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Help --Any advice or suggestions

Posted by Crystal on 8/20/01 at 11:38 (057259)

I had PF release back in February and have been doing great until about a month ago. The last week has been unreal. The last two or three days I have had pain and discomfort like I did before the surgery I have a call into the doctor but I wondered if anyone has gone through this or have suggestions on what I should do. I am stressed and frustrated at this point.

Re: Help --Any advice or suggestions

Ed Davis, DPM on 8/20/01 at 12:50 (057275)

Did you have orthotics made?
Ed

Re: Help --Any advice or suggestions

Crystal on 8/20/01 at 13:00 (057277)

Ed--
I have worn orthotics for years and I have worn them since I have had the surgery too. My doctor even adjusted them alittle after the surgery.
Crystal

Re: Help --Any advice or suggestions

Ed Davis, DPM on 8/20/01 at 14:03 (057281)

The first step would be to return to the surgeon for him to look at your foot. Some possibilities include the development of painful scar tissue in the surgical area, altered biomechanics requiring further orthotic adjustments.
Ed

Re: Help --Any advice or suggestions

Crystal on 8/20/01 at 14:18 (057285)

Ok thanks for the advice I am supposed to hear from the surgeon sometime this afternoon so hopefully I can get on the road to recovery again. I am just trying to keep a positive mind about it. It is just so stressful to be doing great and all of a sudden just be right back where I started. Thanks again.
Crystal

Re: Help --Any advice or suggestions

Pauline on 8/20/01 at 18:01 (057324)

Crystal,
I have be reading, trying to make sense of all the pain and complications people experience following P.F. surgery. In one of the papers I read
it spoke about something called Later Column Syndrome (LCS). This is supposedly one of complications specific to plantar fasciotomies, regardless of how they are performed. Being no doctor, I don't know if this would have anything to do with what you are experiencing, but I throw it out for you to check on.

As I understand LCS is a very difficult complication to understand, diagnose and treat. Its complications do not occur in the first week or two after surgery, but rather 2-4 months after a plantar fasciotomy. From my reading I understand if not diagnosed and untreated it can result in small stress fractures of the lateral and dorsal aspects of the foot.

I sure someone else will be able to shed more light on this topic for you. Since I am in to doing some research on P.F. foot surgery I am wondering just how much information on risks and complications are provided to patients entertaining the surgery.

Are they required to sign papers listing all the possible complications to anesthesia and the surgery it self as with other operations?

I've never been close to having foot surgery, but I would like to know what information the patient had to sign ahead of time. How detailed are the complications spelled out? May you could answer that for me.

I hope that LCS is not your problem and you can eliminate it as a cause for your pain, but I thought you should be aware of it and you could check it out.

If I had one wish, I would wish that I could eliminate all the pain people
all over the world suffer on a daily basis and my wish and prayer for you tonight is just that. I hope you feel better soon.

Re: Help --Any advice or suggestions

Pauline on 8/20/01 at 18:30 (057332)

Crystal,
Sorry should read lateral not late.

Re: Help --Any advice or suggestions--Lateral column syndrome

Ed Davis, DPM on 8/20/01 at 20:00 (057345)

Lateral column syndrome is a very logical potential complication of plantar fascial release surgery and its causes and treatment are well understood.

The plantar fascia is a structure that supports the bones of the tarsus-the small bones across the arch of the foot. Release of the fascia causes the transfer of it's functions to other structures. The ligaments that bridge the bottom of the calcaneo-cuboid joint (primary components of the lateral column) come under additional strain when the plantar fascia is released. That is the main reason why a lot of surgeons do not release the lateral aspect of the plantar fascia.

Lateral column syndrome can generally be resolved, if present, by adjusting the height of the orthotic beneath the calcaneo-cuboid joint upward and relief potentially hastened via cortisone or physical therapy.

Ed

Re: To Dr. Davis Help --Any advice or suggestions--Lateral column syndrome

Pauline on 8/21/01 at 09:10 (057414)

Dr. Davis,
How much, and how many of these surgical complications are on paper for patients to sigh off on before the surgery? I once had abdominal surgery and the complication sheet was very complete to almost frightening, but I sure knew what I was up aginst. It is the same for foot and ankle surgery?
It it written in black and white or just dscussed in the office?

Re: To Dr. Davis Help --Any advice or suggestions--Lateral column syndrome

Dr. Zuckerman on 8/21/01 at 17:43 (057466)

In my office it is written in black and white. It states that it could take up to six months or more for healing and that you still can have pain left in the foot.

There is no standard surgical consent form that I am aware of that each and every doctor must present to his or her patient. But If you don't want to have a unhappy patient who legal problem it is best to write it out for the patient.

Re: To Dr. Davis Help --Any advice or suggestions--Lateral column syndrome

Pauline on 8/21/01 at 17:59 (057472)

Do you actually give a name to all the complications that can happen including things like severed nerves etc. etc. or is it just blanketed.
Although it was frightening to read, I know the papers I had to sign really spelled it out. Is this a form drawn up by your attorney? Do people sign there doctors forms the day of surgery or before?

Re: To Dr. Davis Help --Any advice or suggestions--Lateral column syndrome

Dr. Zuckerman on 8/21/01 at 19:38 (057479)

A surgical consent form should be a written confirmation of what should have been told to the patient before the surgery during the consultation.

For example Mrs. Jones there is a chance that you could still have pain in your foot. There is a chance of infection . There is a chance that it could take six months or more for the foot to get better

I have had two surgical procedure done in my life and the surgeon never told me every single thing that was going to happen.

One was a hernia repair he told me you know it could come back
One was a colonscopy where the surgeon told me that there was a 1.7% chance of tearing the rectum. which is about the same as finding out you have cancer.

What we need is a standard consent process that all doctors must go over for each procedure. and if if is done there can't be any allegation of lack of informed consent

We can talk about consent for ever and there are still going to be claims of I wasn't told that this could happen.

I once had a lawyer tell me that if you knew all the side effects for aspirin you wouldn't take the drug.

Surgical consent is a very complicated procedure. You need to try to tell the patient what can happen and at the same time not scare the living $!$!$
out of that person.

Now going to ever resolve the surgical consent process. there is always going to be disagreement over what should be explained

Re: To Dr. Davis Help --Any advice or suggestions--Lateral column syndrome

Julie on 8/22/01 at 03:15 (057505)

May I add a personal observation here? When considering the question of surgical consent and the information that should be given to the patient beforehand, I think we need to distinguish between essential (I mean life-saving) surgery and elective surgery. When I needed surgery for breast cancer, my consultant did not tell me that it is sometimes necessary to sever the second thoracic nerve, and what the effects are of doing so. In the event he did cut the nerve, because it was in the way of the lymph nodes that had to be removed. Eight years later I am still numb, and always will be, in all the areas supplied by that nerve: the underside of my left arm, my armpit, and the left side of my chest and ribcage. It's not nice, but I have accommodated to it and can live with it. If I had been warned that this might happen, it would have added further anxiety and distress to an already very stressful time. So - I am glad I was not told.

But, if I were considering an elective procedure, I would want to be told of everything significant that might happen so that I could weigh up the pluses and the minuses for myself and make an informed decision.

Re: To Dr. Davis Help --Any advice or suggestions--Lateral column syndrome

Pauline on 8/22/01 at 08:23 (057523)

I was just wondering, because as you said I did have the $%&N scared out of me because every little thing was vividly described. Things like hemorrhage to death, etc. Of course we are talking apples and oranges here because abdominal surgery certainly isn't Plantar surgery, but still in inexperienced hands lots can go wrong.

When I had emergency surgery performed, I signed nothing, my husband did and you know it didn't seem to matter as much because I was already hemorrhaging to death. They just wanted to get in and shut it down which thank God they did.

Re: To Dr. Davis Help --Any advice or suggestions--Lateral column syndrome

Ed Davis, DPM on 8/22/01 at 16:25 (057590)

I agree with Dr. Z concerning standard for listing potential surgical complications. Take a look at any drug description in the PDR (Physician Desk Reference) and you will never take that drug.

There has to be a reasonable listing of possible complications, outcomes and alternatives presented to patients before surgery. I once knew a surgeon who was sued because he gave the patient too much info., they got scared off and did not do the surgery, got worse and sued the doc for doing so.

Lawyers and doctors have argued this point for decades--there is no easy answer. Patients are very different and require different amounts of information before proceeding. A hard thing for doctors to read sometimes.
Some patients simply say, 'Doc, I have full confidence in you--just do what you think is right and don't burden me with the details.' Others want extremely detailed information. The best thing I can emphasize is a good repoire/communication between doctor and patients so that misunderstandings are minimized.
Ed

Re: To Dr. Davis Help --Any advice or suggestions--Lateral column syndrome

Ed Davis, DPM on 8/22/01 at 16:29 (057591)

Pauline:

I had a skin cyst removed from my back at a local surgeons office a few years ago. I signed a consent form which listed complications such as death, hemmorrhage, etc.

I try to write my consent forms in a manner which places things in a reasonable perspective. Most hospitals and many docs use pre-printed forms which may have been written by attorneys.
Ed

Re: Help --Any advice or suggestions

Mike M on 8/27/01 at 17:11 (058138)

Crystal

Just wondering what you found out.
Let us know, your condition sounds sooooooooooooo familiar.
Hope though all went well.

Mike M

Re: Help --Any advice or suggestions

Ed Davis, DPM on 8/20/01 at 12:50 (057275)

Did you have orthotics made?
Ed

Re: Help --Any advice or suggestions

Crystal on 8/20/01 at 13:00 (057277)

Ed--
I have worn orthotics for years and I have worn them since I have had the surgery too. My doctor even adjusted them alittle after the surgery.
Crystal

Re: Help --Any advice or suggestions

Ed Davis, DPM on 8/20/01 at 14:03 (057281)

The first step would be to return to the surgeon for him to look at your foot. Some possibilities include the development of painful scar tissue in the surgical area, altered biomechanics requiring further orthotic adjustments.
Ed

Re: Help --Any advice or suggestions

Crystal on 8/20/01 at 14:18 (057285)

Ok thanks for the advice I am supposed to hear from the surgeon sometime this afternoon so hopefully I can get on the road to recovery again. I am just trying to keep a positive mind about it. It is just so stressful to be doing great and all of a sudden just be right back where I started. Thanks again.
Crystal

Re: Help --Any advice or suggestions

Pauline on 8/20/01 at 18:01 (057324)

Crystal,
I have be reading, trying to make sense of all the pain and complications people experience following P.F. surgery. In one of the papers I read
it spoke about something called Later Column Syndrome (LCS). This is supposedly one of complications specific to plantar fasciotomies, regardless of how they are performed. Being no doctor, I don't know if this would have anything to do with what you are experiencing, but I throw it out for you to check on.

As I understand LCS is a very difficult complication to understand, diagnose and treat. Its complications do not occur in the first week or two after surgery, but rather 2-4 months after a plantar fasciotomy. From my reading I understand if not diagnosed and untreated it can result in small stress fractures of the lateral and dorsal aspects of the foot.

I sure someone else will be able to shed more light on this topic for you. Since I am in to doing some research on P.F. foot surgery I am wondering just how much information on risks and complications are provided to patients entertaining the surgery.

Are they required to sign papers listing all the possible complications to anesthesia and the surgery it self as with other operations?

I've never been close to having foot surgery, but I would like to know what information the patient had to sign ahead of time. How detailed are the complications spelled out? May you could answer that for me.

I hope that LCS is not your problem and you can eliminate it as a cause for your pain, but I thought you should be aware of it and you could check it out.

If I had one wish, I would wish that I could eliminate all the pain people
all over the world suffer on a daily basis and my wish and prayer for you tonight is just that. I hope you feel better soon.

Re: Help --Any advice or suggestions

Pauline on 8/20/01 at 18:30 (057332)

Crystal,
Sorry should read lateral not late.

Re: Help --Any advice or suggestions--Lateral column syndrome

Ed Davis, DPM on 8/20/01 at 20:00 (057345)

Lateral column syndrome is a very logical potential complication of plantar fascial release surgery and its causes and treatment are well understood.

The plantar fascia is a structure that supports the bones of the tarsus-the small bones across the arch of the foot. Release of the fascia causes the transfer of it's functions to other structures. The ligaments that bridge the bottom of the calcaneo-cuboid joint (primary components of the lateral column) come under additional strain when the plantar fascia is released. That is the main reason why a lot of surgeons do not release the lateral aspect of the plantar fascia.

Lateral column syndrome can generally be resolved, if present, by adjusting the height of the orthotic beneath the calcaneo-cuboid joint upward and relief potentially hastened via cortisone or physical therapy.

Ed

Re: To Dr. Davis Help --Any advice or suggestions--Lateral column syndrome

Pauline on 8/21/01 at 09:10 (057414)

Dr. Davis,
How much, and how many of these surgical complications are on paper for patients to sigh off on before the surgery? I once had abdominal surgery and the complication sheet was very complete to almost frightening, but I sure knew what I was up aginst. It is the same for foot and ankle surgery?
It it written in black and white or just dscussed in the office?

Re: To Dr. Davis Help --Any advice or suggestions--Lateral column syndrome

Dr. Zuckerman on 8/21/01 at 17:43 (057466)

In my office it is written in black and white. It states that it could take up to six months or more for healing and that you still can have pain left in the foot.

There is no standard surgical consent form that I am aware of that each and every doctor must present to his or her patient. But If you don't want to have a unhappy patient who legal problem it is best to write it out for the patient.

Re: To Dr. Davis Help --Any advice or suggestions--Lateral column syndrome

Pauline on 8/21/01 at 17:59 (057472)

Do you actually give a name to all the complications that can happen including things like severed nerves etc. etc. or is it just blanketed.
Although it was frightening to read, I know the papers I had to sign really spelled it out. Is this a form drawn up by your attorney? Do people sign there doctors forms the day of surgery or before?

Re: To Dr. Davis Help --Any advice or suggestions--Lateral column syndrome

Dr. Zuckerman on 8/21/01 at 19:38 (057479)

A surgical consent form should be a written confirmation of what should have been told to the patient before the surgery during the consultation.

For example Mrs. Jones there is a chance that you could still have pain in your foot. There is a chance of infection . There is a chance that it could take six months or more for the foot to get better

I have had two surgical procedure done in my life and the surgeon never told me every single thing that was going to happen.

One was a hernia repair he told me you know it could come back
One was a colonscopy where the surgeon told me that there was a 1.7% chance of tearing the rectum. which is about the same as finding out you have cancer.

What we need is a standard consent process that all doctors must go over for each procedure. and if if is done there can't be any allegation of lack of informed consent

We can talk about consent for ever and there are still going to be claims of I wasn't told that this could happen.

I once had a lawyer tell me that if you knew all the side effects for aspirin you wouldn't take the drug.

Surgical consent is a very complicated procedure. You need to try to tell the patient what can happen and at the same time not scare the living $!$!$
out of that person.

Now going to ever resolve the surgical consent process. there is always going to be disagreement over what should be explained

Re: To Dr. Davis Help --Any advice or suggestions--Lateral column syndrome

Julie on 8/22/01 at 03:15 (057505)

May I add a personal observation here? When considering the question of surgical consent and the information that should be given to the patient beforehand, I think we need to distinguish between essential (I mean life-saving) surgery and elective surgery. When I needed surgery for breast cancer, my consultant did not tell me that it is sometimes necessary to sever the second thoracic nerve, and what the effects are of doing so. In the event he did cut the nerve, because it was in the way of the lymph nodes that had to be removed. Eight years later I am still numb, and always will be, in all the areas supplied by that nerve: the underside of my left arm, my armpit, and the left side of my chest and ribcage. It's not nice, but I have accommodated to it and can live with it. If I had been warned that this might happen, it would have added further anxiety and distress to an already very stressful time. So - I am glad I was not told.

But, if I were considering an elective procedure, I would want to be told of everything significant that might happen so that I could weigh up the pluses and the minuses for myself and make an informed decision.

Re: To Dr. Davis Help --Any advice or suggestions--Lateral column syndrome

Pauline on 8/22/01 at 08:23 (057523)

I was just wondering, because as you said I did have the $%&N scared out of me because every little thing was vividly described. Things like hemorrhage to death, etc. Of course we are talking apples and oranges here because abdominal surgery certainly isn't Plantar surgery, but still in inexperienced hands lots can go wrong.

When I had emergency surgery performed, I signed nothing, my husband did and you know it didn't seem to matter as much because I was already hemorrhaging to death. They just wanted to get in and shut it down which thank God they did.

Re: To Dr. Davis Help --Any advice or suggestions--Lateral column syndrome

Ed Davis, DPM on 8/22/01 at 16:25 (057590)

I agree with Dr. Z concerning standard for listing potential surgical complications. Take a look at any drug description in the PDR (Physician Desk Reference) and you will never take that drug.

There has to be a reasonable listing of possible complications, outcomes and alternatives presented to patients before surgery. I once knew a surgeon who was sued because he gave the patient too much info., they got scared off and did not do the surgery, got worse and sued the doc for doing so.

Lawyers and doctors have argued this point for decades--there is no easy answer. Patients are very different and require different amounts of information before proceeding. A hard thing for doctors to read sometimes.
Some patients simply say, 'Doc, I have full confidence in you--just do what you think is right and don't burden me with the details.' Others want extremely detailed information. The best thing I can emphasize is a good repoire/communication between doctor and patients so that misunderstandings are minimized.
Ed

Re: To Dr. Davis Help --Any advice or suggestions--Lateral column syndrome

Ed Davis, DPM on 8/22/01 at 16:29 (057591)

Pauline:

I had a skin cyst removed from my back at a local surgeons office a few years ago. I signed a consent form which listed complications such as death, hemmorrhage, etc.

I try to write my consent forms in a manner which places things in a reasonable perspective. Most hospitals and many docs use pre-printed forms which may have been written by attorneys.
Ed

Re: Help --Any advice or suggestions

Mike M on 8/27/01 at 17:11 (058138)

Crystal

Just wondering what you found out.
Let us know, your condition sounds sooooooooooooo familiar.
Hope though all went well.

Mike M