Tarsal Tunnel Syndrome

Foot pain is a huge part of my life. I’m considered clinically disabled and sometimes have to use a cane or a wheelchair to get around. Here’s the story of my incredibly painful and expensive journey on my way to a diagnosis and, hopefully, a cure…

How Did It Start?

I started noticing my foot pain when I began working for CVS on June 1st of 2010. I didn’t see a doctor until the fall of 2011, because I didn’t realize how serious of a problem it was. I assumed that I was experiencing foot pain because of my weight problem, so I was embarrassed. I wish I would’ve gotten it checked out sooner, because I probably could’ve avoided these past two years of excruciating pain.

At the time of my first doctor’s appointment, the pain was so bad that I would cry after every shift at CVS (and sometimes during). Eventually, I realized that I had to quit my job because I just couldn’t do it anymore. Working was only making my feet worse and making my life miserable. Although I hope that eventually I find a complete cure for my disability, I don’t expect to ever again be able to work in a retail setting. Doctors worry that, even if I am someday pain-free, any type of over-exertion of my feet (such as a retail job) will slowly make the problem reoccur.

Diagnosis

After I had gone through a year and a half of extreme pain, I realized that I needed to see a doctor. I saw my mother’s podiatrist who originally diagnosed me with Plantar Fasciitis. After going through his treatment options with no success, I realized that I needed to see another doctor and get a second opinion.

I went to a few appointments with a neurologist at NeuroHealth and got an EMG test which confirmed that I had Tarsal Tunnel Syndrome. (Do not take this test if you don’t have to – it’s really painful.) He was able to help me get my handicapped parking permit, which is a complete necessity at the University of Rhode Island, where I go to school.

After my EMG test, I started seeing Dr. Greenburg, a podiatrist based in Pawtucket. I also saw two different physical therapists from Physical Therapy Services of RI (I highly recommend that company!)

Treatment

As of now, I’ve been through six months of twice-a-week physical therapy on my feet, but it didn’t help very much and eventually I stopped going after they realized they couldn’t help me. The physical therapy has loosened my muscles and provided me relief for a few hours on the days that I had appointments.

I’ve worn two different foot splints that work to correct your feet during your sleep, but neither made any difference. I’ve committed countless hours to stretching out my foot and calf muscles at home with frozen water bottles, tennis balls, phone books, my boyfriend’s hands, my own hands – but nothing has worked beyond temporary relief.

When I had exhausted all other options, I finally was given cortisone injections into the arches of my feet, a common tool to relieve this type of pain. I experienced a blissful pain-free two-week period before the pain came right back. Repeated cortisone injections would have helped give me temporary relief but wouldn’t have fixed the real problem, so I chose to forgo that option. Also, the injections hurt like hell.

Next, I tried orthotics. Orthotics are shoe inserts that are molded specifically for your foot. They wrap these weird plaster stuff over your feet and then you get your own orthotics a few weeks later! (Only downside is they aren’t fully covered by insurance. These babies cost me $450 out of pocket). Well, the other downside is that they made absolutely no difference. Apparently, they do help a lot of people and they are supposed to be good for your feet whether or not they decrease your pain.

Possibility of Surgery

In the Spring of 2012, I booked a Plantar Fascia surgery with Dr. Greenburg. After hearing my physical therapist express his concern, I went to a different doctor for a second opinion. My new doctor, Dr. DiGiovanni (a Brown University Orthopedic Surgeon who I highly recommend), strongly advised against getting the surgery at that point in time. In fact, he all but came right out and said that Dr. Greenburg had only booked me the surgery to get my money. He said that no self-respecting doctor would suggest having surgery without fully exhausting all other options first.

Currently, I’m furious with Dr. Greenburg. I urge everybody to be very careful about who you let advise you on medical issues! (Another issue I had with him was that he all but promised me that the orthotics were supposed to help with my pain, made me cough up $450, but then when I confronted him about spending all that money on something that didn’t help, he went back on his word and said that he’d never said any such thing. Even though he did.)

The surgery is still on the table, but we decided to try a few more treatments before locking myself into a dangerous procedure that could permanently incapacitate me for life (if something went wrong).

The biggest outcome of that first appointment with my new doctor is that he completely changed my diagnosis. He said that I don’t have Plantar Fasciitis or Tarsal Tunnel Syndrome (previously, I’d been told by more than five doctors that I had PF and three told me I had TTS). I trust him because he is a lot more knowledgable than my previous doctors and he went into great detail about why he came to that conclusion. I also commend him for telling me the truth – that he has no idea what my problem is. Right now I’m still on the road to discovering the cause behind my excruciating pain and how to fix it without a diagnosis.

Click here for a detailed post about this incredibly emotional appointment.

EPAT

Dr. DiGiovanni suggested I try EPAT (Extra-Corporeal Pulse Activation Treatment) – basically, it’s a fancy name for shock therapy. EPAT is approved by the F.D.A, but it’s still very experimental, which means that it’s not covered by insurance (the procedure costs $500 per treatment site on average). It’s so experimental in fact that almost nobody’s heard of it and there’s not even a Wikipedia page that I can link to about this for you! (Click here for a detailed post about my first appointment).

In May/June 2012, I had five treatments in which a specialist rubbed a gel on the underside of my foot and rubbed a tool on the afflicted areas that made a lot of noise and produced “pulses” that are supposed to activate tissue and increase blood flow in the area. It did hurt, but it hurt in such a weird way that I can’t really explain it. The closest thing I can use to describe it is that it’s a little bit like getting a tattoo. The worst part was the night after the treatment, though. The increased blood flow made my feet swell and they were very painful to walk on.

Even though you only get a certain number of treatments, the procedure lasts 3 months. One month of treatments and then two months of recovery before an assessment of its success can be made. I have my assessment appointment at the end of July 2012 when I’ll meet with Dr. DiGiovanni and talk about my options. As of right now, I’ve noticed no change in the amount of pain I have, so I’m very disappointed.

Finally Getting a Diagnosis

On August 2nd, 2012 I had my EPAT follow-up appointment and met with Dr. DiGiovanni to discuss my current situation. After talking about the pain and my symptoms in detail, he was able to give me his professional opinion of what my diagnosis is. I have something called Heel Pad Syndrome. Technically, there’s no test to confirm this condition, so that’s why I said it’s his “professional opinion.”

Here’s a little bit about what it’s all about. Heel Pad Syndrome is a condition that somebody is either born with, or they’re predisposed to and it develops over time. The heel is the part of the body that supports almost all of a person’s bodyweight when they walk, run, or do anything involving their feet. The heel pad (also known as a “heel fat pad”) is a bunch of fatty tissue that protect the heel bone and cushion it during impact. Patients with Heel Pad Syndrome have a decreased amount of tissue making up their heel fat pad. The lack of proper cushioning results in pain when the heel comes in contact with the ground.

Dr. DiGiovanni gave me the bad news that Heel Pad Syndrome currently has no surgical or treatment options – in other words, there’s no cure. Right now, I’m exploring the options of acupuncture, pain clinics, and a silicone heel pad shoe insert in attempt to relieve some of the pain. None of these things are guaranteed to help, and it’s possible that I could simply have to live with this condition for the rest of my life.

After this appointment, I was glad to finally have a name for what has been hurting me for so long, but I also felt discouraged, disappointed, and helpless. In this post, I wrote about the extreme emotions I was having and all of the thoughts that were running through my head.

 

Or Not?

After being diagnosed with Heel Pad Syndrome, I struggled with the idea that there was nothing that I could do to fix what was wrong with me.

A couple of months later, at Thanksgiving Dinner, my grandparents suggested that I go to a special hospital in Massachusetts called The Lahey Clinic to get one more opinion before resigning myself to a lifetime of pain.

Meanwhile, I started physical therapy again, this time at Palladin Physical Therapy in Cranston, RI. I was in bad shape at that point. Dealing with graduating from college and buying my first house made me stressed out, and my feet were taking the brunt of it.

We were able to get an appointment with a orthopedic doctor at the Lahey Clinic in January of 2013. A few more x-rays and MRIs later, this new doctor was still stumped. He disagreed with Dr. DiGiovanni’s diagnosis of Heel Pad Syndrome, but wasn’t sure what was truly wrong with me. He suggested that we make an appointment with one of Lahey Clinic’s orthopedic surgeons, and also wanted me to try cortisone shots one more time, in a different location (in the middle of the heel vs. the side of the arch), to see if that would help.

I was not excited about the idea of getting more cortisone shots. The first time that I received them, at the hands of the awful Dr. Greenburg, it was the worst pain I’ve ever felt in my entire life. Just thinking about going through that again gave me a major panic attack while I was waiting for him to prepare the shots.

But my mom showed me videos of goats to try and calm me down, and that worked a little bit. It wasn’t until halfway through the shots that I realized that something was different. He had given me two separate shots in each foot. I asked him about it and he explained that he had “obviously” given me one shot of novocaine in each foot, and then the cortisone shots.

Um…what? You can get novocaine before you get the cortisone shots? I told him that, last time, I had been given the shots with only a numbing spray and he almost fell out of his chair. He didn’t even realize that you were allowed to give them without novocaine, considering how painful that would be! Needless to say, I was pretty pissed at the sadistically-inclined Dr. Greenburg about that, but I was extremely happy that they hurt way less the second time around.

 

A Real Diagnosis

After that first visit, I was transferred to a new doctor, an orthopedic surgeon at The Lahey Clinic — Dr. Teebagy.

During our first visit with Dr. Teebagy, he explained to me and my Mom that, after examining me and going through all of my symptoms and medical tests, he believes that I do have Tarsal Tunnel Syndrome. After hearing all of his explanations and knowing that he is one of the best orthopedic surgeons in New England, I agree with him.

I’ve known for a long time that Tarsal Tunnel Syndrome was a possible diagnosis, and have been “diagnosed” with it multiple times. We believe that Dr. DiGiovanni misdiagnosed with my Heel Pad Syndrome because he was not very familiar with the rare disorder and that he felt uncomfortable diagnosing (and then potentially having to do surgery on) somebody as young as I am. Heel Pad Syndrome is apparently often used as a “diagnosis” when the real problem is unknown but the doctor wants to give you a name for it.

 

To Surgery or Not to Surgery…

While those cortisone shots that I was given back in January 2013 did help a little bit, they did not fix the problem and only lasted for a couple of weeks.

After seeing Dr. Teebagy a few times, he brought up the option of surgery. I’ve known about the Tarsal Tunnel Surgery for a long time, but I got a lot more information about it from Dr. Teebagy. He said that, if he were to do surgery, he would do the TTS surgery as well as both the plantar fasciitis surgery and the Baxter’s Nerve surgery. He thinks that the combination of Tarsal Tunnel Syndrome, plantar fasciitis, and Baxter’s Nerve Syndrome is what is causing my problems, and that the combination of those three surgeries would hopefully fix it.

The problem with having these surgeries, specifically the Tarsal Tunnel Syndrome surgery, is that it is very dangerous and risky. There is ~50% chance that the surgery would go well and that I would regain normal function in my feet. But that means that there is only a ~50% chance that it would not be successful. If it failed, there is also a chance that I could end up worse than I started out, due to the potential problem of scar tissue growing in the tarsal tunnel nerve (yeah, I know…gross).

 

The Last Step

I’ve been thinking about the possibility of having to have the Tarsal Tunnel Syndrome surgery for a long time (ever since I was first diagnosed with it back in 2011). I’ve thought about the pros and cons for years, just in case I would ever have to make that decision, and I’ve always known that I would go through with it. Even though the potential outcome is honestly terrifying, it’s the only thing that might make me better…it’s just something that I have to do.

Hoping to schedule a surgery for this summer, I was back in Dr. Teebagy’s office in the beginning of June 2013. But there was a little glitch in my plans. Dr. Teebagy decided that he wanted to try one last thing that might work — putting my foot in a cast.

At this point, I had to stop physical therapy, knowing that I couldn’t do PT with a cast, and that I wasn’t getting much out of it anymore anyway. I was put into a cast that went up to my knee on my left leg for 35 days. The idea behind the cast is that the reason I have Tarsal Tunnel Syndrome is because the nerve is being compressed by my calf muscle. Physical therapy was not doing enough to loosen this muscle, so we hoped that putting the muscle in that extended 90˚ position for a long period of time would correct the problem.

 

Surgery on Miranda’s Feet…Coming Soon

After 35 annoying days of being in a cast, nothing was different. It was time for surgery.

But there was a problem.

Dr. Teebagy broke the news to me and my Mom that he will be leaving The Lahey Clinic in September of 2013. This means that I had to make the choice of following him to his new hospital or staying at Lahey Clinic and switching to a new doctor.

I chose to switch to the new doctor because I’d been getting a weird vibe from Dr. Teebagy. Even though we’ve done everything possible, he still seemed reluctant to do the surgery. My mom thought that he might be uneasy about doing such a risky surgery on somebody who’s so young…a problem that we seem to keep running into.

I don’t want somebody to do surgery on me unless they are 100% confident about it. I don’t want somebody to be wishy-washy when my future is in their hands. So I have an appointment with my new orthopedic surgeon, Dr. Lobo, in September of 2013, and hopefully she is on the same page as I am about having the surgery, and I will hopefully be able to have it as soon as possible.

 

 

My Posts About Foot Pain

 

I would highly advise anybody experiencing heel pain to see a doctor or a physical therapist right away. You do not want to end up like me, going through years of pain. I believe that if I had gone to see a doctor immediately, I could’ve avoided this completely.

 

Disclaimer: I am not a medical professional. Everything stated in this post is merely my opinion about my own personal medical problems.

{ 32 comments… read them below or add one }

Alli July 14, 2012 at 8:48 pm

Hi- I could be writing your story.. But mine started in 1997 when I got my RN and was working the floors for 12 hours.. I was diagnosed w plantar fasciitis .. Did every treatment under the sun and had surgery on my right foot in 1999 ( I was 21) that went well.. Then the left started hurting and I finally had surgery in 2004. That was horrible… Never did good w that. All this time I kept working the floor and dying in pain. It was awful . Time passed- I finally moved back fom las Vegas- to NM ( my home) and dr chad Brady was my miracle doctor! After many treatment ps ( the shock therapy u did.. Also platelet therapy) also I feel like I had 3,425 cortisone injections in both feet… They had me do the nerve test too- and dx me w neuropathy. It was great to finally have a diagnosis!!! They had me see a pain specialist and started me on nerve medication- and within a week- the pain was gone. After. Thirteen. Years. Holy. Crap. My life was back!!!! Awesome!!
I was able to work out, run, aerobics.. So cool – lost 40 pounds- feeling great- so stupid me- signed up for an extreme 5k- warrior dash. Sprained the crap out of my ankle 1/2 thru– sh!t!!!! So now 3 months later .. Having numbness in my ankle, even after PT, had the nerve test done gain (hurt like a mo fo!!!) and the nerve damage is worse- and now I have tarsal tunnel syndrome. So I don’t know what the next step is… I seriously need a foot transplant . My feet suck.

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Maren July 15, 2012 at 12:59 pm

Wow. I had ankle reconstructive surgery after I severed a ligament and tore the other two anterior ligaments in my ankle playing basketball when I was a senior in high school. I graduated high school in 2005 and I had the surgery in August 2010.

This comment is going to be a little long, I hope that’s okay :)

Anyways, I also tore my plantar fascia running track. I haven’t had what you have but I know a torn PF is not fun. When I was deciding about having mine, I really wanted to hear stories from people who had had similar procedures so I’m going to write mine down. Read it or not, it’s just something I’d have wanted.

My foot/ankle specialist wanted me to have surgery from 2005-2010. Because all of the 3 anterior ligaments in my ankle were blown out I had zero stability in that ankle and I sprained it all the time. I’d collapse walking down stairs. Not to mention I played college basketball in that time… don’t ask me how I was able to do it.

I refused to have surgery because it wasn’t making my life miserable. Yes it was painful sometimes and it was hard for me to do some things, but I wasn’t bed bound or anything like that.

In 2010 I was training for a half marathon, went out on a 6 mile run and after 2 miles I was in so much pain I almost had to crawl home. It was finally time to seriously consider surgery because my ankle was insanely inflamed and wouldn’t go back to normal.

My surgery was a 3 hr surgery at a surgery center and it required me to be completely bed bound for 3 months, no weight baring activity on the new ankle. Then I was in a walking cast for 4 weeks and after a walking boot for 2 weeks. Then I started 3 months of physical therapy. The procedure was to take a hamstring tendon (I insisted they take my own, but usually they use a doner) and pin it to the foot, bore 2 holes on my ankle joint and pin the tendon in each hole, then pin it back to the foot.

The really hard part after surgery is the recovery. My right leg completely atrophied so I had to completely rebuild all the muscles on that side of my body. 2 years later and I still get sore only on that side after workouts. Physical therapy is a must. If I hadn’t done it I wouldn’t be able to run today, I’d have a permanent limp, and I’d never be able to jump.

Now… after all that, this is what I really wanted to say, lol. Surgery was mentally the hardest thing I’ve ever done and I wouldn’t just recommend to people but it was 150% the right choice for me. Even after a successful surgery your new ankle (or foot, or whatever it is) is still not “normal”. It’s just different. My ankle get’s sore when before it didn’t. Movements are different. It’s not like surgery makes your body exactly like the uninjured one. It’s still different.

If you ever have questions or want to talk to someone who’s (kinda) been there, feel free to ask me. I know you’ll make the right decision.

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Chris waddington July 16, 2012 at 2:12 pm

My problem is this, – I work at a warehouse and im 20, I use a machine called double pallet jack (DPJ) . Currently loaded 300+ boxes on my pallet and was almost done, i was getting off the machine and my arm slid down the accelerator and my ankle was on the floor, i ran over my ankle with a 12000 pound machine.

I went to get an xray and a bone scan and they both came up negative with no problems, My first doctor (x-ray) said i have Plantar fasciitis. Being a warehouse they cover wsib, Plantar fasciitis was not accepted, and was left to drive from doctor to doctor to try and get some more information, my doctor was currently on vacation and was left with nothing, i also drive a manual car and i find it is very painful and weak and find it hard to press.

Just today i was looking on the internet of what my symptoms could be, and tarsal tunnel syndrome is exactly what it feels like. and my doctors have said it is also a crush injury, and nerve damage, and cant seem to go on the internet : / i should be a doctor… i have also got this lower back problem and my left leg is becoming more weak as these months and weeks go on. i dont know how long i will be injured for, but if you are in the same position i am in – it sucks.. you cant do anything you use to do, when i go to the pubs with my friends, i find myself always in the back, smoking a lot, its because very stressful. and i bought my car this year as well (mini cooper) and hit my own friends car because i had no power in my foot and we no longer talk anymore and he was a great friend, almost depressing really. Find myself drinking a lot of alcohol lately because it soothes the pain and drink my self to a stoop. I guess 20 years old is the most stressful part of your life.

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Kim November 29, 2012 at 11:42 am

Oh my gosh, Miranda! Your story is almost identical to mine! I am a Retired RN, not by choice. I had to quit working in 2002 because of a collapsed arch. I searched long and hard for a surgeon, and had Posterior Tibial Tendon repair done in 2008. Yes, I waited that long, my podiatrist said the surgery is often times unsuccessful. The surgery repaired my arch, but left me with chronic, intense heel pain. I’ve had every treatment under the sun. Extensive PT, orthotics, night splint, $3000.00 pharmateuctical cream, tens unit, ultrasound treatment, shock wave therapy, lyrica for nerve pain, nerve conduction study, MRI and probably some others I’ve forgotten. I recently went to another foot surgeon and with one simple test I feel confident I have Tarsal Tunnel Syndrome. He did the tinel (?) test where he flicked the area below my ankle and above my heel and I had a shock wave, and burst of pain spread through my foot and leg. I will be seeing another foot surgeon for a second opinion, but I feel 99% confident in his diagnosis. I plan to have surgery ASAP after the holidays. My life has been miserable for too long! Thanks for sharing your stories everyone. People just don’t understand the severity of this type of pain.

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MirandaMowbray November 30, 2012 at 3:03 am

You’re right… it sounds like we’ve gone through almost exactly the same things! I hope that the surgery works. From what I’ve heard, it is very risky and dangerous! But if it works, that’s amazing and I’m so happy for you. So many different doctors have told me so many conflicting things that I’m not even convinced that I don’t have Tarsal Tunnel Syndrome anymore. There’s some kind of nerve damage, I know that much. I do think you’re right on your last point. I’ve never felt more excruciating pain in my whole life. The pain that I experience 24/7 is consistently worse than the pain I went through when I broke my foot as a teenager. I really hope that your surgery works! It would make me feel better just knowing that somebody who has gone through similar things has found relief somehow.

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Kim November 30, 2012 at 9:21 am

I will keep you posted Miranda!

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Kim December 10, 2012 at 7:19 pm

Miranda, have you had a nerve conduction study done? I had one done in May, and took the results, along with my MRI results to my 2nd surgical consult today. I have lumbosacral radiculopathy which causes impingement on the nerve that affects your foot. Please ask to have one. The foot surgeon I saw today has referred me to a neurologist, and will not consider surgery unless the possibility of this being the root cause is ruled out. So, although I’m still in pain I feel hopeful that I am getting closer to the cause and hopefully the correct treatment. Surgery should always be the last resort…..

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MirandaMowbray December 10, 2012 at 7:31 pm

I don’t really know what that is, but it sounds a lot like an EMG… what’s the difference? I’ve been to a neurologist, so I think (or, at least, I hope) that they would’ve ordered that test for me if they thought it was something I should get. I’m planning on going to a big clinic in Boston soon, so I’ll ask about it when I’m there.

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Nicole December 8, 2012 at 6:20 am

Wow – quite a story. I broke my heel a few years ago – cracked in 1/2 – and had problems with movement for a few months. I’m sorry to hear yours is something that doesn’t have a current cure. Sounds like you’re taking it all in stride.

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Kristi December 22, 2012 at 12:58 am

My story is so.much like your’s it’s…. I want to know where to go from here. I need some help. I can’t hardly walk. It’s Dec 21st. I have no Christmas up or boughten one Christmas present because I am in too much pain to do any of it. where do I go from here?

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james December 26, 2012 at 8:08 am

I read your story and I also agree that don’t go for one doctor just consults with other doctor’s too so that you can take a good decision related to your health.

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Hal Cone January 3, 2013 at 8:17 pm

I have had similar experiences with my heel pain for over a year this time. Been to several different foot doctors and they all work from the same book. They really are just technicians and not true doctors. Sorry but that’s how they all act.

The best relief for my heels is to use the “shape-up” LIV shoes from Skechers. They take some of the stress off the heels.

You may find that the heel pad syndrome is not the answer as well. I don’t know the answer but I’m now researching nerve issues. This could be a nerve problem in the heel because the pain does not really go away with rest, taping, stretching, inserts, etc.

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Leena January 8, 2013 at 3:28 am

Hi Miranda,
After reading about your journey to your diagnose I had an idea… It might sound crazy, but I am curious to see if it helps. I originally found your blog looking for a recipe then decided to read your blog. Anyways I have a Reicepe that is AMAZING and from what I hear very healthy. I make this dish out of cows feet that my family and friends LOVE. It does not sound good but tastes incredibly. Cows feet have a lot of collagen. Collagen supports the skin . bones, hair , finger nails, and cartilage in the joins, so it does not deteriorates that fast. My husband swears it helps his aching feet.

If you want the recipe please let me know…

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MirandaMowbray January 8, 2013 at 4:08 pm

Haha… that’s pretty weird! Thanks for the thought, but the problem is actually in my nerves, ligaments, and muscles — not my bones or cartilage. But next time I go to the doctor, I’ll see what they have to say about it.

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TM January 15, 2013 at 9:08 pm

I completely understand! My problem was diffferent in the fact that I have ad several plastic surgeries involving skin grafting over my entire right foot to remove a cancerous birth defect. Fat pad syndrome can be caused by eitner genetics, injury or trauma to an area. My pain is so severe that I can’t step flat at all. Even pushing on area with my hand causes pain. I was reffered to pain mngt doctor via my reconstrutive surgeon because the surgery that can be doone {a full muscle flap graft} is pretty risky and major recovery time along with pretty bad scarring. I will say to you that I have tried pain meds, gels, creams and even a spinal block with no success. I visited an very highly recommended acupuncturist in my town and was told that it most likely would not help. He wanted to try 8 treatments and said though it might not help but it could not hurt.. I will say why waste my time, especially since it is not covered my insurance. The last option I have is to try botx treatments that could add a little extra padding. After that no other options except for the possible surgery. I do have a question..do you have little fatty bumps on the back of your heel?

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TM January 15, 2013 at 9:25 pm

To add I have also had very painful steriod injections. My surgeon was able to tell me right away that is was a fat pad issue. He did not give me all this hoopla about it may me one thing or another or another. He was pretty much right on. You can even see how thin my heel is. It liking walking with full weight on your knee caps all day. I will say that wearing boots with higher heels kinda helps since the weight seems to be put more towards you foot my your toes. I am no specialist but you kinda know what helps from trial an error. If the botox injections work I will repost as a possibility for people to try. Foot pad syndrome is not a nerve problem. No amount of pain killers, creams, are gonna repair it. I am 33 and even tried to lose weight in hopes it would help. I lost 41 pds and am down to 127 and still have several pain. I was told that even if I got down to 100 pds the problem would not go away. I am keeping my fingers crossed for botox. If that does not work then back to the surgeon I go…this is been a a year long battle of treatments and meds and I am ready for results!

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Lulu January 17, 2013 at 10:09 pm

I know your feeling. I have been working in retail for almost 20yrs and also 7yrs walking long distance because i dont drive to and from work and just the past 3 yrs have been having problems with my feet. Having heal pain in both feet and along the foot and also getting tingling in the ankle to half the leg. Have gotten 2 cortozine shots and it just comes back. have done icing. taking ibprofen, and still comes back. I have even have to buy shoes like every 4 months. which i cant afford. Just alone even to see my doctor i barley can afford the copay. i dont know what else to do. I need money to support myself and my mom who is disabled or we will be living on the streets. I just need some relif of this pain.

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Teresa February 13, 2013 at 5:16 am

I am reversing my tarsal tunnel syndrome naturally. I was misdiagnosed twice and spent a ton of money on treatments that didn’t work. I refused surgery and pain medication. I know that pain is a way of telling me there is something wrong and I was more interested in finding out. When I began having knee and wrist pain, I knew I was not dealing with a foot issue. After much research and plenty of alternative natural therapies, I found what worked for me. I read the book alkalize or die and tested my ph levels. My body was acidic. Disease thrives in an acid body. I gave up meat, dairy, and alcohol because all these things cause the body to become acidic. I found some relief of pain from those changes. More research lead me to have my old dental fillings removed because they leach mercury into the body and cause acidity. This is a controversial subject to most dentists and you have to be very careful about choosing who performs this procedure as if done incorrectly it can cause harm. Dr Mercola has an article about this subject. My knee and wrist pain are all gone. I also sleep on a grounded bed sheet. I read a book called Earthing that explains what that means as well as an article from Dr Mercola. My foot pain has gone down considerably. Never stop searching and never give up.

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Laurie June 12, 2013 at 5:46 am

Miranda,
I stumbled into your blog. I am a Certified Pedorthist (specialist in the biomechanics of feet and gait, shoe and orthotic fitting). I am not at all surprised that you had no success with many of the medical professionals you saw. Unfortunately, the medical community is trained to look internally for foot problems. The reality is that a significant number of problems are the result of the external world that our feet contend with. We evolved to walk on natural, uneven surfaces with terrain that shifts, absorbs shock and challenges the muscles of the feet. What many of you are describing is heel pain that began as the result of prolonged standing or walking on very hard surfaces. This can create excessive force on the fat pads and other structures of the foot. Cushioned footwear alone usually is not enough to address this problem. Because the feet are curved, with the heel and ball of the foot making most of the contact with the ground and, because the ground is no longer natural but now hard and flat, we put excessive pressure on the heel and ball of the foot, while the arch of the foot remains elevated and unsupported. Traditional orthotics do little to adequately fill in the arch space. (Get your orthotics if you still have them, place your foot on them and lift your heel so that your foot is at a 45 degree angle. Now pull the orthotic up to your heel. The gap between your arch and the orthotic is the space that should be filled to meet the shape of your foot while you walk and stand. That gap shows you how far your foot falls before it touches the orthotic with each step.) I have worked with many patients with similar issues to yours. By far, the most effective treatment was the use of a full contact orthotic cast in the MASS position (VERY hard to find — very few medical practitioners even know about this technique) combined with a true rocker bottom shoe — Chung Shi is the most effective brand to alleviate heel pain. The full contact orthotic has a MUCH higher arch than what the vase majority of medical professionals make. It is designed to aggressively hold up the arch of the foot, thereby taking pressure off the heel and ball of the foot. There are some certified pedorthists in a footwear chain called Foot Solutions that make MASS position orthotics. The other resource is an orthotic company called Sole Support. All day long we see people who, just like you, have been to every doctor, spent obscene sums of money and suffered for years with no relief. These few simple steps can make a night and day difference. Feel free to contact me if you want more information. Wishing you and all those who are posting here the relief you deserve. Don’t give up. There are solutions you don’t know about. I am credited with being a miracle worker on a regular basis. I am not. I just look at the foot from the outside in, not the inside out. It’s just a different perspective.

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Jodie August 1, 2013 at 11:04 am

Laurie and Miranda- I’m struggling with what is thought to be fat pad atrophy as well. I had 3 pairs of custom orthotics but I’m very interested in getting in touch with Laurie or someone she recommends in my area in regards to the orthotics she describes. Please email me at jeichmann21@yahoo.com. I’ve been dealing with this for over 10 years and have even had 3 unnecessary and complicated nerve surgeries before realizing it is not nerve related. Any info you can provide on how to get these orthotics made is greatly appreciated. Thanks! Jodie in Chicago

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Deb kiefer July 21, 2013 at 12:31 pm

Disregard my previous accidental post. I was diagnosed with tarsal tunnel about 3 yrs ago. Have had all treatments u have had. My podiatrist referred me to a pain clinic. I have been given the ok by my insurance co to have a neurostimulator permanently installed after having the 5 day trial and it was successful. If u have not heard of this I highly recommend that u research it. I get my implant on August 2. Will let u know what happens. Chronic pain is so depressing. Oh I am 62 and am working but it is extremely challenging with the pain . I have a desk job but have a very hard time just getting up to go to the bathroom. I know u can relate.

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Sue August 8, 2013 at 10:26 pm

Miranda, I am so sorry to hear your story because it is so like mine. Towards the end of my military service I was diagnosed with plantar facitis. After seeing podiatrists in the military, all I ever walked away with were custom inserts for my shoes. Once out of the military, the pain hit me 10-fold. I was working a job where I would be on my feet 10-12 hrs a day. I would hobble home & just cry because the pain was that bad & no one seamed to be able to do anything for me. In fact the last podiatrist that I went to never even touched or x-rayed my feet. She just said “you have plantar fascitis, here’s some exercises.” What a quack! She was not helping me to get to the source of my near crippling pain. Finally, I took my like into my own hands & self-scheduled my own referral. So much attain has been made to 1. listen to my list of signs & symptoms 2. look as what has & has not been done to this point, and 3. action was taken immediately to try to provide me some relief in the form of the cortisone shots. The pain of those shots was well worth it if it can provide me with so temporary relief at least.

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Debbie Terhune September 7, 2013 at 4:26 pm

I would also like to contact Laurie about a pedorthist in my area. my email is debbieterhune@mac.com. I have gone through about 10 months of foot pain and could not walk in July. First diagnosed with plantar fascitis then either posterior tibial syndrome or tarsal tunnel and then achilles tendonitis. Then I went for a nerve test and have peripheral neuropathy. The doctor could not test for the tarsal tunnel because the nerves are already compromised by the pn. The dr put me on cymbalta which has helped with pain and depression. I have gotten two sets of orthotics, $800. My new foot dr is working from the tarsal tunnel angle and did what he called an overcorrect to my orthotics which is probably similar to what Laurie is talking about. This has made it possible for me to walk, stand and have my feet touching the ground. I still feel it poking in my arch but the nerve pain around the inner ankle is much improved. I am walking a mile a day and doing my regular chores and errands. I was also taking aleve during this period but not now. I also did a couple of months of acupunture which may have helped. I am taking vitamins especially the b vitamins and alpha lipoic acid. I use some topicals, rock sauce and traumeel and my doctor has ordered a topical from a compounding shop. I am also doing massage and physical therapy. I do resistance exercises with a band and a number of exercises from the foot doctor and I do them every day. I could not even bend my toes when I started. I have a very high arch and this program has worked so far, so good. I am not normal but very thankful for where I am compared to just 2 months ago. I think a lot of people give up on orthotics and I think I would too if I could walk without them. Miranda ask your doctor about over correcting your arch, try anything and everything before surgery. Also maybe a medication like cymbalta or lyrica. Did your neurologist test you for neuropathy also or just the tarsal tunnel?

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Debbie Terhune September 7, 2013 at 4:29 pm

I forgot to say that I am also taking consuming a juice that my friend got for me called Jusuru. It is full of antioxidants. Expensive from what I understand.

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Margeaux Nicholas September 13, 2013 at 8:14 pm

This is my story I am only giving the highlights because the full version would be a book.

I was an active( not athletic) child I lived in Canada and as a kid you walked or biked everywhere unlike the States where parents drive you around.

My father is a doctor and he had me seen by an Orthopedic surgeon when I was 3 because my feet over pronated back then there was nothing they could do other than some very radical surgeries which my parents thankfully did not pursue.

My first memory of my feet really hurting was standing in the line at Disneyland when I was 9, standing has always been worse than walking. As a teenager I got my first job in retail I did an 8 hr shift and came home crying from the pain went to a podiatrist for a second time got another useless pair of orthodics.

I managed better with 4 hr shift and started waiting tables I could wear cross trainers and you moved around a lot that was much better but by the end of a long weekend shift my feet were throbbing balls of pain. I would be ok the next morning as long as I didn’t walk to much there was no pain.

Fast forward to my late 30′s I moved to Vancouver ( we had move to the states when I was a child). This is an active city everyone walks everywhere. I loved to walk here it is so beautiful. I would walk home everyday it took an hour my feet would be sore but I still loved it. I then started to travel I am not the kind to sit on a bus or stay in the big cities I did small group tours where you walked 4-5 hrs in the country side. The scenery was amazing I love taking photographs I think that kept me going thru the awful pain. I chose a trip with less walking but my feet still were horribly painful especially walking on cement.

I decided to see a podiatrist again by then the window of time before the pain started was down to 15min. The podiatrist did the normal quick look and taped my feet no pain improvement. He then told me he wanted to numb my heels to see if that would stop the pain. I said OK as long as it was not cortisone my sister had a bad experience with it and I knew it was not a cure for pain just a temporary block not the solution I needed. He said it would just numb them the shots were horrible painful there was a particularly intense pain in my left foot. When he was done he said that shouldn’t have hurt so much and that it felt different then others he had done like my heel was gripping the needle ( first rule of medicine if a common procedure seems different STOP).

This is where my story goes form horrible to hell. There was no relief from the shots pain started to shoot up my legs my heels hurt so bad I couldn’t put them down for 3 weeks I have not taken a step without pain since then that was 5 yrs ago. It gets worse the shot triggered some sort of reaction in my small nerve fibres. I developed sensitivity to cold, I couldn’t stand anything touching my feet the area below my inside ankle bone was so sore I could not tie a shoe. I was now in constant pain. I called the podiatrists office to confirm what the injection was it was Depro Medrol ( cortisone!!) I am so angry about this it still makes me want to scream the podiatrist did something I specifically asked him not to do.

The symptoms produced by the injection ( no doctor can explain why the shot did that it just doesn’t happen) confused what the original problem was so getting a diagnosis for that became impossible they got all caught up in my problem being Small Fibre Neuropathy a skin biopsy proved that was not the case.

I tried every treatment you can think of it would be impossible to list them all. I saw 3 neurologists, 3 orthopedic surgeons ( one was Dr Baxter as in Baxter’s nerve)had 3 MRI’s and 3 EMG’s. This past spring I went to see the head of podiatry at Harvard he had a treatment I was interested in. He was the first foot specialist to take the time to listen to my original symptoms. He just push on a few places on my foot and said you have Tarsal Tunnel Syndrome. I said we had thought that but the EMG’s and MRI’s were normal. He said they ususally are the nerve isn’t compressed when you are lying down to take the EMG test he also said my description was classic for TTS any podiatrist who had just listen an pushed on a few places on my foot would have known that there was no need for the cortisone injection. He had no answer for the symptoms I had from the injection but I needed to get the TTS fixed that meant surgery he gave it an 80% chance of success.

I went home found the best surgeon in the Province he was not as optimistic told be my chances for improvement were less than 50% and it could be worse. I had no options so I did it that was 6 months ago the surgery is hell to recovery from there is no improvement but I don’t think it is worse. The nerves were very entrapped and the band was thickened and scarred there was also some damage to the nerve so yes I clearly have TTS.

At this point I am trying surgery to correct my hyper pronation as it was what got me in this mess and I want my feet properly aligned before I try medicines again. I am very sensitive to them I could not deal with the side effects and work I am not working anymore it was just to much to sit at a stressful job with my feet burning all day.

This surgery uses a Hyprocure stint http://hyprocure.com to open up the talio tarsal opening in your foot. Basically hyper pronation is when this tunnel closed when you walk due to lose ligaments our other structurally abnormalities. If you hyper prontate a long list of painful aliments can happen because you are out of line. Over time something will go wrong I just happen to pull the crappiest possible card TTS.

I don’t except this to cure any pain but I will be more stable and I will no longer collapse inward and put pressure on my already damages nerves. I can then try medications knowing that that they will not just mask the pain as my nerves get more and more damaged when I walk. The surgery is not suppose to be bad and it’s reversible so nothing to lose.

I truly believe if they had this procedure when I was younger I would never have had any foot pain. They do it in children with great success they will grow up and not suffer like many of the people here.

Hopefully this will help my feet get better or at least to a level of pain I can manage I want to start a career as a photography I need to walk around to do that.

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MirandaMowbray September 13, 2013 at 9:39 pm

Wow, that is an incredible story. I’m so sorry that you’re going through a similar situation…I truly empathize with everybody who has commented on my story. I’ve never talked to anyone who’s had the TTS surgery before. Honestly, it’s because I’m nervous about it enough on my own, so I don’t want anybody else’s stories to affect my opinion about it negatively or positively, because I definitely know that I want to go through with it no matter what.

Our stories sound a lot alike in what we’ve gone through to get answers, but they are a little different. I don’t have hyper-pronation, although they do turn inwards a little bit. And I never had any foot pain symptoms until I was 18 years old and working my first standing-up job with 8-hour shifts, sometimes more.

But I have the same problems with careers as you do. Right now, I’m working, but I’m working for my Dad’s company so that I can have a very flexible and limited schedule. And even with that, I’m still completely exhausted all of the time from the pain. It’s so hard just to even get out of bed in the morning, and I never feel like I’ve had enough rest. This whole experience has changed my life in so many ways. I don’t talk about it much, but even though my dream has always been to work as an editor, which is naturally a sit-down job, I don’t know if it’s what I want to do for the rest of my life anymore. I want to walk around so badly…I want to work an active job and have an active lifestyle. I’ve never wanted that before, but having it all taken away from me has made me want it more than I’ve ever wanted anything in my entire life.

Thank you so much for writing…Even if we can’t really give each other advice or tell each other what to do, it’s nice to get a chance to talk to other people who know EXACTLY what you’re going through. I get lonely sometimes because I feel like nobody understands. They aren’t inside my head, they can’t comprehend the unimaginable pain — emotional and physical — that I go through every single day of my life now.

I wish you the best for your future. I hope that you find something that works for you, whether it’s that hyper-pronation surgery you talked about or something else. And I hope, above all, that you find a way to be a photographer, live out your dream, and find happiness.

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Deb September 14, 2013 at 12:14 am

Ok long story short. Total left knee replacement in 2009. Flat feet all my life. 2011 right foot pain . Have had physical therapy , podiatrist visits including custom orthotics, cortisone shots every 3 – 4 months until in early 2013 I got relief from them for about 2 weeks. Podiatrist referred me to Pain Specialist. After meeting my pain / anesthesiologist doctor I had a trial and 3 weeks later a permanent spinal neurostimulator was implanted in my lower left back. I now have my life back. I am about 85% pain free. I can once again go to my grand kids activities, go shopping, visit neighbors, and go on trips with my girlfriends. If u suffer from TTS research this St Jude’s is the place affiliated with my dr. I now have my life back and am so happy. Chronic pain …..goodbye. Email me if u r at the end of your rope like I was!

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Jean Johnson September 14, 2013 at 12:26 pm

I would like to know if anyone has fthe Pedorthist Laurie’s email address….I am very interested in the full contact orthotic that she was writing about. Thanks. I have had it with my foot pain!!!

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Margeaux Nicholas September 18, 2013 at 12:57 am

Miranda, I knew you would identify with my story I have read many blogs but never posted until now. It is true nobody can understand what chronic pain does to your life especially when it is your feet. Your whole world stops you can no longer participate, your active friends feel bad but they do active things so you are no longer included and eventually you don’t hear from them, it’s hard just to go out to dinner or see a movie because you are just so worn out from pain by the end of the day.

You said your feet turned in a bit are you sure you don’t over pronate? You might have flexible flat foot here is how you know
1. If your foot has a normal arch sitting but collapses when you stand
2. If you’re standing and shift your weight to the outside of your feet you can make the arches come up to normal position

All my life doctors just said I over pronated I have lose ligaments and gave me orthodics it wasn’t until I actually started researching what causes overpronation I found out about flexible flat foot.

Hyprocure stent procedure is a way to fix what is basically a deformity of your foot that will at some point cause you pain.

There was nothing like this when I was young, earlier versions of the stent were not a successful as the Hyprocure model.

It is of course to late to fix all the damage with just this procedure but it will stop walking from causing more.

I’ll let you know how it goes as I said it’s reversible so nothing to lose.

Take care

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MirandaMowbray September 18, 2013 at 5:40 pm

Yes, please let me know how it works out! I’m almost positive that I don’t over-pronate. I’ve seen so many doctors and physical therapists that one of them would’ve said something about it. My feet do turn in a bit, but it’s only to a normal extent…like how almost everybody either pronates or supinates (turns in or turns out). While I have been prescribed orthotics, it’s never been to fix a pronation problem, only to help support my feet more in general. I hope that this procedure fixes your problem, though!

I need to update this page after my last doctor’s appointment, but I’m actually going to be having a procedure to loosen my calf muscle in November. My tight calves have always been a huge part of the problem, so we’re hoping that they are actually the cause, and that having this procedure will fix the problem (or at least help!).

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TexCyn November 19, 2013 at 9:20 pm

Hi Miranda, I’m writing to see what you’ve decided or where you are medically currently. I’ve had TTS surgery twice now. The first surgery was actually going pretty well. I was healing, doing some small hiking, living my life. Then when they put me in the Chronic Pain Program, the TTS came back! (I was still getting therapy at the time). We thought I developed a ganglion cyst. A new MRI & a nerve test proved that the TTS had returned. So a new surgery was scheduled in Sept 2013. Had the surgery, they discovered then that it was actually scar tissue that brought back the TTS! So scar tissue was removed, an engorged inflammed vein was removed & unfortunately, I had sustained nerve damage, so part of the nerve had to be removed as well. Now that feels really weird! Living with partial feeling in the foot is really odd. Unfortunately, I am still having issues with the foot/ankle. I’m currently in therapy for it, but I’m not gaining any real changes. I have very, very little muscle atrophy, so that’s good & I can walk on the foot. However, the ankle brace really helps on bad days. I’ve had many series of ankle sprains over the years. A big one many years ago, which led to all the smaller ones over the years. Then in 2010, another sprain, which brought the TTS on. Also in 2005, I had to have ligament repair surgery on that same ankle. But that has nothing to do with the TTS. My TTS condition is not common. But it now scares me that if it returns again that I could have even more nerve damage, thus losing more nerves through surgery.
However, in the long run of things, I’m grateful that I can still walk. That I can get some stabilization out of my ankle brace when I wear it & that I still have my foot! (not that there was any threat of me losing my foot that is, but a friend lost his due to something else, so I’m grateful to have mine.)
I still want to go hiking again one day! I am working towards that goal –even if I’m high risk for the TTS to return! I just can’t stop living life & doing the things I still want to do.
Good luck with your decisions. Please discuss the possibility of permanent nerve damage with your podiatrist. And get another opinion if necessary (as you already know by now!) It sounds like you have more going on than TTS, but maybe it is just TTS. It is a painful condition. My tendon along the inside of my leg is sooo tight because of all this. And I still have pain that runs all through my foot (the parts I can still feel). Fortunately, I have a high tolerance for pain, but still. I know what it’s like!

Again, good luck — keep us posted please!

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Laurie December 3, 2013 at 1:01 am

Hi all,

Sorry. I am just becoming aware of this thread again. Sounds like many have you have been through it and back more than a few times. I always hate to hear of these awful ordeals. You all have my deepest sympathy. I am in Maryland but will do my best to direct you to a good pedorthist in your area if I am able. I hope this finds you all doing far better.

Best regards,
Laurie, C.Ped in Maryland

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