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Dr Z and Wander and DAvis

Posted by KIKI on 1/19/05 at 17:08 (167551)


I have been struggling with FHL TEnosynovitis,tibia neurits in ankle for 15 months and am contemplating surgery. I HAVE NO NUMBNESS, TINGLING, BURNING OR SHOOTING TYPE PAIN, just persistent pain in the inner ankle and have diffiuculty standing for more than 20 minutes without pain. I can sleep at night with no problems of it awakening me. My only problem is pain which is been persistent. I have tried orthoics with a first ray cutout with no success, as well as casting 1 month, PT, 2 cortisone injections and difeerent shoes and ortotics.

I had a nerve test which showed MINIMAL nerve irritation of the post tib nerve and no severe frank tarsal tunnel syndrome and an MRI with FHL Tenosynovitis.

Doctor wants to perform a tarsal tunnel release with FHL tenosynovectomy, and says 50/50. Is this surgery warranted/risky based on the results I've given you of tests and treatments?

Could I end up with numbness tinging burning and shooting pains which i dont already have? I HAVE CONSTANT PAIN behind the medial malleous and is localized and really hurts with prolonged standing or walkimg. I did get 3 opinions regarding surgery.

1. Orthopaedic surgeon-50/50
2. Neurologist- Told me based on my nerve test he would not do it. He said if i had severe TTS he would caonsider it. Told me to trest it primarily as the tendinits, but for 15 months??????
3. Poditrist- Told me surgery is warranted , but unpredictasble and said to try pain management.

Please HElP

Thank you very much

Thanks for your advice.


Re: Dr Z and Wander and DAvis

Dr. David S. Wander on 1/20/05 at 07:16 (167581)


This is obviously a tough case and a tough situation. If there is no tarsal tunnel/nerve involvement, entering the tarsal tunnel may open a new can of worms. However, the FHL does run through the tarsal tunnel and if that is the area of tenosynovitis there is no other way to perform surgery on the tendon without entering the tarsal tunnel.

50/50 odds are not what you want to hear, especially if you trade one pain for another. Lately, prolotherapy has been receiving a lot of media attention with some pretty positive feedback. There is an M.D. in my area that I'm friendly with that performs prolotherapy and he relates great results, and he's not a 'quack'. Prolotherapy is not covered by insurance companies, but may be something you should at least research prior to surgery. You've waited for 15 months, a few more weeks of research may be beneficial. If you have difficulty finding someone in your area, let me know because I know that there is an 'official' site. I have no personal experience with prolotherapy and have heard mixed reviews for plantar fasciitis, but I believe that joint and tendon problems are supposed to respond well. Keep me informed.

Re: Thank you Dr WAnder Question??

KIKI on 1/20/05 at 18:03 (167633)

Dr Wander,

I have had 2 cortisone injections a year ago and they did not do much to relieve pain.

The surgeon told me NO MORE injections as it is possible to weaken the tendon to produce a rupturing. Does Prolotherapy involve injections and would there be risks of tearing the tendons???

Thank you God Bless

Re: Sorry Dr Wander one more thing....

KIKI on 1/20/05 at 18:33 (167634)

Dr Wander,

I think this year is the time the EAgles go to the superbowl.

Quick question about this surgery i am contemplating. The tarsal tunnel release as you said must be done to reach the FHL tendon for tenosynovectomy. When this Flexor Retinaculum is 'cut' will the tendons and nerve contained still be supported? I am thinking these structures will no longer be supported, as the flex retinaculum holds the post tib FHL, FDL in place?? Correct me if I'm wrong?

Will the flex retinacul regrow over and possibly entrp my nerve ??

Have you ever performed this type of surgery and what was the success rate or average outcome?

Thanks again!!! Go EAgles

Re: Sorry Dr Wander one more thing....

Dr. David S. Wander on 1/20/05 at 18:54 (167637)

Prolotherapy is a series of injections used to strengthen, not weaken tendons. It is COMPLETELY different than cortisone injections and acts in a completely opposite way. Cortisone inhibits inflammation, and prolotherapy actually causes inflammation. I'm not a prolotherapist, but the idea of prolotherapy is to kick start the body into healing itself, similar to ESWT. I would strongly suggest, as I did before that you actually take the time to research prolotherapy, rather than trying to guess what it is or isn't. I certainly think prolotherapy is worth at least looking into, prior to a surgery that may leave you with additional problems. Yes, I have performed surgery on the tarsal tunnel, but I have not performed surgery in the tarsal tunnel solely for the purpose of cleaning up a tendon. There is basically an 'envelope' that the tendons, nerve, artery and vein run through. The roof of this retinaculum is simply opened to decompress the area. It does not result in lack of support.

Once again, please do yourself a favor and at least do some reasearch on prolotherapy to allow yourself to make a completely educated choice prior to surgery.