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Question for Dr's or anybody?

Posted by Regina Brown on 9/05/01 at 16:53 (059132)

Hello,
I don't post on here all that often but I do read every one's post and find every thing about our feet and the pain we are all having real informative about the different ways to care for them medically.The question I have for Dr. or anyone is: I have been going to physical therapy for a period of about 6 wks.now all together at 3 times a week and am still experiencing some pain and the therapy has been because I have had EPF surgery.Well,it appears that the two therapists that have been doing massage,etc.on my surgery foot has felt the spur in my heel still and they think this is still problem.Should I continue with the therapy and what can one do for their spur?My dr. didn't offer to remove it,he just did the release surgery and never commented anything to me about the spur in any way.
Thanks very much for any advice on this.Regina

Re: CALL the doctor

Carmen H on 9/05/01 at 16:58 (059134)

My suggestion would be to call the dr. who performed the surgery and tell him where you are with this. Was the spur there BEFORE he performed the surgery?

Re: CALL the doctor

Regina Brown on 9/05/01 at 18:04 (059143)

Hi Carmen,
Thanks for your suggestion! Yes,the spur was there before the EPF sugery was done and I had the surgery done on May 3 of this year.I had several x-rays performed before then tho to take to show to dr. and he noticed the spur,etc.but seemed to think that my pain was because I had PF.I had a PT session today as a matter of fact and I asked the therapist if she could feel a spur in my heel as she was doing the massage and she pressed down onto my heel and when she did I sort of yelled and almost came off the table.Another therapist came by to speak with me also and commented that she had felt the spur as she was doing my massage too.So,I am sort of confused now as to what to do next concerning this other THAN to call the dr.The therapist said that the spur was kind of imbedded deep into my heel but she did find it.She also commented that most dr's wouldn't remove the spurs,etc.Do you know if they do?Thanks again,Regina

Re: ouch

Carmen H on 9/05/01 at 18:18 (059145)

Your description sounds painful. Have you researched this site in depth? If you read the PF Book it will give you sooo much information that will help you in regards to the heelspur. I highly recommend reading it and then deciding what your next course of action will be. BUT DO call the doc ASAP. Do you trust your POD? Is he good? Any type of surgery is a serious thing and should not be gone into lightly. What type of treatment did you have on your PF before you had the PF release? Did you take the 'Steps' of conservative treatment before you went into the surgery? Ice, Rest, Tape, Shots, stretching etc?
I don't have the spurs (luckily) but there are lots of people on here that do and will offer you their advice. Take heed to what you read...there are some very smart people on this board that could really help.
But read the book and maybe put 'heelspur' in under the search category and see what types of information you can get from there. I would get thsoe PT to stay awayfrom taht spur too until you know what you are up against.
NO barefeet is VERY important....

Re: Question for Dr's or anybody?

Julie on 9/05/01 at 18:23 (059148)

Regina, I'm not a doctor, but I've read enough here to know that the spur is almost never the the cause of the pain of plantar fasciitis. There are different theories about why spurs are formed: one, as Dr Z has explained, is that they are bone deposits laid down by the body in an attempt to heal the injury to the fascia. In any case, they are almost never removed during release surgery.

If you are concerned, though, you should speak to the doctor who did your surgery.

Re: Question for Dr's or anybody?

Ed Davis, DPM on 9/05/01 at 18:30 (059150)

It is really almost impossible to 'feel' a heel spur externally. Your therapist is probably feeling scar tissue, not the spur. The so-called 'heel spur' is, in reality, a radiographic manifestation. Radiographs are two dimensional representations of three dimensional entities. What may be there is a 'shelf' of bone that forms from chronic excess tension on the fascia. A 'side' view of the shelf appears as a 'spur.' Release the tension on the fascia via EPF or otherwise and the source of pain is relieved.
Ed

Re: Question for Dr's or anybody?

Ed Davis, DPM on 9/05/01 at 19:15 (059156)

I have posted a response but it is not showing up here - unsure why but am posting this to message to see if it appears.
Ed

Re: Question for Dr's or anybody? Trying again.

Ed Davis, DPM on 9/05/01 at 19:21 (059158)

It is really almost impossible to 'feel' a spur externally. Your therapist is probably feeling scar tissue, not the spur. The so called 'heel spur' is, in reality a radiographic manifestation. Radiographs are two dimensional representations of three dimensional entities. What may be there is a shelf of bone that forms from chronic excess tension on the plantar fascia. A side view of the shelf appears as a 'spur.' Release the tension on the fascia via EPF or otherwise and the source of pain is removed.
Ed

Re: Question for Dr's or anybody? Trying again.

Regina Brown on 9/05/01 at 19:50 (059166)

Dr.Davis,
Thanks for your reply.I have just now viewed the heel pain book and from what I can determine myself by all the questions and from the way I can understand what it says it kind of appears that I may be suffering from a stress fracture as it seems that when I have some heel cushioning or padding it seems to relieve the pain--just a little tho. If this may for sure be my problem what is it that I should do now since I have had this EPF surgery already and should I perhaps still call my dr. and discuss this with him further or just continue on with the PT? Am really confused!!!Thanks again everyone. Regina

Re: Question for Dr's or anybody? Trying again.

john h on 9/06/01 at 09:23 (059213)

Dr. Davis: is not the name 'spur' almost a misnomer? It seems when Barb had her spur removed it was almost soft tissue. When people hear the word spur, visions of bony growths protruding into their skin and heal appear in their mind. Spurs, as i understand them run longitudial, and are not of the bone variety as you might find in a joint. Correct me if i have made the wrong assumptions.

Re: Question for Dr's or anybody? Trying again.

Ed Davis, DPM on 9/06/01 at 15:23 (059255)

The term 'spur' is, for the most part, a lay term. It is generally used to describe calcification or ossification (bone formation) of ligaments or tendons, usually at the area which tendons or ligaments attach to bone. The scenario of a sharp spur of bone protruding and causing pain is generally a misconception.
Ed

Re: Re:What is the cause my opinion

Dr. Zuckerman on 9/06/01 at 23:17 (059327)

Hi,

I would like to give my opinion about the 'spur' and why EPF works and why
I will do the surgery right at the insertion where the calification is

I feel that EPF works because if stops the pulling where the tear is and or
non-healing injury of the plantar fascia . This then allow for the areas to heal due to no pulling from the pf because if had been cut.

So in the miminial incision surgery that I do you are releasing some of the pf fibers
and removing the 'spur'. This is the area where there are no major nerves
and or arteries.

At one time I cut only the pf still at the insertion. There were some failures that went on to being cures only after I went back and removed the calification. I have concluded that it is best to cut the pf at the area where it attaches to the heel bone and to remove some if not all of the boney 'spur ' area.

I feel that this is a very logical approach and has worked very well in my hands when used. I do ESWT now because you don't cut any of the plantar fasia.

Any time that you do cut the plantar fascia you risk the chance of a tranfer of pain to the lateral aspect of the foot and or the arch of the foot. This can be for many months and in very very rare cases for ever.

I have sent many of the 'spurs that I have removed and the lab findings are consistent with imcomplete bone healing.

In conclusion I feel that the area at the inserion of the pf is a type of non healing injury similiar to a non union and that the trauma to the area either by MIS surgery or ESWT gives the area a second chance at healing

I hope that this information is helpful and gives patients a better understand of what either ESWT or mis is doing when used.

Re: CALL the doctor

Carmen H on 9/05/01 at 16:58 (059134)

My suggestion would be to call the dr. who performed the surgery and tell him where you are with this. Was the spur there BEFORE he performed the surgery?

Re: CALL the doctor

Regina Brown on 9/05/01 at 18:04 (059143)

Hi Carmen,
Thanks for your suggestion! Yes,the spur was there before the EPF sugery was done and I had the surgery done on May 3 of this year.I had several x-rays performed before then tho to take to show to dr. and he noticed the spur,etc.but seemed to think that my pain was because I had PF.I had a PT session today as a matter of fact and I asked the therapist if she could feel a spur in my heel as she was doing the massage and she pressed down onto my heel and when she did I sort of yelled and almost came off the table.Another therapist came by to speak with me also and commented that she had felt the spur as she was doing my massage too.So,I am sort of confused now as to what to do next concerning this other THAN to call the dr.The therapist said that the spur was kind of imbedded deep into my heel but she did find it.She also commented that most dr's wouldn't remove the spurs,etc.Do you know if they do?Thanks again,Regina

Re: ouch

Carmen H on 9/05/01 at 18:18 (059145)

Your description sounds painful. Have you researched this site in depth? If you read the PF Book it will give you sooo much information that will help you in regards to the heelspur. I highly recommend reading it and then deciding what your next course of action will be. BUT DO call the doc ASAP. Do you trust your POD? Is he good? Any type of surgery is a serious thing and should not be gone into lightly. What type of treatment did you have on your PF before you had the PF release? Did you take the 'Steps' of conservative treatment before you went into the surgery? Ice, Rest, Tape, Shots, stretching etc?
I don't have the spurs (luckily) but there are lots of people on here that do and will offer you their advice. Take heed to what you read...there are some very smart people on this board that could really help.
But read the book and maybe put 'heelspur' in under the search category and see what types of information you can get from there. I would get thsoe PT to stay awayfrom taht spur too until you know what you are up against.
NO barefeet is VERY important....

Re: Question for Dr's or anybody?

Julie on 9/05/01 at 18:23 (059148)

Regina, I'm not a doctor, but I've read enough here to know that the spur is almost never the the cause of the pain of plantar fasciitis. There are different theories about why spurs are formed: one, as Dr Z has explained, is that they are bone deposits laid down by the body in an attempt to heal the injury to the fascia. In any case, they are almost never removed during release surgery.

If you are concerned, though, you should speak to the doctor who did your surgery.

Re: Question for Dr's or anybody?

Ed Davis, DPM on 9/05/01 at 18:30 (059150)

It is really almost impossible to 'feel' a heel spur externally. Your therapist is probably feeling scar tissue, not the spur. The so-called 'heel spur' is, in reality, a radiographic manifestation. Radiographs are two dimensional representations of three dimensional entities. What may be there is a 'shelf' of bone that forms from chronic excess tension on the fascia. A 'side' view of the shelf appears as a 'spur.' Release the tension on the fascia via EPF or otherwise and the source of pain is relieved.
Ed

Re: Question for Dr's or anybody?

Ed Davis, DPM on 9/05/01 at 19:15 (059156)

I have posted a response but it is not showing up here - unsure why but am posting this to message to see if it appears.
Ed

Re: Question for Dr's or anybody? Trying again.

Ed Davis, DPM on 9/05/01 at 19:21 (059158)

It is really almost impossible to 'feel' a spur externally. Your therapist is probably feeling scar tissue, not the spur. The so called 'heel spur' is, in reality a radiographic manifestation. Radiographs are two dimensional representations of three dimensional entities. What may be there is a shelf of bone that forms from chronic excess tension on the plantar fascia. A side view of the shelf appears as a 'spur.' Release the tension on the fascia via EPF or otherwise and the source of pain is removed.
Ed

Re: Question for Dr's or anybody? Trying again.

Regina Brown on 9/05/01 at 19:50 (059166)

Dr.Davis,
Thanks for your reply.I have just now viewed the heel pain book and from what I can determine myself by all the questions and from the way I can understand what it says it kind of appears that I may be suffering from a stress fracture as it seems that when I have some heel cushioning or padding it seems to relieve the pain--just a little tho. If this may for sure be my problem what is it that I should do now since I have had this EPF surgery already and should I perhaps still call my dr. and discuss this with him further or just continue on with the PT? Am really confused!!!Thanks again everyone. Regina

Re: Question for Dr's or anybody? Trying again.

john h on 9/06/01 at 09:23 (059213)

Dr. Davis: is not the name 'spur' almost a misnomer? It seems when Barb had her spur removed it was almost soft tissue. When people hear the word spur, visions of bony growths protruding into their skin and heal appear in their mind. Spurs, as i understand them run longitudial, and are not of the bone variety as you might find in a joint. Correct me if i have made the wrong assumptions.

Re: Question for Dr's or anybody? Trying again.

Ed Davis, DPM on 9/06/01 at 15:23 (059255)

The term 'spur' is, for the most part, a lay term. It is generally used to describe calcification or ossification (bone formation) of ligaments or tendons, usually at the area which tendons or ligaments attach to bone. The scenario of a sharp spur of bone protruding and causing pain is generally a misconception.
Ed

Re: Re:What is the cause my opinion

Dr. Zuckerman on 9/06/01 at 23:17 (059327)

Hi,

I would like to give my opinion about the 'spur' and why EPF works and why
I will do the surgery right at the insertion where the calification is

I feel that EPF works because if stops the pulling where the tear is and or
non-healing injury of the plantar fascia . This then allow for the areas to heal due to no pulling from the pf because if had been cut.

So in the miminial incision surgery that I do you are releasing some of the pf fibers
and removing the 'spur'. This is the area where there are no major nerves
and or arteries.

At one time I cut only the pf still at the insertion. There were some failures that went on to being cures only after I went back and removed the calification. I have concluded that it is best to cut the pf at the area where it attaches to the heel bone and to remove some if not all of the boney 'spur ' area.

I feel that this is a very logical approach and has worked very well in my hands when used. I do ESWT now because you don't cut any of the plantar fasia.

Any time that you do cut the plantar fascia you risk the chance of a tranfer of pain to the lateral aspect of the foot and or the arch of the foot. This can be for many months and in very very rare cases for ever.

I have sent many of the 'spurs that I have removed and the lab findings are consistent with imcomplete bone healing.

In conclusion I feel that the area at the inserion of the pf is a type of non healing injury similiar to a non union and that the trauma to the area either by MIS surgery or ESWT gives the area a second chance at healing

I hope that this information is helpful and gives patients a better understand of what either ESWT or mis is doing when used.