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Why not choose surgery?

Posted by Kitty on 8/14/04 at 08:48 (157823)

I am so greatful for everyone's posts. I am curious as to why more people haven't choosen surgery to TRY to relieve them of their symptoms. It seems like there is a nerve in the foot that is being pinched. Why is it that surgery wouldn't be more successful in making a bigger opening for that nerve to pass through?? Second question. Does TTS always happen to both feet????? It seems so weird that both of my feet have the same exact injury and squeezing of the nerve.

Re: Why not choose surgery?

Terri on 8/14/04 at 09:04 (157826)

Oh, Kitty. That is a loaded question for sure!

First: any surgery has risks and the potential of complications. You need to be fully informed, understand these, have a dr with plenty of experience and SUCCESSES, then make an informed decision. But, try non-invasive techniques first please. Marie and Lara have both posted extensively on options to try. Do a search using their names and see if something you find may help you.

Second: not all of us have it bilaterally (both feet). I do and my dr thinks it's part of my physiology (the way I'm made)and my previous active lifestyle. TTS has been known as not being a 'lazy' person's affliction.

Re: Why not choose surgery?

cindyp on 8/14/04 at 12:17 (157844)

i chose surgery because it was a medical necessity. it seems if there is an identifiable problem ( the dr. can look at a film or whatever and say there is why you are suffering) the better the chance for help. also get a very good dr. i did and he saved my sanity as well as my life.

Re: Why not choose surgery?

LARA on 8/15/04 at 14:28 (157989)

Why not choose surgery?

1. All surgery has risks, but any surgery below the knee is more risky because the blood flow isn't as good as elsewhere in the body. Thus, any surgery on the foot should be considered more carefully. I had an orthopedic surgeon who really didn't know TTS tell me that if I could have a nice life without surgery, she wouldn't recommend surgery on the feet - it's just more difficult.

2. Surgery can cause scar tissue - which can cause TTS if you didn't already have it.

3. TTS is relatively recent in the history of medicine (first one in the 60's I believe). They are still learning the best cut to make, how far to go, who is a good candidate, etc. Several years ago I went to the local med school library to look up stuff. I went to the wall with orthopedic texts and found a HUGE book (probably about 8x/11 and 3 inches thick) on Feet and Ankles. There was about 1-1/2 columns on TTS. So there isn't a lot going on in med school across the board (I'm sure there are exceptions) about TTS.

4. Sharon (a prior frequent and very helpful poster, and nurse) once posted something about the statistics related to TTS. She herself had had surgery - after everything else failed - and did the research before deciding. As best I remember (and perhaps one of the doctors can correct me) she said most people where helped (not necessarily cured) by surgery. HOWEVER, about 10-15% were no better off and about 10% were worse off. Even those people who were helped had a long convalescence that interrupted having a normal life (driving, running after kids, etc) so it depends on your families obligations and resources sometimes whether you can even consider the idea.

One way to improve the odds is probably to go to someone who KNOWS Tarsal Tunnel Syndrome (a lot of doctors don't, including some doing research on TTS - one guy I went to who was doing research on TTS surgery was more interested (IMnever-to-beHO) in researching TTS surgery than in understanding the syndrome and how to best treat it). Among the several doctors I have visited I have been told it was Plantar Fascities, the first sign of diabetes (my blood tests were negative for diabetes) and it was in my head (2 different doctors - one is the TTS surgery researcher! - saying it about how I described my compression stockings working , not about having TTS)

The above among the reasons why most of us will say don't try it until all the other stuff doesn't work.

Re: Why not choose surgery?

Julie on 8/15/04 at 16:23 (158005)

And here's another to add to your list, Lara. I quote my own cancer surgeon (recently retired after 30-odd years of performing surgery: 'There is NO surgery that doesn't carry terrible risks'.

Not least the risk involved in any general anaesthetic.

Re: Why not choose surgery?

LARA on 8/15/04 at 17:32 (158011)

You're right Julie, anesthesia is another risk of any surgery. My understanding is the risk goes way down after you have survived one successful episode of being put under. Maybe one of the doctors can correct me if I'm wrong (my source is a statistician - I think).

Also, when considering TTS surgery (which I decided not to have yet) I asked about a local instead of a general and he said he couldn't do a local because he didn't want me to be able to move on him, but he would consider an epidural (or whatever it is that paralyzes the leg temporarily).

Re: Why not choose surgery?

LARA on 8/15/04 at 17:48 (158013)

Does TTS always happen to both feet????? It seems so weird that both of my feet have the same exact injury and squeezing of the nerve.

I wondered the same thing. It does seem odd. The standard answer from the doctors I've seen is 'the body is bilateral'. To which my response is yes, the body is bilateral but not perfectly bilateral, and my feet feet exactly the same. I don't have an answer, but I do have an observation to suggest the answer isn't the bilaterality of the body:

When I was first diagnosed the doctor only had one compression sock so he put it on the foot that had the worse reading on the NCV test and ordered another one for me. (interestingly, although the symptoms feel identifical on both feet, one foot registered more delay in nerve messaging than the other on the NCV test. Results: BOTH feet got better. So I did an experiment and put the compression sock on the other foot - and both feet got worse. Stopped that experiment and put it back on the first foot. I now wear compression socks on both feet because it just seems logical, although I don't believe it's necessary. One doctor told me it was in my head - the placebo effect where things work because you think they will (which of course doesn't explain why I would have expected it to work and secondly, why it didn't work if I put the sock on the other foot.)

HOwever, I did another experiment. Whenever I wear my compression socks and then take a shower, I come out of the shower with what I call a 'red sock'. This isn't anything remarkable - in fact I think it's predictable. It's just the blood rushing to the area that had been 'compressed' when the hot water streams over it. The redness is in the area that covers where teh compression sock had been.

I went back to wearing one sock for a couple of days. Then took a hot shower to see if I had a red sock on both feet. My hypothesis was that if it was something in the 'messaging system' causing symptoms in both feet although the problem was only in one foot, then maybe the treatment (compression socks) actually affected both feet when I treated the one foot.

AFter one day I didn't notice much. After two days I thought I noticed something. AFter three or four days of wearing the socks 24/7 I came out of the shower with 'red socks' on both feet - although I'd only been wearing the compression sock on one foot. I asked my husband to observe my feet and see if he noticed to be sure I wasn't seeing what I wanted/expected to see.

No one has ever explained it to me. I assume it has something to do with the nervous messaging system.

I mentioned this to my new podiatrist and she said 'Yea, I don't know why, but I've noticed that (treating one foot helps both feet) too so now I only give cortisone shots in one foot at a time at first, and see what happens.

Re: Why not choose surgery?

Julie on 8/16/04 at 01:32 (158047)

That's probably correct, Lara. I suppose that surviving one general anaesthetic indicates that you have no genetic or other inherent risk factors, so the risk now narrows down to external factors, like the skill of the anaesthetist and the functioning of the equipment used. But a risk is a risk, and statistics become irrelevant if you happen to be one of the unfortunate one-in-ten-thousand or one-in-a-million.

But if surgery is the only remaining option, whether in the case of a life-threatening condition or an constantly painful, disabling life-altering one, then surely it is realistic to have it. You have been so admirably patient and diligent in dealing with your TTS, and such a help to others who are dealing with it! If you ever do decide to have surgery, I know you will have made the decision after considering all the pros and all the cons. The people I worry about are those who start considering it before they've even got to first base with their problem.