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Help - surgery question

Posted by Steve Chism on 8/02/01 at hrmin (055188)

We live in northern Mississippi and my wife has been seeing a foot doctor in Southave MS for two years now for PF. The doctor has been injecting her right foot monthly which provides only temporary relief and her overall condition is getting worse.

Two months ago he recommending ESWT surgery. My wife was concerned about surgery and decided that she would like to try totally resting her foot first. So for two months she has been crawling, crutching, and hopping while experimenting with what helps her foot.

At the beginning her foot was numb, cold, and swollen. After experimenting with ice packs etc., she found that light stretching and rubbing worked best. Just in the last few weeks her foot looks 100% normal, warm, with no (0%) pain. She is starting to put just a little weight on it. She wants to continue this approach for several more months if needed.

PROBLEM: Her good foot is starting to bother her some. But not to bad so he wants to totally rest it before it gets injured. No Problem, we will just get a wheelchair for 2 months so we called the doctor. He refuses to authorize a wheelchair and says she needs surgery and it's the only way to correct the problem. He said once she walks on her foot again the pain will return.

Her foot hasn't felt this good for 2 years and she wants to continue to rest the foot and gradually add weight. We will agree to surgery if this doesn't work but we would like to try it. But we need the doctor to approve for a wheelchair for several months because crawling isn't good either.

Doesn't anyone know where to purchase a low priced wheelchair since the doctor is refusing to OK one?

Is the doctor right? Are we unreasonalbe?

Re: Help - surgery question

Steve on 8/02/01 at hrmin (055189)

I forgot to mention that the doctor justed returned for training with ESWT and has yet to do his first patient!

Are we unreasonalbe in wanting to try the wheelchair first? We have seen 98% improvement within the last month with rest. You can't take back surgery once its completed and it may cause more problems. Is there any harm in trying rest (w/ stretching and gradual weight) for two months?

Re: Help - surgery question

Ed Davis, DPM on 8/02/01 at hrmin (055202)

Steve:
ESWT is not surgery--it is treated as such but no incisions are made and there are no significant known side effects nor complications to this procedure. Please take some time to read Scott's heel pain book and study this site. There is a lot that can be done for plantar fasciitis. ESWT is generally done when conventional treatment has failed and patients are basically 'ready' for surgery but desire a conservative treatment with a lower rate of potential complications. It does not take a great deal of skill to 'perform' the procedure since the machine really does the work.
I am not too worried about your doctor's inexperience with the procedure. I am worried about your wife's course of treatment though...

Is a monthly cortisone shot all the treatment your wife has had? If so, there is a lot more that needs to be done to help her. Is her doctor prescribing a comprehensive treatment program to bring the problem to resolution? I generally would not consider a wheelchair to be a reasonable option except in some extreme cases.
Ed

Re: Help - surgery question

Steve on 8/02/01 at hrmin (055204)

The wheelchair is only for 1 to 2 months max.

Her approach to resting the foot within the last two months has been 98 percent effective. While doing the shots for two years, her condition continued to get worse. The shots were the only treatment that was done and it didn't work.

Resting the foot (with stretching) isn't considered an conventional treatment?

What harm can be done by resting the foot for 1 to 2 months?

Re: Help - surgery question

wendyn on 8/02/01 at 11:38 (055208)

I would suspect muscle atrophy and a higher risk of blook clotting from lack of movement could be a risk...I'm not a doctor...PF should not keep someone in a wheelchair for 2 months. If she has to be in a wheelchair for that long then I'd be investigating whether or not PF is really the only thing going on.

Re: Help - surgery question

Dr. Zuckerrman on 8/02/01 at 12:45 (055212)

Too much rest is just as bad as not enought rest. Muscle/tendon atropy and the risk of blood clot are factors to be considered. Physical therapy, orthosis, stretching are all part of the comprehensive treatment plan.

Re: Help - surgery question

Steve on 8/02/01 at hrmin (055222)

I agree with a combination of treatments. :stretching, physical therapy, etc

However, I disagree with surgery when she is just now feeling better after 2 years of pain.

Why say surgery is the only solution when the pain has been reduced so much in three weeks?

Re: Help - surgery question

chris on 8/02/01 at 14:29 (055226)

I am no doctor and by no means extremely knowledgeable in this. I have, however, had a PF release and TTS surgery 9 months ago. What I want to say is that I had had numerous types of tx's done without success and was to the point where I asked the doctor to just cut my foot off becuase I was so sick of the pain.

Yes, rest did help but as soon I started walking again pain would return. Surgery was recommended when TTS was confirmed. I must say at this time it was the best decision I ever made. I am completely pain free, doing all the activiteis I previously did all without pain.

I noticed the pf surgery was immediately successful the tts recovery took a little longer.

i know this does not answer your questions on getting a wheelchair, but in all the time I have been lurking on this board and website I have never seen complete non-weight bearing as a treatment modality.

Re: Help - surgery question

Ed Davis, DPM on 8/02/01 at hrmin (055266)

Some rest is reasonable. If you are seriously still considering the wheelchair then it is important that non-weight bearing exercises be done to prevent blood clots and muscle atrophy. Plantar fasciitis often comes back when activity is resumed. That is true if the biomechanical problems that existed before the period of rest still exist. I would rather see a trial of rest combined with a more complete plan of treatment in order to make recurrence less likely.
Ed

Re: Help - surgery question

Steve on 8/02/01 at hrmin (055275)

I 100% agree with you.

My wife from day one has continued stretching and exercises with her feet. She only wants to avoid 100% weight from walking for a short period of time. Her pain is gone and she stands on her feet, stretching, and exercising them. Again, she only wanted to avoid 'all weight' walking for 1 to 2 months. Since her good foot was becoming sore it would have been nice to have a wheelchair temporarly ....... NOT to use all the time but just to give her feet a break when she had to move around the house alot or go shopping in stores with no aids.

We never considered her just setting in the chair!

Her progress was going so good it just shocked me to hear that surgery was the next option.

Thank you for your comments,

Steve

Re: Help - surgery question

Julie on 8/03/01 at 01:35 (055288)

Steve, Dr Davis has already said this, but it might be worth mentioning again that ESWT is not surgery. It is a non-invasive treatment that has a good success rate and none of the dangers or post-treatment complications of surgery. Please don't think of it in the same breath as surgery - which really is, as you obviously know, a last resort.

It certainly doesn't sound as though your wife's treatment has been comprehensive, or even adequate. And I am worried about all those injections (presumably cortisone?). One a month for two years?

Has she been evaluated to determine if there are any biomechanical faults in the way she walks? These would need to be corrected with orthotics. And orthotics are only as effective as the shoes they are worn in, so footgear needs to be looked into as well.

Continued rest (though I'm relieved to know that she isn't resting ALL the time - that really is not an option) will relieve pain and give the fascia a chance to heal. But if the cause of the plantar fasciitis is not dealt with, it will probably return.

Re: Help - surgery question

Mary J on 8/03/01 at 09:46 (055331)

Steve, I think that resting for two months would be much better than a cortizone shot once a month for 2 years. This could become another effective form of treatment for PF, with many guidelines to follow. Wouldn't it be the similar to a cast, or recuperation time after surgery? Of course, there would be certain exercises such as swimming, bicycling, and all kinds of sitting or prone position exercises. There should be rules such as don't do any form of mobility too much. Crawling is good, but too much may not be good for the knees, etc. Too much use of cruthes may cause problems. Doctors shoud know the problems of all the different ways of mobilization. It would be good to check with them on this. There is also the problem that you mentioned of strain on the opposite foot. The wheelchair would certainly help to keep off both feet. As Julie says, the problem which caused the PF would have to be looked into. However, if it is considered a sports injury, what better help than rest. And it doesn't cost a thing. There have been other people on the board who tried this. I believe it was a Bob who tried it, and said it cured him. Steve, I hope your wife's foot stays pain free. Thanks, Mary J.

Re: Help - surgery question

Steve on 8/03/01 at hrmin (055345)

Money was never the main concern.

Our main concern is that surgery isn't reversible. Once its completed you can't go back so it should be done only as a last option. Total rest was never considered neither. We just didn't want full body weight on her feet while she's walking around for awhile. We are going to try vitamins, paks, exercises, gradual weight increase, massages, etc.

And she does stand on her feet but it's controlled. We know that the shots didn't help while her conditioned got worse. So why not try it.

And for now she seems to be getting better each day.

Thanks for your comments,

Re: Help - surgery question

Julie on 8/03/01 at 13:16 (055350)

Steve, I know I'm being a cracked record - but ESWT is NOT surgery. It is non-invasive. It's success rate is good. Dangers - from what we've heard - are pretty well non-existent. Post-treatment complications also pretty-well non-existent. Recovery time much shorter than for surgery.

If your wife is a candidate for ESWT, and if money is not a problem, you could consider it without the worries that you obviously (and rightly, I think) have regarding surgery.

Re: Help - surgery question

Steve on 8/03/01 at hrmin (055352)

I have said before that we are considering ESWT. However, she is feeling better each day and as long as this continues there is no need for it. She continues to exercise, stretch, physical therapy etc.

This is your quote from a previous post.

'Rest - but of course you must know this: you're trying to heal an injury, so stay off your feet as much as you can. You don't say what your job is - if it's one that requires you to be on your feet a lot, that in itself is contributing to your problems.'

This is exactly what my wife is doing. Your right we are trying to heal an injury. ESWT injures the area again, so why risk it if she is improving? No one fully knows the long term effects of treating PF with multiple 20,000 volt shocks.

Re: Help - surgery question

Julie on 8/03/01 at 14:54 (055356)

OK Steve - you got me.

Re: Help - surgery question

john h on 8/04/01 at 11:55 (055456)

steve: we have two very good foot and ankle surgeons in Little Rock. both have fellowships in foot and ankle surgery. Dr. Steven Kulik and Dr. Ruth Thomas. i assume you are in the west part of the state which is not far from Little Rock.

Re: Help - surgery question

john h on 8/04/01 at 12:03 (055459)

steve: i am not sure by what you mean 'long term' but ESWT has been perfomed in Europe for pehaps a decade with 10's of thousands of documented procedures.

Re: Help - surgery question

Steve on 8/02/01 at hrmin (055189)

I forgot to mention that the doctor justed returned for training with ESWT and has yet to do his first patient!

Are we unreasonalbe in wanting to try the wheelchair first? We have seen 98% improvement within the last month with rest. You can't take back surgery once its completed and it may cause more problems. Is there any harm in trying rest (w/ stretching and gradual weight) for two months?

Re: Help - surgery question

Ed Davis, DPM on 8/02/01 at hrmin (055202)

Steve:
ESWT is not surgery--it is treated as such but no incisions are made and there are no significant known side effects nor complications to this procedure. Please take some time to read Scott's heel pain book and study this site. There is a lot that can be done for plantar fasciitis. ESWT is generally done when conventional treatment has failed and patients are basically 'ready' for surgery but desire a conservative treatment with a lower rate of potential complications. It does not take a great deal of skill to 'perform' the procedure since the machine really does the work.
I am not too worried about your doctor's inexperience with the procedure. I am worried about your wife's course of treatment though...

Is a monthly cortisone shot all the treatment your wife has had? If so, there is a lot more that needs to be done to help her. Is her doctor prescribing a comprehensive treatment program to bring the problem to resolution? I generally would not consider a wheelchair to be a reasonable option except in some extreme cases.
Ed

Re: Help - surgery question

Steve on 8/02/01 at hrmin (055204)

The wheelchair is only for 1 to 2 months max.

Her approach to resting the foot within the last two months has been 98 percent effective. While doing the shots for two years, her condition continued to get worse. The shots were the only treatment that was done and it didn't work.

Resting the foot (with stretching) isn't considered an conventional treatment?

What harm can be done by resting the foot for 1 to 2 months?

Re: Help - surgery question

wendyn on 8/02/01 at 11:38 (055208)

I would suspect muscle atrophy and a higher risk of blook clotting from lack of movement could be a risk...I'm not a doctor...PF should not keep someone in a wheelchair for 2 months. If she has to be in a wheelchair for that long then I'd be investigating whether or not PF is really the only thing going on.

Re: Help - surgery question

Dr. Zuckerrman on 8/02/01 at 12:45 (055212)

Too much rest is just as bad as not enought rest. Muscle/tendon atropy and the risk of blood clot are factors to be considered. Physical therapy, orthosis, stretching are all part of the comprehensive treatment plan.

Re: Help - surgery question

Steve on 8/02/01 at hrmin (055222)

I agree with a combination of treatments. :stretching, physical therapy, etc

However, I disagree with surgery when she is just now feeling better after 2 years of pain.

Why say surgery is the only solution when the pain has been reduced so much in three weeks?

Re: Help - surgery question

chris on 8/02/01 at 14:29 (055226)

I am no doctor and by no means extremely knowledgeable in this. I have, however, had a PF release and TTS surgery 9 months ago. What I want to say is that I had had numerous types of tx's done without success and was to the point where I asked the doctor to just cut my foot off becuase I was so sick of the pain.

Yes, rest did help but as soon I started walking again pain would return. Surgery was recommended when TTS was confirmed. I must say at this time it was the best decision I ever made. I am completely pain free, doing all the activiteis I previously did all without pain.

I noticed the pf surgery was immediately successful the tts recovery took a little longer.

i know this does not answer your questions on getting a wheelchair, but in all the time I have been lurking on this board and website I have never seen complete non-weight bearing as a treatment modality.

Re: Help - surgery question

Ed Davis, DPM on 8/02/01 at hrmin (055266)

Some rest is reasonable. If you are seriously still considering the wheelchair then it is important that non-weight bearing exercises be done to prevent blood clots and muscle atrophy. Plantar fasciitis often comes back when activity is resumed. That is true if the biomechanical problems that existed before the period of rest still exist. I would rather see a trial of rest combined with a more complete plan of treatment in order to make recurrence less likely.
Ed

Re: Help - surgery question

Steve on 8/02/01 at hrmin (055275)

I 100% agree with you.

My wife from day one has continued stretching and exercises with her feet. She only wants to avoid 100% weight from walking for a short period of time. Her pain is gone and she stands on her feet, stretching, and exercising them. Again, she only wanted to avoid 'all weight' walking for 1 to 2 months. Since her good foot was becoming sore it would have been nice to have a wheelchair temporarly ....... NOT to use all the time but just to give her feet a break when she had to move around the house alot or go shopping in stores with no aids.

We never considered her just setting in the chair!

Her progress was going so good it just shocked me to hear that surgery was the next option.

Thank you for your comments,

Steve

Re: Help - surgery question

Julie on 8/03/01 at 01:35 (055288)

Steve, Dr Davis has already said this, but it might be worth mentioning again that ESWT is not surgery. It is a non-invasive treatment that has a good success rate and none of the dangers or post-treatment complications of surgery. Please don't think of it in the same breath as surgery - which really is, as you obviously know, a last resort.

It certainly doesn't sound as though your wife's treatment has been comprehensive, or even adequate. And I am worried about all those injections (presumably cortisone?). One a month for two years?

Has she been evaluated to determine if there are any biomechanical faults in the way she walks? These would need to be corrected with orthotics. And orthotics are only as effective as the shoes they are worn in, so footgear needs to be looked into as well.

Continued rest (though I'm relieved to know that she isn't resting ALL the time - that really is not an option) will relieve pain and give the fascia a chance to heal. But if the cause of the plantar fasciitis is not dealt with, it will probably return.

Re: Help - surgery question

Mary J on 8/03/01 at 09:46 (055331)

Steve, I think that resting for two months would be much better than a cortizone shot once a month for 2 years. This could become another effective form of treatment for PF, with many guidelines to follow. Wouldn't it be the similar to a cast, or recuperation time after surgery? Of course, there would be certain exercises such as swimming, bicycling, and all kinds of sitting or prone position exercises. There should be rules such as don't do any form of mobility too much. Crawling is good, but too much may not be good for the knees, etc. Too much use of cruthes may cause problems. Doctors shoud know the problems of all the different ways of mobilization. It would be good to check with them on this. There is also the problem that you mentioned of strain on the opposite foot. The wheelchair would certainly help to keep off both feet. As Julie says, the problem which caused the PF would have to be looked into. However, if it is considered a sports injury, what better help than rest. And it doesn't cost a thing. There have been other people on the board who tried this. I believe it was a Bob who tried it, and said it cured him. Steve, I hope your wife's foot stays pain free. Thanks, Mary J.

Re: Help - surgery question

Steve on 8/03/01 at hrmin (055345)

Money was never the main concern.

Our main concern is that surgery isn't reversible. Once its completed you can't go back so it should be done only as a last option. Total rest was never considered neither. We just didn't want full body weight on her feet while she's walking around for awhile. We are going to try vitamins, paks, exercises, gradual weight increase, massages, etc.

And she does stand on her feet but it's controlled. We know that the shots didn't help while her conditioned got worse. So why not try it.

And for now she seems to be getting better each day.

Thanks for your comments,

Re: Help - surgery question

Julie on 8/03/01 at 13:16 (055350)

Steve, I know I'm being a cracked record - but ESWT is NOT surgery. It is non-invasive. It's success rate is good. Dangers - from what we've heard - are pretty well non-existent. Post-treatment complications also pretty-well non-existent. Recovery time much shorter than for surgery.

If your wife is a candidate for ESWT, and if money is not a problem, you could consider it without the worries that you obviously (and rightly, I think) have regarding surgery.

Re: Help - surgery question

Steve on 8/03/01 at hrmin (055352)

I have said before that we are considering ESWT. However, she is feeling better each day and as long as this continues there is no need for it. She continues to exercise, stretch, physical therapy etc.

This is your quote from a previous post.

'Rest - but of course you must know this: you're trying to heal an injury, so stay off your feet as much as you can. You don't say what your job is - if it's one that requires you to be on your feet a lot, that in itself is contributing to your problems.'

This is exactly what my wife is doing. Your right we are trying to heal an injury. ESWT injures the area again, so why risk it if she is improving? No one fully knows the long term effects of treating PF with multiple 20,000 volt shocks.

Re: Help - surgery question

Julie on 8/03/01 at 14:54 (055356)

OK Steve - you got me.

Re: Help - surgery question

john h on 8/04/01 at 11:55 (055456)

steve: we have two very good foot and ankle surgeons in Little Rock. both have fellowships in foot and ankle surgery. Dr. Steven Kulik and Dr. Ruth Thomas. i assume you are in the west part of the state which is not far from Little Rock.

Re: Help - surgery question

john h on 8/04/01 at 12:03 (055459)

steve: i am not sure by what you mean 'long term' but ESWT has been perfomed in Europe for pehaps a decade with 10's of thousands of documented procedures.