complications from baxter nerve release
This is a thread posted in category: Tarsal Tunnel Syndrome . . View All Heel Pain CategoriesPosted by theresa on 11/12/07 at 18:41
Also, when I had my previous EMG's back in Febuary, I was told that I needed Baxter nerve release on both feet. After the EMG that I had today, I was told that he was only recommending that the plantar fascia be repaired on the left foot and not the Baxter nerve. I do not feel comfortable with this because the left foot has not had any surgery at all and the pain is worse than it was in Febuary. Could it be bad test results. Could the Baxter nerve repair it's self? Will the DR. be able to see if the nerve is trapped when repairing the plantar fascia?
Posted by Dr. Ed on 11/12/07 at 21:23
Numbness in the 4th and 5th toes has little to do with the Baxter's nerve; it has to do with the lateral plantar nerve.
Dr. Ed
Posted by theresa on 11/12/07 at 21:38
Posted by theresa on 11/12/07 at 22:41
I must have misunderstood the EMG dr. on which nerve it was. I do recall him saying something about the lateral plantar nerve as well.
My main questions are can the EMG test results be wrong about the severity of the damage? Also, can a nerve that needed surgery 9 months ago reapir it's self?
Posted by theresa on 11/12/07 at 23:30
When I went in for my EMG back in Febuary I was told that it was the Baxter nerve. But when I went in for the EMG today Dr. gave me a copy of the post op report which states that it was tarsal tunnel with nerve entrapment in the porta pedis area and chronic plantar fasciotomy.
Under the findings he wrote:
1.Fibrous bands within the porta pedis along the tibial nerve.
2.Hypertrophied abductor ballucis muscle belly, offending the
porta pedis area and the tarsal tunnel.
So, are the baxter nerve and tarsal tunnel the same nerve? I am so confused by this and I am to the point that I don't know if I should even go ahead with the next surgery.
Any help with my confusion is appreciated.
Posted by Dr. Ed on 11/13/07 at 13:30
The NCV is probably accurate if the results correlate with the observed symptoms. Healing of the nerve is relative to the degree of injury. What is the extent of numbness in the fourth and fifth toes -- partially or totally numb? If the answer is 'partially' then the chance of healing is improved and would be expected to occur after approximately 7 months.
Dr. Ed
Posted by Dr. Ed on 11/13/07 at 13:51
The tarsal tunnel is a grouping of compartments within a ligament on the medial side of the ankle. The tendons, nerves, arteries and veins to the top of the foot course over the front of the ankle and top of the foot. It is not possible for that to be the case on the bottom of the foot as one would step on those structures. As such those structures to the bottom of the foot were designed to 'loop around' the inside of the ankle (medial) and enter the bottom of the foot via a 'portal' known as the porta pedis.
The tarsal tunnel contains compartments. The first compartment contains the tibialis posterior tendon (the tendons which pulls up on the arch); the second compartment contains the flexor digitorum longus tendon (the long flexor tendons to the lessor toes that enable us to curl our toes); the third compartment the posterior tibial nerve, posterior tibial artery and its accompanying veins; the fourth compartment compartment contains the flexor digitorum longus tendon (the tendon that flexes the big toe and allows us to push off).
The posterior tibial nerve is the nerve that is affected in tarsal tunnel syndrome. The posterior tibial nerve give off medial calcaneal branches which go toe the bottom of the heel to provide sensation then divides into its two terminal branches, the medial plantar nerve and the lateral plantar nerve. That branching can occur within the tarsal tunnel or below it. The medial and lateral plantar nerve then take a turn to go into the back portion of the arch in an area known as the porta pedis. The porta pedis is partially 'surrounded' by the abductor hallucis muscle (the muscle that pulls the big toe away from the second toe). If that muscle is enlarged it can decrease the size of the portal pedis making it more likely that the nerve branches become entrapped there. This problem has been termed 'distal tarsal tunnel syndrome' although that usage is not universal.
The lateral plantar nerve, soon after entering the foot gives off a branch known as the inferior calcaneal nerve or Baxter's nerve which runs along the bottom of the heel bone, basically between the bone and the origin of the plantar fascia. It is postulated that that nerve can become entrapped in that location.
Here is a diagram of the nerve distribution to the skin on the bottom of the foot: http://en.wikipedia.org/wiki/Image:Gray834.svg
Dr. Ed
Posted by Dr. Ed on 11/13/07 at 13:53
Please place the above post into the library under the term: 'tarsal tunnel.'
Thanks,
Ed
Posted by theresa on 11/13/07 at 18:29
The fifth toe is completely numb. The fourth toe has been partially numb since the surgery. It does seem that the fourth toe is not as numb as it was after the surgery. Could that be a sign of healing?(I hope it's just not wishing thinking)
Thanks again,
Theresa
Posted by theresa on 11/13/07 at 18:34
I can't thank you enough for this info. I learned more from that, than I have since I first started seeking help for this problem back in 2004. It is so wonderful to have a site like this for those of us out here who just feel lost and who just feel like we have no where to turn with our questions and concerns.
Thanks so very much!
Theresa
Posted by Helen W on 11/14/07 at 01:24
Great Job Dr. Ed!! It explains this whole TTS mess better than I have found doing research. Clear, Concise, and Concrete!! Definitely a need to file this in the library for future victims of foot worries.
Posted by Dr. Ed on 11/14/07 at 22:26
If you look at the diagrams on skin innervation on the tarsal tunnel library entry you will note that the 4th toe gets some of its innervation from the medial plantar nerve. That implies that it was the lateral plantar nerve that was damaged. Look at the area, on the diagram again, and let me know if the area innervated by the lateral plantar nerve is numb.
Dr. Ed
Posted by theresa on 11/15/07 at 02:49
Yes, that is it! Down along the side of the foot the numbing has improved but has not gone away. The pain is basicly higher (in the toe area) and below the 4th and 5th toe area. The small toe is still numb. This area is my main concern because it has been a couple of months since I have noticed any improvement at all. It just seems to be at a standstill.
The EMG Dr. said they were going to try to treat it with medication and ultra sounds.
Also, I'm very concerned about the fact that he is only recommending the plantar fascia surgery on the other foot. Mainly because I was told last Feb. that there was nerve damage to the Baxter nerve and surgery was needed for that. I realize now, that it was not the baxter nerve after all. In my post op report it states that there was severe fibrous bands in the porta pedis and tarsal tunnel area. M
Posted by theresa on 11/15/07 at 02:57
So my question with this is...When he does the plantar fascia repair, will he be able to see if there is a problem with the tarsal tunnal and porta pedis area?
I am almost certain that I have the same problem with my left foot as I did with my right foot. I concerned about having surgery again and only getting half the problem fixed.
Thanks again for your time!
Theresa
Posted by theresa on 11/15/07 at 03:22
I also wanted to ask about a part of my post op report that reads...
'The patient is in need of orthotics due to the fact that she has significant rigid forefoot varus deformity and severe gastrocsoleal equinus which need to be accommodated with some physical therapy postoperatively as well as some biomechanical controll with orthotics.'
I think he's talking about the flat feet problem, but I'm not exactly sure because it sounds like two problems.
Theresa
Posted by Ernest Harrell on 4/29/08 at 12:33
Ernest harrell
Posted by Meg C on 3/30/09 at 23:17
Any comments or thoughts?
Thanks,
Meg C
