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Dr. Z, please......

Posted by ChrisO on 5/23/00 at 22:04 (020747)

Well, Dr. Zuckerman, I kind of feel that I'm taking advantage of your expertise, given that I'm not a patient of yours, but here goes......other than non-invasiveness, what's the actual benefit of ESWT over PF release surgury? Aren't they both designed to created small 'cuts' that release fascia, fill with scar tissue and create new blood flow? By the way, thanks for posting information about the EPF - it was very educational.

Re: Dr. Z, please......

Dr. Zuckerman on 5/23/00 at 23:04 (020752)

I don't know if you can consider ESWT as performed small cuts. So the trauma is alot less the EPF cutting surgery. You are cutting completely thru the plantar fascia when you do PF surgery. In addition this is an effect on the pain receptors with ESWT . The receptors in the area are over-stimulated which can and in most cases reduces pain within days from the ESWT procedure. The healing time is much quicker the Pf surgery.
There is the risk of nerve damage with Pf surgery. The most common complications with Pf surgery is what is called calcaneal-cuboid syndrome. This is where the lateral outside joints of the foot are over stressed due to the inability of the medial band of the pf being completely cut thru to support its share of weight during the phase of gait called the contact phase. . If would be like a bridge having one side of the cable supports cut and the entire bridge having to be supported by one cable. This is the most commone and serious complication that can occur with Pf surgery. I have seen this complication as a permanent complication in the human foot. This is why I cut the pf from a small incision thru the bottom of the foot this does avoid this problem but still you can have a temporary calcaneal-cuboid syndrome problem. This problem can last for six months until the medial aspect of the cut portion of the pf is healed and able to support it share of weight. Other complications of pf surgery reported are stress fracture, collapsed arch ( I had this happen to one of my patients about fifteen years ago) RSD, very serious permanent nerve damage problems. There is no help for this if the problem is'nt diagnosed quickly. I saw this problem six weeks ago . The patient came to me for help. There is nothing that I could do for her due to the lack of a diagnosis during the first six weeks that the problem started . Let's see infection very rare, Like I told you the most common problem is the calcaneal cuboid syndrome. This is very painful when it happens.
All of these complications don't exist with ESWT. The complications with ESWT is money . The insurance companies won't pay for this yet.

Re: Dr. Z, please......

ChrisO on 5/24/00 at 11:07 (020772)

Dr. Z - Thanks, as always, for a thorough explanation. I have just one more question and then I'll leave you alone - I promise! You've described the PF surgury as cutting completely through the plantar. I had understood that the surgery is for partial release of the plantar - not complete release. Does it just depend on the patient or is it technique based on judgement? Thankyou!

Re: Dr. Z, please......

Dr. Zuckerman on 5/24/00 at 16:30 (020792)

The cut is completely cut thru the portion that you are cutting. i am talking about depth . So you would release the entire area from the heel but only about one third of the width. If would be like cutting an apple in half but completely in half . You need to have separation of the portion of the fascia that you are cutting from the heel bone. This isn't the same thing as a complete release. You can ask me any quesiton you want. !!!!

Re: Dr. Z, please......

Dr. Zuckerman on 5/23/00 at 23:04 (020752)

I don't know if you can consider ESWT as performed small cuts. So the trauma is alot less the EPF cutting surgery. You are cutting completely thru the plantar fascia when you do PF surgery. In addition this is an effect on the pain receptors with ESWT . The receptors in the area are over-stimulated which can and in most cases reduces pain within days from the ESWT procedure. The healing time is much quicker the Pf surgery.
There is the risk of nerve damage with Pf surgery. The most common complications with Pf surgery is what is called calcaneal-cuboid syndrome. This is where the lateral outside joints of the foot are over stressed due to the inability of the medial band of the pf being completely cut thru to support its share of weight during the phase of gait called the contact phase. . If would be like a bridge having one side of the cable supports cut and the entire bridge having to be supported by one cable. This is the most commone and serious complication that can occur with Pf surgery. I have seen this complication as a permanent complication in the human foot. This is why I cut the pf from a small incision thru the bottom of the foot this does avoid this problem but still you can have a temporary calcaneal-cuboid syndrome problem. This problem can last for six months until the medial aspect of the cut portion of the pf is healed and able to support it share of weight. Other complications of pf surgery reported are stress fracture, collapsed arch ( I had this happen to one of my patients about fifteen years ago) RSD, very serious permanent nerve damage problems. There is no help for this if the problem is'nt diagnosed quickly. I saw this problem six weeks ago . The patient came to me for help. There is nothing that I could do for her due to the lack of a diagnosis during the first six weeks that the problem started . Let's see infection very rare, Like I told you the most common problem is the calcaneal cuboid syndrome. This is very painful when it happens.
All of these complications don't exist with ESWT. The complications with ESWT is money . The insurance companies won't pay for this yet.

Re: Dr. Z, please......

ChrisO on 5/24/00 at 11:07 (020772)

Dr. Z - Thanks, as always, for a thorough explanation. I have just one more question and then I'll leave you alone - I promise! You've described the PF surgury as cutting completely through the plantar. I had understood that the surgery is for partial release of the plantar - not complete release. Does it just depend on the patient or is it technique based on judgement? Thankyou!

Re: Dr. Z, please......

Dr. Zuckerman on 5/24/00 at 16:30 (020792)

The cut is completely cut thru the portion that you are cutting. i am talking about depth . So you would release the entire area from the heel but only about one third of the width. If would be like cutting an apple in half but completely in half . You need to have separation of the portion of the fascia that you are cutting from the heel bone. This isn't the same thing as a complete release. You can ask me any quesiton you want. !!!!