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So long does it take for recovery after pf \-heel spur surgery

Posted by Dr. Zuckerman on 3/06/01 at 13:32 (040593)

I tell all of my patients that it can take up to six months and sometime more for the pain to go away after miminial incision foot surgery.

If the doctor is using open pf/ excision of heel spur it can take up to one year or more.

Here is my exact conversation. Three out of ten patients that have mis heel spurs surgery will have no pain at all. The next three will have pain alot ( demeral is used) for about one week and then pain off and on for about one month. The last four out of ten will have alot of pain for one week and then pain off and on for up to six months or more.

I do the heel spurs surgery in about two minutes in my office just like the ESWT procedure using a local anesthetic.

The infection is zero. No patients feel anything . I know how to block the foot for this procedure. The problem is that you are working on the bottom of the human foot.

I don't care who or what the procedure is EPF, MIS or open procedure these are the facts and just the facts of this procedure.

Complications from foot surgery are there and will happen so that is why I do ESWT first and then foot surgery second.

IF only the east coast insurance company presidents had a heel spur then ESWT will be the covered procedure that it is.

The only way that ingrown toe nail treatments became part of medicare was because Lyndon Johnson has an ingrown toe nail and a podiatrist helped him

So are there are Senators out there that need ESWT I will treat them is they can get their insurance to cover this very needed and effective procedrue.

Re: So long does it take for recovery after pf \-heel spur surgery

P. Ann on 3/06/01 at 15:34 (040621)

If this is the way that it is done, then why is my Doctor having my surgery in a hospital operating room? I will be having a spur removal this Friday 9th. My doc will also be cutting the medial tendon to avoid future complications of another spur. I have been reading this board for a couple of months now, and see alot of people that still have the surgery after ESWT. Are there any places in NY that have the ability to do ESWT and if so what is the success rate? I have agonized over my surgery decision for nearly 7 months. I DO NOT want to have this done. I spoke to my Doc about ESWT and was told that it wasn't for me, but that the office was trying to be a test site for this. I am in a good deal of pain, and am having complications elsewhere from overcompensating for the foot pain. Thus, my final decision. But, 4 months after my major Gallbladder removal, they approved the laser surgery, so I don't want that to happen again! I understand the complications from surgery and will be trying to avoid overstressing my foot by going back to work in a wheelchair. I do see some positive feedback on the boards so that is encouraging. But, what are the odds for horrible results?
I hope that IF ESWT is an effective solution that someone will approve it. But, I really hope they FULLY test this so as not to have bad results like some of the medications they have rushed to approve.
P.Ann

Re: So long does it take for recovery after pf \-heel spur surgery

Dr. Zuckerman on 3/06/01 at 17:54 (040640)

ESWT is the option for avoiding foot surgery. The sucess rates will vary depending on the doctor, the patient. The average sucess rate is about 75%

So you have a 75% chance of avoiding surgery which has alot of complicatoins some which are very serious.

ESWT doesn't have the serious complication that can happen with heel spur surgery..

If ESWT doesn't help you then surgery can still be done. Reading this board is going to show you the type of complications that can and do happen even if they are not that often

ESWT and it advantage of not having to cut into your foot is an advantage that speaks for itself. You must understasnd that not every foot is going to repond with ESWT just as not every foot is going to respond to foot surgery, but when you have poor heel spur surgery results you can be crippled for life. So in a nut shell foot surgery can leave you crippled.
ESWT can't.

Re: So long does it take for recovery after pf \-heel spur surgery

Susan U on 3/06/01 at 18:16 (040642)

I know Dr. Zuckerman talks about ESWT and he did send me a lot of info on the procedure, but I can't help but wonder why other orthopedic surgeons don't mention this procedure and Dr. Zuckerman seems to be the only one in New Jersey doing it. Also, it is quite expensive and insurance will not cover it. I think the best thing any of us can do is find a doctor we can trust!

Re: So long does it take for recovery after pf \-heel spur surgery

Dr. Zuckerman on 3/06/01 at 19:15 (040646)

I agree that you should find a doctor that you can trust. You will hear more and more about ESWT in the near future. I can't help that I am the only doctor whether orthopedic or podiatric that is still looking for better and better procedure out there. I will tell you the real reason that most doctor don't invest in ESWT machines It is very expensive and most doctors are still waiting for New Jersey Blue Cross to pay for this procedure. Most doctors have the fear of the insurance company paying so low for this procedure that the doctor has to work and work and work just to cover the cost of this technology. So who is to blame that is an entire different discussion for another day So you can wait in pain or take the chance of a cure without the fear of the complications of foot surgery. If you do want surgery that also is an option .

There is always going to be patients that will pay for quality care and then there is always going to be patients that will only do a procedure if the insurance pays for the procedure.

I still do miminial incision foot surgery for chronic heel pain . This is still the best procedure in my hands for a surgical approach .

So the choice is always up to the patient. If you don't want to have ESWT or you want to wait or you want to have surgery or you don't want to have surgery you have choices. My job is to offer the choice and you the patient must decide and take responsibility for your choice or lack of choice.

I don't want to sound tough but you have to in the end live with your choice so get involved.
.

Re: So long does it take for recovery after pf \-heel spur surgery

P. Ann on 3/07/01 at 15:27 (040733)

Not everyone has the CHOICE to spend thousands of dollars for an 'experimental' unapproved procedure. I for one, cannot afford to have this procedure done. This does not mean that I don't want quality care,or that I have made a bad choice by not trying a relatively untested procedure. I agree with Susan U., I think that it is important to find a doctor that you can trust. I don't want to have surgery. But I also don't want to continuously put my back out and hurt my knee by over-compensating for my pain. I have made a very tough decision and have had my diagnosis confirmed with two other doctors. I have read the message boards on several sites. I have read all the information I could find about my foot troubles. I am not uniformed nor am I unwilling to listen to options, but I think that until ESWT is an approved medical procedure that it should not be considered an option. My Doctor told me that it is NOT an approved medical procedure and that she is trying for a test site. I also think that since she knows how great my fears are that she would tell me that ESWT is the best thing for me to do, she hasn't. I have also discussed this with the other doctors and their feelings were the same. Until it is approved, it should not be considered an option.
I hope that in the future there will be a less invasive procedure other than surgery. If that is ESWT, then great, but until then I guess I will have to opt for surgery and trust my doctor and my intuition.

Re: So long does it take for recovery after pf \-heel spur surgery

Nancy S. on 3/07/01 at 19:48 (040756)

Hi P. Ann, this is not to deter you from your surgery decision if you trust your doctor, have examined all other options, and want to go ahead with it.
I just want to point out that ESWT _is_ FDA approved -- it was approved last year. I know that the OssaTron machine is FDA approved, and the Orbasone is FDA cleared, and there are a few others being used (I'm not sure about the others' FDA status, but they are being used legally as I understand it).
You may still want to go ahead with the surgery because of the current cost of ESWT or because you may not be a candidate for ESWT according to your doctor; I just didn't want you thinking of ESWT as still an experimental, unapproved procedure. (Many doctors don't keep up on the latest, apparently.) The FDA ran many clinical trials and did approve ESWT in mid-2000.
By the way, I haven't had ESWT or surgery -- I'm much much better after almost 2 years of conservative treatments. Just wanted to set the record straight.
Best of luck to you.
Nancy

Re: So long does it take for recovery after pf \-heel spur surgery

P. Ann on 3/07/01 at 20:14 (040759)

Thank you. Both of the specialists' that I've seen have said this was not approved. The last doctor that I went to said that his wife was better after several years of conservative treatments also. I wish that I wasn't damaging my knee and hip from overcompensating, but no matter how hard I try, I still do. So unfortunately I will have to suffer the surgery. I was rather nervous to know that the wife of a Podiatrist would rather suffer than have surgery. But even he stated that I really needed the surgery. Just out of curiosity, did you try the night splints? Thank you also for the good wishes. I am glad that you are better without having to resort to the extremes of so many on these boards.
P.Ann

Re: So long does it take for recovery after pf \-heel spur surgery

Darlene B on 3/07/01 at 20:37 (040765)

Excerpt from FDA : Ossatron was approved on October 12, 2000

HealthTronics studied 302 people with chronic pain who had failed other treatments in the previous six months. Half were treated with the OssaTron; half received a sham treatment. All were given a local anesthetic or an ankle block before treatment. Patients were followed for three months.

Most patients (60%) treated with the OssaTron reported that they experienced some improvement in pain; 48% of those treated with the sham said they experienced some improvement in pain.

Complications included mild neurological symptoms in 6 patients (2%) and plantar facial tears (tears in the tissue in the bottom of the foot) in 2 patients (0.6%).

As a condition of approval, FDA is requiring HealthTronics to conduct a study to further evaluate the problems of neurological symptoms and plantar fascial ruptures.

Re: P. Ann I do have another option for you

Dr. Zuckerman on 3/07/01 at 21:06 (040772)

I do have an option if you would like to discuss this with me. e-mail Dr. Z at footcare@home.com .

Re: So long does it take for recovery after pf \-heel spur surgery

Nancy S. on 3/07/01 at 21:29 (040773)

P. Ann, yes, I did use a night splint. After developing severe PF in my left foot in May '99, my podiatrist tried a cortisone shot, the night splint, and some really bad orthotics, and then was ready to do EPF surgery on me after 8 months. That was the extent of my 'treatment'! Fortunately, I found this site and learned of many other conservative measures I should have been trying.
At the time, the night splint hadn't helped me -- but I learned that he had put it on me way too loosely, and in January I started wearing it so that my foot stayed in the correct position, and I do believe it helped. Not a cure, but it was one of the combination of treatments that I think got me where I am today -- which also included (after finding this site and a good sports med. doctor) serious rest, months of physical therapy, and gentle stretching and strengthening with the Acu-Flex (not available here anymore, apparently?).
I do know what you mean about the overcompensating causing other problems. I could barely use my left foot for months, was walking with a cane, and eventually developed bad tendonitis (achilles, peroneal, and posterior tib.) in _both_ feet, which I attribute mostly to walking so wackily for so long.
I have a good pair of orthotics now, though I'm still trying to get them adjusted just right. Birkenstocks have helped me ever since I learned about them on this site.
The latest thing to push me farther along the recovery path, which I never thought I'd try, is homeopathy. I've been on homeopathic medicines since January 24, and they've boosted me up to the almost-recovered realm, though I expect to have to take good care of these flippers for the rest of my life!
I do think there's great potential in ESWT -- have you checked out the ESWT section here? Click on 'patient progress reports' there, which Scott set up several months ago. I think the results, in general, are very encouraging. I see Darlene is on there with the lowest satisfaction rating, and I'm sorry it hasn't worked for her; but many other people have had significant improvement from it. If I were still in the agony I was in for so long, I would be going for ESWT (and borrowing money to do it . . . I know what you mean on that score, also).
Again, best of luck to you, P. Ann -- I know these are hard decisions and PF is awful to live with.
Nancy

Re: So long does it take for recovery after pf \-heel spur surgery

Dr. Marlene Reid on 3/12/01 at 02:15 (041120)

Please understand that ESW IS NOW an approved treatment. It is no longer considered investigational and we are getting the OssaTron approved by insurance companies. Maybe because the FDA did approve it for PF in October. The problem is that many insurance companies just do not know about it. So it takes a little work getting it approved, but my office has been able to. You need to find someone in your area that is using an approved machine and you will have better luck with your insurance company. Good luck.

Re: So long does it take for recovery after pf \-heel spur surgery

P. Ann on 3/06/01 at 15:34 (040621)

If this is the way that it is done, then why is my Doctor having my surgery in a hospital operating room? I will be having a spur removal this Friday 9th. My doc will also be cutting the medial tendon to avoid future complications of another spur. I have been reading this board for a couple of months now, and see alot of people that still have the surgery after ESWT. Are there any places in NY that have the ability to do ESWT and if so what is the success rate? I have agonized over my surgery decision for nearly 7 months. I DO NOT want to have this done. I spoke to my Doc about ESWT and was told that it wasn't for me, but that the office was trying to be a test site for this. I am in a good deal of pain, and am having complications elsewhere from overcompensating for the foot pain. Thus, my final decision. But, 4 months after my major Gallbladder removal, they approved the laser surgery, so I don't want that to happen again! I understand the complications from surgery and will be trying to avoid overstressing my foot by going back to work in a wheelchair. I do see some positive feedback on the boards so that is encouraging. But, what are the odds for horrible results?
I hope that IF ESWT is an effective solution that someone will approve it. But, I really hope they FULLY test this so as not to have bad results like some of the medications they have rushed to approve.
P.Ann

Re: So long does it take for recovery after pf \-heel spur surgery

Dr. Zuckerman on 3/06/01 at 17:54 (040640)

ESWT is the option for avoiding foot surgery. The sucess rates will vary depending on the doctor, the patient. The average sucess rate is about 75%

So you have a 75% chance of avoiding surgery which has alot of complicatoins some which are very serious.

ESWT doesn't have the serious complication that can happen with heel spur surgery..

If ESWT doesn't help you then surgery can still be done. Reading this board is going to show you the type of complications that can and do happen even if they are not that often

ESWT and it advantage of not having to cut into your foot is an advantage that speaks for itself. You must understasnd that not every foot is going to repond with ESWT just as not every foot is going to respond to foot surgery, but when you have poor heel spur surgery results you can be crippled for life. So in a nut shell foot surgery can leave you crippled.
ESWT can't.

Re: So long does it take for recovery after pf \-heel spur surgery

Susan U on 3/06/01 at 18:16 (040642)

I know Dr. Zuckerman talks about ESWT and he did send me a lot of info on the procedure, but I can't help but wonder why other orthopedic surgeons don't mention this procedure and Dr. Zuckerman seems to be the only one in New Jersey doing it. Also, it is quite expensive and insurance will not cover it. I think the best thing any of us can do is find a doctor we can trust!

Re: So long does it take for recovery after pf \-heel spur surgery

Dr. Zuckerman on 3/06/01 at 19:15 (040646)

I agree that you should find a doctor that you can trust. You will hear more and more about ESWT in the near future. I can't help that I am the only doctor whether orthopedic or podiatric that is still looking for better and better procedure out there. I will tell you the real reason that most doctor don't invest in ESWT machines It is very expensive and most doctors are still waiting for New Jersey Blue Cross to pay for this procedure. Most doctors have the fear of the insurance company paying so low for this procedure that the doctor has to work and work and work just to cover the cost of this technology. So who is to blame that is an entire different discussion for another day So you can wait in pain or take the chance of a cure without the fear of the complications of foot surgery. If you do want surgery that also is an option .

There is always going to be patients that will pay for quality care and then there is always going to be patients that will only do a procedure if the insurance pays for the procedure.

I still do miminial incision foot surgery for chronic heel pain . This is still the best procedure in my hands for a surgical approach .

So the choice is always up to the patient. If you don't want to have ESWT or you want to wait or you want to have surgery or you don't want to have surgery you have choices. My job is to offer the choice and you the patient must decide and take responsibility for your choice or lack of choice.

I don't want to sound tough but you have to in the end live with your choice so get involved.
.

Re: So long does it take for recovery after pf \-heel spur surgery

P. Ann on 3/07/01 at 15:27 (040733)

Not everyone has the CHOICE to spend thousands of dollars for an 'experimental' unapproved procedure. I for one, cannot afford to have this procedure done. This does not mean that I don't want quality care,or that I have made a bad choice by not trying a relatively untested procedure. I agree with Susan U., I think that it is important to find a doctor that you can trust. I don't want to have surgery. But I also don't want to continuously put my back out and hurt my knee by over-compensating for my pain. I have made a very tough decision and have had my diagnosis confirmed with two other doctors. I have read the message boards on several sites. I have read all the information I could find about my foot troubles. I am not uniformed nor am I unwilling to listen to options, but I think that until ESWT is an approved medical procedure that it should not be considered an option. My Doctor told me that it is NOT an approved medical procedure and that she is trying for a test site. I also think that since she knows how great my fears are that she would tell me that ESWT is the best thing for me to do, she hasn't. I have also discussed this with the other doctors and their feelings were the same. Until it is approved, it should not be considered an option.
I hope that in the future there will be a less invasive procedure other than surgery. If that is ESWT, then great, but until then I guess I will have to opt for surgery and trust my doctor and my intuition.

Re: So long does it take for recovery after pf \-heel spur surgery

Nancy S. on 3/07/01 at 19:48 (040756)

Hi P. Ann, this is not to deter you from your surgery decision if you trust your doctor, have examined all other options, and want to go ahead with it.
I just want to point out that ESWT _is_ FDA approved -- it was approved last year. I know that the OssaTron machine is FDA approved, and the Orbasone is FDA cleared, and there are a few others being used (I'm not sure about the others' FDA status, but they are being used legally as I understand it).
You may still want to go ahead with the surgery because of the current cost of ESWT or because you may not be a candidate for ESWT according to your doctor; I just didn't want you thinking of ESWT as still an experimental, unapproved procedure. (Many doctors don't keep up on the latest, apparently.) The FDA ran many clinical trials and did approve ESWT in mid-2000.
By the way, I haven't had ESWT or surgery -- I'm much much better after almost 2 years of conservative treatments. Just wanted to set the record straight.
Best of luck to you.
Nancy

Re: So long does it take for recovery after pf \-heel spur surgery

P. Ann on 3/07/01 at 20:14 (040759)

Thank you. Both of the specialists' that I've seen have said this was not approved. The last doctor that I went to said that his wife was better after several years of conservative treatments also. I wish that I wasn't damaging my knee and hip from overcompensating, but no matter how hard I try, I still do. So unfortunately I will have to suffer the surgery. I was rather nervous to know that the wife of a Podiatrist would rather suffer than have surgery. But even he stated that I really needed the surgery. Just out of curiosity, did you try the night splints? Thank you also for the good wishes. I am glad that you are better without having to resort to the extremes of so many on these boards.
P.Ann

Re: So long does it take for recovery after pf \-heel spur surgery

Darlene B on 3/07/01 at 20:37 (040765)

Excerpt from FDA : Ossatron was approved on October 12, 2000

HealthTronics studied 302 people with chronic pain who had failed other treatments in the previous six months. Half were treated with the OssaTron; half received a sham treatment. All were given a local anesthetic or an ankle block before treatment. Patients were followed for three months.

Most patients (60%) treated with the OssaTron reported that they experienced some improvement in pain; 48% of those treated with the sham said they experienced some improvement in pain.

Complications included mild neurological symptoms in 6 patients (2%) and plantar facial tears (tears in the tissue in the bottom of the foot) in 2 patients (0.6%).

As a condition of approval, FDA is requiring HealthTronics to conduct a study to further evaluate the problems of neurological symptoms and plantar fascial ruptures.

Re: P. Ann I do have another option for you

Dr. Zuckerman on 3/07/01 at 21:06 (040772)

I do have an option if you would like to discuss this with me. e-mail Dr. Z at footcare@home.com .

Re: So long does it take for recovery after pf \-heel spur surgery

Nancy S. on 3/07/01 at 21:29 (040773)

P. Ann, yes, I did use a night splint. After developing severe PF in my left foot in May '99, my podiatrist tried a cortisone shot, the night splint, and some really bad orthotics, and then was ready to do EPF surgery on me after 8 months. That was the extent of my 'treatment'! Fortunately, I found this site and learned of many other conservative measures I should have been trying.
At the time, the night splint hadn't helped me -- but I learned that he had put it on me way too loosely, and in January I started wearing it so that my foot stayed in the correct position, and I do believe it helped. Not a cure, but it was one of the combination of treatments that I think got me where I am today -- which also included (after finding this site and a good sports med. doctor) serious rest, months of physical therapy, and gentle stretching and strengthening with the Acu-Flex (not available here anymore, apparently?).
I do know what you mean about the overcompensating causing other problems. I could barely use my left foot for months, was walking with a cane, and eventually developed bad tendonitis (achilles, peroneal, and posterior tib.) in _both_ feet, which I attribute mostly to walking so wackily for so long.
I have a good pair of orthotics now, though I'm still trying to get them adjusted just right. Birkenstocks have helped me ever since I learned about them on this site.
The latest thing to push me farther along the recovery path, which I never thought I'd try, is homeopathy. I've been on homeopathic medicines since January 24, and they've boosted me up to the almost-recovered realm, though I expect to have to take good care of these flippers for the rest of my life!
I do think there's great potential in ESWT -- have you checked out the ESWT section here? Click on 'patient progress reports' there, which Scott set up several months ago. I think the results, in general, are very encouraging. I see Darlene is on there with the lowest satisfaction rating, and I'm sorry it hasn't worked for her; but many other people have had significant improvement from it. If I were still in the agony I was in for so long, I would be going for ESWT (and borrowing money to do it . . . I know what you mean on that score, also).
Again, best of luck to you, P. Ann -- I know these are hard decisions and PF is awful to live with.
Nancy

Re: So long does it take for recovery after pf \-heel spur surgery

Dr. Marlene Reid on 3/12/01 at 02:15 (041120)

Please understand that ESW IS NOW an approved treatment. It is no longer considered investigational and we are getting the OssaTron approved by insurance companies. Maybe because the FDA did approve it for PF in October. The problem is that many insurance companies just do not know about it. So it takes a little work getting it approved, but my office has been able to. You need to find someone in your area that is using an approved machine and you will have better luck with your insurance company. Good luck.