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TTS symptoms? Help! (long post)

Posted by Michelle on 9/21/04 at 20:37 (160288)

I've had foot pain for about 4 years now. It started in my right foot and then migrated to my left. I was diagnosed with PF and treated conservatively (stretching, phys. therapy, night splits, orthodics) but the pain didn't go away.

So I had a cortizone shot. This didn't make things better but just made them worse. I developed a new pain right along the injection line. It is least intense right when I wake up or after resting for a while and most intense after standing for more than 5 mins. The pain runs along the inside of my foot/arch between my big toe bone and my ankle bone.

One day after going figure skating (which remarkably didn't usually hurt things) I took off my boot and my foot seized up with unbelievable pain. So, the docs immobilized my foot for 6 wks thinking it was just PF.

While I was immobilized in the soft cast my foot swelled up especially around the ankle. It also became hypersensitive (I couldn't comfortably lay it on the bed). When I stepped on it, I had shooting 'zinging' searing pain across my heel and lower ankle. These shooting pain synmptoms eventually went away on their own, but the same pain I went into the cast for (pain along the iside of my arch) still stuck around. This pain is best in the morning and worse after standing for about 5 minutes or so.

Now the docs think it is nerve related. Intially they thought it was RSD, but now they are thinking TTS or nerve entrapment. They have me scheduled for am EMG but I am afraid that this test will make things worse. The only other time I had needles in my foot (ie - cortisone shot) I ended up with constant pain at the injection site. Has anyone had lasting pain from this test?

At this point I just don't know what to do or who to trust. I have bounced around between 4 doctors over the last 4 years and no one seems to be able to help. Any advice on whether these symptoms seem to be TTS related or not would be greatly appreciated.

Re: TTS symptoms? Help! (long post)

Terri on 9/21/04 at 21:05 (160291)

Michelle,

Was there a particular activity that you think may have caused the pain in your right foot 4 years ago? It could be the left acted up because you were over-compensating for the right. What other tests have you had done and besides the casting, what treatments are you trying?

I don't know of anyone here who's reported lasting pain after an EMG. The needle is very short and the administering neurologist doesn't need to go as deep as is needed for a cortisone shot. It can be a little uncomfortable, yes, but no need to fear this one.

If you still don't feel you have an adequate dx, take your test results to a sport's dr as a next step. I've read many posts here where people have found help or a confirmed dx and treatment plan that way. Good luck to you!

Re: TTS symptoms? Help! (long post)

Darlene on 9/21/04 at 21:50 (160298)

At your next doctor appointment ask them to show you the course of the posterior tibial nerve. It comes around behind the ankle bone (very close to the bone) and then below the bone with one branch innervating the arch of your foot. So it could be tts. Another question is whether it is getting entrapped within the tarsal tunnel or at another point.

An MRI would be helpful to show any possible obstruction in the tt.

Darlene

Re: TTS symptoms? Help! (long post)

LARA on 9/21/04 at 21:50 (160299)

One day after going figure skating (which remarkably didn't usually hurt things)

I hadn't thought about ice skating but it makes sense to me. I find that the flexing motion of walking, or swimming, or running, etc, that causes the most problems. So I find the only aerobic exercise I can do are things with minimal flexing at the ankle. Ice Skating might fit because the shoes are laced high and tightly.

Re: TTS symptoms? Help! (long post)

LARA on 9/21/04 at 21:53 (160300)

I agree with Terri & Darlene. I finally got help when I found a sports doctor (be it podiatry or orthopedic surgeon, or osteopathy). Also the NCV/EMG was sort of like a visit to the dentist. Not a peak experience, but I can handle it just fine.

Re: TTS symptoms? Help! (long post)

Michelle on 9/21/04 at 23:42 (160314)

Thanks for the advice on the EMG test. I'll be brave.

As for what caused this whole thing. At my job I routinely stand 10 h and I was an avid runner. That started the PF. Then it transfered to my left foot just from the overcompensation.

To make matters worse, after the cortisone shot I did step aerobics for 2 months (until the pain became REALLY bad). Since then I have done nothing. lots of sitting.

The only 'treatments' I have been doing are stuff I was told to do for plantar fasciitis - ie. I stretch the calf and foot by using a towel, I do my exercises for PF and I am going to physical therapy where they are focusing on strengthening my plantar and ankle muscles. I wear a night splint and ice. I haven't been standing or walking much in the past 6 months. I use crutches to get around but I am trying to wean myself from them when I can.

If you have any advice on how to prevent TTS from getting worse - some conservative strategies (ie - non surgical) i'd love to hear them.

Thanks again!
ps - lara .. skating boots made my feet feel good but if you try that I would reccommend a really good pair of boots. Most beginner skates are fairly flexible and might not offer the support that you need. I was a competitive skater when I was in high school and college so my skates are REALLY stiff (ie I can't really bend them with my hands). That way there is no way that the ankle bends.

Re: TTS symptoms? Help! (long post)

Terri on 9/22/04 at 06:30 (160323)

Do a search here using Lara or Marie's name(s). They've both posted a detailed list several times of treatment options that have worked for them and/or others. You may want to look at some supplements also, especially B-6, B12 and E as they are essential to nerve health.

Re: TTS symptoms? Help! (long post)

jimmy on 9/23/04 at 20:24 (160422)

I had an e.m.g and had no pain whatsoever,after the test was done.The shock portion may not be fun for you though.I asked the doctor how far the needle was going to go,and he said only like a 10th of a mm.it's nowhere as bad as cortizone shots are.you should do it for sure.waiting in the lobby will probobly be worse.I hope this helps.

Re: TTS symptoms? Help! (long post)

JEANNIE B on 9/27/04 at 16:22 (160601)

I HAVE HAD PF FOR OVER A YEAR NOW FROM LIFTS THAT THE DR. SUGGESTED USING BEFORE MY ORTHONICS WERE READY. I DON'T KNOW WHY IT CAUSED THIS BUT IT DID. I HAVE DONE ALL THE PT AND GOT SOME RELIEF FROM AN ACID BATH. TWO MONTHS AGO I STARTED WATER PT AND HAD RELIEF FROM THE VERY FIRST TREATMENT. NOW FOR THE FIRST TIME IN OVER A YEAR I NO LONGER WALK LIKE A DUCK.

Re: TTS symptoms? Help! (long post)

Michele on 9/29/04 at 16:22 (160700)

What is water PT? How is it different from normal PT?