Dr Edward Davis DPMPosted by John Martello on 5/21/04 at 17:29 (150990)
Sorry to keep bothering you, but your advice is greatly appreciated. I am contemplating surgery for FHL And FDL tenosynovitis documented on MRI and my nerve test study showed MINIMAL NERVE IRRITATION TO THE POST TIB NERVE. My pain is LOCALIZED AND CONSTANT NO MATTER WHAT I DO , BUT I AM ABLE TO SLEEP AT NIGHT. I HAVE NO NUMBNESS OR TINGLING, JUST LOCALIZED PAIN below the medail malleous in the tarsal tunnel area. Lets say i tried the orthotics with the skive and ray cut out with no success. My questions concerns the surgery Regarding the tenosynovectomy and tarsal tunnel release.
1) Besides infection what are the risks with this surgery?
2) REcovery time?
3) What is the worse case scenario with this type of surgery?
4) Success rate?
Thanks again for your expertise.
Re: Dr Edward Davis DPMEd Davis, DPM on 5/22/04 at 01:51 (151012)
Actually my first full name is 'Eddie,' not Edward. My son is Edward.
Thank you for localizing the pain in this post -- it is more specific so easier to give advice. The problem is in an area of proximity to the post tibial nerve so ESWT does not sound like an option. Actually, the questions you have really need to be reserved for your surgeon as much will depend on his technique and experience so it is not easy to do this for him. I can try to generalize though.
The potential complication that would bother me the most is to actually create a tarsal tunnel syndrome where none now exists. I would consider that to be one of the worst case scenarios. Formation of excessive scar tissue can be a problem and my inclination would be to get you into aggressive physical therapy fairly early to help prevent that. It is this same scar tissue that can place pressure on the nearby nerve to cause a tarsal tunnel syndrome.
Success rate is a bit hard to come up with becuase this procedure is not done in large numbers. I would definitely ask your surgeon how mamy he/she has done.
Recovery: again quite a bit of variabilty but I would have you in a U-shaped splint, partial weight bearing for 2 weeks followed up with a CAM walker (removable cast) for an addtional 2 to 3 weeks. One reason for the removable walker is to allow the therapist accees to the area.
One reason that surgery is not that common is that conservative treatment does cure most individuals. You appear very interested in the surgical treatent but the chance of treating you coonservatively and sucessfully is fairly good.
Re: Dr Edward Davis DPMDr. Z on 5/22/04 at 08:31 (151021)
The key is to have a foot surgeon who does alot of surgery in the TTS area and or ankle area. So they should be board certified in ankle surgeon. Where do you live?
Re: Dr Edward Davis DPMJohn Martello on 5/22/04 at 20:41 (151047)
Sorry for calling you Edward,
Are you saying I should give this more time? I've had it for 8 months now and am really discouraged with it. Is there a possiblity it can heal on its own? Can you think of any other CONSERVATIVE treatments I can try besides the orthotics that mght help take the edge off? I am currenlty on Lexapro for the depression assocaiteed with this constant pain , but my doctor would not give me an anti inflammatory. He says ADVIL is just as effective as Vioxx, Celebrex, Bextra, Etc there all marketed and are basically the same, but i disagreed with him and hea was unwillin gto give me any medication.
Re: Dr ZJohn Martello on 5/22/04 at 20:44 (151048)
Rochester, NY Going to University of Rochester Medical Center
Dr. Benedict Digiovanni Foot and Ankle MD
Re: Dr ZDr. Z on 5/22/04 at 21:01 (151049)
How you tried a foot and ankle foot orthosis and or an Arizona brace?
Re: Dr Edward Davis DPMEd Davis. DPM on 5/23/04 at 00:18 (151056)
I am not sure if more time is the answer but more aggressive conservative treatment. Again, I am being repetitive but an orthotic with a Kirby skive and a first ray cut out will do the trick for this most of the time.