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Considering Surgery Seeking Input

Posted by davidg on 4/08/01 at 15:47 (044001)

I am a 37-year-old runner, cyclist, skier, mountaineer, etc., and have been wrestling with TTS for 8+ years and am contemplating the surgery. I have read many of the postings and am beginning to have serious doubts about the success of the Release procedure.

History/Story
My initial problem started when I was running on an indoor track at The University of Iowa in the fall of 1992. At the time I was diagnosed with a partial rupture of the Achilles Tendon (Dr. A). In 95 I went to a different doctor, Dr. B, who diagnosed me with Retro Calcaneal Bursitis (RCB) and I had my first cortisone injection and was doing great, i.e., full activity. Re-tweaked it 18 months later and had a second C injection with the same great result. Tweaked the foot again 5/99 no C tweaked it again 10/31/99. Went back to Dr B who sent me to the Podiatrist in their group (Dr. C) he made orthotics and ordered a course of PT, still thinking RCB, no help. Dr. C wanted to get an MRI but I didn't have the insurance or the $1500. So there I sat and waited. Took a job with insurance and saw the new Podiatrist (Dr. D) got the MRI, which came back negative for RCB or anything else wrong. Dr. D went on to explain that he thought I might be suffering form some degree of TTS. He ordered an NCT which came back somewhat positive but, not necessarily conclusive. He explained that with my past treatments we are basically down to the surgery option.

I am in an odd place it seems if I do 'normal activity' I'm more or less OK, i.e., little pain. But, if I try activities Run, Hike even hilly walking cause trouble. I really want that active life back but I'm afraid the surgery will leave me worse off.

Any advice or input would be helpful.

I'd be interested Scott, Mor S. and Ashley's feedback about how they came to the decision to have the surgery, since we seem to have/had similar activity levels.

I'd also be interested in Dr. Zuckerman's prediction for a satisfactory outcome. Dr. D say ~80% chance for an excellent to good outcome. My review of the Medline database suggests that this estimate is optimistic. I also wonder if it might be better to have the surgery while the nerve is in relatively good condition or wait till the situation progressed to an intolerable one.

David

Re: Considering Surgery Seeking Input

wendyn on 4/08/01 at 15:52 (044004)

David - I'll be interested to see the opinion of others. If I was you? I would not have the surgery. If I had a normal life with little restriction - I'd take it. My doctor has given me less than 50/50 chance that a release would help - at least in my case. For me, the risk is not worth it - and I will continue to work at conservative measures. But - I'm just one person, and that's only one option.

Re: Considering Surgery Seeking Input

Dr. Zuckerman on 4/08/01 at 15:56 (044006)

Hi,

This is a tough since it is not causing severe pain during the daily life activity of work and is sports related to some degree.

The sucess rate for TTS surgery is very variable and you need to see a doctor who has done alot of TTS surgery. Experience in surgical correction of TTS and not just the plantar fascia surgery is very important.

In my practice I see alot of TTS and I have a Foot and Ankle specialist who does alot of this type of surgery perform the surgery on my patients .

My study of the literature is about 50-60% sucess with TTS. Now if you have numbness and burning in the sole of the foot and or pain in the Sinus Tarsus area then you are in the group that needs to consider TTS release.

Mal-functioning ankle function will contribute to TTS and or plantar fasciits pain.

So this is my initial take on your specific problem .

Re: Considering Surgery Seeking Input

chris on 4/09/01 at hrmin (044055)

I'm no doctor...From what I've read on this board, I've seen lots of people with considerable amounts of pain. I found this board after I had tts/pf surgery. My problems began Jan 2000 and I had surgery in NOvember. Why did I decide to have surgery, I did not want to live my life with pain, even a little bit. I noticed that my other leg and foot began hurting because of all the compensation i was doing with the painful foot.
I may not run marathons, but I bowl and am fairly active chasing my boys around.
I often wonder if I had waited or suffered the # of years some of the people have would my surgery have been as successful. It's scary, I almost had surgery for just PF in august, but my podiatrist was inssitent on trying non-surgical methods before, for whatever reason she thought I might have had tts and after a postive eng(?) i had surgery.
Feel free to e-mail me if you want.
chris

Re: Considering Surgery Seeking Input

davidg on 4/09/01 at 11:06 (044083)

Hi Chris,

Thanks for the response

Sounds like you are about 5 to 6 months post-op. At this point are you satisfied with the outcome and what does your doctor say about the long-term outlook for pain free activity.

David

Re: Considering Surgery Seeking Input

davidg on 4/09/01 at 11:15 (044084)

Hi Dr. Z,

Thanks for the candid advice, it's not exactly what I wanted to hear but is probably the response I would have given (although I'm not a Physician), after all priority one is do no harm or at least don't make it worse.

One concern I have is that if the nerve continues to worsen do I lesson my chances for a positive surgical outcome with increasing damage to the nerve.

David

Re: Considering Surgery Seeking Input

chris on 4/09/01 at 11:22 (044085)

I am 5 months post-op...I am very satisfied. From time to time I have a little pain, but nothing like before. I suppose a big test will be this summer when I return to the amusement parks with my boys and endure lots of walking. For now though, everything seems great.
I still have to schedule my final post-op appointment. I have been real busy with work and the hospital is an hour away, so it requires taking off of work and I have been feeling fine....Previously, my doctor said that is a chance that the scar tissue will return and I may need surgery again....I will just hope that doesn't happen but if it does, and I need surgery again, I would do it again.

Re: Considering Surgery Seeking Input

davidg on 4/09/01 at 11:25 (044086)

Hi Wendy,

Hope your doing well. I hear what your saying but it's hard when everything you do and are about is about being outside and playing I'm really dreading the longer day and the summer.

David

Re: Considering Surgery Seeking Input

Scott2 on 4/09/01 at 11:30 (044088)

David,

For me the decision to have surgery was an easy one because I had exhausted all other non-invasive methods and I was in constant pain throughout the day.

It wasn't that I couldn't be active anymore, but I could not even walk without pain so it was time. I felt that if I did not do it, that I would never get better and had to at least try.

The surgery at this point I would say (almost three months) has gone well. I still have pain and soreness, but it's a different kind. My heel is sore from the surgery still and I am still working hard to get my strength and flexibility back. I started riding my bike outdoors again and I am swimming as well. That's progress.

Ultimately, it is up to you to have surgery. As others have suggested, do your homework and find the best doctor you can. I am on an HMO, but I changed my Primary to get into a network of a well known Podiatrist that did the surgery. You have to decide if being pain free and leading a 'normal' life is good enough for you. If you are very active and you get a lot of enjoyment from activities that you cannot do now, then you may have to think it through more.

The way I saw it, if after all of the surgery and rehab that if it did not work, then at the worst, I was still at square one. If I never did the surgery and kept dealing with the pain, then I would never know. I would not say the surgery has left me worse off. If it ends up that I cannot run again, but be pain free, I'll take it - but I'm not settling for that yet.

The surgery is nothing. The rehab and uncertainty is the challenge. It takes a long time and you have to keep working hard and be patient with the results which can be slow.

Again, that is just one person's opinion. Many others here say they would have never done it and others say it was the right thing. That is what can make this condition additionally frustration along with the pain. It's not a slam dunk.

Re: Considering Surgery Seeking Input

Dr. Zuckerman on 4/09/01 at 11:55 (044091)

That is another consideration. You may have to modify your sports activity in your life. Regular evaluation at least once yearly is also important.

Re: Considering Surgery Seeking Input

wendyn on 4/09/01 at 17:46 (044116)

david - I know it's hard. I used to be super active too. Now I am still active - just not so much so. Dealing with restrictions is a whole 'nother ball game so to speak. I do understand where you're coming from - and I struggle with the same decisions. Although a TT release is not an option for me - a complete reconstruction of my arches is. I have an appt with my surgeon at the end of May to discuss again. I need to know more before I can consider doing it now (he is not recommending it now - told me to put it off as long as I can).

But - same issue, do I live with what I have now - or go for broke?

Re: Considering Surgery Seeking Input

davidg on 4/09/01 at 18:03 (044117)

Sorry about that, sometimes I get a little mellow dramatic. I should probably be thanking my lucky stars that it's not worse, at least I can get around without too much difficulty.

One of the concerns I have about putting it off as long as possible is; is there a slimmer chance for a 'successful' surgical outcome the more the nerve is damaged.

Maybe we need to start walking on our hands. Oh, that would just cause carpal TS :-)

David

Re: Considering Surgery Seeking Input

Helene M on 4/09/01 at 19:12 (044120)

How does one find a dr. who does a lot of TTS surgery? Does a dr. need special training for this type of surgery?

Re: Considering Surgery Seeking Input

Chad H on 4/09/01 at 20:14 (044135)

David,

I don't know how long you have been reading the posts on this board, and I hate to go back and tell my whole story over again. However,it appears that I am one of the few on this board to try having a TTS release twice. I also had a third surgery on my ankle to attempt to fit a damaged tendon (sprained ankle) caused by not walking properly from the TTS pain. All of this took place from November 1997 - November 1999.

I would say that I am actually worse off because of the surgery. The time in the cast and the lack of proper PT afterward caused me to regress greatly.

With all of this in mind, I will likely have surgery again in the next few years. I am wiser, but unwilling to live the rest of my life in this much pain. I am 28 years old.

I have talked to a doctor about a vein wrap, and will likely have this done. I would recommend finding the absolute best doctor, discussing your options, and making a decision you can live with.

For me, I don't think I can get any worse, so I am willing to try again. I live a normal life. I walk okay (limp when the pain is bad), I rollerblade and snow ski (ankle is locked in the boots), I can hike, and run a little. The pain is just too much for me though.

Good luck

Re: Considering Surgery Seeking Input

wendyn on 4/08/01 at 15:52 (044004)

David - I'll be interested to see the opinion of others. If I was you? I would not have the surgery. If I had a normal life with little restriction - I'd take it. My doctor has given me less than 50/50 chance that a release would help - at least in my case. For me, the risk is not worth it - and I will continue to work at conservative measures. But - I'm just one person, and that's only one option.

Re: Considering Surgery Seeking Input

Dr. Zuckerman on 4/08/01 at 15:56 (044006)

Hi,

This is a tough since it is not causing severe pain during the daily life activity of work and is sports related to some degree.

The sucess rate for TTS surgery is very variable and you need to see a doctor who has done alot of TTS surgery. Experience in surgical correction of TTS and not just the plantar fascia surgery is very important.

In my practice I see alot of TTS and I have a Foot and Ankle specialist who does alot of this type of surgery perform the surgery on my patients .

My study of the literature is about 50-60% sucess with TTS. Now if you have numbness and burning in the sole of the foot and or pain in the Sinus Tarsus area then you are in the group that needs to consider TTS release.

Mal-functioning ankle function will contribute to TTS and or plantar fasciits pain.

So this is my initial take on your specific problem .

Re: Considering Surgery Seeking Input

chris on 4/09/01 at hrmin (044055)

I'm no doctor...From what I've read on this board, I've seen lots of people with considerable amounts of pain. I found this board after I had tts/pf surgery. My problems began Jan 2000 and I had surgery in NOvember. Why did I decide to have surgery, I did not want to live my life with pain, even a little bit. I noticed that my other leg and foot began hurting because of all the compensation i was doing with the painful foot.
I may not run marathons, but I bowl and am fairly active chasing my boys around.
I often wonder if I had waited or suffered the # of years some of the people have would my surgery have been as successful. It's scary, I almost had surgery for just PF in august, but my podiatrist was inssitent on trying non-surgical methods before, for whatever reason she thought I might have had tts and after a postive eng(?) i had surgery.
Feel free to e-mail me if you want.
chris

Re: Considering Surgery Seeking Input

davidg on 4/09/01 at 11:06 (044083)

Hi Chris,

Thanks for the response

Sounds like you are about 5 to 6 months post-op. At this point are you satisfied with the outcome and what does your doctor say about the long-term outlook for pain free activity.

David

Re: Considering Surgery Seeking Input

davidg on 4/09/01 at 11:15 (044084)

Hi Dr. Z,

Thanks for the candid advice, it's not exactly what I wanted to hear but is probably the response I would have given (although I'm not a Physician), after all priority one is do no harm or at least don't make it worse.

One concern I have is that if the nerve continues to worsen do I lesson my chances for a positive surgical outcome with increasing damage to the nerve.

David

Re: Considering Surgery Seeking Input

chris on 4/09/01 at 11:22 (044085)

I am 5 months post-op...I am very satisfied. From time to time I have a little pain, but nothing like before. I suppose a big test will be this summer when I return to the amusement parks with my boys and endure lots of walking. For now though, everything seems great.
I still have to schedule my final post-op appointment. I have been real busy with work and the hospital is an hour away, so it requires taking off of work and I have been feeling fine....Previously, my doctor said that is a chance that the scar tissue will return and I may need surgery again....I will just hope that doesn't happen but if it does, and I need surgery again, I would do it again.

Re: Considering Surgery Seeking Input

davidg on 4/09/01 at 11:25 (044086)

Hi Wendy,

Hope your doing well. I hear what your saying but it's hard when everything you do and are about is about being outside and playing I'm really dreading the longer day and the summer.

David

Re: Considering Surgery Seeking Input

Scott2 on 4/09/01 at 11:30 (044088)

David,

For me the decision to have surgery was an easy one because I had exhausted all other non-invasive methods and I was in constant pain throughout the day.

It wasn't that I couldn't be active anymore, but I could not even walk without pain so it was time. I felt that if I did not do it, that I would never get better and had to at least try.

The surgery at this point I would say (almost three months) has gone well. I still have pain and soreness, but it's a different kind. My heel is sore from the surgery still and I am still working hard to get my strength and flexibility back. I started riding my bike outdoors again and I am swimming as well. That's progress.

Ultimately, it is up to you to have surgery. As others have suggested, do your homework and find the best doctor you can. I am on an HMO, but I changed my Primary to get into a network of a well known Podiatrist that did the surgery. You have to decide if being pain free and leading a 'normal' life is good enough for you. If you are very active and you get a lot of enjoyment from activities that you cannot do now, then you may have to think it through more.

The way I saw it, if after all of the surgery and rehab that if it did not work, then at the worst, I was still at square one. If I never did the surgery and kept dealing with the pain, then I would never know. I would not say the surgery has left me worse off. If it ends up that I cannot run again, but be pain free, I'll take it - but I'm not settling for that yet.

The surgery is nothing. The rehab and uncertainty is the challenge. It takes a long time and you have to keep working hard and be patient with the results which can be slow.

Again, that is just one person's opinion. Many others here say they would have never done it and others say it was the right thing. That is what can make this condition additionally frustration along with the pain. It's not a slam dunk.

Re: Considering Surgery Seeking Input

Dr. Zuckerman on 4/09/01 at 11:55 (044091)

That is another consideration. You may have to modify your sports activity in your life. Regular evaluation at least once yearly is also important.

Re: Considering Surgery Seeking Input

wendyn on 4/09/01 at 17:46 (044116)

david - I know it's hard. I used to be super active too. Now I am still active - just not so much so. Dealing with restrictions is a whole 'nother ball game so to speak. I do understand where you're coming from - and I struggle with the same decisions. Although a TT release is not an option for me - a complete reconstruction of my arches is. I have an appt with my surgeon at the end of May to discuss again. I need to know more before I can consider doing it now (he is not recommending it now - told me to put it off as long as I can).

But - same issue, do I live with what I have now - or go for broke?

Re: Considering Surgery Seeking Input

davidg on 4/09/01 at 18:03 (044117)

Sorry about that, sometimes I get a little mellow dramatic. I should probably be thanking my lucky stars that it's not worse, at least I can get around without too much difficulty.

One of the concerns I have about putting it off as long as possible is; is there a slimmer chance for a 'successful' surgical outcome the more the nerve is damaged.

Maybe we need to start walking on our hands. Oh, that would just cause carpal TS :-)

David

Re: Considering Surgery Seeking Input

Helene M on 4/09/01 at 19:12 (044120)

How does one find a dr. who does a lot of TTS surgery? Does a dr. need special training for this type of surgery?

Re: Considering Surgery Seeking Input

Chad H on 4/09/01 at 20:14 (044135)

David,

I don't know how long you have been reading the posts on this board, and I hate to go back and tell my whole story over again. However,it appears that I am one of the few on this board to try having a TTS release twice. I also had a third surgery on my ankle to attempt to fit a damaged tendon (sprained ankle) caused by not walking properly from the TTS pain. All of this took place from November 1997 - November 1999.

I would say that I am actually worse off because of the surgery. The time in the cast and the lack of proper PT afterward caused me to regress greatly.

With all of this in mind, I will likely have surgery again in the next few years. I am wiser, but unwilling to live the rest of my life in this much pain. I am 28 years old.

I have talked to a doctor about a vein wrap, and will likely have this done. I would recommend finding the absolute best doctor, discussing your options, and making a decision you can live with.

For me, I don't think I can get any worse, so I am willing to try again. I live a normal life. I walk okay (limp when the pain is bad), I rollerblade and snow ski (ankle is locked in the boots), I can hike, and run a little. The pain is just too much for me though.

Good luck