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EMG Diagnosis of Calcaneal nerve entrapment

Posted by Karole M on 5/20/04 at 13:49 (150913)

Had my neuro test done today and was diagnosed with calcaneal nerve entrapment. I have not seen this posted? Anyone out there have this? What is next?

Re: EMG Diagnosis of Calcaneal nerve entrapment

chrisb on 5/20/04 at 17:09 (150920)

Karole -
There may be several things next -- I would strongly suggest you try all possible non-surgical alternatives before considering surgery.

I don't know if this will be of help to you but for what its worth:
I spent a lot of time trying to figure out if I had calcaneal nerve entrapment. My impression is that its not easy to diagnose, so if you have a strong diagnosis you're one step ahead of where I was.
My EMG was inconclusive but showed slight latency of medial nerve. My local doc injected marcaine to the area where the calcaneal(s) sweep under the heel as a diagnostic. The idea was that if it numbed the pain it could help suggest the calcaneal as culprit. It did numb the pain. Later I had the pressure-sensitive nerve test from Dr Dellon's office in Baltimore. It also suggested nerve entrapment.
I had surgery 8 weeks ago which found that I have 4 calcaneal nerves (most people have fewer). They were decompressed. No mass or lump was found. So far I can't say the surgery has been a magic bullet but I'm still hoping.
Have you had an MRI? If it were to show a lesion pressing on the nerve it might give you a clearer picture of whats going on.

Re: EMG Diagnosis of Calcaneal nerve entrapment

Karole M on 5/20/04 at 22:40 (150938)

Chris,
Thanks..I already have had 3 surgeries on my heel this past year and a half for PF and a neuroma in my heel. The pain is worse than before and would do anything to get back up on my feet. I can't do cortisone or NSAIDS, allergic. Since I got such a definitive diagnosis for this from the EMG,should I request an MRI or would a CT scan be better? What kind of Dr. did your surgery? Any suggestions to help with constant pain? thks

Re: EMG Diagnosis of Calcaneal nerve entrapment

chrisb on 5/21/04 at 09:34 (150945)

Karole -
3 surgeries - I guess you've been through the mill on this. As to CT or MRI I'm not a medical professional and I don't know, I'm sure your doctor would. The reason I mention MRI is that some people on this list have said that surgery for nerve entrapment is more likely to be successful when there is a lesion, lump or cyst of some kind causing pressure on the nerve. I had an MRI which didn't show anything abnormal tissue -wise (it was a standard MRI which images tissue not nerves). I didn't have a CT and I don't know what the difference is. There is a kind of MRI that images nerves -- if you do a search on this list for Neurogram you'll probably find it. Its not widely available and its expensive but a couple of peoplee on this list last year had one.

The surgeon who did my TTS operation was a plastic/neuro surgeon, A. Lee Dellon in Baltimore.

I'd suggest you try to nail down the diagnosis as accurately as possible before considering surgery. I think TTS surgery is not a magic bullet for everyone's condition.

Re: EMG Diagnosis of Calcaneal nerve entrapment

Ed Davis, DPM on 5/21/04 at 15:19 (150977)

Karole:
The medial calcaneal nerve gives innervation (sensation) to the area at the bottom of the heel. If entrapped one as the option of releasing it or sometimes just removing it as there is a trade off of pain for some numbness.
Ed

Re: EMG Diagnosis of Calcaneal nerve entrapment

Karole M on 5/22/04 at 02:50 (151016)

Dr. Davis,
Since I already have had a neuroma and some heel pad removed would it be better to just have the nerve removed? I could stand numbness compared to not being able to stand any contact to this area. Besides surgical pain, would this mean a quick recovery? Thank you....

Re: EMG Diagnosis of Calcaneal nerve entrapment

Ed Davis, DPM on 5/24/04 at 18:52 (151154)

Karole:
My experience leads me to beleive that removal would be better for the following reasons:
1)the incidence of re-entrapment tends to be fairly high as these are very small delicate nerves
2)the nerve branche(s) are sensory only so there is no function lost when removing them, only an area of numbness on the bottom is caused
3)recovery would be potentially quicker since it takes a long time to recover from nerve entrapment release surgery.
Ed

Re: EMG Diagnosis of Calcaneal nerve entrapment

chrisb on 5/26/04 at 14:33 (151327)

Ed -
You said 'recovery would be potentially quicker since it takes a long time to recover from nerve entrapment release surgery'. I had thought cutting the nerve requires implanting it in muscle tissue -- do you mean recovery is generally quicker than from TTS surgery?
Thanks.

Re: EMG Diagnosis of Calcaneal nerve entrapment

Karole M on 5/26/04 at 21:52 (151351)

Dr. Davis,
Thank you for your imput. I have gotten back with the original Pod. surgeon and am awaiting his getting my report from the EMG. I will mention about removing the nerve as I feel that after 3 surgeries I have had about all I can. Thanks again.