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TTS Surgery Question Dr Ed Or Dr Pearl

Posted by J. Shockey #80 on 10/06/04 at 19:12 (161070)

Dr,

I would like to know if tts surgery without me having any numbness or tingling or burning is risky and can i end up with these symptoms after a tasrsal tunnel release tenosynovectomy?

Note: I have had this for 1 year and tried all conservative measures, injections 2, cast, rest, phy therapy, nsaids, several orthotics.

I have had an NCV test which indicated only minimal irritation to the posterior tibial nerve. My MRI showed tenosynovits in the FHL, and FDL tendons and the pain is present below the medial malleous.

The pain is present at rest , but is more agravting when i am on my feet for 1/2 hour or more. I cannot mow my lawn due to the uneven ground.

My foot and ankle doc says 50% success rate. He has done only 40 of these operations in 5 years.

What would you do if it was your foot??? Thanks doctor!!!!!

Re: TTS Surgery Question Dr Ed Or Dr Pearl

Ed Davis, DPM on 10/06/04 at 20:27 (161074)

Having done 40 is not a low number because TTS does not occur with a very high frequency. Also, if it is a mild case, which you seem to be saying here, why is your doctor not treating it conservatively?
Ed

Re: TTS Surgery Question Dr Ed Or Dr Pearl

J. Shockey #80 on 10/08/04 at 07:06 (161136)

As I stated he did treat it conservatblity for 1 year!!!!!!

What do you thing about the surgery?

Re: TTS Surgery Question Dr Ed Or Dr Pearl

Ed Davis, DPM on 10/08/04 at 14:50 (161175)

What, specifically were the conservative treatments?

Surgery has an approximate 2/3 success rate so one has to weigh the severity of symptoms, the response or lack of response to conservative treatment while be willing to accept that there is a 1/3 chance that the surgery will not work.
Ed

Re: TTS Surgery Question Dr Ed Or Dr Pearl

J. Shockey #80 on 10/09/04 at 07:16 (161190)

Dr Ed, Thanks for replyling

Conservative treatments included:

Rest
Ice/Heat
Hard cast immobilization 6 weeks
3 pair orthotics - including powersteps purchased off this site
accupuncture
phy. therapy- stretching iontophoresis, phonphoresis
2 cortisone injections but NO more
Current;y trying Active release therapy which provides some relief
Bextra 20mg for 3 weeks

Also DR Ed is their a chance the surgery can make my condition worse off?

Re: TTS Surgery Question Dr Ed Or Dr Pearl

Ed Davis, DPM on 10/09/04 at 09:48 (161199)

I would give surgery about a 10% chance of worsening things. One thing I would have added is use of hyaluronidase, an enzyme that is specific for alleviating scar tissue about the tarsal tunnel. Important: it is singinficant to treat the 'entire' tarsal tunnel, that means the area from the level of the ankle bone to the arch (porta pedis) where the nerve turns into the foot.
Ed

Re: TTS Surgery Question Dr Ed Or Dr Pearl

Kathy G on 10/09/04 at 10:16 (161204)

I don't know....the Jeremey Shockey I watch would never treat anything conservatively! For that matter, he wouldn't let a little thing like TTS stand in his way, he's just mow it over.

No offense meant :) - I just had to respond to your user name and I'm very sorry to hear that you're experiencing the pain of TTS, a truly horrible condition.

Re: TTS Surgery Question Dr Ed Or Dr Pearl

Dr Ben Pearl on 10/11/04 at 19:45 (161303)

It sounds like you gave the conservative routes ample time.