Home The Book Dr Articles Products Message Boards Journal Articles Search Our Surveys Surgery ESWT Dr Messages Find Good Drs video

Post Surgery Update

Posted by Donna Y. on 1/25/01 at 21:33 (037381)

I will be starting an entry in the surgery database to keep from spamming this message board with too much, but I wanted to post an update here since so many of you were kind enough to offer your much appreciated advice.

I had an open procedure done Monday, January 22nd, to remove a heel spur and perform a fascia release. I am feeling surprisingly good and can't say enough great things about my surgeon. While this procedure certainly isn't the best option in all cases, it seemed to be the best option in my particular situation. Once I fully recover, I am planning on possibly persuing ESWT in the other heel. Even my surgeon quotes very high success rates for ESWT, but he didn't believe it would help in my left heel.

Once the surgery was completed, I spoke to my doctor who let me know that the Plantar fasciitis was actually only a minimal problem in that heel. The heel spur was quite large and formed at such an angle that this was the source of most of my continuing pain. I realize that there are many different schools of thought concerning heel spur removal, but I can assure you that the pain I' m feeling post-op is minimal. I am in a bandage and post-op shoe and can wiggle my toes and move my ankle with little or no pain. I have been keeping my foot elevated to make sure I keep any swelling to a minimum and will be on crutches with no weight bearing on that foot until after the stitches are removed. It's entirely possible that I will feel a good bit more pain once I begin to walk on that foot again, but I'm very optimistic about my recovery.

Thank you all for your support and well wishes. I will keep the database up if anyone else is considering this surgery or is interested in following my recovery through the next 6-8 weeks.

Re: Post Surgery Update

Laurie R on 1/25/01 at 21:51 (037385)

Hi Donna,
I am so glad to hear that you are doing so well .Your attitude is wonderful and I am sure will recover well.Thank you for your post. We all need to understand that sometimes surgery is necessary .PLEASE keep us posted on your recovery .It is so good to hear that surgery has helped .

My very best to you Donna......Laurie R

Re: Post Surgery Update

Julie on 1/26/01 at 02:31 (037401)

Hi Donna

Your post was very informative and useful. Please don't think you are 'spamming' when you share your experience, and please keep posting on the board. Some of us (I'm one) never check the surgery database (no time, after keeping up with all the boards!) but that doesn't mean we aren't interested. So keep keeping us informed about your progress with surgery, and, if you have it, with ESWT.

Julie

Re: Post Surgery Update

Dr. Zuckerman on 1/26/01 at 07:38 (037405)

Glad you are doing great. Please take it easy and don't push the foot too soon. I have seen many patients feel great and then try to get to the long walks, mall shopping too quick. You deserve the rest and the reward of pain free feet so let the body take a rest.

Good luck!!

Re: Post Surgery Update

marie r on 1/26/01 at 15:36 (037444)

Donna, I do not know you but I was thrilled to hear about your surgery. I am going in for the exact same surgery as you had next week. My problem also is not just plantar's fasciitis. In my case as well, the bone in my left heel is causing a lot of my pain per my orthopedic surgeon. Please keep posting your progress. I hope you continue to feel great as I am sure you will. I have been really concerned about the post op pain, so thanks for sharing.

Re: Post Surgery Update

P. Ann on 1/26/01 at 20:58 (037475)

Donna,
Wonderful News!! I am glad to hear some good news about the surgery. My doctor tells me the same thing, Large heel spur. I am very leary about the surgery, but you have given me hope. She is trying to become a test site for ESWT here in NY, but no luck so far. She also doesn't feel that it would help my foot either. Did your doctor cut your medial tendon since the plantar fascia wasn't that bad??
Thank you for sharing and I wish you a full recovery.
P.Ann

Re: Post Surgery Update

Dr. Kosova on 1/26/01 at 23:20 (037481)

Dear Donna Y.

You made a very important point. Your heel spur was at an angle and not just straight. That is why it is so hard to listen to any of our advise and trust your doctor. Large spur or not it is the angle that is important.Your Dr. seems like he(PIPE)she made the right choice and Im sure you will recovery great.

Good luck!!

Dr. Kosova

Re: Post Surgery Update

Donna Y. on 1/27/01 at 00:07 (037488)

Marie,

I certainly can understand the oncern about post-op pain. That was probably my biggest concern, but thankfully it hasn't been bad at all. After going through the daily pain for years, the mild pain I feel right now is easily bearable. One of the things my surgeon did to make it easier was to give me a nerve block which he said would last for several hours after surgery. The nerve block (or it's possible that it was caused by the trauma to the nerves during surgery? I'm not positve on this) actually caused the heel and bottom of my foot to be numb for several days, which was fine with me. I now have no numbness or tingling and I'm hoping that any severe pain I might have felt directly from the surgery (rather than the pain of recovery, once I start weight bearing again and so on) was masked by this numbness. I don't know that it's standard procedure to do this with the surgery, but it did seem to work well for me. Perhaps some of the doctors here can let us know a little more about nerve blocks and how they work.

As for medication, I am taking Toradol 3 times a day for 7 days with Percocet for any severe pain. I rarely have to take the Percocet and the times that I have taken it were only because I woke up at night with a pain that I felt might grow in severity if I didn't head off the pain. But all in all, there has been very little pain. More itching than anything and I can't get to the itchy spots, but what a small price to pay if it turns out that I have a great recovery from what seems to have been a wonderful surgery.

I have had a couple of tripping incidents on my crutches, so for now I'm just trying to stay off of them as much as possible. One of them had me instinctively setting my toes down to catch my balance and -that- did hurt. I felt a pretty severe shock of pain that had me seeing stars for a moment. Moral of that story is to always wear your post-op shoe when you're out of bed. Even when you're just hobbling to the bathroom.

One last note, but it seems worth mentioning again. The surgeon that performed this surgery is an orthopaedic surgeon who specializes in foot and ankle surgery. He's a very capable surgeon and I believe that this is the number one reason I have so far had such a good experience. I wish you the very best and hope your surgery and recovery go as smoothly as mine seem to be going. Please feel free to ask if you have any questions I can answer from a patient standpoint.

Donna

Re: Post Surgery Update

Donna Y. on 1/27/01 at 00:13 (037489)

Dr. Z,

I am looking forward to another week of mostly rest and elevating my foot. Once I start any weight bearing, I'm going to really take it easy and try not to exert myself too much. The worst part about taking it easy is not driving, but I just keep reminding myself that rest is the best thing to do right now. I'll have years of pain free feet if I can just be patient for a few weeks.

Donna

Re: Post Surgery Update

Donna Y. on 1/27/01 at 00:31 (037491)

P. Ann,

I am not sure I can give you a correct answer for certain, but I believe that my doctor did the release since the fasciitis was evident. It just wasn't nearly the problem that the heel spur had become. I think his exact words were, 'The Plantar fasciitis was a problem, but the spur was chewing you up.' I had been led to believe at one point that a heel spur doesn't actually cause pain in most cases, but apparently mine had formed in such a way that it did. I hope that if you do decide on surgery everything turns out well. Keep us all posted on how things go for you.

Donna

Re: Post Surgery Update

marie r on 1/27/01 at 08:42 (037511)

Donna, thank you so much for your response. I too have an orthopedic surgeon that specializes in foot and ankle. He is very reputable so I feel like I am in good hands. I really dread this but I can not continue the way I am. Hopefully it will go as well as yours. I am so happy to hear from someone who has gone through this. Thanks again.

Re: Post Surgery Update

Abby on 1/27/01 at 21:18 (037544)

I'm glad to here that there are others out there who are having successful surgeries as I feel I have. I posted here about a month ago telling my story of EPF surgery, performed 3 months ago. I was beginning to think my podiatrist was a quack with his description of the spur digging into the tissue, causing pain. Now I read there are other doctors who agree with my doctor. I would love to here from the two new doctors on this subject. I was beginning to feel that I jumped into surgery too soon and my doctor lied to me.

Re: Heel spur: painful or not???

Dr. Marlene Reid on 1/31/01 at 23:56 (037937)

Abby, Donna and everyone else,

When I was in my residency, heel spur surgery ALWAYS included taking off the spur. That was only 10 years ago. I used to ake my attendings if I could try one case with leaving the spur intact, and the answer was always, sure, you can do it, on your OWN patients. So we never tested the theory that the pain was due to the fascia only.

Now, most podiatrists I know only release the fascia. There are several methods to do this and my personal opinion of the EPF is that it is a 'new toy' and I really think it gets used WAY too often as a first line of treatment. Dr. Kosova and I do them through a small incision on the medial side of the heel and pretty much do it by feel. (I should say used to do them, because we are very hopeful that ESW will replace all heel spur surgey).

By the way, our practice is 40% heel pain and only about 3 or 5% of those patients needed surgery to beginwith.

I can't comment on the orthopedic opinion on heel spur surgery. I do feel comfortable saying that I dought that many orthos (even foot and ankle fellows) ever read the podiatic literature. Many orthos still do a certain type of toe surgery that makes us podiatrists cringe (although, it brings us business because they usually end up in our offices)!

Very rarely, the shape and contour of the heel bone does cause pressure when walking and this may cause heel pain. I have seen it most often on the lateral side of the bottom of the foot. I can tell you it was much easier to explain the surgery to patients when you tell them you need to remove the spur!

A little note about nerve blocks: usually the long lasting anesthesia does wear off in 8 hours or so, but I have had several patients tell me they were numb for much longer (ie days).

Hope this infor helped and didn't confuse.

Re: Heel spur: painful or not??? Not anymore!!

Abby on 2/11/01 at 15:02 (038688)

Hi Dr. Reid. My podiatrist did not remove the heelspur when he performed EPF surgery 3 1/2 months ago and I am pain free. He told me that spur removal was the last resort. If after 6 months I still have pain, then he will go back in and remove the heel spur. Most patients cannot be incapacitated for 8 weeks in crutches and doing EPF first is less invasive. These are his reasons for performing EPF surgery instead of spur removal. Would love to know your opinion of the heel spur digging into the tissue as the cause of heel pain. My spur goes straight down and is on the inside of my heel. I also have one on my other foot but it doesn't bother me - yet!

Re: Heel spur: painful or not??? Not anymore!!

Dr. Marlene Reid on 2/12/01 at 22:08 (038776)

Hi Abby, yes I was out of town at a conference.
About 40% of my practice is heel pain (probably more like 65% now that I am an OssaTron provider and heel pain patients are coming out of the woodwork)and approximately only 5% of my own patients ever needed surgery.

First of all, I do not perform EPF. I think its like reinventing the wheel. I do a partial release through a small incision. It is not manditory to fully visualize the structure, in this case. I strongly believe in open surgery for EVERYTHING else.

As far as the bone spur, there are a lot more possible complications when removing the bone. The healing period is longer and the bone becomes suseptible to all kinds of things (i.e. infection, fracture, fragmentation, painful, etc) that would never be a problem if the bone were not touched. So I totally agree with your pod to leave it alone. Most of us do not feel that it is the source of the pain, with a few exceptions. I have seen some spurs that directly go down and are the exact spot of pain and the pain is NOT the same as with plantar fasciitis. I have also removed enlarged lateral portions of the heel bone that were problematic (sp?). Again, the symptoms were different.
And so many people have heel spurs without any pain. One important question, has your pod put you in post op orthotics??

Hope this helped!

Re: Heel spur: painful or not??? Not anymore!!

Abby on 2/13/01 at 15:44 (038853)

Yes I do have orthotics that I wear at least 5 out of 7 days and on the other days I wear sneakers or well made shoes. One more question, please. What exactly is removed during EPF. The pain I experienced was in the exact area of the heel spur but the pain radiated all over my heel just before the surgery. My heel could not even be lightly touched. Is it true there are 3 bands (I think they're called fascia) and with EPF surgery only the band that the heel spur digs in and out of is removed? What is your opinion? What is a partial release?

Re: Heel spur: painful or not??? Not anymore!!

Dr. Marlene Reid on 2/13/01 at 23:00 (038908)

Abby,

A partial release is usually performed. Most people state that the medial band is released, but actually , the medial band is really very medial (as I once did a informal study on cadavers) and it is actually the medial portion of the central band that is released. I really so it more by feet. You can feel the portion of hte band that is tight. Even if the pain spread laterally as time went on, I would not do a total release. Too many possibilities of biomechanical problems after. In fact, there are common problems with EPF's after surgery when too much is released. I am glad to hear that your surgery was so sucessful. I think the national statistic for success after surgery is only 70 or 75%. Be sure to follow your pods post op advise and return to him/her if any pain redevelopes.

Re: Post Surgery Update

Laurie R on 1/25/01 at 21:51 (037385)

Hi Donna,
I am so glad to hear that you are doing so well .Your attitude is wonderful and I am sure will recover well.Thank you for your post. We all need to understand that sometimes surgery is necessary .PLEASE keep us posted on your recovery .It is so good to hear that surgery has helped .

My very best to you Donna......Laurie R

Re: Post Surgery Update

Julie on 1/26/01 at 02:31 (037401)

Hi Donna

Your post was very informative and useful. Please don't think you are 'spamming' when you share your experience, and please keep posting on the board. Some of us (I'm one) never check the surgery database (no time, after keeping up with all the boards!) but that doesn't mean we aren't interested. So keep keeping us informed about your progress with surgery, and, if you have it, with ESWT.

Julie

Re: Post Surgery Update

Dr. Zuckerman on 1/26/01 at 07:38 (037405)

Glad you are doing great. Please take it easy and don't push the foot too soon. I have seen many patients feel great and then try to get to the long walks, mall shopping too quick. You deserve the rest and the reward of pain free feet so let the body take a rest.

Good luck!!

Re: Post Surgery Update

marie r on 1/26/01 at 15:36 (037444)

Donna, I do not know you but I was thrilled to hear about your surgery. I am going in for the exact same surgery as you had next week. My problem also is not just plantar's fasciitis. In my case as well, the bone in my left heel is causing a lot of my pain per my orthopedic surgeon. Please keep posting your progress. I hope you continue to feel great as I am sure you will. I have been really concerned about the post op pain, so thanks for sharing.

Re: Post Surgery Update

P. Ann on 1/26/01 at 20:58 (037475)

Donna,
Wonderful News!! I am glad to hear some good news about the surgery. My doctor tells me the same thing, Large heel spur. I am very leary about the surgery, but you have given me hope. She is trying to become a test site for ESWT here in NY, but no luck so far. She also doesn't feel that it would help my foot either. Did your doctor cut your medial tendon since the plantar fascia wasn't that bad??
Thank you for sharing and I wish you a full recovery.
P.Ann

Re: Post Surgery Update

Dr. Kosova on 1/26/01 at 23:20 (037481)

Dear Donna Y.

You made a very important point. Your heel spur was at an angle and not just straight. That is why it is so hard to listen to any of our advise and trust your doctor. Large spur or not it is the angle that is important.Your Dr. seems like he(PIPE)she made the right choice and Im sure you will recovery great.

Good luck!!

Dr. Kosova

Re: Post Surgery Update

Donna Y. on 1/27/01 at 00:07 (037488)

Marie,

I certainly can understand the oncern about post-op pain. That was probably my biggest concern, but thankfully it hasn't been bad at all. After going through the daily pain for years, the mild pain I feel right now is easily bearable. One of the things my surgeon did to make it easier was to give me a nerve block which he said would last for several hours after surgery. The nerve block (or it's possible that it was caused by the trauma to the nerves during surgery? I'm not positve on this) actually caused the heel and bottom of my foot to be numb for several days, which was fine with me. I now have no numbness or tingling and I'm hoping that any severe pain I might have felt directly from the surgery (rather than the pain of recovery, once I start weight bearing again and so on) was masked by this numbness. I don't know that it's standard procedure to do this with the surgery, but it did seem to work well for me. Perhaps some of the doctors here can let us know a little more about nerve blocks and how they work.

As for medication, I am taking Toradol 3 times a day for 7 days with Percocet for any severe pain. I rarely have to take the Percocet and the times that I have taken it were only because I woke up at night with a pain that I felt might grow in severity if I didn't head off the pain. But all in all, there has been very little pain. More itching than anything and I can't get to the itchy spots, but what a small price to pay if it turns out that I have a great recovery from what seems to have been a wonderful surgery.

I have had a couple of tripping incidents on my crutches, so for now I'm just trying to stay off of them as much as possible. One of them had me instinctively setting my toes down to catch my balance and -that- did hurt. I felt a pretty severe shock of pain that had me seeing stars for a moment. Moral of that story is to always wear your post-op shoe when you're out of bed. Even when you're just hobbling to the bathroom.

One last note, but it seems worth mentioning again. The surgeon that performed this surgery is an orthopaedic surgeon who specializes in foot and ankle surgery. He's a very capable surgeon and I believe that this is the number one reason I have so far had such a good experience. I wish you the very best and hope your surgery and recovery go as smoothly as mine seem to be going. Please feel free to ask if you have any questions I can answer from a patient standpoint.

Donna

Re: Post Surgery Update

Donna Y. on 1/27/01 at 00:13 (037489)

Dr. Z,

I am looking forward to another week of mostly rest and elevating my foot. Once I start any weight bearing, I'm going to really take it easy and try not to exert myself too much. The worst part about taking it easy is not driving, but I just keep reminding myself that rest is the best thing to do right now. I'll have years of pain free feet if I can just be patient for a few weeks.

Donna

Re: Post Surgery Update

Donna Y. on 1/27/01 at 00:31 (037491)

P. Ann,

I am not sure I can give you a correct answer for certain, but I believe that my doctor did the release since the fasciitis was evident. It just wasn't nearly the problem that the heel spur had become. I think his exact words were, 'The Plantar fasciitis was a problem, but the spur was chewing you up.' I had been led to believe at one point that a heel spur doesn't actually cause pain in most cases, but apparently mine had formed in such a way that it did. I hope that if you do decide on surgery everything turns out well. Keep us all posted on how things go for you.

Donna

Re: Post Surgery Update

marie r on 1/27/01 at 08:42 (037511)

Donna, thank you so much for your response. I too have an orthopedic surgeon that specializes in foot and ankle. He is very reputable so I feel like I am in good hands. I really dread this but I can not continue the way I am. Hopefully it will go as well as yours. I am so happy to hear from someone who has gone through this. Thanks again.

Re: Post Surgery Update

Abby on 1/27/01 at 21:18 (037544)

I'm glad to here that there are others out there who are having successful surgeries as I feel I have. I posted here about a month ago telling my story of EPF surgery, performed 3 months ago. I was beginning to think my podiatrist was a quack with his description of the spur digging into the tissue, causing pain. Now I read there are other doctors who agree with my doctor. I would love to here from the two new doctors on this subject. I was beginning to feel that I jumped into surgery too soon and my doctor lied to me.

Re: Heel spur: painful or not???

Dr. Marlene Reid on 1/31/01 at 23:56 (037937)

Abby, Donna and everyone else,

When I was in my residency, heel spur surgery ALWAYS included taking off the spur. That was only 10 years ago. I used to ake my attendings if I could try one case with leaving the spur intact, and the answer was always, sure, you can do it, on your OWN patients. So we never tested the theory that the pain was due to the fascia only.

Now, most podiatrists I know only release the fascia. There are several methods to do this and my personal opinion of the EPF is that it is a 'new toy' and I really think it gets used WAY too often as a first line of treatment. Dr. Kosova and I do them through a small incision on the medial side of the heel and pretty much do it by feel. (I should say used to do them, because we are very hopeful that ESW will replace all heel spur surgey).

By the way, our practice is 40% heel pain and only about 3 or 5% of those patients needed surgery to beginwith.

I can't comment on the orthopedic opinion on heel spur surgery. I do feel comfortable saying that I dought that many orthos (even foot and ankle fellows) ever read the podiatic literature. Many orthos still do a certain type of toe surgery that makes us podiatrists cringe (although, it brings us business because they usually end up in our offices)!

Very rarely, the shape and contour of the heel bone does cause pressure when walking and this may cause heel pain. I have seen it most often on the lateral side of the bottom of the foot. I can tell you it was much easier to explain the surgery to patients when you tell them you need to remove the spur!

A little note about nerve blocks: usually the long lasting anesthesia does wear off in 8 hours or so, but I have had several patients tell me they were numb for much longer (ie days).

Hope this infor helped and didn't confuse.

Re: Heel spur: painful or not??? Not anymore!!

Abby on 2/11/01 at 15:02 (038688)

Hi Dr. Reid. My podiatrist did not remove the heelspur when he performed EPF surgery 3 1/2 months ago and I am pain free. He told me that spur removal was the last resort. If after 6 months I still have pain, then he will go back in and remove the heel spur. Most patients cannot be incapacitated for 8 weeks in crutches and doing EPF first is less invasive. These are his reasons for performing EPF surgery instead of spur removal. Would love to know your opinion of the heel spur digging into the tissue as the cause of heel pain. My spur goes straight down and is on the inside of my heel. I also have one on my other foot but it doesn't bother me - yet!

Re: Heel spur: painful or not??? Not anymore!!

Dr. Marlene Reid on 2/12/01 at 22:08 (038776)

Hi Abby, yes I was out of town at a conference.
About 40% of my practice is heel pain (probably more like 65% now that I am an OssaTron provider and heel pain patients are coming out of the woodwork)and approximately only 5% of my own patients ever needed surgery.

First of all, I do not perform EPF. I think its like reinventing the wheel. I do a partial release through a small incision. It is not manditory to fully visualize the structure, in this case. I strongly believe in open surgery for EVERYTHING else.

As far as the bone spur, there are a lot more possible complications when removing the bone. The healing period is longer and the bone becomes suseptible to all kinds of things (i.e. infection, fracture, fragmentation, painful, etc) that would never be a problem if the bone were not touched. So I totally agree with your pod to leave it alone. Most of us do not feel that it is the source of the pain, with a few exceptions. I have seen some spurs that directly go down and are the exact spot of pain and the pain is NOT the same as with plantar fasciitis. I have also removed enlarged lateral portions of the heel bone that were problematic (sp?). Again, the symptoms were different.
And so many people have heel spurs without any pain. One important question, has your pod put you in post op orthotics??

Hope this helped!

Re: Heel spur: painful or not??? Not anymore!!

Abby on 2/13/01 at 15:44 (038853)

Yes I do have orthotics that I wear at least 5 out of 7 days and on the other days I wear sneakers or well made shoes. One more question, please. What exactly is removed during EPF. The pain I experienced was in the exact area of the heel spur but the pain radiated all over my heel just before the surgery. My heel could not even be lightly touched. Is it true there are 3 bands (I think they're called fascia) and with EPF surgery only the band that the heel spur digs in and out of is removed? What is your opinion? What is a partial release?

Re: Heel spur: painful or not??? Not anymore!!

Dr. Marlene Reid on 2/13/01 at 23:00 (038908)

Abby,

A partial release is usually performed. Most people state that the medial band is released, but actually , the medial band is really very medial (as I once did a informal study on cadavers) and it is actually the medial portion of the central band that is released. I really so it more by feet. You can feel the portion of hte band that is tight. Even if the pain spread laterally as time went on, I would not do a total release. Too many possibilities of biomechanical problems after. In fact, there are common problems with EPF's after surgery when too much is released. I am glad to hear that your surgery was so sucessful. I think the national statistic for success after surgery is only 70 or 75%. Be sure to follow your pods post op advise and return to him/her if any pain redevelopes.