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TTS Symptoms

Posted by michaels on 6/10/04 at 09:29 (152629)

I have a history of ankle sprains. I am 28 and have played competitive sports all of my life. About once a year I would sprain each of my ankles but always recovered and continued to play. In July of 2003 I sprained my ankle playing basketball. I did not get medical attention because I figured it was just another sprain, 'walked it off', took it easy for about a week and then started trying to participate in sports again. However, the pain was to great for me to participate. To make a long story short I finally went to a Sports Medicine center a couple of months ago. They did an X-Ray and said they couldn't find a problem so they recommended a CT scan. Again they said they couldn't find a problem. They said option one was a pill form of an anti-flammitory, if that didn't work then a cortison injection, and if that didn't work they would have to 'go in there' to see what is wrong. They suggested it might be torn cartlidge somewhere. From what I have read on this site I believe I might have TTS. Would an X-Ray or CT scan pick that up if they werent looking for it?
My symptoms are: when I wake up in the morning I have pain on the inside of my ankle. After going through some light stretches the pain mostly goes away. I do not have the ability to cut or jump as I did prior to the pain. Matter of fact, I quit playing basketball because my ankle feels like it might not be stable enough to handle the jumping around. After participating in a sports activite I have more pain. Walking up or down stairs causes slight pain. Running causes slight pain. However, I can walk in most cases with out any pain at all. I seem to feel less pain in my activities as my ankle gets 'warmed up.'
I would love to continue playing sports but my biggest concern is being able to play with my kids. I have a 17 month old and a newborn and in a few years I want to be able to chase them around the park.
I will keep reading to find out more about TTS but do these symptoms sound like they might be TTS. Any recommmendations on treatments? Is TTS related to ankle sprains? Sorry for being so long winded, I am just kind of lost with all of this right now.

Re: TTS Symptoms

LARA on 6/10/04 at 11:18 (152644)

They don't sound like TTS to me, but there is a wide range of symptoms. Why do you think it might be TTS?

Re: TTS Symptoms

michaels on 6/10/04 at 11:49 (152648)

I don't know if TTS is my problem. I just know that the doctors seemed confused about the description of my pain and the results of the X-Ray and CT scan. They couldn't give me a diagnoses for my problem. I still have the pain and I don't want to take anti-flammatories or have surgery if they don't know what is wrong.
I went to http://www . emedicine.com and it says TTS can be caused due to trama such as an ankle sprain. I began having the problem following an ankle sprain. It also says, 'Symptoms vary from individual to individual, but findings generally include the following: sensory disturbance that varies from sharp pain to loss of sensation, motor disturbance with resultant atrophy of intrinsic musculature, and gait abnormality (eg, over pronation and a limp due to pain with weight bearing).' All of which I have in the area of the Tarsal Tunnel. Although the pain is usually only severe enough to cause me to limp first thing in the morning and and after my body cools down from physical activity.
The website that directed me to this message board http://members.efn.org/~opal/tarsal1.html has pictures of the location of the Tarsal Tunnel and where it is located, is the percise area that I feel pain. This site also has a test you can perform to see if you might have TTS. I performed the test as directed and I have pain in the area it describes.
Like I said, I don't know if I have TTS I am just trying to figure out away to get whatever is wrong healed up. I have been living with this for nearly a year so far and I am worried where I am going to be in 3 to 5 years if it is not taken care of.
Thanks for your response!

Re: TTS Symptoms

Ann L on 6/10/04 at 13:14 (152657)


TTS does not normally show up on Xray and rarely on CT or MRI. The only time these tests show possible TTS is if there is a definite mass compressing the tunnel. One test that is helpful in ruling in TTS is a nerve conduction test - NCV. It is not accurate for ruling it out, sometimes there is a false negative. If I were you, I would go ahead and take the anti-inflammatory for your pain, but don't stop there. Continue to pursue why you are in pain (without surgery at this point!) You may want to consider another opinion from a different doctor. Several people on this board have used docs that specialize in sports medicine. It is a possibility that instead of TTS, you have a torn tendon or ligament in that area, or a combination of something torn and TTS. When you tap your inner ankle, do you have pain just in that area or does it radiate into your arch and toes? What type of pain do you have; achiness, soreness, stabbing, burning, pins and needles, or another type, or a combination of types of pain?

I am like you, I have a long history of sprained ankles and on top of that, almost every job I've had has been on my feet. I grew up considering myself to have weak ankles and I think that definitely contributed to my TTS.


Re: TTS Symptoms

michaels on 6/10/04 at 15:13 (152678)

Supposedly the Raidologist that worked with the doctor checked for torn ligaments and tendons. The doctor suggested it might possibly be torn cartlidge in an area of the ankle the CT couldn't pick up. I did take an anti-flammatory for a couple of weeks but it didn't do much to help. The doctor said if that didn't work an injection then surgery would be the next options. I am just leary because they couldn't tell me what was wrong and I am not a big fan of medicine anyhow.
The pain in my ankle in the mornings and after physical activity is sharp and when I put pressure on that leg my first reaction is to immediately remove the pressure so I would say like pins and needles. After a while the pain dulls and for the most part is just a sore aching feeling when I turn my foot certain ways. When I try to walk up or down stairs the pain gets sharper. When I put pressure on the area around my ankle the pain is sharpe. So the pain changes depending on the level of activity and the way in which my foot is being used.

Re: TTS Symptoms

LARA on 6/10/04 at 20:26 (152695)

THat's a stumper Michaels. I can why you are considering TTS after reading the website. Have you asked this question on 'Ask the Doctor' (another board on this website). They might be able to help you more. My gut reaction is it still doesn't sound like what I've heard on this board, but then my diagnosis was missed for three years because the doctors couldn't recognize it until I got to a sports med guy.

I tried to explain why I don't think it sounds like TTS, but I found I was confusing myself so wouldn't be much help again. Let me try again, and maybe others can confirm or correct me.

My pain responds to my activity level, but it's the same sensation. I don't get an immediate sense of pain for any particular activity. As I walk on hard surfaces my feel start burning sooner, but I couldn't tell you what step it was that 'caused' the pain. I think that is similar to what I see other people posting. That's not what I think you are describing about stairs and such. However you do describe the tingling pins and needles which is classic nerve pain I think. I don't know what might cause both. I can't say TTS doesn't cause both symptoms, I just don't think I've heard it described that way before. However, I didn't get to this board until after I had a diagnosis, so I quickly skip over things that clearly aren't related to my problems and may have missed something.

I don't blame you for not wanting surgery without knowing what they will
find and do. Surgery on feet is particularly more difficult and burdensome during the recovery. HOpefully someone will recognize your pattern of symptoms.

Re: TTS Symptoms

wendyn on 6/10/04 at 20:50 (152698)

Michael, what makes me suspect your problems are not TTS is that your ankle feels better once it's 'warmed up'. Most people with TTS report pain with increased use. Usually TTS is better in the morning, but your pain is worse.

It almost sounds to me like you have something arthritic going on, but I'm certainly not a doctor. Did your doctors do any blood work?

You may want to give the anti-inflammatories a good try as well as physio. I'd certainly get at least one other opinion (by a foot and ankle surgeon and maybe also by a podiatrist) before consenting to surgery.

Re: TTS Symptoms

Julie on 6/11/04 at 01:12 (152707)

Michael, in your first post you mentioned your history of ankle sprains. The cumulative effect of these repeated injuries could well be a thickening of the injured tendons or ligaments. The ankle is an extremely complex joint, a real 'spaghetti junction' of tissues, so any thickening/ scar tissue could easily cause pain on movement. An xray would not pick this up - I'm not sure whether or not a CT would, but an MRI might. Damaged cartilage is also a possibility, as has been suggested.

I don't know enough about TTS to know whether that needs to be considered - but it's interesting that two people who know a great deal about TTS think it probably isn't. I can't think of a single reason why surgery, which would quite likely pile more scar tissue into your poor ankle, should be considered, so please be VERY careful. That would be your very last resort, a long way down the line. At the moment, the only reason for it would be to see what's going on in there, and that is NOT a good reason!

I would suggest you get an MRI, and as Wendy suggested, another opinion from a podiatrist or a foot and ankle surgeon. And it might be a good idea to see a practitioner who practices hands-on therapy, such as a massage therapist, or a chiropractor, who might be able to feel what's going on in there.

Re: TTS Symptoms

LARA on 6/11/04 at 08:12 (152716)

I've mentioned this before and feel a little sheepish, but it might be more applicable in your case. If you can find the team doctor for a local professional basketball team (men's or women's), they might have an idea. Basketball is different from other professional sports in that there is a lot of running, changing direction, etc. on a hard surface. The same might be true for gymnastics (they do it in bare feet!) track and tennis, but finding a 'team doctor' for that could be tough. I thought about perhaps doctors for college teams but my husband pointed out that college athletes are young and healthy and often don't develop problems for several more years.

In any case, I imagine basketball stars suffer lots of ankle sprains and I know they have LOTS of feet problems. MOre than other sports. I don't know where you are, or how to find out who the 'team doctor' is, but you seem very good at tracking down information. I worked for an orthopedic surgeon once and was all ga-ga when a professional athlete walked in who I recognized (with all the maturity of a typical 20-year-old meeting an icon). My doctor was covering for another doctor who was the 'team doctor'. My impression was a lot of the team doctors have a thriving practice for 'just us folks and week-end athletes'

Good luck. I'm not sure if it's TTS, but it does sound like there could be some nerve involvement.

Re: TTS Symptoms

michaels on 6/11/04 at 11:10 (152741)

Thank you all for taking the time to respond to my post. I will continue to research my ankle problem and see what I come up. I could possibly drive to Indianapolis it is about an hour away a see the Pacers team doctor. The area that I am in has basically one Sports Medicine center that everyone uses. The sports medicine center works with the hospital for X-Rays and CT scans. The hospital sent the X-Rays to one of the surgeons at the Central Indiana Otherpedics (the sports medicine place) and he is who suggested surgery to see what was going on in there. So in around about way I had three qualified professionals look at the X-Rays and CT scans 1. the radiology department at the hospital, 2. the actual sports medicine doctor I saw, 3. the surgeon at Central Indiana Orthepedics. I think my next best bet would probably be to take the advice to see a foot and ankle specialist. I just hope they don't send me back to the sports medicine place.
Again, thank you for taking the time to post and give me your advice and thoughts on my problem.

Re: TTS Symptoms

LARA on 6/11/04 at 11:34 (152746)

Good luck. I'd love to hear how it goes. We all learn from these stumpers.