So I have had pain and continuous swelling in my right ankle for the last 9+ months. My rheumy gave me a steroid injection and said well it's just the PsA. It seemed to help for awhile then got worse again. So off to the Dr for another injection. This time it didn't help much and about a month later I had my first episode of psoriasis...at the injection site. And again it worsened...I returned to the rheumy and showed him the enlarged ankle and his response was "that's PsA". Well I wasn't okay with blowing it off and I went to my primary Dr.
She ordered a MRI which I did a couple of weeks ago. The results were as I mentioned in my subject line...ganglions (plural) and tenosynovitis with fluid in the tarsal tunnel. So now it's off to the podiatrist/surgeon.
My question is has anyone had a tarsal tunnel surgery or any ankle surgery due to their PsA? How did it go and what was your recovery like? Thanks for reading my post and any comments. :)
Oh oh oh HoneyBunny! Back in my pre-diagnosis days, my GP sent me for testing to check for tarsal tunnel because of my foot pain and neuropathy. (I had already been diagnosed with carpal tunnel.) The tests came back negative. Just another “who knows” moment in my medical history. I’d had so many of those that I was at the point of thinking that I was a complete nut case and that my problem was psychiatric. I suspect that my doc would have concurred. Anyway, I continued to limp along until I couldn’t take the foot pain any more. That’s when they discovered the erosions and I got the PsA diagnosis.
Fast forward two years, to the point where Enbrel was getting traction. The neuropathy pretty much resolved, and the foot pain was much improved. Those symptoms had been PsA, not TT. Incidentally, pre-diagnosis, I’d had one Carpal Tunnel release, and needed another. That got so much better that I’ve put it off indefinitely.
I’m with you on the Stelara assessment. If I were you (and I’m not …) I’d be trying other treatments for PsA before I’d sign up for TT surgery.
Here are a few random thoughts. If it’s just one joint, then changing meds is probably not the way to go. Treating the ankle is more appropriate.
What you are talking about is all based on inflammation. Tarsal tunnel syndrome is based on nerve compression, not just swelling in the area. You would need nerve studies to diagnose it firmly, and you would want to try other treatments first. Would physical therapy be appropriate to help things move properly and to quiet down inflammation? What about booting it?
It sounds like your next move is good, going to the foot doctor. You can come up with treatment plans. Hopefully you would talk booting long before considering any surgery.
I wish you luck with this. It sounds like it’s really become a problem.
I have a lot of foot problems and one thing that has helped me find some relief are paraffin wax baths. Bed bath and beyond sells a kit, and I watched some youtube videos on how to do it. It relieved alot of pain in my feet for me. Its a bit time consuming but I can walk better now.
My PsA started in my feet and ankles. My doctor said "it's arthritis, take Motrin and keep your feet up." ( I had a 5 year-old son at the time!) Then I had an x-ray, and he said, "it isn't broken." I changed doctors and she gave me Celebrex, that DID help, but I suffered with PsA for 20 years, so I tried everything for my feet. This is what helped me: I made a wet dressing with EPSOM salt and wrapped my foot with it, then a loose ace bandage to keep it in place, next a layer of plastic wrap, and last a loose sock; and I put it on after work--around 5:00 p.m.--and slept with it until 5:00 a.m., when I got ready for work. (I stood 8 hours a day). It still hurt but the swelling and inflammation were considerably less. I did this every night. I used Mineral Ice too, when I ran out of Epsom salt, it worked too, it says NOT to cover it but I thought it couldn't hurt any worse! The water alone helps too, but not as much. (take fish oil too)
Finally, about 3 years ago, I saw a podiatrist that saw the damage to my feet, he gave me 3 steroid injections, and sent me to a rhuematologist, they found the PsA. I take Enbrel and MTX now and I don't have any swelling. If I am on my feet or walking for a long time, they do start to hurt. I'm not working anymore either. The less I weigh the less they hurt too. lol. I've learned what I can and can't do. I can't use a treadmill, but an exercise bike is no problem. I have PsA in many more joints now, but my feet and my hip were the worst. I became frightened that I would be confined to a wheel chair and that led me to severe depression. Good luck, give my suggestion a try. I know I would have tried anything for just a little relief.
They have an Epsom Lotion by Morton that works well and requires less effort. I use it on my feet before bed. I found it over the counter, online and at Walgreens and Walmart. Look for it.
Andy said:
My PsA started in my feet and ankles. My doctor said "it's arthritis, take Motrin and keep your feet up." ( I had a 5 year-old son at the time!) Then I had an x-ray, and he said, "it isn't broken." I changed doctors and she gave me Celebrex, that DID help, but I suffered with PsA for 20 years, so I tried everything for my feet. This is what helped me: I made a wet dressing with EPSOM salt and wrapped my foot with it, then a loose ace bandage to keep it in place, next a layer of plastic wrap, and last a loose sock; and I put it on after work--around 5:00 p.m.--and slept with it until 5:00 a.m., when I got ready for work. (I stood 8 hours a day). It still hurt but the swelling and inflammation were considerably less. I did this every night. I used Mineral Ice too, when I ran out of Epsom salt, it worked too, it says NOT to cover it but I thought it couldn't hurt any worse! The water alone helps too, but not as much. (take fish oil too)
Finally, about 3 years ago, I saw a podiatrist that saw the damage to my feet, he gave me 3 steroid injections, and sent me to a rhuematologist, they found the PsA. I take Enbrel and MTX now and I don't have any swelling. If I am on my feet or walking for a long time, they do start to hurt. I'm not working anymore either. The less I weigh the less they hurt too. lol. I've learned what I can and can't do. I can't use a treadmill, but an exercise bike is no problem. I have PsA in many more joints now, but my feet and my hip were the worst. I became frightened that I would be confined to a wheel chair and that led me to severe depression. Good luck, give my suggestion a try. I know I would have tried anything for just a little relief.
I think it will end us as tarsal tunnel due to the ganglions. (fibrous tumors) that they have seen on the MRI. I completely agree that the inflammation is the root and hope to get it under control soon. I will update my post after the appt on tuesday with the podiatrist/surgeon.
I suffer from tendonitis, peripheral neuropathy, chronic arthritis,chronic plantar fascia,flat feet,hammer toe, degenerative joint disease and of course PsA loves dancing around with it's friends...in both feet and ankles. I'm trying the soft braces that provide me with a more stable feeling when I walk. I walk with a walker anywhere away from home. I still don't have a whole bunch of time on the feet or the knees. Just had some repair work done on my R knee to buy me a couple of years before full replacement...expects the other to follow suit.
I live in the Northwoods of Michigan so when I go out I have to wear boots and my choice is with combat boots...yep, Grandma wore combat boots(back in the late 70's) Combined with my braces it's better walking for sure.
I also get injections on top to fill the pad of my foot and usually in the heel for the fascia and tendonitis. I get these every month and usually feel it wear off just short of it.
So for now I am going the braces, cortisone, Neurontin, Norco and we'll see. I always try the least invasive remedy first. I also get regular physical therapy for feet, knees and back.
I hope you find a way thru and over this. This is only what I know and do for foot and ankle pain. Good luck and be sweet to yourself.
My feet were one of my worst sources of pain. I did not have a lot of visible swelling. Voltaren gel gave some temporary relief. Enbrel, injected Methotrexare and Celebrex really helped in the long term.
It will definitely be interesting to see what happens when you see the doctor. Keep us in the loop.
HoneyBunny said:
I think it will end us as tarsal tunnel due to the ganglions. (fibrous tumors) that they have seen on the MRI. I completely agree that the inflammation is the root and hope to get it under control soon. I will update my post after the appt on tuesday with the podiatrist/surgeon.
Hi HoneyBunny,.....for the last 2 weeks I have had a very tender spot on the bottom of my foot...just below the pad. I have had several little cysts pop up in between the joints in my hands...small and go away...but this has just gotten bigger and more painful. Was wondering if ganglion cysts could show up anywhere or just wrists...where I have had one for a long time....you answered that for me! So, the next question for me is....is it related to PsA or just a bonus???
Hope you get answers and help for your issues soon :)
Ganglion cysts can be related to PsA due to the chronic tendon inflammation we can suffer. Ganglion are usually related to a joint or tendon sheath and can be located almost anywhere. However most 70% or so are in the hand and wrist. From what I have read the conservative treatment is rest (splints etc), cold therapy, and steroids. Most resolve over time but sometimes they persist and then they become candidates for removal.
I am hoping for removal as strange as that sounds. I am working a busy schedule in the hospital still and I am often on my feet for 12 hours. I use compression, anti inflammatory and pain medicine in addition to lidocaine patches to keep walking. Hope you get relief soon. :)
I imagine I sound like a nut case in that I am considering TT surgery. Thing is the ankle doesn't improve and I gotta keep working. From what I have read ganglions in the tunnel almost require removal. Draining them is risky as a "blind" procedure and the possible damage to the nerves. But I don't know what the Dr will say...maybe just the standard of "that's PsA"...LOL... :)
Seenie said:
Oh oh oh HoneyBunny! Back in my pre-diagnosis days, my GP sent me for testing to check for tarsal tunnel because of my foot pain and neuropathy. (I had already been diagnosed with carpal tunnel.) The tests came back negative. Just another "who knows" moment in my medical history. I'd had so many of those that I was at the point of thinking that I was a complete nut case and that my problem was psychiatric. I suspect that my doc would have concurred. Anyway, I continued to limp along until I couldn't take the foot pain any more. That's when they discovered the erosions and I got the PsA diagnosis.
Fast forward two years, to the point where Enbrel was getting traction. The neuropathy pretty much resolved, and the foot pain was much improved. Those symptoms had been PsA, not TT. Incidentally, pre-diagnosis, I'd had one Carpal Tunnel release, and needed another. That got so much better that I've put it off indefinitely.
I'm with you on the Stelara assessment. If I were you (and I'm not ...) I'd be trying other treatments for PsA before I'd sign up for TT surgery.
Thanks for the comment Stoney. Weird thing about the meds is that the Stelara has flared the arthritis a week or so after each shot. I guess I am sorta desperate for some relief and I know everyone can relate with that! I hope we all have a better 2015. :)
Stoney said:
Here are a few random thoughts. If it's just one joint, then changing meds is probably not the way to go. Treating the ankle is more appropriate.
What you are talking about is all based on inflammation. Tarsal tunnel syndrome is based on nerve compression, not just swelling in the area. You would need nerve studies to diagnose it firmly, and you would want to try other treatments first. Would physical therapy be appropriate to help things move properly and to quiet down inflammation? What about booting it?
It sounds like your next move is good, going to the foot doctor. You can come up with treatment plans. Hopefully you would talk booting long before considering any surgery.
I wish you luck with this. It sounds like it's really become a problem.
WEll yaaaaaaa, HoneyBunny … it gets to the point where you will consider ANYTHING that will let you continue doing what you need to do. You don’t sound like a nut case at all.
Make sure to tell us what the doc says. And hope it isn’t “that’s PsA”.
I get it! And I am sorry that you are suffering. I told my Rheumy three weeks ago that the pain was so bad in my feet that I was ready to amputate. Obviously, he didn’t take me seriously. He just suggested that we give new infusions of Remicade additional time to reduce swelling. So far, No relief. And how am I supposed to walk or stand in the interim? I have heel spurs and achilles enthesopathy. From what I’ve been able to discern on this condition; it rarely resolves on its own and that once people have surgery they are sorry they waited so long. However, as with any type of surgery, particularly one involving connective tissues, tendons/ligaments, the recovery is slow.
Lyndsey, I could have written that post myself, except for the remicade part. I told the foot surgeon that if he offered amputation and giving me a couple of Bladerunner style blades, I’d sign up. He looked very serious and said “I wouldn’t offer that because I’d be afraid that you might shoot your top model lover through the bathroom door”. Took me a minute for the penny to drop. LOL too funny!
I saw the podiatrist/surgeon and he has referred me to a neurosurgeon. The cysts are in the tarsal tunnel near the nerve and he said I need a more skilled surgeon. In the mean time he recommended custom orthotics and PT while I am waiting for an appointment with the new doctor.
He said the hind foot is collapsing and would result in flat foot deformity. My PsA has been flaring the last year in that ankle/foot and the chronic inflammation has resulted in the falling arch. At this point the other foot is fine so it is all centered on the right. Actually most of my more severe arthritis is all on the right side of my body. I will let you know what the neuro Dr has to say.
Thanks for the update. You're at least making progress in dealing with all of this. I'm glad to hear that PT was recommended for you as well.
Isn't it interesting how there are different patterns of disease? You said yours is mostly on the right side, mine is nearly symmetrical, though one side or the other is typically a bit worse.