirby skive, first ray cut out -- trying to invert the heel to take tension off tib. posterior and relax the FHL. What do the tendons look like on the MRI?

Ed

Re: DR Z

Dr. Z on 4/27/04 at 22:56 (149681)

The inversion of the heel is an important orthosis modification. Dr. Ed make a very good point. I always assume that the orthosis were made to the correct prescription. This is a serious procedure with possible very poor results.

Re: Dr Davis Tendons on MRI state:

Alex Prato on 4/28/04 at 15:25 (149719)

Dr Ed DAvis,

My MRI reads:

FINDINGS:

THERE IS FLUID SIGNAL INTENSITY SURROUNDING THE FLEXOR HALLUCIS AND FLEXOR DIGITORUM TENDONS CONSISTENT WITH TENOSYNOVITIS. THIS IS MORE PROUNOUNCED SURROUNDING THE FHL TENDON AND THERE MAY BE A SEPTATION ASSOCIATED WITH IT. NO TEAR OF THE TENDON IS SEEN. THE SURROUNDING MUSCLES ARE NORMAL IN SIGNAL INTENSITY AND MORPHOLOGY. THE EXTENSOR TENDONS APPEAR INTACT. THE PCT APPEARS INTACT AS WELL AS THE ACHILLES TENDON. THE ANTERIOR AND POSTERIOR TALOFIBULAR LIGAMANTS ARE INTACT.

IMPRESSION: Tenosynovitis of the FDL&FHL particualry the FH, where there is a septation within the fluid.

DR Ed? What does the septation signify ? is this important?

Please advise on the MRI report and what i should do. Thank you for your time.