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The response to the question below was authored by Marc Mitnick DPM

baxters nerve

by Roxanne
(Seattle)

tarsal tunnel-baxters nerve entrapment




I have endured over 2 years of pain in my left foot/ankle. The pain occured after a gastro recession surgery for a torn peronial longus tendon. The surgery resolved that problem, but this much more painful nerve problem appeared.

I do not have any swelling in the ankle or foot area. The biggest symptom I have is pain in the ankly/heal area. I can only walk about 10 minutes and have to sit down. I have seen many Dr.'s in the Seattle area who say their is nothing I can do, just live with the pain. I am only 43 and use to be very active. This whole problem started with a bad sprain, that was not cared for properly.

I guess my question is...Do you have to visually see a cyst or scar tissue on the mri for the tarsal release surgery to be effective (that is what I am being told by some of the best Dr.'s at the UW hospital). I do not have tingling or numbness, mostly just burning pain. (it is also in the other foot, although not as bad) I have had an emg-which confirms baxters nerve and a PSSD which was negative.

Any thoughts?



Thanks,

Roxanne



Hi Roxanne,
I am a little confused by your description as it would seem to me your original incision really should not have been as close to the tarsal canal as you describe. A torn peroneal longus tendon rupture would have an incision on the outside of the foot, whereas the tarsal tunnel is on the inside of your foot
What I will say is that if you have a tarsal tunnel condition, the MRI does not have to show a cyst or scar in order for you to have surgery.
Has anyone tried injecting the tarsal tunnel or addressing the way your foot functions in gait, like excess pronation? Addressing these issues, even if it only gives you short term relief would certainly substantiate a diagnosis of tarsal tunnel and then ultimately surgery.
Marc Mitnick DPM

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Sep 22, 2011
Rating
starstar 		more surgery will leave more scar tissue
by: Certified Neuromuscular Therapist

By getting more surgery, this will leave more scar tissue, causing more ischemia (lack of blood flow in the tissue), more entrapment of nerves, blood vessels & tendons, which will most likely result in more pain & dysfunction.

You may want to try doing something more conservative & often more effective, called Neuromuscular Therapy. It is a type of soft tissue manipulation (or very specific massage therapy) that actually works to help you increase blood supply, break up fibrous adhesions & entrapment of all the structures in the foot, no matter where the surgery was done. A well trained Neuromuscular Therapist will take you through the Neuromuscular Stages of Rehab and apply not just specific massage releasing trigger points but movement re-education, flexibility stretching, strengthening and aerobic endurance. they will look at posture/biomechanic distortion, nerve compression/ entrapment, ischemia/circulation in tissues, nutrition & mental/emotional well-being.

You mentioned that you had pain in your other foot but not as bad. This reminds me of a Pfluger's Law, a neurological law called Law of Symmetry & Law of Intensity.

A Certified Neuromuscular Therapist is not a doctor and cannot diagnose, but can facilitate healing & rehab process.
Jan 13, 2011
Rating
starstarstarstarstar 		Tarsal Tunnel Help
by: Anonymous

I have been in agony for 17 years after tarsal tunnel surgery recently I fell and sprained the same foot. The pain has increased. I can not walk, steps are horrid and simple booties cause increases in pain. I have been told I have RSD and have been on painkillers for years. Is there any other options for relief? I know how hard it is to go thru tests, only to have lesions found on surgery. Thank you for your kindness. Pills only tamp it down and I am looking for any option.
I had burning pain in the same leg for ten years prior and tests etc showed nothing. I have been told that 80% of all pain syndromes don't show up on medical tests.
Mar 14, 2010
Rating
starstarstarstarstar 		ankle and foot pain
by: Deborah

I feel you pain Roxanne. I have had 3 surgeries on my left ankle - first time for unicameral bone cyst in heel bone - second time for peroneal tendons out of place - third time in Nov. 2009 with torn peroneal tendons - tendons out of place, plus DR found nerve stuck to tendon and moved back in place. Still now almost 4 months later I have severe pain in outside of left foot, plus my toes are numb and area across top of my left foot feels like electrical shocks every time I touch it. Dr. prescribe anti-inflammtory gel and exercise - been doing both, but still have same problems. Dr. said it would take time to heal, but come on - already at 4 months and no real relief - What do I do now - live with it???

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Columbia University Department of Rehabilitation

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