Hi everyone. New to the forums.

I've been struggling with chronic forefoot pain since the beginning of the year. In April, I had a positive tinel sign in both the left and right ankles. My podiatrist suspected tarsal tunnel so I had a nerve conduction test done and while not conclusive, the neurologist wrote in his report that there could well be an underlying component of tarsal tunnel.

We tried a number of things including acupuncture and physical therapy but it wasn't improving. It was suggested that I have an mri done of my spine. The mri showed that the disc is herniated at the right L5 nerve root. The orthopedist I saw to get the mri done suggested an epidural. I'm now 10 days past the injection and some of my symptoms have improved and some haven't. Specifically:

Rectal pain - gone the next day after the injection.
Vibrating sensation in my groin - 99% gone.
Numb feeling in my right foot as if asleep - 50% improvement.
Pain in the arch of my feet - 30 to 50% improvement.
Pain in the ball of my feet - little improvement although I'm walking slightly farther.
Pressure and "twitching" sensation on the inside area of both ankles - unchanged.

So this leads to several questions:

Is there anyone on these boards that had tarsal tunnel symptoms that was caused by a herniated disc?
What was done to treat it?
What are the odds that I would have bilateral tarsal tunnel and a herniated disc and they're not related?

Also, I had a complete blood count done and everything looked great, including B12 levels and my thyroid.
I'm at very low risk of exposure to toxins.
(My house is 25 years old, the building I work in is 20 years old. I don't golf.)

There are a lot of helpful and dedicated people on these boards.
I'd like to thank everyone in advance for their response.
Good health to all.

--for such symptoms to be traced to pressure on nerve roots in the lower lumbar and sacral spine areas.

What that would mean, of course, is that technically you don't have true tarsal tunnel, as the symptoms are starting higher up than that area. You could have some compression going on in the foot ankle area as well, though--the so-called "double crush phenomenon".

Neural symptoms from widely different causes can "feel" exactly the same--they may be caused by peripheral nerve problems, problems in the spine, or even in the brain--which is why investigation into their causes are often long, expensive and rather process of elimination.

I've read about the double crush phenomenon and wondered if that might be what's happening. It feels as if the problem is cascading down from the lumbar to the ankle, and then on to the bottom of my feet.

You're right in that it's a long, expensive process to arrive at an accurate diagnosis. I had an mri done of my feet back in April. It's a shame that while it was being done, they didn't also slide me another 3 feet into the machine and scan my spine as well. We would now be 4 months ahead of where we're at, having saved an awful lot of time and money on physical therapy and acupuncture, not to mention the amount of physical and psychological suffering that has happened since then.

I don't believe there's a silver bullet in all of this, but rather a combination of things that can resolve the foot pain I've been having. I would think that someone else on these boards has been through this and can offer some advice on what ultimately worked for them.

Thanks for the reply, glenntaj. I appreciate it.

I have several thoughts. While EMG's are not hugely sensitive, NCV's are...in the order of 90+ %. So the diagnosis of tarsal tunnel syndrome should be fairly straight forward. MRI's are an anatomical study so that alone is not ultimately diagnostic but combined with your ESI improvement, there is probably more happening there. Tarsal tunnel syndrome BTW, many times is exacerbated by over-stretching of the posterior tibial nerve from over-pronatory issues that can be addressed with semi-ridged functional orthotics. Steroid injection sometimes helps as well. Also, if it is truly TTS, manipulation of the mortise joint sometimes helps too. Good luck!