Peroneal /Tarsal Tunnel problems

I know this is a long and involved post, and that is the third time I have posted but another opinion is greatly needed. My mother, age 70, was recently diagnosed with left peroneal nerve entrapment, and tarsal tunnel syndrome of the left foot. As a backround, the tarsal tunnel was found on an emg/nerve conduction test 4 months ago after she had an avulsion fx of her talus last Sept.. The peroneal nerve was also found on the same test. For the last four years, she has had pain in her leg, around the thigh and buttock area, for which she received epidurals, facet injections, 3 course of PT, as well as having ct scan, MRI, and myelogram and acupunture. The diagnostics only revealed some disc bulging as l4-l5, with no nerve involvment and no cord compression. She had nerve conductions 3 years ago that were negative, although she had the same leg pain as she does now.

Her neurologist stated that her problem was not originating in her back, and she then treated with a pain clinic for the epidurals.etc. She has not had much relief. Her current pain dr now wants her to receive facet joint injections under a fluoroscope, and she is reluctant to do this, since it did not provide relief 2 years ago. Multiple medications were also tried with no real relief, plus she does not tolerate meds well as she had a colon resection 10 years ago following cancer. Addtionally, she is now trying orthotics for the tarsal tunnel syndrome, but is concerned as she is not experiencing much, if any relief. She is aware that surgery is risky for the tarsal. She has not had any injections in the tarsal area, although she did have cortisone in her heel area for plantar facitits, again with no real relief.  Currently she is trying Vioxx for inflammation. . At this point, we are at a loss as to what steps to take next, or even if she should contin

[CCF Neuro[P] MD, RPS]

Dear John:

Sorry to hear about your mother. They have located the problem to the peroneal nerve and not at the root if I read your posting correctly.  If they have tried steroid injections at the tarsel tunnel site and found relief then tarsal tunnel surgery is an option.  However, if steroids did not help then it is doubtful that surgery would help your mother.  Since the problem has been localized more periperal to the root, then I would doubt that facet joint surgery would be of help.  This is further suggested by a normal EMG.  I am not sure what to tell you that already has been discussed.  Sorry.

Sincerely,

CCF Neuro MD