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questions to ask our doctors, Scott, anyone???

Posted by joan on 8/10/99 at 20:33 (009623)

I am wondering, just wondering, if anything cutting edge is being done relevant to surgery for this condition. I too get pain after stretching, even carefully, and it occurs to me that it is because of reinjuring the already tight tissues. It seems to go like this: 1)plantar fasciitis is caused due to initial injury (in my case and sports-related ones, anyway); 2) in healing, scar tissue is formed which heals the site of injury but of course shortens the fascia, resulting in all the future loss of flexibility, reinjuring due to stretching and walking, etc. Basically, the scar tissue has formed a contracture on the bottom of the foot. Contractures can be fixed (rigid and inflexible) or movable (somewhat flexible) but the area is never really the same again. THEREFORE, my question for all/any of us to throw out to our doctors, contacts, the research world, etc. is as follows: HAS ANYONE EVER THOUGHT OF DOING A SURGERY WHERE INSTEAD OF JUST CUTTING THE FASCIA, THEY CUT IT AND SEW IN SOME FORM OF MATERIAL TO RE-LENGTHEN IT??? It seems that with all the joint replacements, space-age materials, implants, etc., there ought to be some kind of flexible but resilient material that could be used for such a surgery. Can we all ask our doctors if anyone/anywhere is looking into this? Even if it's not pf-related research, such stuff MUST be going on. And with persistence, it might become an answer. Scott? Anyone else have thoughts on this?

Re: questions to ask our doctors, Scott, anyone???

Bea on 8/10/99 at 22:39 (009626)

I admire your belief on the skill of doctors to operate and make us well. This is a very delicate area and much damage can be done if extreme care is not taken. I am very much afraid to have a surgury on such an important area, one can wind up in worse shape very easily.

Re: questions to ask our doctors, Scott, anyone???

john on 8/11/99 at 09:05 (009633)

my understanding is that when a fascia release is done (usually around 33%) that tissue grows back resulting in lengthening. another procedure commonly used (baxter procedure) a small wedge of fascia is removed from the center of the fascia just forward of the heel rather than releasing the fascia on one side or the other. of course, what i write is my 'understanding' and not the gospel.

Re: questions to ask our doctors, Scott, anyone???

john on 8/11/99 at 09:15 (009634)

bea: surgery is a scary proposition but from reading the many studies from various medical institutions the success rate of a PF release is rather high. I asked my surgeon who is a foot and ankle surgeon with a fellowship in foot and ankle surgery what was the odds surgery could make my foot worse. He said very small probably less than 5%. the biggest danger being infection. I am having surgery (chelictomy on my big toe) on the 24th of this month and I have until that time to make up my mind of the fascia release (open method) to be done at the same time. The doctor said it was my call since the symptons I present are not the classic PF Smyptons. I do not have early morning pain or a spot you can press on to induce pain. This has been ongoing for 5 or more years and has really disruppted my life as most of you will attest too.

Re: questions to ask our doctors, Scott, anyone???

joan on 8/11/99 at 22:22 (009651)

I would be the very last person on the planet to just jump into any kind of surgery----that said, I do think it is wise to keep looking for anything new and promising that may be on the horizon.. I just saw an orthopedist who was first a podiatrist, and he said that in the 5% of people who don't get better on their own from this, about half opt for surgery and that the success rate (in his experience) has been quite high. Take that with a grain of seasoning, as I would have to hear that from at least five or six very good doctors who I researched before I even consulted with them, BUT it does register in my brain as the first positive thing I've heard about surgery. I am nowhere near rushing out to do it--my pf is not that bad--however, I will file it away in my mind as a potential option should this ever get worse, or should it go on so long that I get so da%$ed sick of it that I beg for the surgery. I am beginning to get quite da$%ed sick of it, but basically I am just dramatically venting now, so take me with a grain of salt too! :o) But thanks for the info. on the surgery and the types of cuts. I learn a LOT from these boards. Thanks.

Re: questions to ask our doctors, Scott, anyone???

john on 8/12/99 at 12:12 (009666)

if you go to the home page and access 'Plantar Fascia Journal Articles' and then access 'All Surgery Abstracts' you will find a number of studies by reputable hospitals on success/failure stats from various studies on PF release. I have always thought that we on this board are the hard core cases for the most part and are not represenative of the failure/success rate of various procedures and alternatives that are successful. Few people who have this problem even have access to a computer and many who have access do not make their way to the board. Most people (who are cured thru whatever method) are not heard from by us. If i had access to this board 6 or 7 years ago i would have IMMEDIATELY quit running when the first signs of pf appeared. I had never even heard of pf other than carl lewis the world champion runner had surgery for pf and came back to win major championships. this is surely the most informative board on the subject i have ever seen and does provide hope and a great source of information. i have no data to support itbut my gut feeling is that most people on our board have 'not' had surgery and are very reluctant to try it. i am one of them but D-Day is approaching as I have to make my decision by the 24th when I have toe surgery. My biggest concern is not that surgery will cure it but that it could make it worse.

Re: questions to ask our doctors, Scott, anyone???

joan on 8/12/99 at 12:33 (009668)

I understand your hesitancy about surgery, John. I feel the same way. I just want you to know that I hope it all works out for you. Good luck. Thanks for the reference to the pf research articles. I will certainly look them up.

Re: questions to ask our doctors, Scott, anyone???

Bea on 8/10/99 at 22:39 (009626)

I admire your belief on the skill of doctors to operate and make us well. This is a very delicate area and much damage can be done if extreme care is not taken. I am very much afraid to have a surgury on such an important area, one can wind up in worse shape very easily.

Re: questions to ask our doctors, Scott, anyone???

john on 8/11/99 at 09:05 (009633)

my understanding is that when a fascia release is done (usually around 33%) that tissue grows back resulting in lengthening. another procedure commonly used (baxter procedure) a small wedge of fascia is removed from the center of the fascia just forward of the heel rather than releasing the fascia on one side or the other. of course, what i write is my 'understanding' and not the gospel.

Re: questions to ask our doctors, Scott, anyone???

john on 8/11/99 at 09:15 (009634)

bea: surgery is a scary proposition but from reading the many studies from various medical institutions the success rate of a PF release is rather high. I asked my surgeon who is a foot and ankle surgeon with a fellowship in foot and ankle surgery what was the odds surgery could make my foot worse. He said very small probably less than 5%. the biggest danger being infection. I am having surgery (chelictomy on my big toe) on the 24th of this month and I have until that time to make up my mind of the fascia release (open method) to be done at the same time. The doctor said it was my call since the symptons I present are not the classic PF Smyptons. I do not have early morning pain or a spot you can press on to induce pain. This has been ongoing for 5 or more years and has really disruppted my life as most of you will attest too.

Re: questions to ask our doctors, Scott, anyone???

joan on 8/11/99 at 22:22 (009651)

I would be the very last person on the planet to just jump into any kind of surgery----that said, I do think it is wise to keep looking for anything new and promising that may be on the horizon.. I just saw an orthopedist who was first a podiatrist, and he said that in the 5% of people who don't get better on their own from this, about half opt for surgery and that the success rate (in his experience) has been quite high. Take that with a grain of seasoning, as I would have to hear that from at least five or six very good doctors who I researched before I even consulted with them, BUT it does register in my brain as the first positive thing I've heard about surgery. I am nowhere near rushing out to do it--my pf is not that bad--however, I will file it away in my mind as a potential option should this ever get worse, or should it go on so long that I get so da%$ed sick of it that I beg for the surgery. I am beginning to get quite da$%ed sick of it, but basically I am just dramatically venting now, so take me with a grain of salt too! :o) But thanks for the info. on the surgery and the types of cuts. I learn a LOT from these boards. Thanks.

Re: questions to ask our doctors, Scott, anyone???

john on 8/12/99 at 12:12 (009666)

if you go to the home page and access 'Plantar Fascia Journal Articles' and then access 'All Surgery Abstracts' you will find a number of studies by reputable hospitals on success/failure stats from various studies on PF release. I have always thought that we on this board are the hard core cases for the most part and are not represenative of the failure/success rate of various procedures and alternatives that are successful. Few people who have this problem even have access to a computer and many who have access do not make their way to the board. Most people (who are cured thru whatever method) are not heard from by us. If i had access to this board 6 or 7 years ago i would have IMMEDIATELY quit running when the first signs of pf appeared. I had never even heard of pf other than carl lewis the world champion runner had surgery for pf and came back to win major championships. this is surely the most informative board on the subject i have ever seen and does provide hope and a great source of information. i have no data to support itbut my gut feeling is that most people on our board have 'not' had surgery and are very reluctant to try it. i am one of them but D-Day is approaching as I have to make my decision by the 24th when I have toe surgery. My biggest concern is not that surgery will cure it but that it could make it worse.

Re: questions to ask our doctors, Scott, anyone???

joan on 8/12/99 at 12:33 (009668)

I understand your hesitancy about surgery, John. I feel the same way. I just want you to know that I hope it all works out for you. Good luck. Thanks for the reference to the pf research articles. I will certainly look them up.