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plantar fasciotomy post op pain - question for doc and other fasciotomy patients

Posted by judyml on 8/20/01 at 17:18 (057319)

hello
i have posted many messages regarding my post op pain and numbness (i am almost 3 weeks post op.) I find it very odd that my pain is no where near the incision site. I have a numb little toe, EXTREMELY tender (sensitive) skin running down the outer edge of my foot and a big numb spot about mid way down the outer edge going about 1 1/2' towards the center of my foot. I also have a very tender spot (painful) in the center of my foot. I was wondering what the possibility was that i was injured when the anesthesiologist gave me the block in my foot. I noticed a tiny little needle puncture wound in one of my toes and even the top portion of my foot is very tender. Is it possible that i have some type of nerve injury caused by the anesthesiologist needle? I was under IV sedation so i never heard any talk by the doctors while the procedure was in progress (like oh, oh, we should not have injected that.) Has anyone else who had the fasciotomy experienced numbing for so long (my fasciotomy was not done my endoscopy). Thank you all for your support in my previous posts.
Judy

Re: plantar fasciotomy post op pain - question for doc and other fasciotomy patients

Ed Davis, DPM on 8/20/01 at 19:50 (057342)

I am not sure why you would have a needle mark in one of your toes if the surgery you had was a plantar fascial release.

The anesthesiologist generally will start the IV in your arm and provide you with sedation while the surgeon numbs your foot (usually but not always). It is unlikely but not impossible that the numbing of your foot caused the problem.

A more likely scenario is that the lateral plantar nerve was injured during the surgery. If it was just bruised, it will recover. If nicked or cut, recovery is less likely. Is the toe next to the little toe numb, particularly on the side facing the little toe? Is the numb spot just on the outer edge of your foot or on the outer portion of the sole (bottom) of your foot. If just the outer edge, not the sole, is numb and just the outer portion of the little toe is numb, then the sural nerve as opposed to the lateral plantar nerve would be involved. The sural nerve would be somewhat more likely to be injured by local anesthesia or even by an ankle tourniquet (use to stop bleeding) in surgery.
Ed

Re: plantar fasciotomy post op pain - question for doc and other fasciotomy patients

Dr. Zuckerman on 8/20/01 at 19:56 (057343)

Could be the lateral plantar nerve is either bruised or cut. If cut will have some pain or numbness forever. No way to determine this but to let time help you or tell you.

Re: plantar fasciotomy post op pain - question for doc and other fasciotomy patients

judyml on 8/20/01 at 21:19 (057360)

I feel numbness of my little toe in the fleshy part (the part that would hit the floor when you walk)on the sides of the toe it really is not numb. On the toe next to the little toe, there is a slight numbness on the side facing the little toe but not numb on the fleshy part or the other side. As far as the numbness of my foot, it becomes numb going from the little toe, down the outer side of my foot (sole). The outer edge of my foot is slightly numb. Once I reach my heel I have feeling once again. If I take my fingernail and begin to scratch a path on the top of my foot going towards the little toe, around the edge of my foot and onto the sole, the feeling stops until i get mid-sole area. Lately when I walk I get this sort of 'calloused' line going down the outer edge of my foot (no idea what that is from). I just got off antibiotics (Levaquin) for an infection or abscess under the suture line. When I press near the incision site, it feels as if I get little jolts of electricity which i feel up at the little toe. Every so often I am still getting sharp spasms in the center of my foot. If the plantar nerve was bruised (i dont even want to THINK that the nerve was nicked or cut) how long can i expect to feel this way? Are there tests to determine, if in fact, the plantar nerve was cut? I hope i did not make a big mistake having this surgery.
Looking forward to your reply. Thanks
Judy

Re: plantar fasciotomy post op pain - question for doc and other fasciotomy patients

Ed Davis, DPM on 8/20/01 at 21:40 (057365)

Nerve tissue is the slowest healing tissue in the body so it is hard to make time predictions-- a bruised nerve can heal from a minimum of 2 to a maximum of 7 months. If sensation is not back or at least greatly improved in 7 months then I would suspect more than a bruise to the nerve.
Ed

Re: plantar fasciotomy post op pain - question for doc and other fasciotomy patients

judyml on 8/20/01 at 21:48 (057366)

doctor ed,
thank you again for your reply. i know the doctor told me he nicked a vein during the procedure which he tied off; would he be aware if he accidentally cut or nicked a nerve (and would he admit it?)
judy

Re: Go for your records

BrianG on 8/21/01 at 11:20 (057425)

Hi Judy,

I would write, or call, the hospital and order a complete set of your records. Mine cost me $30. I feel it was money well spent. At least you'll know what the 'official' results were. Mine has an account of everything the Pod did, from start to finish. There is also an anestheology report. Good luck.

BCG

Re: plantar fasciotomy post op pain - question for doc and other fasciotomy patients

Ed Davis, DPM on 8/20/01 at 19:50 (057342)

I am not sure why you would have a needle mark in one of your toes if the surgery you had was a plantar fascial release.

The anesthesiologist generally will start the IV in your arm and provide you with sedation while the surgeon numbs your foot (usually but not always). It is unlikely but not impossible that the numbing of your foot caused the problem.

A more likely scenario is that the lateral plantar nerve was injured during the surgery. If it was just bruised, it will recover. If nicked or cut, recovery is less likely. Is the toe next to the little toe numb, particularly on the side facing the little toe? Is the numb spot just on the outer edge of your foot or on the outer portion of the sole (bottom) of your foot. If just the outer edge, not the sole, is numb and just the outer portion of the little toe is numb, then the sural nerve as opposed to the lateral plantar nerve would be involved. The sural nerve would be somewhat more likely to be injured by local anesthesia or even by an ankle tourniquet (use to stop bleeding) in surgery.
Ed

Re: plantar fasciotomy post op pain - question for doc and other fasciotomy patients

Dr. Zuckerman on 8/20/01 at 19:56 (057343)

Could be the lateral plantar nerve is either bruised or cut. If cut will have some pain or numbness forever. No way to determine this but to let time help you or tell you.

Re: plantar fasciotomy post op pain - question for doc and other fasciotomy patients

judyml on 8/20/01 at 21:19 (057360)

I feel numbness of my little toe in the fleshy part (the part that would hit the floor when you walk)on the sides of the toe it really is not numb. On the toe next to the little toe, there is a slight numbness on the side facing the little toe but not numb on the fleshy part or the other side. As far as the numbness of my foot, it becomes numb going from the little toe, down the outer side of my foot (sole). The outer edge of my foot is slightly numb. Once I reach my heel I have feeling once again. If I take my fingernail and begin to scratch a path on the top of my foot going towards the little toe, around the edge of my foot and onto the sole, the feeling stops until i get mid-sole area. Lately when I walk I get this sort of 'calloused' line going down the outer edge of my foot (no idea what that is from). I just got off antibiotics (Levaquin) for an infection or abscess under the suture line. When I press near the incision site, it feels as if I get little jolts of electricity which i feel up at the little toe. Every so often I am still getting sharp spasms in the center of my foot. If the plantar nerve was bruised (i dont even want to THINK that the nerve was nicked or cut) how long can i expect to feel this way? Are there tests to determine, if in fact, the plantar nerve was cut? I hope i did not make a big mistake having this surgery.
Looking forward to your reply. Thanks
Judy

Re: plantar fasciotomy post op pain - question for doc and other fasciotomy patients

Ed Davis, DPM on 8/20/01 at 21:40 (057365)

Nerve tissue is the slowest healing tissue in the body so it is hard to make time predictions-- a bruised nerve can heal from a minimum of 2 to a maximum of 7 months. If sensation is not back or at least greatly improved in 7 months then I would suspect more than a bruise to the nerve.
Ed

Re: plantar fasciotomy post op pain - question for doc and other fasciotomy patients

judyml on 8/20/01 at 21:48 (057366)

doctor ed,
thank you again for your reply. i know the doctor told me he nicked a vein during the procedure which he tied off; would he be aware if he accidentally cut or nicked a nerve (and would he admit it?)
judy

Re: Go for your records

BrianG on 8/21/01 at 11:20 (057425)

Hi Judy,

I would write, or call, the hospital and order a complete set of your records. Mine cost me $30. I feel it was money well spent. At least you'll know what the 'official' results were. Mine has an account of everything the Pod did, from start to finish. There is also an anestheology report. Good luck.

BCG