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Surgeon Recommendation Needed; Questions to ask

Posted by John MG on 3/07/05 at 11:46 (170606)

My girlfriend was recently diagnosed with bilateral TTS; her feet have been progressively getting worse over the last few months. She can walk fair distances with some (not extreme) pain; steps give her the most trouble.

Can anyone recommend a good surgeon to perform the TT Release surgery for her? Although she's already sick of going to the doctor, I am making her make another appointment so I can ask questions on her behalf. You all might find the list I've composed to be worthwhile (for those of you considering the procedure); please let me know if there are any good questions I might be missing!
- What are the other recommended methods of providing relief/making it a livable condition without surgery (ex: orthodics, acupuncture, massage, compression socks?), and how long should each be tried before giving up on them?
- What is the proper process for orthodics? No direction was given in how to 'break into them'- should they be tried more, possibly in a more gradual way (a few hours a day, gradually increasing)? Would it be more helpful if there were orthodics that were more 'cushiony'?
- Is there any belief that cortozone shots or ultrasound therapy could be helpful, either in place of, or to supplement the surgery?
- Are lidoderm patches helpful in relieving pain for this condition (either before or after the surgery), and would this be a good case for them?
- I have read that Tarsal Tunnel Syndrome is not a well-defined clinical diagnosis and is somewhat controversial; what specifically leads the doctor to believe this is the problem? How confident is he in the diagnosis, and how confident is he that the Tarsal Tunnel Release surgery is the most appropriate way to make things better?
- What is 'Reflex Sympathetic Dystrophy Syndrome (RSDS)', and does it have any interplay in this case as being something that could be exist either before the surgery, or after the surgery if it is not successful?
- Has an EMG test been done, and what were the results of it (positive or negative, & what are the specifics)?
- Has a Nerve Conduction Test (NCV) been done, and if so what were the results of it?
- Is there an 'identifiable mass' (scar tissue, growth, etc.) causing the condition?
- What is the likelihood that the condition could recur several months or years down the road?
- Why do you suggest that physical therapy is not needed?
- Are the existence of vericose veins in other areas of the feet/legs help or detract from the diagnosis? Is there a vericose vein going through the tarsal tunnel on the MRI?
- Is it important in the diagnosis to know about your back pain? Could it be related, and if so, how?
- Is there any indication of Plantar Facitis?
- Has the doctor checked the 'high tarsal tunnel zone' (about 4 inches up from the ankle)? I have read that a major reason these surgeries fail is because the doctor hasn't checked for compression far up the ankle
About the surgery:
- Can a local anesthetic be used instead of a general?
- What precautions can be taken to minimize the amount of scar tissue after the surgery (scar tissue can cause the tarsal tunnel surgery to reappear)?
- On a scale of 1-10 (1 being no tarsal tunnel, 10 being an extreme case of it), what is the severity of the tarsal tunnel syndrome in this case?
- We know that if the surgery is a success, the pain will be 70-80% better; however, how likely is it that the surgery is a success- I have read that many are not successful.
- If the surgery is not a success, what could result?
- What are the odds of 'making things better', 'things staying the same', and 'things getting worse'?
- When will the doctor know if the surgery is a success? How is the success of the surgery rated (is there a scale from 1-10 or something similar)?
- What pain relief medicine is usually prescribed; is tylonel (maybe prescription strength) worth looking into, as has been more helpful then Vicaden & Percocet?
- How often does the doctor perform this tarsal tunnel release surgery? (Ex: a few times a week, a few times a month, a few times a year)
- How many times has he done this surgery?
- How many years has the doctor been performing this surgery?
- Where and by whom was the doctor trained to perform this surgery?

Re: Surgeon Recommendation Needed; Questions to ask

Darlene on 3/07/05 at 12:56 (170614)

2 docs with good reputations are Dr. Dellon in Baltimore and Dr. Deland in NYC. I've also read research by a Dr. Sammarco.

It is interesting that you mention that long distances are easier to walk than steps. I find working in the kitchen to be the worst.

What diagnostic tests has she had?

You are a nice boyfriend!

Re: Surgeon Recommendation Needed; Questions to ask

John MG on 3/07/05 at 14:30 (170627)

She's had an MRI & EMG done, although I'm not sure of the specific details of each.

Another ?- any thoughts on the role age might have on recovery; my thought is that the younger the person is when they have the surgery, the more likely they might be to have a good response to the surgery, but I was wondering if anyone had any details??

Re: Surgeon Recommendation Needed; Questions to ask

denise g on 3/07/05 at 19:15 (170659)

I had tss surgery with Dr. Deland in NYC at the Hospital for Special Surgery in Oct. I had excellent results, no pain at all now. He diagnosed it strictly through a hands on exam, mri showed nothing. Good luck. He's worth the trip, there are people from all over the U.S. and other countries in his office. I had to wait 3 months for an appt. but it was worth it.

Re: Surgeon Recommendation Needed; Questions to ask

JG on 3/07/05 at 21:29 (170666)

Like your girlfriend, walking became very difficult for me. I had tarsal tunnel surgery on my left foot on Dec. 28, 2004. Tomorrow I am having surgery on my right foot. I am 48 years old, and I think I have recovered pretty well from the first surgery. My toes are still numb, but the burning sensation is gone as far as I can tell. Nerve regeneration is a long haul, so I have learned. I had time to do a month of physical therapy, which I believe helped. My surgeon is Jeff Dunkerley of Martin Foot and Ankle, York PA. He studied under Dr. Dellon, and I would not hesitate to recommend him. Best wishes to your girlfriend in whatever method she chooses for herself.

Re: Lists of Dellon trained Docs throughout the world.

Camilla on 3/08/05 at 09:58 (170683)

Hi, I have TTS in both legs. Had one leg done in October and it feels great so I am having the other one done in a few weeks. Here is a list of Dellon trained docs which I think is highly important in finding a surgeon.

my testimonial is also on there.

Good luck!

Re: Surgeon Recommendation Needed; Questions to ask

Dr. Wishnie on 3/08/05 at 12:07 (170694)

There are many reasons why people get TTS. You have mentioned several above. What treatments have been tried? What tests were performed? Surgery works about 50%. I have been using cryotherapy for this with great results. you can go to: stopfootpainfast.com to learn about the procedure. You can e-mail me the above info so I can give you more info.

Dr. Wishnie

Re: Surgeon Recommendation Needed; Questions to ask

cindyp on 3/08/05 at 12:43 (170701)

George Quill out of Louisville Orthopedic is a very good foot and ankle reconstructive surgeon. If you are in this general vicinity give him a try.

Re: Surgeon Recommendation Needed; Questions to ask

Darlene on 3/08/05 at 14:09 (170717)

Would you kindly explain what exactly is done using cryosurgery for TTS?

What are the risks?

How many have been done?

Is it a short term or long term answer?