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Strassburg sock Dr Wander

Posted by Tony Graziano on 7/25/04 at 08:01 (156226)

Dr WAnder,

Would you reccomednd the Strassburg sock for any tendonitis problems , such as Flexor Hallucis longus tendonitis or is it streiclty for plantar faciaits?

Thank you Tony

Re: Strassburg sock Dr Wander

Dr. David S. Wander on 7/25/04 at 20:08 (156240)

Tony, that's an excellent question. The Strassburg sock is used for plantar fasciitis to help stretch the Achilles tendon and intrinsic muscles of the foot. You really can not directly stretch the plantar fascia. If you have been diagnosed with FHL tendinitis, stretching it may cause more discomfort. If the discomfort is secondary to tightness of the FHL the Strassburg Sock may be of some benefit. Since I haven't examined your foot and don't know the cause of the tendinitis, you should speak with your doctor or physical therapist. Where is the pain from your FHL? The FHL passes down the back of the ankle and runs down the back of the talus. Often, there is a small fracture at the posterior aspect of the talus, and this is irritated when the FHL tendon passes over the area. Let me know exactly where your pain is along the tendon.

Re: Dr Wander Thank you Pain is located near....

Tony Graziano on 7/26/04 at 08:59 (156251)

Dr Wander,

Thank you for your response. My pain has been ongoing for 10 months and it is present at rest, but more pronounced upon weightbearing, and prolonged standing and walking. The pain is very localized which is just on the inside of the ankle, below the medial malleous.Supposedly my doctor says it is in the tarsal tunnel region if that helps you any. My doctor diagnosed me with having FHL/FDL tenosynovitis documented on MRI and also said I have tibial neuritis. My NCV study stated I have very Minimal irritation to the post tib nerve. I am able to raise up on my toes from a standing position with no excruciating pain , but the pain is present even at rest.

There is absolutlety NO NUMBNESS, TINGLING, BURNING, OR SHOOTING TYPE PAIN ASSOCITED WITH MY problem, just strictly pain and very tender to touch and discomforting.

Conservative treatments tried with no success.

Massaage, ultrasound, 2 cortisone injections - which gave me slight relief but only for a week. , short leg cast immobilization for 4 weeks as well as crutches for an additional 4 weeks but in a soft boot cast.

Accunpuncture, Nsaids, 600mg neurontin for 2 weeks, ibuprofen cream on this website, ( funny thing is it helped quite a bit, but for only the first application, not sure if it was the ibuprfen or lidocaine in it?
3 pairs of orthotics, which i cuurently have soft cork type material.

PT- iontophoresis,phonophoresis, streching seemed to aggravte the area when looping a towel around my toes and pulling forward.

My Doctor wants to perform a TENOSYNOVECTOMY OF THE FHL/FDL AND A TARSAL TUNNEL RELEASE WITH ODDS OF ONLY 50%.

I am currently trying Low Level Laser Therapy at a chiropractors office and is quite expensive, and see no reduction in pain after 7 visits already.

Can you offer me any advise on what else I can try and what you think about surgery? I am 33yr old male and am taking lexapro and bextra currently to combat the pain and depression with this.

Thank you Dr WAnder

Tony

Re: Dr Wander Thank you Pain is located near....

Dr. David S. Wander on 7/26/04 at 17:28 (156294)

Tony,

First, I would definitely stop the chiropractic treatments that you have said are expensive and of no benefit. Have you had a second opinion regarding the surgery? Have you seen a physiatrist or pain specialist? Does your doctor have experience with performing this procedure? With the symptoms you've described, I do not believe the Strassburg sock would be beneficial. Has your doctor performed any blood tests to rule out any other disorders? If everything conservative has failed, and you have confidence in your doctor, and your doctor has significant experience with the proecedure, surgery may be the next alternative.

Re: Thank you Dr. DAvid Wander please note...

Tony Graziano on 7/26/04 at 18:32 (156298)

Dr WAnder,

To answer your questions is the Low lewver laser therapy a scam?
I have had 4 opinions regarding the surgery.

2 podiatrists- said surgery is 75-80% success

2 foot and ankle orthopaedic surgeons say 50% and the other says unpredicatable numbers to put on it.

I have not seen a pain specialist and would you reccomend this before surgery?

I did have blood tests including thyroid,infalmmatory, etc. all normal..

Dr WAnder I would like to ask you an important question. One of the podiatrists i saw for a consultation for surgery suggested to try a Arizona ankle brace for my FHL/FDL tenosynovitis before attempting surgery. How do you feel about the success i might have with an Arizona ankle brace? The pod said I would be essentilaly immobilizaing the ankle area , but still able to walk. I already have a ankle brace that is nylon with velcro strapsd supporting both sides of the ankle and it is a lace up type. It was not custom made and cost me only $25. It feels to give me some support than compared to not wearing it , but is constrictive and tight fitting. Could an Arizona actually be the answer to my problem or not?

Your medical opinion is greatly appreciated.

Re: Strassburg sock Dr Wander

sean g. on 7/27/04 at 05:02 (156320)

Is the sock good for treating achilles tendonitis? what are other method? hot and cold contrast? ultrasound?

Re: Thank you Dr. DAvid Wander please note...

Dr. David S. Wander on 7/27/04 at 07:48 (156326)

Tony,

I won't comment on whether the chiropractic laser therapy you are having is a scam. I will recommend that you search the internet for LEGITIMATE studies showing the efficacy of this treatment. This should be from a well known medical journal. If you find this information, please let me know the journal and the article for my review.

The Arizona Ankle may not be the 'answer' to your problem, but may be a temporary solution. If you have some relief with the OTC ankle brace, the Arizona ankle should be more sucessful. It is more supportive than the OTC brace and is custom made, therefore should be much more comfortable, and if it's not it should be adjusted. The Arizona ankle is basically an immobilizer that limits subtalar joint range of motion and provides support. This can certainly calm down your discomfort and may actually eventually help your problem resolve. Sorry, I don't remember, but did your doctor try putting you in a cast to immobilize the area for a few weeks to let things calm down? If he/she didn't this may be another simple option.

Re: Thank you Dr. DAvid Wander please note...

Dr. David S. Wander on 7/27/04 at 07:58 (156327)

Tony,

There is a website thorlaser.com that has some research papers referenced. You may want to review the papers on this site, but keep in mind that Thor is the manufacturer of a low level laser.

Re: Yes I was casted for 8 weeks

Tony Graziano on 7/27/04 at 18:10 (156363)

dr wander,

thanks for the advice. I was casted for 4 weeks in a hard cast and 4 weeks in a soft boot cast which did not aggravate it , but i still felt the pain. I probably opt for the surgery. How does a doctor do a tendon debridement and is it really successful and won''t there be more inflammation?