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fascia surgery

Posted by Jen H on 10/25/00 at 07:39 (031210)

I am considering all the options and am a little confused. If the fascia is cut during surgery to relieve tension, and the fascia is what holds everything together, what will hold it together afterwards? How close is the nerve to the fascia, my doctor believes I have nerve entrapment, what are the chances of the nerve being damaged during surgery. Is there somewhere at this site that explains this better, pictures maybe?

Re: fascia surgery

Dr. Zuckerman on 10/25/00 at 08:16 (031212)

Hi,

This is a very good question. The fasica should be cut very little.
The more you cut the greater the risk for collapse of the foot and or other pain in other parts of the foot and leg. This is one of the big reasons that I do ESWT before pf releases . I have done over 1000 mis heel spur and or pf releases in the past twenty two years and if it were my foot and I had the clinical determination that ESWT is indicated then I would do ESWT. If you want additional information please call my office and speak with Katie. She is my ESWT coordinator. You will find her you very knowledgeable and caring. So give her a call at 1-856-848-3338

Re: My podiatrist's explanation of the fascia

Mary on 10/25/00 at 16:03 (031258)

I had EPF surgery a week ago. Still hard to walk on the heel. He explained to me that there are 3 bands of fascia. The middle one gets cut ('which is not really needed anyway')to relieve the pain, at least in my case - the spur is on the inside of my heel, where the spur is digging in and out of like a sewing machine needle would. The tissue is removed therefore there is nothing for the spur to dig into anymore. 'The arch does not colapse because you have the front and back bands holding everything together'. Good luck with your decision. Ask lots of questions till you're satisfied. Try cortisone injections first. I did - two shots did nothing. You may have better luck. I hope so.

Re: My podiatrist's explanation of the fascia

Barbara TX on 10/25/00 at 21:48 (031294)

Mary - your advice about asking a lot of questions is right on the money... but where did your DPM get the idea that the middle band of fascia 'is really not needed anyway?' The middle band holds you up just like the other two do! B.

Re: fascia surgery

Jen H on 10/26/00 at 07:23 (031313)

Thanks for the information everyone. I have tried one cortizone shot, it gave relief for about a week. We are now trying ultrasound and taping, which was done for the first time Tuesday and will be repeated today, so far it's not doing anything. My doctor also explained the fascia as 'bands' and I believe the band that is giving me trouble is the one closest to the heel. We both feel at this point that there is nerve involvement, I thought so and he mentioned it Tuesday, confirming my thoughts. We are still going round and round about orthodics, I have a pair that are about 7 years old, my doc feels they are not rigid enough and would like me to get new ones but insurance will only pay $79.00 leaving me to pay the remaining $150.00. I am not too anxious to pay that much for something that 'may' help, then have to search for shoes that will accomodate them. He discussed the night splint, to reduce the first step pain, but that is not my biggest problem. My pain is worst for the first 2-3 steps but it's not that much different than the pain I have the entire day. I have pain while sitting!! I feel I am nearing the end of the rope. If I decide to go with surgery it will be after the holidays, Santa can't shop on crutches...Thanks for all the great information everyone, I look forward to hearing anything else you think may help me.

Re: My podiatrist's explanation of the fascia

Mary on 10/26/00 at 08:38 (031319)

Hi Barbara. Are you a doctor? I am very concerned that my doctor has lied to me about the anatomy of the foot and I have allowed him to perform EPF surgery my foot. Would appreciate hearing from a foot specialist - someone who really knows. Thanks.

Re: My podiatrist's explanation of the fascia

Barbara TX on 10/26/00 at 11:02 (031331)

Mary - no, I'm not a doctor. However, I think that its just common sense to think that the parts of our body are there for a reason, and few of them 'are not really needed anyway.' There are some for which no use can presently be determined (like an appendix), and when they go wrong, we take them out. But, all the bands of your fascia are needed - that is why they are there. Yours has become injured to such a degree that your doctor has determined that its best to cut it. But, it became injured through overuse - it was being used to support your arch and your weight. This may have been a very good decision, because the doctor determined that it was beyond repair. The other bands of your fascia will compensate for not having that middle band and you may experience this compensation pain. Dr. Z told me that this usually resolves in about 6 months (it will not be as severe as your heel pain). I did not mean to panic you! Hopefully the doctors will sound off on this subject soon and put you at ease. My best, B.

Re: fascia surgery

chris J on 10/26/00 at 11:14 (031332)

You may want to ask the doctor about a walking cast. I tried it on my right foot and that really helped. It may get you through the holidays.
chris

Re: Would A Doctor Please Post Here on this Issue? I am Very Confused Now. :)

salina on 10/26/00 at 12:48 (031349)

Hi guys. I don't even know what I am doing over here on the 'surgery' board. But after reading the posts about Mary's surgery, it has me confused. I guess surgery is always in the backs of people's minds, even if they have not reached that decision yet.
And I thought I understood that the the fascia is cut towardsthe heel, where all the bands have sort of joined up together. So it affects all the fascia bands a little, but they are all left at least somewhat intact. Just not as tight anymore.
Mary, did your doctor say he totally cut the middle band?
I hope one of the doctors willhelp us understand better.
And I hope your surgery will do the trick for ya, mary. Best wishs to ya.

Re: fascia surgery

Jen H on 10/26/00 at 16:12 (031379)

Does anyone know where I can find a visual aid showing the fascia and anatomy of the foot, so we can understand the 'band' theory. Perhaps that will help clear this up. Every picture I have ever seen just shows the fascia as a flat layer on the bottom of the foot....Boy is this confusing.

Re: re:fascia surgery

Jen H on 10/26/00 at 16:14 (031381)

Chris do you mean pre or post surgery or as an alternative?

Re: re:fascia surgery

chris J on 10/26/00 at 20:19 (031411)

I mean before surgery. You said you wanted to wait till after the holidays to do the surgery. It may help when you are out shopping. It will calm the your foot down a little. I wore one for 6 weeks on my right foot and I think I can put off surgery on that foot for a year or so.

Re: Would A Doctor Please Post Here on this Issue? I am Very Confused Now. :)

MARY on 10/27/00 at 08:21 (031436)

HI SALINA. I TOO WISH A DOCTOR WOULD CLEAR THIS ONE UP. SAW MY DOC YESTERDAY AND HE EXPLAINED THAT HE CUT UP TO WHERE HE SEES THE MUSCLE AND STILL CONTENDS THAT THE OTHER BANDS ARE NOT AFFECTED. HE REMOVED THE MIDDLE BAND AND SOME FAT TISSUE.

Re: Would A Doctor Please Post Here on this Issue? I am Very Confused Now. :)

salina on 10/27/00 at 12:22 (031465)

Yeah, don't worry about it. He might be on to something with this aproach. Please keep posting on your progress, and keep resting as much as possible.
My pain is all along the arch, right where the middle band is I am guessing. Sometimes I stare at my feet, wishing I could just rip the middle part of my fascia out myself to stop the throbbing.
Best wishes to you, and keep us posted.

Re: fascia surgery...I have the visuals for you

Kate on 10/29/00 at 11:32 (031567)

I have some wonderful visual literature that I'd be happy to send you. Please email me with your name and address (snail mail), and I'll send it right out!
kate Jurman
ESWT Coordinator

Re: My podiatrist's explanation of the fascia

john h on 10/30/00 at 10:18 (031634)

i echo barbara here. you certainly do need all your fascia to help support your foot. it is cut (released) only as a last resort.

Re: Would A Doctor Please Post Here on this Issue? I am Very Confused Now. :)

john h on 10/30/00 at 10:25 (031636)

the first orthopedics foot and ankle surgeon i saw some years ago would not perform surgery to release any of the fascia under any circumstance. the foot and ankle surgeon that perfomed my surgery actually did not cut a band of fascia loose from my heel. he removed about a 1/2' semicircular wedge of fascia from over the baxter nerve where the fascia attaches to the heel. this in effect took some of the tension off the fascia but left it intact. any release of the fascia will cause some loss of foot support which may or may not cause other problems to develop. lots of people have success with the surgery some do not. just make sure as dr z often says that your surgeon has performed no less than 100 of these procedures (more in my opinion).

Re: Would A Doctor Please Post Here on this Issue? I am Very Confused Now. :)

Dr. Biehler on 10/30/00 at 13:57 (031642)

It is usually the medial ( not middle ) band that is cut. The cut is normaly at the insertion of the heel but can be anywhere along the arch depending on the technique being used. There are different surgical procedures and approches depending on the individuales circumstances. Some doctors want to remove as much of the band as they can (permanatly) and are not worried about the lack of support caused, and others want to remove the least and have the band heal being just alittle longer. Dr. B.

Re: fascia surgery

rosemary on 11/05/00 at 23:14 (032040)

Message Number 32041
Re: Winter View Thread
Posted by JudyS on 11/05/00 at 23:14


OK Wendy - NOW I remember why I decided to live in California instead of settling in my home state of Michigan!

Re: fascia surgery

Dr. Zuckerman on 10/25/00 at 08:16 (031212)

Hi,

This is a very good question. The fasica should be cut very little.
The more you cut the greater the risk for collapse of the foot and or other pain in other parts of the foot and leg. This is one of the big reasons that I do ESWT before pf releases . I have done over 1000 mis heel spur and or pf releases in the past twenty two years and if it were my foot and I had the clinical determination that ESWT is indicated then I would do ESWT. If you want additional information please call my office and speak with Katie. She is my ESWT coordinator. You will find her you very knowledgeable and caring. So give her a call at 1-856-848-3338

Re: My podiatrist's explanation of the fascia

Mary on 10/25/00 at 16:03 (031258)

I had EPF surgery a week ago. Still hard to walk on the heel. He explained to me that there are 3 bands of fascia. The middle one gets cut ('which is not really needed anyway')to relieve the pain, at least in my case - the spur is on the inside of my heel, where the spur is digging in and out of like a sewing machine needle would. The tissue is removed therefore there is nothing for the spur to dig into anymore. 'The arch does not colapse because you have the front and back bands holding everything together'. Good luck with your decision. Ask lots of questions till you're satisfied. Try cortisone injections first. I did - two shots did nothing. You may have better luck. I hope so.

Re: My podiatrist's explanation of the fascia

Barbara TX on 10/25/00 at 21:48 (031294)

Mary - your advice about asking a lot of questions is right on the money... but where did your DPM get the idea that the middle band of fascia 'is really not needed anyway?' The middle band holds you up just like the other two do! B.

Re: fascia surgery

Jen H on 10/26/00 at 07:23 (031313)

Thanks for the information everyone. I have tried one cortizone shot, it gave relief for about a week. We are now trying ultrasound and taping, which was done for the first time Tuesday and will be repeated today, so far it's not doing anything. My doctor also explained the fascia as 'bands' and I believe the band that is giving me trouble is the one closest to the heel. We both feel at this point that there is nerve involvement, I thought so and he mentioned it Tuesday, confirming my thoughts. We are still going round and round about orthodics, I have a pair that are about 7 years old, my doc feels they are not rigid enough and would like me to get new ones but insurance will only pay $79.00 leaving me to pay the remaining $150.00. I am not too anxious to pay that much for something that 'may' help, then have to search for shoes that will accomodate them. He discussed the night splint, to reduce the first step pain, but that is not my biggest problem. My pain is worst for the first 2-3 steps but it's not that much different than the pain I have the entire day. I have pain while sitting!! I feel I am nearing the end of the rope. If I decide to go with surgery it will be after the holidays, Santa can't shop on crutches...Thanks for all the great information everyone, I look forward to hearing anything else you think may help me.

Re: My podiatrist's explanation of the fascia

Mary on 10/26/00 at 08:38 (031319)

Hi Barbara. Are you a doctor? I am very concerned that my doctor has lied to me about the anatomy of the foot and I have allowed him to perform EPF surgery my foot. Would appreciate hearing from a foot specialist - someone who really knows. Thanks.

Re: My podiatrist's explanation of the fascia

Barbara TX on 10/26/00 at 11:02 (031331)

Mary - no, I'm not a doctor. However, I think that its just common sense to think that the parts of our body are there for a reason, and few of them 'are not really needed anyway.' There are some for which no use can presently be determined (like an appendix), and when they go wrong, we take them out. But, all the bands of your fascia are needed - that is why they are there. Yours has become injured to such a degree that your doctor has determined that its best to cut it. But, it became injured through overuse - it was being used to support your arch and your weight. This may have been a very good decision, because the doctor determined that it was beyond repair. The other bands of your fascia will compensate for not having that middle band and you may experience this compensation pain. Dr. Z told me that this usually resolves in about 6 months (it will not be as severe as your heel pain). I did not mean to panic you! Hopefully the doctors will sound off on this subject soon and put you at ease. My best, B.

Re: fascia surgery

chris J on 10/26/00 at 11:14 (031332)

You may want to ask the doctor about a walking cast. I tried it on my right foot and that really helped. It may get you through the holidays.
chris

Re: Would A Doctor Please Post Here on this Issue? I am Very Confused Now. :)

salina on 10/26/00 at 12:48 (031349)

Hi guys. I don't even know what I am doing over here on the 'surgery' board. But after reading the posts about Mary's surgery, it has me confused. I guess surgery is always in the backs of people's minds, even if they have not reached that decision yet.
And I thought I understood that the the fascia is cut towardsthe heel, where all the bands have sort of joined up together. So it affects all the fascia bands a little, but they are all left at least somewhat intact. Just not as tight anymore.
Mary, did your doctor say he totally cut the middle band?
I hope one of the doctors willhelp us understand better.
And I hope your surgery will do the trick for ya, mary. Best wishs to ya.

Re: fascia surgery

Jen H on 10/26/00 at 16:12 (031379)

Does anyone know where I can find a visual aid showing the fascia and anatomy of the foot, so we can understand the 'band' theory. Perhaps that will help clear this up. Every picture I have ever seen just shows the fascia as a flat layer on the bottom of the foot....Boy is this confusing.

Re: re:fascia surgery

Jen H on 10/26/00 at 16:14 (031381)

Chris do you mean pre or post surgery or as an alternative?

Re: re:fascia surgery

chris J on 10/26/00 at 20:19 (031411)

I mean before surgery. You said you wanted to wait till after the holidays to do the surgery. It may help when you are out shopping. It will calm the your foot down a little. I wore one for 6 weeks on my right foot and I think I can put off surgery on that foot for a year or so.

Re: Would A Doctor Please Post Here on this Issue? I am Very Confused Now. :)

MARY on 10/27/00 at 08:21 (031436)

HI SALINA. I TOO WISH A DOCTOR WOULD CLEAR THIS ONE UP. SAW MY DOC YESTERDAY AND HE EXPLAINED THAT HE CUT UP TO WHERE HE SEES THE MUSCLE AND STILL CONTENDS THAT THE OTHER BANDS ARE NOT AFFECTED. HE REMOVED THE MIDDLE BAND AND SOME FAT TISSUE.

Re: Would A Doctor Please Post Here on this Issue? I am Very Confused Now. :)

salina on 10/27/00 at 12:22 (031465)

Yeah, don't worry about it. He might be on to something with this aproach. Please keep posting on your progress, and keep resting as much as possible.
My pain is all along the arch, right where the middle band is I am guessing. Sometimes I stare at my feet, wishing I could just rip the middle part of my fascia out myself to stop the throbbing.
Best wishes to you, and keep us posted.

Re: fascia surgery...I have the visuals for you

Kate on 10/29/00 at 11:32 (031567)

I have some wonderful visual literature that I'd be happy to send you. Please email me with your name and address (snail mail), and I'll send it right out!
kate Jurman
ESWT Coordinator

Re: My podiatrist's explanation of the fascia

john h on 10/30/00 at 10:18 (031634)

i echo barbara here. you certainly do need all your fascia to help support your foot. it is cut (released) only as a last resort.

Re: Would A Doctor Please Post Here on this Issue? I am Very Confused Now. :)

john h on 10/30/00 at 10:25 (031636)

the first orthopedics foot and ankle surgeon i saw some years ago would not perform surgery to release any of the fascia under any circumstance. the foot and ankle surgeon that perfomed my surgery actually did not cut a band of fascia loose from my heel. he removed about a 1/2' semicircular wedge of fascia from over the baxter nerve where the fascia attaches to the heel. this in effect took some of the tension off the fascia but left it intact. any release of the fascia will cause some loss of foot support which may or may not cause other problems to develop. lots of people have success with the surgery some do not. just make sure as dr z often says that your surgeon has performed no less than 100 of these procedures (more in my opinion).

Re: Would A Doctor Please Post Here on this Issue? I am Very Confused Now. :)

Dr. Biehler on 10/30/00 at 13:57 (031642)

It is usually the medial ( not middle ) band that is cut. The cut is normaly at the insertion of the heel but can be anywhere along the arch depending on the technique being used. There are different surgical procedures and approches depending on the individuales circumstances. Some doctors want to remove as much of the band as they can (permanatly) and are not worried about the lack of support caused, and others want to remove the least and have the band heal being just alittle longer. Dr. B.

Re: fascia surgery

rosemary on 11/05/00 at 23:14 (032040)

Message Number 32041
Re: Winter View Thread
Posted by JudyS on 11/05/00 at 23:14


OK Wendy - NOW I remember why I decided to live in California instead of settling in my home state of Michigan!