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Foot Surgery- Location of incision

Posted by Tracey A. on 7/26/01 at hrmin (054416)

Dear doctors,
I've been coming to this website for atleast 6 months and yet to have a question answered in full. I want to know what is an acceptable place to make an incision in the foot for Planter-facsia release? I ask this question because I had 2 surgeries done one on my right foot, the 1st doctor(pod)made the cut inside the right heel almost starting from the rear of the heel it was 1 and 1/2 inches long (lower part of the heel) and the 2nd doctor(orthopedic surgeon) extended that incision that went under the arch and it 2 inches long. These surgeries were done last summer and early fall (06/07/00 and 09/12/00. As of this writing I am not doing better and was told by 3rd doctor(pod) that the damage is permanent. Half my heel is numb and purple because the 2nd doctor cut the blood vessels in the foot. I had no test before surgery nor informed consent because I would never gone through this hell. I found out 2 mos. ago that I am diabetic. I had to quit my job. I'm suffering from depression and am on medication. I think this is malpractice.... As I asked at the beginning what is considered acceptable area to make the incision and shouldn't time be taken to avoid nerves and blood vessels???? I have surgeries before and never had any trouble recovery. I can't work out at the gym, rollerblade or walk the park with my family. Doctors need to be accountable for making mistakes. Please give me a medical answer and the location for incisions. Thank-you Tracey A.

Re: Foot Surgery- Location of incision

Mary J. on 7/27/01 at 07:02 (054444)

Tracey, I had a nerve decompression and partial fasciotomy two weeks ago. The cut was two inches long, started just under the ankle and went diagonally under the foot. It is too early to tell if it helped. I am sorry you received no help. I will be so dissappointed if mine does not get better. But I know that I have only about a 60% chance of getting better. I am not a doctor, so I guess I didn't help much. Let us hear how you are doing. Sincerely, Mary J.

Re: Foot Surgery- Location of incision

Dr. Zuckerman on 7/27/01 at 15:15 (054533)

I will tell you what incision I make. A make a 1/2 half inch incision on the bottom of the foot directly under the bottom of the heel where the plantar fascia attaches to the heel bone. Good location due to the lack of nerves and blood vessels and isn't near any structures that are on the medial side of the heel bone. Yes surgeons should try to avoid nerves , and blood vessels. Yes there are surgeons that make their incision on the side of the foot. The length is different for every patients when doing open surgery. The surgeon will make a incision larger enough so that he can see the structures he is looking for.

There are a percentage of people that will have the surgery done perfectly and be in the exact position that you are in.

The heel is a very difficult place to have surgery. People will heal faster having heart by pass surgery.

I understand the pain frustation and anger you are going through. I wish I could give you an answer to this horrible pain you are having.

Poor results and worse results may not be malpractice but I am not an attorney so you will have to have an attorney tell you if there is malpractice

Re: Foot Surgery- Location of incision

Ed Davis, DPM on 7/27/01 at hrmin (054564)

There are several ways to do the surgery and that is the reason why there are a number of different types of incisions. I would not focus on the incisions because they probably have little relevance to what was actually done inside--that is what counts.

One of the key issues, in terms of liability, was if an adequate course of conservative treatment was provided before proceeding to surgery. The vast majority of plantar fasciitis is cured without surgery.

I hope this information is helpful to you. We have not examined your foot nor have we looked at your medical records or report of operations. Without doing so we can only speculate as to why you are still having pain and if something was not done right. Please understand the limitations of what can be accomplished online with limited information. It sounds like you need further examination by a qualified individual. I can provide you some names if you provide me your location.
Ed

Re: Foot Surgery- Location of incision

Tracey A on 7/27/01 at 19:32 (054575)

Doctor,
I live in Oklahoma City OK

Re: Foot Surgery- Location of incision

Ed Davis, DPM on 7/29/01 at hrmin (054699)

Tracey-
I do not know most of the doctors there on a personal basis. I utilized the web site http://www.acfas.org in order to search through members of the American College of Foot & Ankle Surgeons.

A well regarded individual on the list is:

Robert D. Sowell, DPM, FACFAS
5100 N. Brookline Avenue, #375
Oklahoma City, OK 73112-3603

405-943-7797

Hope things work out for you.
Ed

Re: For Dr. Z

Paula G. on 7/30/01 at 13:29 (054824)

What if they talk about making the incision on the side of the foot and heel? My doctor says he does NOT go in right at the heel under the foot.
He says he makes the incision at the inside side??

Re: For Dr. Z

Dr. Zuckerman on 7/30/01 at 19:27 (054858)

I use a miminial incision approach directly on the bottom of the heel. There are alot of doctors that cut thru the side. The bottom is something that I like to do and have been using this approach for over fifteen years. It avoids nerves, arteries etc. This is my own approach. I do this due to the exact problems that you are having. In MY OPINION the side is a bad approach but I think if you did a survey of doctors they still would use the side due to that is the way they learned. I realize very early on that the side can damage nerves. Very very hard to see the nerves in the foot with a side incision.

Even with the bottom approahc which I feel should be used you still can have a very long healing. With the bottom incision you are right this at the medial tubercle of the heel

Re: Foot Surgery- Location of incision

Mary J. on 7/27/01 at 07:02 (054444)

Tracey, I had a nerve decompression and partial fasciotomy two weeks ago. The cut was two inches long, started just under the ankle and went diagonally under the foot. It is too early to tell if it helped. I am sorry you received no help. I will be so dissappointed if mine does not get better. But I know that I have only about a 60% chance of getting better. I am not a doctor, so I guess I didn't help much. Let us hear how you are doing. Sincerely, Mary J.

Re: Foot Surgery- Location of incision

Dr. Zuckerman on 7/27/01 at 15:15 (054533)

I will tell you what incision I make. A make a 1/2 half inch incision on the bottom of the foot directly under the bottom of the heel where the plantar fascia attaches to the heel bone. Good location due to the lack of nerves and blood vessels and isn't near any structures that are on the medial side of the heel bone. Yes surgeons should try to avoid nerves , and blood vessels. Yes there are surgeons that make their incision on the side of the foot. The length is different for every patients when doing open surgery. The surgeon will make a incision larger enough so that he can see the structures he is looking for.

There are a percentage of people that will have the surgery done perfectly and be in the exact position that you are in.

The heel is a very difficult place to have surgery. People will heal faster having heart by pass surgery.

I understand the pain frustation and anger you are going through. I wish I could give you an answer to this horrible pain you are having.

Poor results and worse results may not be malpractice but I am not an attorney so you will have to have an attorney tell you if there is malpractice

Re: Foot Surgery- Location of incision

Ed Davis, DPM on 7/27/01 at hrmin (054564)

There are several ways to do the surgery and that is the reason why there are a number of different types of incisions. I would not focus on the incisions because they probably have little relevance to what was actually done inside--that is what counts.

One of the key issues, in terms of liability, was if an adequate course of conservative treatment was provided before proceeding to surgery. The vast majority of plantar fasciitis is cured without surgery.

I hope this information is helpful to you. We have not examined your foot nor have we looked at your medical records or report of operations. Without doing so we can only speculate as to why you are still having pain and if something was not done right. Please understand the limitations of what can be accomplished online with limited information. It sounds like you need further examination by a qualified individual. I can provide you some names if you provide me your location.
Ed

Re: Foot Surgery- Location of incision

Tracey A on 7/27/01 at 19:32 (054575)

Doctor,
I live in Oklahoma City OK

Re: Foot Surgery- Location of incision

Ed Davis, DPM on 7/29/01 at hrmin (054699)

Tracey-
I do not know most of the doctors there on a personal basis. I utilized the web site http://www.acfas.org in order to search through members of the American College of Foot & Ankle Surgeons.

A well regarded individual on the list is:

Robert D. Sowell, DPM, FACFAS
5100 N. Brookline Avenue, #375
Oklahoma City, OK 73112-3603

405-943-7797

Hope things work out for you.
Ed

Re: For Dr. Z

Paula G. on 7/30/01 at 13:29 (054824)

What if they talk about making the incision on the side of the foot and heel? My doctor says he does NOT go in right at the heel under the foot.
He says he makes the incision at the inside side??

Re: For Dr. Z

Dr. Zuckerman on 7/30/01 at 19:27 (054858)

I use a miminial incision approach directly on the bottom of the heel. There are alot of doctors that cut thru the side. The bottom is something that I like to do and have been using this approach for over fifteen years. It avoids nerves, arteries etc. This is my own approach. I do this due to the exact problems that you are having. In MY OPINION the side is a bad approach but I think if you did a survey of doctors they still would use the side due to that is the way they learned. I realize very early on that the side can damage nerves. Very very hard to see the nerves in the foot with a side incision.

Even with the bottom approahc which I feel should be used you still can have a very long healing. With the bottom incision you are right this at the medial tubercle of the heel