Tarsal Tunnel

[UndercovrAngel]

In August of this year, I began having problems with my right foot. My PCP ordered x-rays thinking that I might have stepped on something that was embedded up in my foot. Boy what a shock when the x-ray showed a heel spur which led to the diagnosis of plantars fasciitis. But the pain didn't stop there.

Evidently the Dr that read the x-ray saw something on it that he didn't like, and the next thing I know, I am scheduled for an MRI of my foot. Although nothing conclusive was found, I was then scheduled to see an ortho Dr who did some tests and gave me orthotic inserts for my shoes and scheduled an appointment for me with a neurologist.

The neurologist did and EMG/NCS that showed signs of tarsal tunnel as well as well as problems with my l-5 /S-1 vertabrae in my lower back. He sent me for an MRI of my lumbar spine. There is some problems there, but he figured that PT would help as well as meds. He gave me a one month scrip and sent me back to the ortho Dr for the tarsal tunnel

The ortho Dr, without trying any other treatment for the tarsal tunnel told me that my only option was surgery. I underwent the surgery on October the 22nd. I have been on FMLA and receiving short term disability through my company. The Dr removed the stitches 2 weeks after my surgery, but I found one that he missed 2 weeks later, and just found a second on the 14th of this month. I haven't healed as quickly as he thought I should (originally had me scheduled to go back to work 3 weeks after the surgery) as I am flat footed, as well as diabetic. He now has me on 75 mgs Lyrica x2 daily, 50 mgs tramadol x4 daily, celebrex 200 mgs x1 daily and lortab 7.5/750 4 x daily.

I have had severe pain that has continued to get worse with each passing day. Even the touch of a sheet on my foot would bring tears to my eyes. I saw my ortho for the last time on Monday. He wants me to stay out of work for the last 4 weeks of my FMLA and believes that I have developed RSD /CRPS due to the surgery. I am currently waiting for his assistant to call me with an appointment with a cronic pain clinic. He stopped the PT that I was receiving, tells me to ice my foot and elevate it after being out and about, especially if I have driven, which is another story in itself. If a sheet on my foot brings me to tears, how am I supposed to withstand the weight of the ice ??

My question is, has anyone else had to deal with this after tarsal tunnel release ?? And if so, what they did to alleviate the problem. What should I do, if anything about the heel spur and plantars fasciitis ?? I know that they are in some ways contributing to the pain I am feeling. I can't walk on the bottom of my foot as normal people do, instead I have to walk on the outer part of my foot and I have lost most of the ROM (range of motion) in my ankle.

I have 4 weeks to get this straightened out before I loose my job, my insurance and my income. Any help will be greatly appreciated.

[pixielisa]

I had the release surgery two years ago and I'm having the same problem as you, although I was told that it's still just tarsal tunnel. Only worse and growing, apparently. I think what happened with both of us is that scar tissue built up from the stitches that weren't removed (I had that, too, along with a slow recovery). At the moment, I'm on Gabapentin and working on getting a sit-down job. I've been told that there's nothing else to do but manage the pain. So I've been trying every trick in the book.

Try an ankle brace with metal sides. For me, immobilizing the ankle has reduced the swelling and the pain, especially while I'm driving. Try to get an orthotic that has more cusioning. My leather ones absorb more of the shock from walking than my hard plastic ones, making it easier on the ankle.

Crush the ice and stick with it. It'll hurt at first, but the cold will eventually numb the area and help reduce the swelling.It might also help to keep your foot warm when it's cold, too. I think when the blood rushes away from the extremities, it cause as much pain as when it's rushing towards them. It's worth a shot.

Try proping your feet when you sleep, too. Sometimes I have the same problem with blankets and sleeping on my side. Both hurt. Proping my foot a bit on a stiff pillow reduces the swelling enough for me to sleep. On the worst days, I pop those horse-pill Motrins. They help...a bit...for a time. 800mg worth of the others is effective, too.

Unfortunately, I don't think any of this will be enough to save your job, unless they're kind enough to put you in a sit-down position. I was medically discharged from the Army because of my tarsal tunnel, and that was before the surgery. Right now I'm school for a sit-down career. I know that's not what you wanted, but you may have to consider changing jobs if your tarsal tunnel is that bad. Take the four weeks and weigh your options. Seriously weigh your options. If you hold on too tightly to what you know, you may end up losing everything.

[RobinSchares]

I have re-read your post and my heart goes out to you. I had to quit my job a year and half ago because of the pain (I was a waitress in a fast paced bar/restruant). I didn't know there was help for me such a disability etc.
I had a few questions for you regarding RSD and CRPS? What does that mean? How do you get it? I have paid over $5000 for these surgeries and I pay a monthly premium for health insurance for $250. Is there any way for me to get help to offset the costs of the medical bills as I am unable to work now and have been that way for a long time. In Nov. I had the final surgery for neruoma and tarsal tunnel in the right foot but it is a mess. They cut really deep and so they left the stitches in over 3 and half weeks. I don't think it looks good at all and still have considerable pain. How do you know if you have scar tissue?
Is there any help out there for me regarding bills and a job in the future.
How are you doing now? I don't think there is anything they can do for tarsal tunnel other than surgery. I didn't mind having it as the pain was bad enough but if I am still unable to be employed and have all these bills, then what was the point?
Explain what those things mean if you would please.
Thanks

[UndercovrAngel]

Robin,

In answer to your question, here is a website that explains RSD/CRPS. It basically has to do with the nerves between your injury/surgery sight and the brain misfiring.

[moderator note: website address has been removed]

I finally got an appointment with a pain management specialist for the 21st of this month, however, I am scheduled to return to work on the 16th. So it will be a week at work, taking meds that make me dizzy, drowsy and disoriented before I will get any help at all. I do have a sedentary job, making reservations for cars for AVIS rentals. We are, however, required to keep our stats at a certain level and give our customers the best experience so that they come back when they need a car again. I am afraid that my work will suffer as I am not at my best while on these meds.

Yes, I can stand up, but am tied to a phone and computer during my entire work day. So if we are back to back with calls, I can't stand up and try to type the info needed as this puts pressure on my L-5 /S-1 nerve in my lower back, which again, adds to the pain in my foot. And if I sit for to long, the pressure on the back of my leg makes the pain worse in my foot. Kinda darned if I do and darned if I don't.

My place of work, according to the lady that handles my short term disability is willing to work with me on any and all accomadations that I need in order to return. It will be interesting to see how they handle my having to keep my foot elevated, as well as being able to put ice on it through out the day .. and needing to get up and move away from my desk at least once every hour to keep the pain at a minimum. We do not have assigned desks .. so they would basically have to assign me one that no one else could use, and supply me with something under the desk to put my foot up on. We will see what happens.

As for help with medical bills, check with the surgery center or hospital where it was performed and see if there is anything that they can do / suggest to help with the cost. With having medical insurance, you don't qualify for medicaid. So if things get to bad, I would suggest dropping the insurance and getting qualified for medicaid. Although my insurance is good, I too still have a lot of bills that I need to pay for all of the treatment that I have recieved. Well over 1500.00. With all the other bills that I have to pay (rent, utilities, insurance on car, car payment, loan for downpayment on car, food etc.... ) and only recieving 70% of my regular pay, I have had to let the bills go. Many have already gone to collections and show on my credit report. I am seriously thinking of filing for bancruptcy here in the near future. I am waiting to see what happens when I go back to work and start receiving my full pay as to whether I can start to pay off the bills or not.

As for scar tissue build up .. I know that I have that, without any diagnostic testing. I had it happen back in 03 when I had surgery on my right wrist for de'queravains stenosing tenosynovitis. I had to have a scar revision surgery done to release my wrist. I can feel the lumps under the skin when I am massaging it at night when the pain is at it's worse. And to really kick things up a notch, I found a third stitch on the 28th (two months after they had supposedly removed them all).

My boyfriend, who has a fit over people filing frivolous law suits can't wiat for me to have this appointment and see what the specialist thinks. With all that has been happening (or didn't happen since this started .. IE.. the ortho only gave me heel cups for my shoes and a scrip for lortab, sent me for the EMG and then went right to surgery instead of trying anything else .. and there were many other options he could have tried that I am only finding out about now) he feels that the Dr screwed up BIG time and that there is the chance that I may be able to sue him for malpractice. We shall have to see about that after my appointment in 2 weeks.

I wish that I could give you better advice, but with being new to all of this myself.. I really don't know what to say. Would I have the surgery again.. knowing what I know now ??? Not until all other evenues of treatment had been explored and discarded. And I would have been better prepared for things here at home than I was. (I only had 5 days to get things together when the Dr decided that I needed surgery).

Stay in touch and let me know how things are going on your end.

Angel ^j^

[RobinSchares]

thanks for responding. I am seeing the doctor this Wed. It doesn't look good and I want to make sure everything is allright.
Thanks for the info.
Take care.

[UndercovrAngel]

Robin,

Sorry that they edited the web addy that I posted. But if you google RSD/CRPS there is a lot of information out there. I was also able to find out, that with medical agreement and records that RSD/CRPS is considered a medical disability that will be covered by SSDI (Social Security Disability income) so that if I can't get relief from this, and the pain management Dr tests me and finds I indeed do have it, and I can't continue at my job, I can apply for SSDI.

I have found a great deal of info on the net in regards to tarsal tunnel surgery. Many of the experts on the subject recommend that you start physical therapy within 2 or three weeks of the sugery so that you can retain the ROM (range of motion) in your foot as well as helping maintain strength on your leg. Most of the therapy has to do with heat, tens unit (electric stimulation) and ultrasound therapy. My dr waited way to long to start me on therapy, so it was basically a waste of time for me as well as a waste of money.

I went out and bought a pair of Dr Scholl's tennis shoes this weekend. They have the built in gel insole, as well as a heel cup to keep your foot aligned when walking and a great arch support (remember I am flat footed). They were under $30, and with the time that I wore them Saturday and Sunday, I got a great deal of relief. When I walk around my home barefooted, I end up walking on the outside of my foot. (I also was diagnosed with a heel spur and plantars fasciitis prior to tarsal tunnel and still deal with that as well). But with the new shoes, I can walk on my foot like a normal person would. I still ended up with a great deal of pain at night after I was trying to relax enough to go to sleep. I am hoping that the pain management Dr will be able to help me. I just HATE waiting around to get to see him. You might see if you can get a referral to a pain management Dr if you are still having problems this long after your surgery.

Hope that you get good news from your Dr Wednesday. Let me know what happens.

Angel ^j^

[UndercovrAngel]

[quote="pixielisa"]I had the release surgery two years ago and I'm having the same problem as you, although I was told that it's still just tarsal tunnel. Only worse and growing, apparently. I think what happened with both of us is that scar tissue built up from the stitches that weren't removed (I had that, too, along with a slow recovery). At the moment, I'm on Gabapentin and working on getting a sit-down job. I've been told that there's nothing else to do but manage the pain. So I've been trying every trick in the book. {/quote}

Pixie,

Have you seen a pain management specialist yet?? It sounds like we have a lot in common as to our surgeries. What with both of us finding stitches after they had supposedly been removed (real shocker when you find one well over 2 months after they say they took them out). I know that I have scar tissue buildup, as I can feel the lumps around the area in my foot where they did the incision. I am also having to deal with pain from a heel spur and plantars fasciitis due to being flat footed, and nueropathy from being diabetic. This doesn't add up to a quick and successful recovery. Which my place of business has a problem understanding.

The reason I ask about the pain management specialist ?? It sounds like you might also be a candidate for RSD/CRPS if you are still having pain this long after surgery. It might benefit you if you could be diagnosed as the treatment would be different than what you are getting now. If you have any of the following symptoms there is a good chance that you have it.

severe burning pain
pathological changes in bone and skin (do your toenails grow faster on one foot than the other, or the hair grow back faster on one leg than the other) ( are you loosing muscle mass in the leg of the effected foot)
excessive sweating or excessive changes in the temperature of your foot
tissue swelling
extreme sensitivity to touch

My ortho has me on Lyrica 75 mgs x2, tramadol (ultram) 50mg x4. celebrex 200mg x1 and lortab 7.5/750 as needed. None of it seems to help, so I am hoping that the pain Dr can find something that will. I have also become highly depressed over all of this and even considered taking my life over the holidays. That is another big sign of cronic pain. I am one that can generally tolerate pain, going so far as to having cavities filled or teeth pulled with no anesthesia as I hate needles (go figure).

I am hoping that you will look into some of what I have given you here and that maybe you can find some releif.

Angel ^j^

[RobinSchares]

OMG I did not even finish reading your post because you mentioned a disability and SSI and I got so encouraged. I have not been working for a year and half (due to pain), and I was a waitress. We are broke. We got into the rental business and have 3 properties and help us to make money but to think that there would be help is awesome.
Thanks for that information.
I see the Dr. Wed. and will ask about it.
xoxoxoxo

[RobinSchares]

I am going to look those things up. The first surgery was great. Down for 4 weeks and then to a shoe (with orthodic) and then the second foot has been hell.
Down 6 weeks and then in a boot for 2 more and then a shoe. I can hardly walk across the floor in the morning and tend to walk on the outsides too.
The doctor that perscribed pain meds was my family doctor and he was great through both surgeries but reluctant to keep giving me meds as he needs to see the end in site.
I am scare that I will not get any in a week, and will deal with that then. I did call a pain management doc. but they couldn't see me that day and then I forgot about it.
I read about TTS before the surgeries and seen therapy in almost every article. I asked after the first surgery cause when I started walking it was painful. He said it wasn't necessary. The second surgery I asked twice cause I still have no range of motion. Still no!
Not sure why but don't think I want it now if you had it later on and it didn't work. This whole thing has cost me so much money and I pay an insurance premium if $250 a month. Crazy!
Good luck to you.

[RobinSchares]

okay seen the doc today and was told the pain was normal. That I cannot walk and flex my foot is normal. I was finally told I could have physical therapy was great but wonder if it would work at this point. Sometimes I feel the neuroma pain just as I did before the surgery and he said that too was normal. I didn't understand why I was never given therapy or a set of excersises that might have helped my recovery. I am grateful that I had the surgeries though because it was very painful before I had them and this at least is tolerable.
I was excited about going back to work and thought that would be posslbe at this point. I did not talk to him to see if he would help me if I did decide to pursue some sort of compensation for being without work.
I am very interested in pursuing that if things don't get better quickly.
How are things with you? Better? Also he gave me relefin which I have never taken before but he thought that would be helpful. I also get narcotics from my family doctor because he perscribed for me during both surgreies.
Good luck to everyone on these boards and it is comforting to know that we are not alone and that somebody really understands.
Take care.