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More pain after Surgery than before !

Posted by Sherry S. on 10/06/01 at 17:54 (062403)

I had surgery in March for planters fascitis after suffering through a year of anti-immflammatory drugs, expense shoe inserts, injections in my foot and chronic pain-- I opted for surgery. I did exactly what the doctor said, had a cast for 10 days, then soft cast, etc....But the incision just did not heal properly and kept opening. It finally did heal after I went back to the doctor several times and he removed a 'hard core' from the center of the incision area. After that I begin to have pain coming from the small incision and it has gotten worse over time. The pain comes from the surgery site down the right side of my foot. I can wear only sneakers, any other shoe kills me. I must have shoes on all the time or the pain is very significant. I can no longer even go for a walk. I am so tired of this...do you think all these problems sound like scar tissue? Please respond as I am considering another surgery to remove the scarring.

Re: More pain after Surgery than before !

Dr. Zuckerman on 10/06/01 at 18:56 (062407)

Hi,

could be scar tissue, or small nerve entrapment. The only course is surgical removal or local steriod injections. Good luck.

Re: the scar tissue issue

elliott on 10/07/01 at 17:09 (062445)

I was wondering if the Drs. here could help clear up the scar tissue issue, as this comes up repeatedly and many of us are unclear about it. Here's some questions of mine:

1. How does one figure out he/she has scar tissue and not something else? For example, how does one who has had a PF release or posterior tibial tendon repair who has post-surgical problems know it's scar tissue and not a weakened PF or foot as a result of surgery?

2. How are the doctors sure scar tissue is the culprit? How definitive is an MRI?

3. How can one distinguish between poor surgical technique resulting in scar tissue and the usual scar tissue risks associated with surgery?

4. Regarding TTS in particular, Question 3 again (obviously, when dealing with nerves, even if the doctor is very competent, such risks are greater). And how can one tell if scar tissue and not something else is the culprit in the case of a failed TTS surgery resulting in resumption or onset of post-surgical nervy symptoms? If it is scar tissue, is that suggestive of dramatically decreased chances of success for a second surgery to eliminate the TTS nerve pain? (The chances are already dramatically decreased as it is. :-))

5. As far as treatments, can anything possibly work other than cortisone and yet more surgery (prolonged rest; ultrasound; ESWT-if so, success rate(?); stretching; exercise; orthotics)? I believe Dr. Ed has mentioned a few times on this board some other type of substance to inject which doesn't have the tissue-thinning drawbacks of cortisone. How viable is that? Can that work over a wide area as well?

6. If one feels further tearing post-first surgery, is that a sure sign surgery is necessary to remove scar tissue? Are there great dangers in waiting?

7. Regarding surgical removal of scar tissue, since more surgery begets yet more scar tissue, around what are the chances for success for such a surgery? If it depends, on what? Are the odds as small as for TTS surgery itself? And by success, are we typically talking about complete use of the foot (as in running) or something much less so (e.g. relatively painfree walking but within limits)?

Thanks for any insight into clearing up scar tissue (issue :-)).

----

Re: the scar tissue issue

Ed Davis, DPM on 10/08/01 at 15:32 (062481)

Scar tissue is often diagnosed by clinical findings. Scar tissue is a type of tissue that the body uses to repair itself. It is a good thing in the right quantity but can cause problems in excess.

Scar tissue has a different consistency than normal tissue---it is harder, denser, less pliable. As such, it is something that the clinician can feel. Diagnostic tests such as MRI's are necessary only occasionally.
If excess scar tissue places pressure on a nerve, pain and numbness can occur. Excess scar tissue can bind down tendons so they don't glide properly.

Excess scar tissue can form for a number of reasons--poor surgical technique, inadequate immobilization after surgery, overuse after surgery, uncontrolled swelling or due to genetic predisposition. Surgical removal of scar tissue can creat more scar tissue so that is something that should be reserved only if there is a very large amount of scar tissue to be removed. Conservative techniques to mitigate scar tissue include ultrasound, massage and injection therapy. Wydase or hyaluronidase is an enzyme that breaks down scar tissue with little effect on adjacent tissues and can be injected into scar tissue. Repository steroids such as triamcinolone acetonide cause scar tissue to involute but must be used with caution as surrounding tissues can atrophy.
Ed

Re: More pain after Surgery than before !

Dr. Zuckerman on 10/06/01 at 18:56 (062407)

Hi,

could be scar tissue, or small nerve entrapment. The only course is surgical removal or local steriod injections. Good luck.

Re: the scar tissue issue

elliott on 10/07/01 at 17:09 (062445)

I was wondering if the Drs. here could help clear up the scar tissue issue, as this comes up repeatedly and many of us are unclear about it. Here's some questions of mine:

1. How does one figure out he/she has scar tissue and not something else? For example, how does one who has had a PF release or posterior tibial tendon repair who has post-surgical problems know it's scar tissue and not a weakened PF or foot as a result of surgery?

2. How are the doctors sure scar tissue is the culprit? How definitive is an MRI?

3. How can one distinguish between poor surgical technique resulting in scar tissue and the usual scar tissue risks associated with surgery?

4. Regarding TTS in particular, Question 3 again (obviously, when dealing with nerves, even if the doctor is very competent, such risks are greater). And how can one tell if scar tissue and not something else is the culprit in the case of a failed TTS surgery resulting in resumption or onset of post-surgical nervy symptoms? If it is scar tissue, is that suggestive of dramatically decreased chances of success for a second surgery to eliminate the TTS nerve pain? (The chances are already dramatically decreased as it is. :-))

5. As far as treatments, can anything possibly work other than cortisone and yet more surgery (prolonged rest; ultrasound; ESWT-if so, success rate(?); stretching; exercise; orthotics)? I believe Dr. Ed has mentioned a few times on this board some other type of substance to inject which doesn't have the tissue-thinning drawbacks of cortisone. How viable is that? Can that work over a wide area as well?

6. If one feels further tearing post-first surgery, is that a sure sign surgery is necessary to remove scar tissue? Are there great dangers in waiting?

7. Regarding surgical removal of scar tissue, since more surgery begets yet more scar tissue, around what are the chances for success for such a surgery? If it depends, on what? Are the odds as small as for TTS surgery itself? And by success, are we typically talking about complete use of the foot (as in running) or something much less so (e.g. relatively painfree walking but within limits)?

Thanks for any insight into clearing up scar tissue (issue :-)).

----

Re: the scar tissue issue

Ed Davis, DPM on 10/08/01 at 15:32 (062481)

Scar tissue is often diagnosed by clinical findings. Scar tissue is a type of tissue that the body uses to repair itself. It is a good thing in the right quantity but can cause problems in excess.

Scar tissue has a different consistency than normal tissue---it is harder, denser, less pliable. As such, it is something that the clinician can feel. Diagnostic tests such as MRI's are necessary only occasionally.
If excess scar tissue places pressure on a nerve, pain and numbness can occur. Excess scar tissue can bind down tendons so they don't glide properly.

Excess scar tissue can form for a number of reasons--poor surgical technique, inadequate immobilization after surgery, overuse after surgery, uncontrolled swelling or due to genetic predisposition. Surgical removal of scar tissue can creat more scar tissue so that is something that should be reserved only if there is a very large amount of scar tissue to be removed. Conservative techniques to mitigate scar tissue include ultrasound, massage and injection therapy. Wydase or hyaluronidase is an enzyme that breaks down scar tissue with little effect on adjacent tissues and can be injected into scar tissue. Repository steroids such as triamcinolone acetonide cause scar tissue to involute but must be used with caution as surrounding tissues can atrophy.
Ed