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Taping Foot DR ED or Z

Posted by Daniel Killings on 12/15/04 at 19:09 (165690)

Dr ED or Z,

I had taped my foot for plantar facitis i found on a website because i walk many miles for my job on a daily basis. (6-7miles).

The taping was underneath the foot and around the inside of the ankle. I did this for 1 month for 8 hours a day and stopped after noting inner ankle pain near the tarsal tunnel.

I am now diagnosed with FHL/FDL tibia neuritis with mild latencty on emg of the post tib nerve. Also MRI shoed fluid surrrounding FHL known as tenosynovitis. My question is could the taping cause this mini tarsal tunnel syndrome or have you never heard such a thing? I did have the tape snug to provide support and wonder if it was the tape or not?

I have had this pain for 15 months and have tried every possible treatment.

My doc wants to do a tarsal tunnel release with a tenosynovectomy of the fhl tendon. I do not have any burning or numbnss or tingling just pain that is aggarcvated with prolonged standing or walking.

I went to 2 opinions :

One says 50% success, 25% no change 25% worse.

The other doc says unpredictable results and do not want to put numbers on it.

What do you personally think of this surgery and the success rate inviolved? Doc says i could devellop RSD, infection as risks, .

I am really undecided what to do!!\\

Thanks for listening!!!!!!!

Re: Taping Foot DR ED or Z

Ed Davis, DPM on 12/20/04 at 13:27 (165884)

Daniel:
Taping is great but not always for long term use as it can irritate the areas you mentioned. If taping works, then an orthotic should swork well too.
What conservative treatments have been advised or tried for your TTS and FHL tenosynovitis?
Ed

Re: Conservative treatmnets tried

Daniel Killings on 12/23/04 at 16:49 (166049)

include:

3 pair orthotics
ice,heat,
2 steroid shots
ultrasound
ART
Accupuncture
Light laser therapy- waste of money
streching aggravates it more
Bextra 20mg helps but cannot take long term

Re: Conservative treatmnets tried

Darlene on 12/23/04 at 19:05 (166057)

Daniel:

Apparently the current issue of Podiatry Today has an article on TTS and orthotics. I received the e-mail below from an orthotics lab.




Orthotic Communique: Orthoses for Tarsal Tunnel Syndrome Dec. 8, 2004



Dear Colleague,

New research is essential to support the therapeutic use of foot orthoses and to allow us to improve our orthotic prescriptions and outcomes. Today we will look at research that examines the relationship between heel eversion and tarsal tunnel syndrome.

Larry Z. Huppin, DPM; Medical Director
Paul R. Scherer, DPM; CEO and Education Director

ProLab Orthotics/USA

Use Orthoses to Control Rearfoot Eversion for Tarsal Tunnel Syndrome

For decades, conservative treatment of tarsal tunnel syndrome with orthoses has been based on anecdotal evidence. A study by Trepman and Kadel, published in Foot and Ankle International, provided documentation that eversion of the calcaneus (pronation of the STJ beyond perpendicular) might have a causal relationship to tarsal tunnel syndrome. This study demonstrated that increased heel eversion resulted in higher tarsal tunnel pressure. The mean pressure when the foot was in neutral was 2 mm Hg, increasing to a mean of 32 mm Hg in full eversion. The results of this study support the hypothesis that increased pressure within the tarsal tunnel when the foot is everted may contribute to posterior tibial nerve entrapment.

How can we use this research to make a better orthotic for this pathology and improve the clinical outcomes for our patients?

Since calcaneal eversion affects tarsal tunnel pressure, then the medial heel skive technique would be an ideal correction to use when treating tarsal tunnel syndrome that presents with calcaneal eversion. This cast correction technique essentially creates a varus wedge inside the heel cup to elevate the medial side of the heel cup. This increases ground reactive force on the medial side of the calcaneus and can position the everted heel in a more neutral position. Theoretically, this reduction in calcaneal eversion will decrease the pressure in the tarsal tunnel and reduce symptoms. The amount of medial skive prescribed should be proportional to the amount of calcaneal eversion in stance.

Ref: Trepman, E, Kadel, N, Foot and Ankle International 20(11):721-6, 1999.

Rethinking Tarsal Tunnel Syndrome

For more information on tarsal tunnel syndrome, refer to this month's article by Dr. Scherer in Podiatry Today.

Podiatry Today (Dec 2004) article on Tarsal Tunnel Syndrome

UPCOMING SEMINAR - Florida Podiatric Medical Association: Science and Managment Symposium (SAM)

January 12 - 16, 2005
Orlando, FL

Dr. Larry Huppin will be in Orlando to lecture in the Biomechanics track of the Florida annual state seminar. Dr. Huppin will be available at the ProLab booth in the exhibit hall for any questions about orthotic therapy and/or biomechanics.

Florida Podiatric Medical Association - SAM Symposium

UPCOMING SEMINAR - New York Podiatric Clinical Conference

January 21 - 23, 2005
New York, NY

ProLab is coming to New York City! If you are attending the NY state clinical conference, make sure you come by the ProLab booth to meet Dr. Paul Scherer and learn more about orthotic therapy.

New York Podiatric Clinical Conference




--------------------------------------------------------------------------------

ProLab Orthotics/USA
575 Airpark Road
Napa, CA 94558
Phone: 800 477 6522
Fax: 707 257 4420
Web site: http://www.prolaborthotics.com
E-mail: (email removed)



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Re: Conservative treatmnets tried

LJ Smith on 12/25/04 at 06:38 (166103)

Darlene,

I am confused . What do theyh mean by heel eversion? Is this meaning the higher the heel the more pressure on the tarsal tunnel area? I tend to notice an increaee in pain when i wear my mens dress shoes with a elevated heel, as to when i wear my new balance sneakers which are flat.

Thanks for the info.

Re: Conservative treatmnets tried

Darlene on 12/25/04 at 13:56 (166118)

I think eversion refers to a sideways turn. For example if you pronate, your ankles come in and your heel goes out (I think).

I hope a doc could comment on this.

Re: Conservative treatmnets tried

Dr. Z on 12/25/04 at 14:25 (166119)

Hi

Pronation is a tri-plane motion. It looks like the heel-arch are turning in. The eversion part of the tri-plane motion is where the heel inner edge is tilting inward, toward the inside of the body. I will try to look for a picture of this on the web. It is a very complicated motion. Pronation is normal during the walking cycle. It is when it becomes excessive that problem can start.