Long time no see friends! I have several posts to catch up on. In following orders from my new doctor who specializes in peripheral nerve pain, I went for a 3rd electromyography (EMG). He said I could get it done anywhere, but I decided to go with the neurologist that he knew and recommended, even though it’s a bit of a drive for me. The things I do for these injuries. Whatever it takes.
I forgot how not fun EMGs are. However, I would have an EMG over dry needling any day! Anyway, the neurologist determined that there’s nothing to indicate I have tarsal tunnel. However, I’ve read that EMGs may be helpful in diagnosing tarsal tunnel but not always. He suggested being tested for small fiber neuropathy, which would require them to take a small piece of my skin to be sent off and studied. The doc later decided it wasn’t necessary to do this test. He prescribed me for Cymbalta, but for some reason I didn’t sleep well after taking it. It may have been a mental thing and I couldn’t get over the fact that I was taking Cymbalta.
I went back to my peripheral nerve-specializing doctor to do another test and find out the results of my neurography scans of my calves and feet. The specific test, neurosensory testing with the pressure-specified sensory device (PSSD) is not covered by insurance and costs $300. It’s a painless test and basically involves being poked with some needles to see how much feeling/sensitivity you have in the injured area. They found some areas of my feet were more sensitive than others.
Lastly, my doctor concluded that, again, all signs point toward tarsal tunnel, including the radiating pain on the bottom of my feet. Here’s my neurography scan deets:
Right foot/ankle: 1) Moderately increased signal in lateral plantar nerve, and mildly increased signal in the medial plantar nerve consistent with neuropathy. 2) Tibialis posterior tenosynovitis. 3) Mild acute on chronic plantar fasciitis. 4) Small amount of reactive edema, less so than on the left, at the calcaneonavicular articulation which may indicate some element of fibrous coalition.
Left foot/ankle: 1) Moderately increased signal in the medial and lateral plantar nerves consistent with neuropathy. 2) Low-grade partial tear of the tibial posterior. (WHAT??!!) 3) Reactive edema, more than on the right, at the calcaneonavicular articulation, which may indicate some element of fibrous coalition.
Right soleal sling: 1) Normal appearance to tibial nerve and branches without sign of compression of focal neuroma. 2) Anatomy associated with patellar maltracking.
Left soleal sling: 1) Normal appearance to tibial nerve and branches without sign of compression of focal neuroma. 2) Focally increased signal in the common peroneal nerve only at the fibular head. 3) Anatomy associated with patellar maltracking.
The doctor said that I would be a good candidate for tarsal tunnel release surgery, but I’m not ready for that, especially considering I need to deal with more pressing issues like my TMJ and neck/shoulder pain. And I have not had PT that was focused on tarsal tunnel. In the meantime, I’m considering going gluten free to see if it helps with the foot pain.
THE Chronic Foot Pain Ninja Warrior
Walking On Needles 