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Surgery count-down

Posted by Sara E. on 9/26/01 at 13:07 (061632)

I had unsuccessful PF release approximately 1 year ago. Now have severe nerve compression and TTS surgery is scheduled for the 23rd of October. I'm wanting some realistic expectations post-surgery. I.E. recovery time, how long will I need crutches (Dr says most walk normally after a few days, his nurse says a few weeks), swelling and pain control. Any advice would greatly be appreciated.

Re: Surgery count-down

Pauline on 9/26/01 at 17:01 (061655)

Sara,
I think the people posting here will probably agree more with your doctor's nurse and that makes me nervous for you because I don't think your doctor is being completely honest with you. This really upsets me because how can you have faith and trust in a doctor who right from the start doesn't tell you the truth. What happens if you have a complication?
How will he treat you then. Sorry to point this out, but before you hand over your feet, I suggest another visit and put the questions to him again and this time tell him you want the truth. Maybe even ask to speak to other patients. These snip, snip you walk out the door stories need to stop. Patients suffer from them.

I've watch this board for almost 2 years, and the more P.F. surgery I read about, the more TTS surgery appears as a direct result of the person having had the P.F. surgery in the first place. All these people can't be wrong. I'm beginning to think that having P.F. surgery will almost guarantee TTS surgery will follow within the next few months.
Something is wrong with the technique or the surgery itself or this pattern wouldn't keep repeating itself over and over again.

I think you deserve straight, honest answers before the cutting begins because afterward it's too late. My suggestion to you is make another appointment and get your answers written by the doctor in black and white.
I bet his story will be different if he has to sign it. Good Luck

Re: Surgery count-down

cindyp on 9/26/01 at 18:00 (061668)

My advice is this. If this dr is not a good foot and ankle reconstructive surgeon then tell him no thanks. Most tts surgeries if performed by competent dr.s will come out okay. Your time off your feet with stitches is at the very least two weeks. For about a month after that if not a months and a half i had problems with swelling and couldn't put a shoe on. I am 90 days + out and am still occasionally sore. If this guy is telling you this I myself would look elsewhere for a better more competent dr. At the very least ask him how many of these surgeries he has done.

Re: To Cindy Surgery count-down

Pauline on 9/26/01 at 18:59 (061670)

Cindy,
I know you have been through a lot and have seen your share of physicians. Do you have any idea why nerve entrapments such as TTS are not referred to neurosurgeons for surgery? It appears to me that maybe this speciality should be doing TTS and other entrapment surgeries.

I think there are far too many failures and injuries in the P.F. and TTS surgeries and it past due to investigate what is happening. Too many people are getting hurt and no documentation is taking place. We see it being pushed under the carpet or simple written off. Personally I'm tired of seeing it happen. I think if the numbers were known we'd be shocked.

Re: kinds of docs, good or bad? can find in all types both

tammie on 9/26/01 at 19:31 (061672)

Are you saying a pod dr. cannot do this type of surgery as effectivly as a foot and ankle resconstructive surgeon? Are they two different kinds of dr.s? Just wondering as I still can see I have lots to learn, but I had a pod do mine and I felt as comfortable with him doing surgery as a ortho,as
the ortho didnt even want to try conservitive at all.I personally believe good drs come in all areas, and what you percieve is a good dr. to u may not
be the same for me or someone else.

I do believe there expierance and knowledge is important. I felt and again it is my opioion, that a pod gave me a much better exam then the foot ankle ortho, they even were better equiped with xray, providing a rail to hold on to,among other things that made comfort when a hurt foot was involved. I will say I had long waits, office was packed, and heard only good about them in waiting room. Except long waits. Ortho was more impatient looking for something to do a surgery on, in fact at first he did not see spurs and said to bad could have cut them out and problem solved.
He also sent me home with celebrex a dx of pf and said it will go away sometime u will wake up and gone. No follow up needed. I must add that he was highly recomended.

Now again this was only one expierance, and several could share good ones with others as well as bad with pods, I strongly think that
there are many types of dr.s along with people and we all have special needs, or things besides knowledge and expierance we look for,I myself
could list things I did not like about my pod, but I did like most of what he is about. And we are going to find good and bad, never perfect,
as what is perfect for one may not be for another. And today may be perfect and tomorrow may not be.

Also I must say this we tend to grade our dr. by what he has done for us, if he has suceeded as we like he is great and wonderful and a idol.
If the treatments or surgery had complications or poor results then he is awful or a bad dr. I think it is sad, as he is not God, just tries to do what
he knows and sometimes he has patients who do what they are told or do it as it suits them ( I would be a good example) therefore more troubles
or longer healing.

My pod is a optimistic person also saying less then what the nurse told me, they do not say yes definetly 2 weeks usually he says oh about 2 wks,
depending on how you heal . The nurse usually says take that and add a few days or so either way . I believe they have estimate they go by now how
exact can they be? Everyone is quite unique and heal at there own rates and may do fine and be ahead and others may be slower, and still others
may have complications. That is medicine and healing . I guess this bothers me as I was extreamy hard on my dr. I did not like him I felt he did not
talk to me, looking back and listening to my hubby talk he did try, I wasnt hearing him, not because he wasnt talking to me, but I did not want to hear what he was saying,it was not to MY liking so I closed him out.

I found out tho that he cared and went beyond his duty as a dr. and no he could make me no promises but he was with me all the way.
He had enough to tell me and urge me to see other dr.s if I was uncomfortable with his suggestions, also told me whatever I needed from him
he would be there still, and had sense enough to tell my hubby that it was my decision not his and he wanted me to take the time I needed.
I think I judged him harshly and gave him a bad rap, and because of this , I guess I am trying to be more intune to this problem. How would we feel if a dr. interviewed us to see if he wanted to be our dr. lol can u imagine, it could be quite comical. I hear allot of dr. bashing and it concerns me as so he said a difference then the nurse in healing time, if this is important then yes you should talk with him by all means. I am sure that could be a person to person thing, I see many dr.s have different ways. What ever works for u as a individual is what i think is better.My dr. had his faults as well as I did
and I do not know what will be the results of surgery at this point , but whatever i took my chances, as I would have if it was my gall bladder, female surgery or any other type. Surgery is a risk , any kind even the simplest still has risks, even done by the king of kings in surgery.And
complications occur on good and bad surgeries. So I feel it is up to the indivdual to do there homework and decide what is best for them,
and decide if they are willing to accept the risk .

Again this is just something I am reading also more and more and seems to me that we are quick judges sometimes,can run to 10 dr.s and most likely
will get lots of differences in treatments , personalities,office policies,nurses, and most things, it must be up to you what you feel comfortable with. i hope not to anger anyone , this is just a thought from me .

Re: wonder

Tammie on 9/26/01 at 19:51 (061674)

I tend to wonder if it has something to do with the lenghth of time we suffer with pf before treatment , or before we do something to stop the changes
effecting or gait or foot, the way we walk for months and months sometimes years? Then we go and decide to try surgery and discover allot of damage has been done? Just a thought! And another thought scar tissue developed? And is this true as I have heard it , That pf and tts has very similar symptoms often mimicking each other ???? And dx is very difficult sometimes even with all tests, which can either be positive or negitive.
With conflicting results. Just some thoughts.

I also think there are so very many with good results, that are not told about as who looks here if they are fine and out and about living
life with no pain or even less. Also I believe this occurs in most surgeries, feet , abdominal, cardi, ears nose throat etc, there will always be good
results and there always will be poor or unsatisfactory results. Surgery is a risk period any kind. On the other hand we could count the failed pf treatments to look at all the conservitive treatments and the faliures there to, people living withthis for 7, 10 , more years, what is it why is the feet so very hard to keep healed, why dont we look at this, now we have this ESWT, I imagine inyears to come something new will come in and
people will say whyyyyyyyyyy the faliures. As has it been around long enough to know what 20 years or 50 yrs will bring as results? Now I am not against it Please hear me I am totaly for anything that may help and it does not cut u , so yes good to start with, I am just trying to compare down the line years from now when the next new cure comes we are always going to think why the faliures, that brings about new knowledge and new cure tactics. It used to be hmmm what herbs to cure things or what ever , then maybe surgeries, now ESWT , years from now maybe something new and better, but always the questions. Just more thoughts.

Re: To Tammie wonder

Pauline on 9/26/01 at 21:06 (061679)

Tammie,
I think you make some very good points and present a very informative argument but my gut tells me a neurosurgeon may be best suited for nerve entrapment and other neurosurgeries just as an Endodontist is best suited to handle root canals. It's knowing what to do when the going gets rough and having the training and skill to prevent complications. Quite honestly, I haven't seen enough of it. You questioned if there was a difference between Pods and Orthos and the answer is yes. Compare for
yourself Harvard Medical School and The Ohio College of Podiatry course by course. I remember one posting putting into question the quality of training at the Mayo Clinic. I had to laugh, because Mayo reputation says it all. The argument between who is better Pods or Orthos will go on forever. The bottom line is, as you say finding a doctor you feel comfortable with and have confidence in to handle your case. If you have a good outcome, you'll be praising his name, if not you suffer the consequences. It's the second one you worry about.

Re: To Cindy Surgery count-down

cindyp on 9/26/01 at 22:13 (061686)

As for the neurologists doing this more I don't know. They say podiatrists are foot specialists and everyone of those I saw ran like bleep. A few orthopedists I saw also said go away. So I don't know. Maybe if they worked together? I agree if we knew the numnbers of failures we would be astonished. All I know is the dr. I saw was an orthopedist and did his fellowship? in foot and ankle reconstruction. I know that some feel podiatrists are better. None that I saw was qualified to do this surgery that I needed. So I don't know what to say other than find the most qualified dr. you can afford and get kinda pushy. If they are not listening let them know that you are paying their fee and you want answers. and by all means RESEARCH. that is a key.

Re: kinds of docs, good or bad? can find in all types both

cindyp on 9/26/01 at 22:18 (061689)

No not at all. I just think you need to research and do more research and if the dr. that you are seeing isn't telling you the right thing then run in the opposite direction. I saw 9 dr. before I found someone to help me. The idiots at the v.a.( i am venting sorry) told me to see a psychiatrist. So find the best dr. you can afford or by insurance and ask him all the quesitons you have. if he doesn't want to answer or is answering you know to be incorrect go elsewhere. your feet are tooo important. the dr. that finally helped me was an ortho who did his fellowship in foot and ankle and played me straight answered all my questions and told me that it may not work and i probably won't be 100 percent ever. I have had the problem for about 15 years but didn't know that is what it was. I am now 85 percent most days and that's good enough. I am profoundly lucky and grateful. I am a success story.

Re: To Cindy Surgery count-down

Ed Davis, DPM on 9/26/01 at 22:24 (061691)

Pauline:

A. Lee Dellon M.D. of Baltimore is a neurosurgeon who has one of the best techniques for tarsal tunnel surgery I have seen. His procedure is published on CD ROM and I use his CD to teach my podiatric surgical residents. He is one of the few neurosurgeons interested in the area though. I offered to show the CD presentation to several local neurosurgeons but they had no interest. It just is not an area of interest nor involvement of most neurosurgeons. I really think that potentially their skills and training would make them the ideal surgeons to treat this.
Ed

Re: kinds of docs, good or bad? can find in all types both

Ed Davis, DPM on 9/26/01 at 22:33 (061695)

Tammie:

A large number of podiatrists would be classified as 'foot and ankle reconstructive surgeons' since that is their primary training and what they spend most of their time doing. Podiatrists do the majority of foot surgeries in the US today. The subspecialty of 'foot and ankle orthopedics' is a fairly new one. Most of the orthopedic surgeons who committed a large part or all of their practice to foot surgery did so out of interest in the area as opposed to subspecialty training. Most subspecialty training in the area involved 'fellowships' in which an interested individual acted as an apprentice to one of the orthopods interested in foot surgery. Those individuals eventually formed the residency programs, mainly in the last decade, that graduated practitioners who are specifically trained in the area.
Ed

Re: Surgery count-down

Ed Davis, DPM on 9/26/01 at 22:42 (061697)

Pauline:

Keep in mind that the sampling of cases includes a preponderance of failed cases. There is really no anatomic or physiologic explanation for plantar fascial releases causing TTS or the need for TTS surgery. A couple possibilities: heel pain caused by TTS but misdiagnosed as plantar fasciitis--these individuals do not respond to typical treatments for PF. Conservative treatments usually work for plantar fasciitis. If conservative treatments for plantar fasciitis are effectively provided but fail, the first question should be...'Is this something other than plantar fasciitis?' That question needs to be dealt with before going to PF surgery. A 'large' incision for plantar fasciitis that leads to nerve entrapment could cause TTS but such surgical approaches (I would hope) are rare.
Ed

Re: To Tammie wonder

wendyn on 9/26/01 at 22:52 (061701)

I asked if a neurosurgeon or neurologist would treat TTS - I was told by my doctors that they do not.

Re: Surgery count-down

Pauline on 9/27/01 at 07:32 (061710)

Dr. Davis,
How do you feel about some centralized record keeping? Scott pointed out to me a while back that there are approx 15,000 Pods trained to do P.F. and TTS surgeries and I believe 1200 Orthos nation wide with Foot and Ankle specialities and include any other physician doing the same surgery. If they each did only one P.F. or TTS surgery a year and tracked that patient for 6 to 12 months we'd have a pretty good sampling of results. I really would like to see some major tracking done because personally I believe P.F. surgery has become too common place. It's replaced the tonsillectomy surgery of '40ties and '50ties.

I think it's high time for some 'show me' results on P.F. and TTS surgeries.

Re: To Cindy Surgery count-down

To Dr. Davis on 9/27/01 at 15:51 (061750)

Hi Dr. Davis,
I did some research on Dr. Lee Dellon M.D. He has quite the reputation in his field. I think if I had TTS I'd head to see him. He is one more name I'll file in my 'Just in Case' book. It's a good file to keep. Thanks

Re: Surgery count-down

Ed Davis, DPM on 9/27/01 at 21:13 (061762)

Pauline:

There are not many plantar fascial releases being done in my area (Northwest US). I know of very few colleagues who perform plantar fascial releases in appreciable numbers. Your experience must derive from an area where more of such procedures are being performed. There is geographic variability with this procedure and also with others. Some prominent examples are the C-section rates and numbers of hysterectomies performed.

Tracking numbers and results may be a good idea. Would reporting of statistics be voluntary or mandatory? Which agency would have the responsibility to gather the statistics? How would the accuracy of the statistics be verified? How would the results of the statistics be used?Until these questions are answered or agreed upon by the various parties involved, it is unlikely that this will occur.

Interestingly, insurance companies, probably have more data on how many of such procedures are performed, where, when... Also, insurance companies regularly second guess and limit conservative treatment of plantar fascia but never question surgical treatment.
Ed

Re: Surgery count-down

Karma on 9/28/01 at 14:53 (061814)

Iam 9 days post tts pfs and heal spur surgury. My doc told me no walking on my foot for two weeks the and walking boot for two weeks the a surgury shoe for two weeks When they got in there i had more extensive nerve damage than they thought and i had a large heal spur and they clip my tendion so i can streght my foot back out so far the pain is not to bad just getting stir carzy sitting here. I have three inscisons one very large one to samll ones.

Re: Surgery count-down

Jana on 9/30/01 at 18:46 (061933)

Disturbing that they limit conservative treatment but don't question surgery. What a money game. Just out of curiosity, approximately how many of both of these surgeries do you do a year?

Another thing to consider as to why the surgery numbers may very geographically is the lifestyle in different regions. I live in Southern California, someone is jogging on every corner. Pounding their feet on concrete obsessively because this area is all about fitness and physical looks. I went to visit relatives in Missouri and went for a jog, not another runner in town! I'm willing to bet there are fewer cases of tarsal tunnel or plantar fasciitis there.

Dr., why do you think there are not more physicians checking this board? I mentioned it to one of my podiatrists and he had never heard of it. I was surprised! If I do a search on almost any search engine for anything related to heel pain, foot pain, nerve compression, plantar fasciitis etc. I always get a link to this site. It sure would be nice to see more doctors aboard.

Something I also wonder about this site, do you think it is a collection of people with failed surgeries because people with successful surgeries don't have a need to come back to this board? When I look at this site, I am decidedly against surgery because so few are successful and so many seem to cause additional complications. But I wonder if we just aren't hearing from the people who had successful experiences.
When I read this board, almost every surgery fails it seems. Why are doctors still doing the surgery at all?
When you ask doctors (at least in my experience) about the likelihood for success, they give very high numbers. When I last spoke with my Ortho, she said almost 85 percent likelihood for success. I have a positive nerve conduction, which for her confirms the need for the surgery. I know from reading this board I cannot trust that. I repeatedly see comments about nerve conduction studies not being accurate. I repeatedly see people with failed surgeries who believed broken promises who were also told they had a very high percentage likelihood for success. I wonder how many doctors are not being honest with their patients. I wonder how many doctors are doing inaccurate nerve conduction studies.

Do you think that there are that many doctors out there who are really intentionally being dishonest or who are that incompetant? I find that hard to believe. Maybe they are being honest and we just aren't hearing from the people who are recovered. What is your opinion?

Re: To Cindy Surgery count-down

Jana on 9/30/01 at 18:55 (061936)

What is unique about his technique? Can you please provide some more information or tell us how to get this CD? It would be helpful for me to discuss the variety of techniques used with my ortho. I have not yet gotten a doctor to be very specific with me about the procedure (they must think were stupid) and I know there are several. It seems like the patient has to become the expert in order to ensure the most likely for success.

Re: Surgery count-down

Ed Davis, DPM on 10/01/01 at 23:44 (062035)

Jana:

Doctors are bombarded with information overload so they have to do a lot of filtering, occasionally filtering out good stuff. A lot of docs just don't realize this site exists. Others may have read the site but choose not to participate.

Keep in mind that patients who have met with rapid success are not as likely to be on this site as those who have encountered difficulties. I am not a big fan of plantar fascial release surgery. I would estimate that I see about 700 new cases of heel pain per year, the majority or which are caused by plantar fasciitis. I perform about 12 to 15 plantar fascial releases per year-- a surgery rate of about 2 percent. Of that 2% approximately 90% are getting better or cured with surgery. Keep in mind that if I operated on a higher percentage of patients, my surgical success rate would decrease appreciably. Patient selection is a key factor.

Tarsal tunnel syndrome is significantly more rare than plantar fasciitis but the need for surgery is higher. Success statistics are more reliable when there are adequate numbers to look at. My success rate with tarsal tunnel surgery is about 85 t0 90% but that is really not a meaningful statistic because it is not based on large numbers. (Not based on adequate numbers to have statistical significance). I would be a bit suspicious if any individual claims to have large numbers of tarsal tunnel releases on an individual basis, other than a few individuals who have a particular reputation in this area. I would rather look at the overall success rates in this situation which I would place at about 70%.

There are some factors, which I believe, lead to higher success rates in TTS surgery. Those include a positive NCV test. NCV is not perfect but keep in mind that there is a fair percentage of TTS surgery being done on patients who have negative NCV results. Another factor can be the discovery of a structure which is pressing on the nerve---varicosities, growths, cysts, etc. Discovery and removal of such an identifiable structure generally leads to good outcomes.

Ed

Re: Surgery count-down

Jana on 10/02/01 at 19:25 (062106)

What is the difference between a plantar facia release and removing the plantar facia bundle? My surgeon has suggested we remove the bundle and do the TTS release. She said she would not do a plantar facia release because it would guarantee me long-term pain in other areas of my foot.

How do you test in advance for varicosities, growths, cysts? If you are bilateral, isn't it fairly unlikely that there are obstructions in both feet (I am 32 if that is helpful).

I also have bilateral epicondylitis and carpal tunnel/RS I. I have approached my tarsal tunnel diagnosis conservatively because I find it almost impossible to believe that all four quadrants of my body would develop nerve related injuries within the same one year period (CTS followed TTS within a year). I have heard pregnancy can cause carpal tunnel. Just before I developed tarsal tunnel, I was taking Depo for six privera. Do you know if there is any correlation between peripheral nerve related conditions and any of the following: exposure to moldy environments, depo privera, exposure cigarette smoke, alcohol, problems in the spine?

One other thing, the orthopedic who gave me the 85 percent success rate claims she has done many of these surgeries but couldn't give me an exact percentage rate for success (the 85 percent was rough) because most of the people she sees have already had the procedure done three or four times. That's kind of mixed information. If someone has done in the procedure three or four times, why do they continue to do it and what is going so wrong in all of these surgeries that patients are going through them so many times? It's hard to understand in Layman's terms. Do you have any tips as to how to delicately ask her for patient references? She has an excellent surgical reputation but a difficult personality, something I'm willing to tolerate to get the technical expertise.

Re: Surgery count-down

Jana on 10/02/01 at 19:28 (062107)

I forgot to ask you, you mentioned the need for surgery for tarsal tunnel is higher. Why? Because of permanent nerve damage? What if you don't have the physical symptoms? I have only inside ankle pain and a positive nerve conduction study. No burning, no numbness, no tingling.

Re: Surgery count-down

Ed Davis, DPM on 10/02/01 at 20:38 (062112)

Jana:
The need for surgery is higher in TTS than PF because we really do not have as good an armamentarium of conservative modalities which are very effective at treating TTS. PF success rates with conservative treatment are better than 90% but we, probably, can only treat about 30 to 40% of TTS with successful conservative treatment.
Ed

Re: Surgery count-down

Ed Davis, DPM on 10/02/01 at 20:48 (062113)

Patient references are a delicate subject. The reason is that a physician cannot divulge the medical problems of another patient. In other words, if your doctor gave you patient references on others he has treated for TTS, he would be divulging confidential medical information. One possiblity would be for the doctor to have those patients sign a written release allowing him to do so.

MRI, especially if it is of high quality, can often show pathology---varicosities or other growths pressing on the nerve.

There is a good possibility that TTS surgery could help you but, based on what you have stated about the multiple nerve related injuries, it would be a good idea to obtain a consultation with a neurologist before moving forward with surgery. Exposure to mold is an unlikely culprit. How much exposure to cigarrette smoke? If you are a smoker, expect your surgical recovery to take longer and potentially a lower success rate. Problems in the spine can mimick TTS and that is why you should see a neurologist. Alcohol, in excess can lead to alcoholic polyneuropathy-- a peripheral neuropathy that can mimic TTS symptoms. Unsure about Depo-Provera.
Ed

Re: Surgery count-down

Joan S on 10/03/01 at 21:12 (062190)

Sara,

I had TTS surgery on 9/21 and it was complicated by the removal of a fibroma on the inside of my arch. Really had little pain, did not even finish my pain prescription. Kept my foot elevated for the 1st 48 hours and iced it 30 minutes off and 30 minutes on for 48 hours. Do need someone to help with this. Dr. also put me in a cast for the first week to keep me from moving it. After 7 days went to a wrap with a walking shoe. As of today I am no longer walking on my toes and starting to put weight on foot and have gone to using only 1 crutch.. TTS was the easiest, the other incision was a little more tender. I think the ice and elevation really was the key for my foot really never did swell.
I also had a great orthopedic Dr., who only specializes in Ankles and feet.
Good luck and I am glad that I had the procedure. Even now my foot hurts less then before.

Re: To Jana

Pauline on 10/04/01 at 10:19 (062217)

Jana,
I would come right out and ask her for patient references. She wouldn't be giving you their names unlessed she had releases first. Most people feel the fear of asking this question to all surgeons regardless of their field, but sometimes it's the difficult questions that tell you a lot about the physician. To me when it comes to surgery any question you have is a good one to ask. Go for it.

Re: Surgery count-down

Pauline on 9/26/01 at 17:01 (061655)

Sara,
I think the people posting here will probably agree more with your doctor's nurse and that makes me nervous for you because I don't think your doctor is being completely honest with you. This really upsets me because how can you have faith and trust in a doctor who right from the start doesn't tell you the truth. What happens if you have a complication?
How will he treat you then. Sorry to point this out, but before you hand over your feet, I suggest another visit and put the questions to him again and this time tell him you want the truth. Maybe even ask to speak to other patients. These snip, snip you walk out the door stories need to stop. Patients suffer from them.

I've watch this board for almost 2 years, and the more P.F. surgery I read about, the more TTS surgery appears as a direct result of the person having had the P.F. surgery in the first place. All these people can't be wrong. I'm beginning to think that having P.F. surgery will almost guarantee TTS surgery will follow within the next few months.
Something is wrong with the technique or the surgery itself or this pattern wouldn't keep repeating itself over and over again.

I think you deserve straight, honest answers before the cutting begins because afterward it's too late. My suggestion to you is make another appointment and get your answers written by the doctor in black and white.
I bet his story will be different if he has to sign it. Good Luck

Re: Surgery count-down

cindyp on 9/26/01 at 18:00 (061668)

My advice is this. If this dr is not a good foot and ankle reconstructive surgeon then tell him no thanks. Most tts surgeries if performed by competent dr.s will come out okay. Your time off your feet with stitches is at the very least two weeks. For about a month after that if not a months and a half i had problems with swelling and couldn't put a shoe on. I am 90 days + out and am still occasionally sore. If this guy is telling you this I myself would look elsewhere for a better more competent dr. At the very least ask him how many of these surgeries he has done.

Re: To Cindy Surgery count-down

Pauline on 9/26/01 at 18:59 (061670)

Cindy,
I know you have been through a lot and have seen your share of physicians. Do you have any idea why nerve entrapments such as TTS are not referred to neurosurgeons for surgery? It appears to me that maybe this speciality should be doing TTS and other entrapment surgeries.

I think there are far too many failures and injuries in the P.F. and TTS surgeries and it past due to investigate what is happening. Too many people are getting hurt and no documentation is taking place. We see it being pushed under the carpet or simple written off. Personally I'm tired of seeing it happen. I think if the numbers were known we'd be shocked.

Re: kinds of docs, good or bad? can find in all types both

tammie on 9/26/01 at 19:31 (061672)

Are you saying a pod dr. cannot do this type of surgery as effectivly as a foot and ankle resconstructive surgeon? Are they two different kinds of dr.s? Just wondering as I still can see I have lots to learn, but I had a pod do mine and I felt as comfortable with him doing surgery as a ortho,as
the ortho didnt even want to try conservitive at all.I personally believe good drs come in all areas, and what you percieve is a good dr. to u may not
be the same for me or someone else.

I do believe there expierance and knowledge is important. I felt and again it is my opioion, that a pod gave me a much better exam then the foot ankle ortho, they even were better equiped with xray, providing a rail to hold on to,among other things that made comfort when a hurt foot was involved. I will say I had long waits, office was packed, and heard only good about them in waiting room. Except long waits. Ortho was more impatient looking for something to do a surgery on, in fact at first he did not see spurs and said to bad could have cut them out and problem solved.
He also sent me home with celebrex a dx of pf and said it will go away sometime u will wake up and gone. No follow up needed. I must add that he was highly recomended.

Now again this was only one expierance, and several could share good ones with others as well as bad with pods, I strongly think that
there are many types of dr.s along with people and we all have special needs, or things besides knowledge and expierance we look for,I myself
could list things I did not like about my pod, but I did like most of what he is about. And we are going to find good and bad, never perfect,
as what is perfect for one may not be for another. And today may be perfect and tomorrow may not be.

Also I must say this we tend to grade our dr. by what he has done for us, if he has suceeded as we like he is great and wonderful and a idol.
If the treatments or surgery had complications or poor results then he is awful or a bad dr. I think it is sad, as he is not God, just tries to do what
he knows and sometimes he has patients who do what they are told or do it as it suits them ( I would be a good example) therefore more troubles
or longer healing.

My pod is a optimistic person also saying less then what the nurse told me, they do not say yes definetly 2 weeks usually he says oh about 2 wks,
depending on how you heal . The nurse usually says take that and add a few days or so either way . I believe they have estimate they go by now how
exact can they be? Everyone is quite unique and heal at there own rates and may do fine and be ahead and others may be slower, and still others
may have complications. That is medicine and healing . I guess this bothers me as I was extreamy hard on my dr. I did not like him I felt he did not
talk to me, looking back and listening to my hubby talk he did try, I wasnt hearing him, not because he wasnt talking to me, but I did not want to hear what he was saying,it was not to MY liking so I closed him out.

I found out tho that he cared and went beyond his duty as a dr. and no he could make me no promises but he was with me all the way.
He had enough to tell me and urge me to see other dr.s if I was uncomfortable with his suggestions, also told me whatever I needed from him
he would be there still, and had sense enough to tell my hubby that it was my decision not his and he wanted me to take the time I needed.
I think I judged him harshly and gave him a bad rap, and because of this , I guess I am trying to be more intune to this problem. How would we feel if a dr. interviewed us to see if he wanted to be our dr. lol can u imagine, it could be quite comical. I hear allot of dr. bashing and it concerns me as so he said a difference then the nurse in healing time, if this is important then yes you should talk with him by all means. I am sure that could be a person to person thing, I see many dr.s have different ways. What ever works for u as a individual is what i think is better.My dr. had his faults as well as I did
and I do not know what will be the results of surgery at this point , but whatever i took my chances, as I would have if it was my gall bladder, female surgery or any other type. Surgery is a risk , any kind even the simplest still has risks, even done by the king of kings in surgery.And
complications occur on good and bad surgeries. So I feel it is up to the indivdual to do there homework and decide what is best for them,
and decide if they are willing to accept the risk .

Again this is just something I am reading also more and more and seems to me that we are quick judges sometimes,can run to 10 dr.s and most likely
will get lots of differences in treatments , personalities,office policies,nurses, and most things, it must be up to you what you feel comfortable with. i hope not to anger anyone , this is just a thought from me .

Re: wonder

Tammie on 9/26/01 at 19:51 (061674)

I tend to wonder if it has something to do with the lenghth of time we suffer with pf before treatment , or before we do something to stop the changes
effecting or gait or foot, the way we walk for months and months sometimes years? Then we go and decide to try surgery and discover allot of damage has been done? Just a thought! And another thought scar tissue developed? And is this true as I have heard it , That pf and tts has very similar symptoms often mimicking each other ???? And dx is very difficult sometimes even with all tests, which can either be positive or negitive.
With conflicting results. Just some thoughts.

I also think there are so very many with good results, that are not told about as who looks here if they are fine and out and about living
life with no pain or even less. Also I believe this occurs in most surgeries, feet , abdominal, cardi, ears nose throat etc, there will always be good
results and there always will be poor or unsatisfactory results. Surgery is a risk period any kind. On the other hand we could count the failed pf treatments to look at all the conservitive treatments and the faliures there to, people living withthis for 7, 10 , more years, what is it why is the feet so very hard to keep healed, why dont we look at this, now we have this ESWT, I imagine inyears to come something new will come in and
people will say whyyyyyyyyyy the faliures. As has it been around long enough to know what 20 years or 50 yrs will bring as results? Now I am not against it Please hear me I am totaly for anything that may help and it does not cut u , so yes good to start with, I am just trying to compare down the line years from now when the next new cure comes we are always going to think why the faliures, that brings about new knowledge and new cure tactics. It used to be hmmm what herbs to cure things or what ever , then maybe surgeries, now ESWT , years from now maybe something new and better, but always the questions. Just more thoughts.

Re: To Tammie wonder

Pauline on 9/26/01 at 21:06 (061679)

Tammie,
I think you make some very good points and present a very informative argument but my gut tells me a neurosurgeon may be best suited for nerve entrapment and other neurosurgeries just as an Endodontist is best suited to handle root canals. It's knowing what to do when the going gets rough and having the training and skill to prevent complications. Quite honestly, I haven't seen enough of it. You questioned if there was a difference between Pods and Orthos and the answer is yes. Compare for
yourself Harvard Medical School and The Ohio College of Podiatry course by course. I remember one posting putting into question the quality of training at the Mayo Clinic. I had to laugh, because Mayo reputation says it all. The argument between who is better Pods or Orthos will go on forever. The bottom line is, as you say finding a doctor you feel comfortable with and have confidence in to handle your case. If you have a good outcome, you'll be praising his name, if not you suffer the consequences. It's the second one you worry about.

Re: To Cindy Surgery count-down

cindyp on 9/26/01 at 22:13 (061686)

As for the neurologists doing this more I don't know. They say podiatrists are foot specialists and everyone of those I saw ran like bleep. A few orthopedists I saw also said go away. So I don't know. Maybe if they worked together? I agree if we knew the numnbers of failures we would be astonished. All I know is the dr. I saw was an orthopedist and did his fellowship? in foot and ankle reconstruction. I know that some feel podiatrists are better. None that I saw was qualified to do this surgery that I needed. So I don't know what to say other than find the most qualified dr. you can afford and get kinda pushy. If they are not listening let them know that you are paying their fee and you want answers. and by all means RESEARCH. that is a key.

Re: kinds of docs, good or bad? can find in all types both

cindyp on 9/26/01 at 22:18 (061689)

No not at all. I just think you need to research and do more research and if the dr. that you are seeing isn't telling you the right thing then run in the opposite direction. I saw 9 dr. before I found someone to help me. The idiots at the v.a.( i am venting sorry) told me to see a psychiatrist. So find the best dr. you can afford or by insurance and ask him all the quesitons you have. if he doesn't want to answer or is answering you know to be incorrect go elsewhere. your feet are tooo important. the dr. that finally helped me was an ortho who did his fellowship in foot and ankle and played me straight answered all my questions and told me that it may not work and i probably won't be 100 percent ever. I have had the problem for about 15 years but didn't know that is what it was. I am now 85 percent most days and that's good enough. I am profoundly lucky and grateful. I am a success story.

Re: To Cindy Surgery count-down

Ed Davis, DPM on 9/26/01 at 22:24 (061691)

Pauline:

A. Lee Dellon M.D. of Baltimore is a neurosurgeon who has one of the best techniques for tarsal tunnel surgery I have seen. His procedure is published on CD ROM and I use his CD to teach my podiatric surgical residents. He is one of the few neurosurgeons interested in the area though. I offered to show the CD presentation to several local neurosurgeons but they had no interest. It just is not an area of interest nor involvement of most neurosurgeons. I really think that potentially their skills and training would make them the ideal surgeons to treat this.
Ed

Re: kinds of docs, good or bad? can find in all types both

Ed Davis, DPM on 9/26/01 at 22:33 (061695)

Tammie:

A large number of podiatrists would be classified as 'foot and ankle reconstructive surgeons' since that is their primary training and what they spend most of their time doing. Podiatrists do the majority of foot surgeries in the US today. The subspecialty of 'foot and ankle orthopedics' is a fairly new one. Most of the orthopedic surgeons who committed a large part or all of their practice to foot surgery did so out of interest in the area as opposed to subspecialty training. Most subspecialty training in the area involved 'fellowships' in which an interested individual acted as an apprentice to one of the orthopods interested in foot surgery. Those individuals eventually formed the residency programs, mainly in the last decade, that graduated practitioners who are specifically trained in the area.
Ed

Re: Surgery count-down

Ed Davis, DPM on 9/26/01 at 22:42 (061697)

Pauline:

Keep in mind that the sampling of cases includes a preponderance of failed cases. There is really no anatomic or physiologic explanation for plantar fascial releases causing TTS or the need for TTS surgery. A couple possibilities: heel pain caused by TTS but misdiagnosed as plantar fasciitis--these individuals do not respond to typical treatments for PF. Conservative treatments usually work for plantar fasciitis. If conservative treatments for plantar fasciitis are effectively provided but fail, the first question should be...'Is this something other than plantar fasciitis?' That question needs to be dealt with before going to PF surgery. A 'large' incision for plantar fasciitis that leads to nerve entrapment could cause TTS but such surgical approaches (I would hope) are rare.
Ed

Re: To Tammie wonder

wendyn on 9/26/01 at 22:52 (061701)

I asked if a neurosurgeon or neurologist would treat TTS - I was told by my doctors that they do not.

Re: Surgery count-down

Pauline on 9/27/01 at 07:32 (061710)

Dr. Davis,
How do you feel about some centralized record keeping? Scott pointed out to me a while back that there are approx 15,000 Pods trained to do P.F. and TTS surgeries and I believe 1200 Orthos nation wide with Foot and Ankle specialities and include any other physician doing the same surgery. If they each did only one P.F. or TTS surgery a year and tracked that patient for 6 to 12 months we'd have a pretty good sampling of results. I really would like to see some major tracking done because personally I believe P.F. surgery has become too common place. It's replaced the tonsillectomy surgery of '40ties and '50ties.

I think it's high time for some 'show me' results on P.F. and TTS surgeries.

Re: To Cindy Surgery count-down

To Dr. Davis on 9/27/01 at 15:51 (061750)

Hi Dr. Davis,
I did some research on Dr. Lee Dellon M.D. He has quite the reputation in his field. I think if I had TTS I'd head to see him. He is one more name I'll file in my 'Just in Case' book. It's a good file to keep. Thanks

Re: Surgery count-down

Ed Davis, DPM on 9/27/01 at 21:13 (061762)

Pauline:

There are not many plantar fascial releases being done in my area (Northwest US). I know of very few colleagues who perform plantar fascial releases in appreciable numbers. Your experience must derive from an area where more of such procedures are being performed. There is geographic variability with this procedure and also with others. Some prominent examples are the C-section rates and numbers of hysterectomies performed.

Tracking numbers and results may be a good idea. Would reporting of statistics be voluntary or mandatory? Which agency would have the responsibility to gather the statistics? How would the accuracy of the statistics be verified? How would the results of the statistics be used?Until these questions are answered or agreed upon by the various parties involved, it is unlikely that this will occur.

Interestingly, insurance companies, probably have more data on how many of such procedures are performed, where, when... Also, insurance companies regularly second guess and limit conservative treatment of plantar fascia but never question surgical treatment.
Ed

Re: Surgery count-down

Karma on 9/28/01 at 14:53 (061814)

Iam 9 days post tts pfs and heal spur surgury. My doc told me no walking on my foot for two weeks the and walking boot for two weeks the a surgury shoe for two weeks When they got in there i had more extensive nerve damage than they thought and i had a large heal spur and they clip my tendion so i can streght my foot back out so far the pain is not to bad just getting stir carzy sitting here. I have three inscisons one very large one to samll ones.

Re: Surgery count-down

Jana on 9/30/01 at 18:46 (061933)

Disturbing that they limit conservative treatment but don't question surgery. What a money game. Just out of curiosity, approximately how many of both of these surgeries do you do a year?

Another thing to consider as to why the surgery numbers may very geographically is the lifestyle in different regions. I live in Southern California, someone is jogging on every corner. Pounding their feet on concrete obsessively because this area is all about fitness and physical looks. I went to visit relatives in Missouri and went for a jog, not another runner in town! I'm willing to bet there are fewer cases of tarsal tunnel or plantar fasciitis there.

Dr., why do you think there are not more physicians checking this board? I mentioned it to one of my podiatrists and he had never heard of it. I was surprised! If I do a search on almost any search engine for anything related to heel pain, foot pain, nerve compression, plantar fasciitis etc. I always get a link to this site. It sure would be nice to see more doctors aboard.

Something I also wonder about this site, do you think it is a collection of people with failed surgeries because people with successful surgeries don't have a need to come back to this board? When I look at this site, I am decidedly against surgery because so few are successful and so many seem to cause additional complications. But I wonder if we just aren't hearing from the people who had successful experiences.
When I read this board, almost every surgery fails it seems. Why are doctors still doing the surgery at all?
When you ask doctors (at least in my experience) about the likelihood for success, they give very high numbers. When I last spoke with my Ortho, she said almost 85 percent likelihood for success. I have a positive nerve conduction, which for her confirms the need for the surgery. I know from reading this board I cannot trust that. I repeatedly see comments about nerve conduction studies not being accurate. I repeatedly see people with failed surgeries who believed broken promises who were also told they had a very high percentage likelihood for success. I wonder how many doctors are not being honest with their patients. I wonder how many doctors are doing inaccurate nerve conduction studies.

Do you think that there are that many doctors out there who are really intentionally being dishonest or who are that incompetant? I find that hard to believe. Maybe they are being honest and we just aren't hearing from the people who are recovered. What is your opinion?

Re: To Cindy Surgery count-down

Jana on 9/30/01 at 18:55 (061936)

What is unique about his technique? Can you please provide some more information or tell us how to get this CD? It would be helpful for me to discuss the variety of techniques used with my ortho. I have not yet gotten a doctor to be very specific with me about the procedure (they must think were stupid) and I know there are several. It seems like the patient has to become the expert in order to ensure the most likely for success.

Re: Surgery count-down

Ed Davis, DPM on 10/01/01 at 23:44 (062035)

Jana:

Doctors are bombarded with information overload so they have to do a lot of filtering, occasionally filtering out good stuff. A lot of docs just don't realize this site exists. Others may have read the site but choose not to participate.

Keep in mind that patients who have met with rapid success are not as likely to be on this site as those who have encountered difficulties. I am not a big fan of plantar fascial release surgery. I would estimate that I see about 700 new cases of heel pain per year, the majority or which are caused by plantar fasciitis. I perform about 12 to 15 plantar fascial releases per year-- a surgery rate of about 2 percent. Of that 2% approximately 90% are getting better or cured with surgery. Keep in mind that if I operated on a higher percentage of patients, my surgical success rate would decrease appreciably. Patient selection is a key factor.

Tarsal tunnel syndrome is significantly more rare than plantar fasciitis but the need for surgery is higher. Success statistics are more reliable when there are adequate numbers to look at. My success rate with tarsal tunnel surgery is about 85 t0 90% but that is really not a meaningful statistic because it is not based on large numbers. (Not based on adequate numbers to have statistical significance). I would be a bit suspicious if any individual claims to have large numbers of tarsal tunnel releases on an individual basis, other than a few individuals who have a particular reputation in this area. I would rather look at the overall success rates in this situation which I would place at about 70%.

There are some factors, which I believe, lead to higher success rates in TTS surgery. Those include a positive NCV test. NCV is not perfect but keep in mind that there is a fair percentage of TTS surgery being done on patients who have negative NCV results. Another factor can be the discovery of a structure which is pressing on the nerve---varicosities, growths, cysts, etc. Discovery and removal of such an identifiable structure generally leads to good outcomes.

Ed

Re: Surgery count-down

Jana on 10/02/01 at 19:25 (062106)

What is the difference between a plantar facia release and removing the plantar facia bundle? My surgeon has suggested we remove the bundle and do the TTS release. She said she would not do a plantar facia release because it would guarantee me long-term pain in other areas of my foot.

How do you test in advance for varicosities, growths, cysts? If you are bilateral, isn't it fairly unlikely that there are obstructions in both feet (I am 32 if that is helpful).

I also have bilateral epicondylitis and carpal tunnel/RS I. I have approached my tarsal tunnel diagnosis conservatively because I find it almost impossible to believe that all four quadrants of my body would develop nerve related injuries within the same one year period (CTS followed TTS within a year). I have heard pregnancy can cause carpal tunnel. Just before I developed tarsal tunnel, I was taking Depo for six privera. Do you know if there is any correlation between peripheral nerve related conditions and any of the following: exposure to moldy environments, depo privera, exposure cigarette smoke, alcohol, problems in the spine?

One other thing, the orthopedic who gave me the 85 percent success rate claims she has done many of these surgeries but couldn't give me an exact percentage rate for success (the 85 percent was rough) because most of the people she sees have already had the procedure done three or four times. That's kind of mixed information. If someone has done in the procedure three or four times, why do they continue to do it and what is going so wrong in all of these surgeries that patients are going through them so many times? It's hard to understand in Layman's terms. Do you have any tips as to how to delicately ask her for patient references? She has an excellent surgical reputation but a difficult personality, something I'm willing to tolerate to get the technical expertise.

Re: Surgery count-down

Jana on 10/02/01 at 19:28 (062107)

I forgot to ask you, you mentioned the need for surgery for tarsal tunnel is higher. Why? Because of permanent nerve damage? What if you don't have the physical symptoms? I have only inside ankle pain and a positive nerve conduction study. No burning, no numbness, no tingling.

Re: Surgery count-down

Ed Davis, DPM on 10/02/01 at 20:38 (062112)

Jana:
The need for surgery is higher in TTS than PF because we really do not have as good an armamentarium of conservative modalities which are very effective at treating TTS. PF success rates with conservative treatment are better than 90% but we, probably, can only treat about 30 to 40% of TTS with successful conservative treatment.
Ed

Re: Surgery count-down

Ed Davis, DPM on 10/02/01 at 20:48 (062113)

Patient references are a delicate subject. The reason is that a physician cannot divulge the medical problems of another patient. In other words, if your doctor gave you patient references on others he has treated for TTS, he would be divulging confidential medical information. One possiblity would be for the doctor to have those patients sign a written release allowing him to do so.

MRI, especially if it is of high quality, can often show pathology---varicosities or other growths pressing on the nerve.

There is a good possibility that TTS surgery could help you but, based on what you have stated about the multiple nerve related injuries, it would be a good idea to obtain a consultation with a neurologist before moving forward with surgery. Exposure to mold is an unlikely culprit. How much exposure to cigarrette smoke? If you are a smoker, expect your surgical recovery to take longer and potentially a lower success rate. Problems in the spine can mimick TTS and that is why you should see a neurologist. Alcohol, in excess can lead to alcoholic polyneuropathy-- a peripheral neuropathy that can mimic TTS symptoms. Unsure about Depo-Provera.
Ed

Re: Surgery count-down

Joan S on 10/03/01 at 21:12 (062190)

Sara,

I had TTS surgery on 9/21 and it was complicated by the removal of a fibroma on the inside of my arch. Really had little pain, did not even finish my pain prescription. Kept my foot elevated for the 1st 48 hours and iced it 30 minutes off and 30 minutes on for 48 hours. Do need someone to help with this. Dr. also put me in a cast for the first week to keep me from moving it. After 7 days went to a wrap with a walking shoe. As of today I am no longer walking on my toes and starting to put weight on foot and have gone to using only 1 crutch.. TTS was the easiest, the other incision was a little more tender. I think the ice and elevation really was the key for my foot really never did swell.
I also had a great orthopedic Dr., who only specializes in Ankles and feet.
Good luck and I am glad that I had the procedure. Even now my foot hurts less then before.

Re: To Jana

Pauline on 10/04/01 at 10:19 (062217)

Jana,
I would come right out and ask her for patient references. She wouldn't be giving you their names unlessed she had releases first. Most people feel the fear of asking this question to all surgeons regardless of their field, but sometimes it's the difficult questions that tell you a lot about the physician. To me when it comes to surgery any question you have is a good one to ask. Go for it.