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diagnosis of TTS -- to all the all knowing out there??

Posted by Marty in SLC on 7/08/04 at 18:35 (154882)

Can those of you out there who know these medical terms please help me?

If I'm reading this right it's saying that tests can be preformed that can help narrow down if one really has TTS, P/N etc. Is this correct?
- Marty

'The clinical diagnosis of tarsal tunnel syndrome should be supported by electrodiagnostic methods, which can help differentiate radiculopathy, peripheral nerve entrapment and peripheral neuropathy. Lateral plantar versus medial plantar nerve involvement may be distinguished as well as if the lesion is primarily axonal or demyelinating. With this information the treating doctor can best provide a diagnosis, prognosis, and treatment plan.'

Re: diagnosis of TTS -- to all the all knowing out there??

john h on 7/09/04 at 09:37 (154921)

marty i have had tts surgery and all the various test to diagnose tts. my surgeon was highly qualified being an orthopedic foot and ankle specialist with a fellowship in foot and ankle surger. the doctor who specialaized in nerve condiction test does nothing else but this procedure so he was very good at what he does. with tts there is no gold standard test. after all is said and done the only positive way to identify a trapped nerve in the tarsal tunnel is to have surgery and look and see. my various test were somewhat positive and my surgeon said that was no guarantee he would find any problem in the tarsal tunnel and in the final analysis it would be my call. The surgery itself does not take long. perhaps 30 minutes. you are left with a scar about 6' long that runs from the inside edge of the foot up over the ankle bone. it caused me no pain but you will wear some sort of cast for approximately two weeks and be on crutches. this is delicate surgery if you should choose to have it and you want to make sure your surgeon is well quallified and perfored the procedure many times. you can screw up your foot if he miscalulates. when cutting above the ankle I personally lean towards an orthopedic foot and ankle surgeon. If having pf surgery i might lean towards a podiatrist. my gut instinct tells me there are too many tts surgeries performed. i do not recall anyone on this board reporting being cured of foot pain with tts surgery and this spans around 9 years. i read often on the board that tts pain and pf pain can be much alike. in my experience with pinched nerve pain in other parts of the body the pain is very different from the pf type pain i have experienced for the past 9 years. a pinched nerve (tts) can cause numbness, tingleing and the type pain you have when you hit your elbow and get the electric shock type pain. my pf pain (my case only) is nothing like other nerve related pain i have experienced. If you consider surgery ask your doctor (1) what is the best outcome I can expect (2) what is the worst outcome I can expect (3) how many of these procedures have you done (4) how long will recovery last and what are your recovery procedures. This can be a serious surgical procedure and not taken lightly. If doing this again I would want at least three (3) concurring opinions from three different doctors. Good luck. when i had this surgery i also had at the same time and on the same foot a cheilectomy,pf release (baxter procedure), and of course the tts surgery. I made the decision on the tts surgery as he was rolling me into the operating room. I had a small vericose vein in the tarsal tunnel but the surgeon said this was not my problem. I was not cured but more importantly I was not made worse.

Re: diagnosis of TTS -- to all the all knowing out there??

LARA on 7/09/04 at 10:04 (154925)

Tests can help. There can be a systemic problem (most common diabetes) which can be found with a blood tests. I think most doctors, even ones that don't know TTS, will perform this blood test. Peripheral Neuropathy is common with diabetes and the symptoms of PH and TTS have overhap.

The NCV test is the best test for determine TTS. HOWEVER, it is not definitive if the result is negative. the NCV test has few false positives - but false negatives are not uncommon.

And MRI can sometimes find something in the foot/tarsal tunnel that could be causing a problem. I think it is usually reserved for pre-surgical procedures, although I think there a large numbers who may do it diagnostically.

Good luck

Re: diagnosis of TTS -- to all the all knowing out there??

Marty from SLC on 7/09/04 at 12:54 (154949)

Thanks john, I remember you well but you don't me. I have had this condition going on 8 years and started coming to this site back in 1998 I think.

I have had one foot operated on for TTS and EPF. I like you I made the decision to have the procedure done while being wheeled into the operating room but for the EPF instead. This was my mistake I think somehow another nerve was pinched when the plantar was released and this is my problem now. I don't know if I can stand the pain in the other foot much longer and I'm thinking about getting TTS release proceedure and NOT! the EPF done this time.

From what I read from the article it seems to be saying there's different test they can perform to narrow it down. If this is the case I wanted to try and narrow it down. Your saying there's not a sure fire test to determined whether one has TTS or another condition like PN. Is this what your thoughts are?

Re: diagnosis of TTS -- to all the all knowing out there??

Marty from SLC on 7/09/04 at 13:01 (154951)

Hmmmm it seemed to me that this artical was saying there's other conduction tests or rather differant places to test to narrow it down. I really would like to rule out PN. I have been tested for diabetes among other things already.

Thanks Lara,


Re: diagnosis of TTS -- to all the all knowing out there??

john h on 7/09/04 at 14:53 (154971)

Marty I understand how you feel. When you are in enough pain you will opt for almost anything. I have seem some post on the board they would prefer to have their foot amputated than live the way they were. We have had people on the board who have been in wheelchairs for over a year. A couple of them disappeared off the board and I often wonder what happened to them. Fortunately for me I am in the 2-3 level of pain. Enough to screw up my former active life but not bad enough to drive me to more drastic procedures. I did not know many doctors were still doing endoscopic PF releases anymore. I thought most had gone to minimally invasive surgery as many people were experiencing nerve damage from endoscopic surgery. I agree with my Doctor when he said there is no fool proof test for TTS. I think this is where 'art' comes into medicine. Your Doctor will look at all the various test results and with his experience offer you an option based on his findings. I have bilaterl PF and the question I always pose is what are the odds of having bilateral TTS with the same pain on the same spot on each foot. These seem like long odds to me. If your Doctor is CONVINCED you have TTS then I would go for it. I did go for it but I asked him ahead of time what were the odds this could make me worse and he said in only one case over 15 years had one of his patients become worse and she was a diabetic. How many Doctors have told you that you have TTS and have any advised surgery? It is all going to come down to you making the call. I do not recall many on the board having TTS surgery other than me. A lot of people discuss it. I am always interested in talking to someone that has actually had a procedure before I try it but never did talk to anyone about TTS release and as you know made my decision on the way into surgery. My best wishes for you..

Re: diagnosis of TTS -- to all the all knowing out there??

john h on 7/09/04 at 14:56 (154973)

Marty I clearly remember you but did not associate your name with the problem we discussed some years ago. Do you have bilaterial problems?

Re: not EPF sorry

Marty from SLC on 7/09/04 at 15:55 (154984)

Yes I have bilaterial pf problems and over the years most of our dicussuions were about pain medicaitons. If I remember correctly you are a big advocate of pain control. It's been about a year since we talked I think.

I'm sorry my mix up but I did not have EPF, I'm not sure what the term is but it's where they leave about 1/3 to ¼ of the Fascii attached. Oh man I wish I could take that part of the surgery back. Not that it's bad but it takes allot longer to recover from that TTS surgery. It least for my that is, I still can't walk correctly from pain on the bottom of my foot due to that surgery where the TTS incision is pretty well healed all up.

So you have had botht pf and tts surgery and still can't return to normal activity? How long did it take you to get back to a level 2-3 in pain?

Re: not EPF sorry

john h on 7/10/04 at 09:15 (155028)

Marty for most of my PF life it is been around a pain level of 2-3 with an occasional spike to 5. I have never had the pain of so many that report crawling, missing work, etc. I have never found a pain medication that helped PF and I have tried many. Brian (where are you) was our resiident pain control expert on drugs. There are a lot of people on the site that have reported very bad results from surgical release of the fascia. Some Dotors release the entire fascia and some less. The Doctors say they due it by feel so they cannot be exact as to how much they release unless they realease the entire fascia. My fascia release only released about 10% and really should not be called a fascia releas because that was or is not its intended purpose. It was called the Baxter procedure. a 1/2' half moon piece of fascia is removed where it attaches to the heel so you are releasing 1/2' of fascia. this piece of fascia is located over the Baxter Nerve and Dr. Baxter's theory is that much of the pain is caused by an inflamed fascia pressing on the Baxter Nerve. When I pull back on my toes I can clearly see all the fascia protruding through the skin so my foot structure is still very much intact. Dr. Baxter is quoted in many medical journals and is considered an expert in his field. Not many Doctors are trained in this procedure and they will be Orthopedic Foot and Ankle Specialist. The real plus for this procedure is that if it does not work it is rare for your foot to become worse. Only a small incision and a 25 minute procedure at most. Of the three surgeries I had at the same time TTS,Baxter Procedure and Chelictomy the Cheilectomy was by far the worst as they removed some bone in the joint of the big toe. That indeed does cause some pain. I was on crutches for 2 weeks, driving in 3 days and back at work in 4 days. I should have been smarter and stayed in bed for a week.