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Saw the doctor today, new surgery recommended, what do you think?

Posted by Chad H on 10/30/01 at 12:46 (063831)

I went back to the doctor today after being away for 18 months. I hate to repeat myself, but for any new people, let me give some background. I have had two TTS releases on my right ankle and arthroscopic surgery on a damaged ligament (sprain) on the outside of my right ankle. None of the surgeries have helped at all. This has all taken place since 1997. I have constant pain in the lower portion of my right leg. Because of the TTS and the associated pain I now have no range of motion in my right ankle. My ankle is VERY stiff and my right calf and leg have atropied.

So, doc is recommended a tendon lengthening in the gastroc / achillies area. He says they deleveloped a new way to do this procedure about 2 years ago, and the success rate has been fantastic in increasing range of motion. He said it is outpatient with 1 week in a cast. We would follow with PT.

He is not saying this will cure my underlying problems (tts and sprain). He thinks that the tightness in my ankle is a major problem though, and until we correct this, we can't correct the other issues.

To give you an example of how tight my achillies and gastroc are, with my right foot flat on the ground, I am just barely able to bend my knee. When I am sitting, I can't point my toes forward or back, or move my ankle side to side.

I think he is on the right track. I know this won't be my last surgery, but maybe it is a step in the right direction.

The pain is overwhelming. I am 29 years old and can't live the rest of my life like this. My primary care doctor is concerned with the amount of pain meds I take. I was taking 2 Aleve twice a day, plus a prescription strength Motrin. Doc says I will destroy my kidneys.

My ortho put my on Celebrex today and said to stop taking the others.

So, what do you think?

Re: Saw the doctor today, new surgery recommended, what do you think?

Chris M. on 10/31/01 at 12:48 (063879)

Hello Chad. I would like to ask if the physician discussed the particulars of the procedure, of just how they will lengthen your Achilles. I consulted my favorite book at the moment, Sports Injuries of the Ankle and Foot, by Marder and Lian, this one is from 97. It discusses in the text, altering the achilles with a turn down flap, and so I wondered if that was what they proposed to do to you. In this book they state it is the best way to fix the tendon as opposed to other treatments cited: V-Y gastrocplasty (no idea what that is) and also grafting the flexor digitorium longus to the calcaneus, also a bad idea THEy say

I am most interest to hear how they will alter your Achilles.

Do you have nerve and sensory pain, just curious.

Also has your leg atrophied and now it is one big contracture, which is like rigor mortis on a living person, not to be gross. Or do you have a lot of scarring, is that limiting your ROM?

Finally, please give the particulars of the surgery, if you can. I would never say do it or don't...because I cannot even relate to what you must go through. But I may be able to recite some of this info on the 'turn down of the proximal achilles tendon' FYI: this procedure won't have you up and about quickly.

Re: Maybe one of our local docs could help explain???

Chad H on 10/31/01 at 16:43 (063890)

Regarding the procedure, I need to talk to my doctor and get more details. Maybe one of our doctors on the board could explain also based on the following: He told me that that they make a small incision in the lower calf, about 8 inches above the heel of the foot. The lengthening takes place in the area where the muscle becomes the tendon. Exactly what they do to 'lengthen' the tendon is beyond me. When I get more answers I will let you know. Please understand that I am not having this done next week. This was just an initial conversation, surgery is months off. Also, the doctor said that this is a new procedure as of about 2 years ago, and that it totally changed the way they lengthened the tendon.

My pain started as just Tinal(sp?)sign pain about 6 years ago. I noticed it when I moved my ankle certain ways, when I walked on unlevel ground, and obviously when I tapped in that area. I immediately starting having pain above the outside ankle bone of the same foot. Doctors attributed that to a sprain and didn't say much about it. Because of the pain, I began to alter the way I walked and moved my ankle. By limited motion to avoid pain, I slowing lost that motion.

The atropy has been caused by lack of vigorous movement and spending time in casts due to surgery without proper PT to follow it up.

Regarding the TTS, I have had varying results on EMG tests. The first test I had came up positive, other tests have had varying results. I have been told that once you have had surgery, EMG tests are useless. Both times I was opened up for TTS the doctors told me they were amazed at the amount of scar tissue I have in my ankle and TT. They said they had never seen anything like it. They tried to clean things up, but to no avail. My current doctor and I have discussed a vein wrap, and I have met with a microvascular surgeon to discuss this option. I have no idea what caused the build-up of scar tissue in the first place.

I don't have all the symptoms of TTS though. I have never had an numbness, and the actually TTS pain has never really gotten worse. What has changed is the surrounding pain.

Pain in my ankle is everywhere now. Sometimes I have the shooting nerve pain, other times it is the sprain, and then I also have a general ache in the area surrounding the achillies. Doctor put me on Celebrex yesterday, it seems like it is helping so far. It is much better than all that Aleve and motrin everyday.

Thanks for responding. I really want so advice and input and I enjoy having someone to talk to about this. Anyone else please also chime in. I would love to hear from on of the docs as well.

Re: Saw the doctor today, new surgery recommended, what do you think?

BrianG on 10/31/01 at 19:15 (063900)

Hi Chad,

While I don't have TTS, I do have PF and did have failed surgery. I'd advise you to speak with your doc and get some names of people he has treated. Call them, find out if he is telling the truth. About your meds, no wonder four feet hurt. You are barely taking enough to help a hangnail. There are many doctors that are afraid to prescribe adaquate pain meds. It sounds like you have one. If you'd like to do a little reading on the subject, check out http://www.pain.com Good luck

BCG

Re: Saw the doctor today, new surgery recommended, what do you think?

Ed Davis, DPM on 11/01/01 at 16:18 (063953)

Lack of ankle dorsiflexion range of motion is a big culprit behind a lot of foot problems. Is this the same doc who performed the other surgeries?
New procedure to lengthen the achilles? What is the name of the procedure?
Tendo achilles lengthening procedures have been around for along time and they take a lot more than one week in a cast in order to heel properly.
Please consider a second opinion.
Ed

Re: Saw the doctor today, new surgery recommended, what do you think?

Chad H on 11/02/01 at 20:40 (064031)

The procedure is called a Gastroc Recession. I was not home today when the nurse returned my call and my wife took the message. She didn't find out any additional details about how it is performed.

The nurse said the recovery times can vary greatly based on each individual case, but that time in a non-weight bearing cast varied from 1 week to 3 weeks.

Dr. Thomas Lee in Columbus, Ohio is regarded as one of the finest foot and ankle surgeons in the area and is national known. He performed the arthroscopic surgery on my sprained ankle, he did not perform any of the TTS releases. He just isn't willing to try again on the TTS based on the success of the other doctors. He has discussed having in microvascular surgeon do a vein wrap.

I am more than willing to talk with other doctors and get second opinions. That is why I posted this thread on this board, just to get other opinions! The problem that I am finding with TTS and ankle problems in general is that EVERYONE has an opinion, and each person is sure they are right, and they say all the others are wrong. They are like salespeople, and they want you to buy their pitch.

Over the past 6 years I have seen 11 different doctors. I have been diagnosed with torn tendons, sprains, TTS, neronmas, neropathy, nerve damage, ankle instability, etc. I have had tests for rhematoid arthritis, MRI, bone scans, x-rays, emgs, nerve conductivity tests and others. I have orthotics, been through 5 rounds of PT, 3 surgeries, and the list goes on. (I don't claim that my story is any worse than anyone else, please understand). My point is that I feel like I need to put my faith in someone. I need to find a doctor who is willing, interested, and knowledgable enough to help me. I can't continue on the path I am on right now. Bouncing from doc to doc doesn't work either. I just end up going in circles. I need to be moving the ball down field!

Please understand I am just trying to put my thoughts down. I post hear because there are people who really understand listening. I am not trying to be a jerk with this post. I just want to make good decisions.

I will find out more from the doctor on Monday. I am also considering who I should go see for additional opinions. I have had surgery from 3 docs in central Ohio, and from the research I have done, they are the three best! I don't know where to turn.

Re: Saw the doctor today, new surgery recommended, what do you think?

Ed Davis, DPM on 11/03/01 at 14:59 (064060)

Chad:

I can certainly sympathize with your dilemna. This is certainly a good forum to present your thoughts as most individuals here are sympathetic.
A gastrocnemius recession is not a new procedure, it has been done for decades. It involves lengthening the larger of the two muscles that make up the achilles, the gastrocnemius. It is a fairly benign procedure although immobilization and healing do take substantially longer than a week.

Surgery is a serious matter and it should never be 'sold' to patients by doctors or others. My defenses tend to go up when I hear what sounds like exaggerated claims, claims of unreasonably short recovery periods or anything else that would give a patient expectations that may not be accurate.

Ultimately, if you have confidence in your physician, that is what is most important and you need to follow your instincts. One individual who could provide you with a second opinion is Gerard V. Yu, DPM of North Olmstead, Ohio, tel. 216-734-5662
Ed

Re: Thanks Dr. Davis

Chad H on 11/03/01 at 16:09 (064061)

Thank you for the referral and for listening and responding. Input, advise, and a kind ear is what this board is all about and you are a huge asset! I will likely give Dr. Yu a call.

I will also find out more about this procedure Dr. Lee is recommending and find out what part of it is 'new'. He made it sound like something had changed about 2 years ago in the way they did it which has increased the success and decreased the trauma. When I get more information I will post it.

It isn't so much being sold, it is that many of the doctors approach my ankle with complete confidence that their solution is 100% correct. After three surgeries, and zero success, two of the three doctors have basically seemed to run and hide. As if they don't want to admit that they are not perfect. I just can't seem to get consistant, straight answers. It is very frustrating.

Re: Thanks Dr. Davis

wendyn on 11/04/01 at 14:10 (064105)

Chad, it sounds to me as though you've done your homework and you're going to be very confident of your surgical decision if you chose to go that way.

I agree with I think (?)Brian that Motrin and Aleve hardly sound adequate for someone with your degree of pain and limitation. I hope the Celebrex is helpful.

Has anyone ever suggested that you may have RSD? I only ask because you mention sugery and atrophy - limited motion etc. As long as there is no possibility that you have RSD - I think I would continue to pursue the possible surgical options you're looking at (if I were you).

When was your last bone scan?

Re: Thanks Dr. Davis

Chad H on 11/04/01 at 18:11 (064120)

Wendy,

The bone scan was back in '97. I hate to admite this, but I have never heard of RSD until you just mentioned it. I did a search on Yahoo, so now I have plenty of info!

From what I have read so far, it seems very interesting. Not sure if I have it, but I can't rule it out.

How often have you heard of RSD being confused with TTS? I am going to keep reading and I may post more later.

Re: Thanks Dr. Davis

Laurie R on 11/04/01 at 20:55 (064125)

Dear Chad , Hi , I have PF and TTS and RSD and a fibroma and tenosynivitis , all in my right foot. You could have your doctor check for RSD , their is not a test for it , from what I understand. They also call RSD/CRPS which stands for cronic regional pain syndrome ... It is very painful . I am being treated right now for it . I have had three different doctors tell me that I do have it along with everything else. You can find all kinds of info on the web about it .

Now the RSD is what is holding up my much needed foot surgery . They have to get it under control before any type of foot surgery . If you don't the RSD can go crazy . If I did not have RSD then I could of had surgery a long time ago .

Please before you have surgery make sure you do not have RSD ....

My very best to you Chad , if I can help in any way please feel free to ask.

Laurie R

Re: Thanks Dr. Davis

wendyn on 11/04/01 at 22:31 (064136)

Chad - bear in mind that I'm not a doctor....just a patient.

I don't know how often the two (RSD and TTS) are confused or related, but I know it does happen. Laurie has been diagnosed with RSD, I have been diagnosed with it - albeit not an 'acute' form (?) We've had a few others here with it as well.

It seems to be difficult to diagnose.

From what I understand, it can eventually cause osteoporosis - and that part may be caught with a bone scan. I think - remember I'm not a doctor.

Any chance of repeating the bone scan to see if anything has changed after 4 years?

I am told that my occasional swelling, increased temperature, bright red color changes, and puffiness in my feet is related to RSD. Thankfully it does not happen too often any more.

When my pain was bad, the simple touch of a bed sheet was unbearable. I remember telling my son (six at the time) that if he looked at my feet it would hurt them. I was only sort of kidding.

I also understand that surgery is not a great idea if a person is suffering from RSD. That is why the doctor's are working so hard to bring Laurie's RSD under control - they need to do surgery but they have to get the nerve to settle down first.

In my case, the surgeon has pretty much refused to do surgery because of the RSD. Fortunately, I have improved a lot (for somewhat unexplained reasons)on my own. I imagene that if I was as bad off as I was - they would be treating my foot very similarly to what they're doing with Laurie.

Re: Thanks Dr. Davis

Chad H on 11/05/01 at 06:44 (064143)

Wendyn

I am glad to hear you have improved! I have been following the board on and off but I haven't heard you discuss that. That is fantastic!

Honestly, from the reading I have done, I don't think that I have RSD. However, I will discuss it with my family care doctor first, and then may go to a pain management specialist again.

From the reading, I don't think my condition is THAT bad. RSD sounds like hell! Maybe I am there and just don't know it! I have never had the redness or the temperature changes in my foot. I have never been so sensative that the wind would hurt my foot, (unless I touch that one spot, or I jarr it somehow).

I have had swelling since the first surgery 4 years ago. It has started to diminish, but still comes around at the end of the day. I haven't seen my ankle bone in years. Shooting pains, constant aches, atrophy, lack of ROM, yes, I have all of that.

Thanks for the replies, your messages mean a great deal to me. I will keep you posted on what I learn.

Re: Update on the surgery

Chad H on 11/05/01 at 16:48 (064174)

I spoke to the nurse today.

She says that what has changed as of about two years ago is that the doctor now uses the gastroc muscle rather than the tendon to create the 'lengthening'. She said that he makes an incision in the gastroc muscle and then manipulates the ankle to 'stretch' the muscle and thereby increasing the range of motion in the achillies. She compared it to stretching or creating a run in pantyhose.

She keeps telling me that normal cast time is 3 weeks in a non-weight bearing cast. She said she hasn't seen the doc's notes yet which may specify a shorter cast time based on the severity of my particular condition.

That is all I know at this time!

Re: Update on the surgery

Ed Davis, DPM on 11/05/01 at 19:35 (064185)

Chad:
Use of the gastroc muscle, again, is not anything new---it is known as a gatrocnemius recession and is one way of potentially giving more length to the achilles. It is somewhat 'safer' than lengthening the achilles itself because the achilles tends to be more delicate and dificult to heel than the gastrocnemius muscle. The gastroc recession has become more popular in the last few years because of the quicker recovery and lower complication rate. The achilles is made up of primarily two muscles, the gastrocnemius and the soleus. The gastroc is the bigger of the two muscles. A gastroc recession will not work if the soleus remains tight though so that needs to be measure carefully. Three weeks in a cast sounds a lot more realistic of an estimate. Considering what you have been through, I think that the second opinion would be very valuable before proceeding. Best wishes.
Ed

Re: Update on the surgery

momstv on 11/07/01 at 19:35 (064347)

I feel for you if you have RSD as I have it also along with TTS and PF I have had several bouts of PT and none of them were successful.. I have had 3 sets of spinal injections for the RSD and they have helped immensly.I still had to have the TTS surgery and the PF release but at least I feel like I'm on the right track. I also took OXYCONTIN twice a day for three weeks and it actually Hepled the pain. Really it DId. You have to know that it is an addictive drug and may not be right for you but it saved my life I feel because I was near suicide with the pain. And that is no joke. I feel for you as I have had all of the tests you have had and then the surgeries and then the spinal injections. I can walk some now and I hope that if I get the weight off I will be able to do more. Keep us posted and hang in there.

Re: Update on the surgery

Laurie R on 11/07/01 at 20:31 (064355)

Dear Momstv, I don't know who you were replying to ,but you and I sound a lot a like . I am so happy to hear that the spinal injections worked for you . I had my first one done two weeks ago . As soon as the meds wore off all the pain was back . In was in a few hours.

I saw my PM doctor today and they want to do another spinal injection. So I am to call tomarrow to set it up. They told me if the next two injections only give me the few hours of relief that will be all the will do . Which I am glad ,because I don't want to keep having them if they don't work.

I with you the RSD has been terrible , the pain is so bad. I am in pain 24?7 . I also have PF TTS and a fibroma and tenosynivitis in my FHL tendon . They did tell me from the start that the injections will not help all of these other problems . They are trying to get the RSD under control. I need surgery ,but I can not have it now ,until the RSD in ok. I am also happy to hear that the Oxy is working for you , I think that is wonderful .

To me whatever it takes to take some of the pain away . I really feel for you because I know what you are going through .

I would love to talk to you more . If you would like here is my email address . Please feel free to email me anytime .. ricoslady1108@yahoo.com

My very best to you , Laurie R

Re: Update on the surgery

BrianG on 11/08/01 at 09:11 (064396)

Hi Moms,

As one who takes daily pain meds I'm glad to her the Oxycontin worked for you. Yes, people in pain do become accomodated to the opiates. Studies have proved that 99% of those people can taper off the meds with little, or no problem, when necessary. Good luck

BCG

Re: Momstv

Tammie on 11/09/01 at 10:56 (064505)

I am so very sorry for your troubles it must be very difficult to live with so much pain for so long! I do hope that u find some comfort in your treatments and the continued care u recieve! I can understand that desperation of feeling pain 24/7 with no breaks it does sink u to a very low area a scary place to be some nights! Although I cannot begin to compare as I have been very lucky to only have to deal with the pf and tts stuff and not the RSD. I still can understand how it brings a person down with no feelings of ever recovering and having a sort of life we once new. Life hands out allot of hurdels and I guess this is a pretty big one for most here!

I just wanted to say how much I admire u for sharing your deepest feelings of where u were and where u are at in your search for freedom of pain! Please know that my prayers are with u for the finding of relief and the strenghth to keep your head up tall and your heart filled with happiness and love! And know that you are a very special person sent here to help others find a way to come thru without that dark side threatening to claim a lost and tired soul! Keep up the positive search and we are with u always! A great big hug for u!

Re: Saw the doctor today, new surgery recommended, what do you think?

Chris M. on 10/31/01 at 12:48 (063879)

Hello Chad. I would like to ask if the physician discussed the particulars of the procedure, of just how they will lengthen your Achilles. I consulted my favorite book at the moment, Sports Injuries of the Ankle and Foot, by Marder and Lian, this one is from 97. It discusses in the text, altering the achilles with a turn down flap, and so I wondered if that was what they proposed to do to you. In this book they state it is the best way to fix the tendon as opposed to other treatments cited: V-Y gastrocplasty (no idea what that is) and also grafting the flexor digitorium longus to the calcaneus, also a bad idea THEy say

I am most interest to hear how they will alter your Achilles.

Do you have nerve and sensory pain, just curious.

Also has your leg atrophied and now it is one big contracture, which is like rigor mortis on a living person, not to be gross. Or do you have a lot of scarring, is that limiting your ROM?

Finally, please give the particulars of the surgery, if you can. I would never say do it or don't...because I cannot even relate to what you must go through. But I may be able to recite some of this info on the 'turn down of the proximal achilles tendon' FYI: this procedure won't have you up and about quickly.

Re: Maybe one of our local docs could help explain???

Chad H on 10/31/01 at 16:43 (063890)

Regarding the procedure, I need to talk to my doctor and get more details. Maybe one of our doctors on the board could explain also based on the following: He told me that that they make a small incision in the lower calf, about 8 inches above the heel of the foot. The lengthening takes place in the area where the muscle becomes the tendon. Exactly what they do to 'lengthen' the tendon is beyond me. When I get more answers I will let you know. Please understand that I am not having this done next week. This was just an initial conversation, surgery is months off. Also, the doctor said that this is a new procedure as of about 2 years ago, and that it totally changed the way they lengthened the tendon.

My pain started as just Tinal(sp?)sign pain about 6 years ago. I noticed it when I moved my ankle certain ways, when I walked on unlevel ground, and obviously when I tapped in that area. I immediately starting having pain above the outside ankle bone of the same foot. Doctors attributed that to a sprain and didn't say much about it. Because of the pain, I began to alter the way I walked and moved my ankle. By limited motion to avoid pain, I slowing lost that motion.

The atropy has been caused by lack of vigorous movement and spending time in casts due to surgery without proper PT to follow it up.

Regarding the TTS, I have had varying results on EMG tests. The first test I had came up positive, other tests have had varying results. I have been told that once you have had surgery, EMG tests are useless. Both times I was opened up for TTS the doctors told me they were amazed at the amount of scar tissue I have in my ankle and TT. They said they had never seen anything like it. They tried to clean things up, but to no avail. My current doctor and I have discussed a vein wrap, and I have met with a microvascular surgeon to discuss this option. I have no idea what caused the build-up of scar tissue in the first place.

I don't have all the symptoms of TTS though. I have never had an numbness, and the actually TTS pain has never really gotten worse. What has changed is the surrounding pain.

Pain in my ankle is everywhere now. Sometimes I have the shooting nerve pain, other times it is the sprain, and then I also have a general ache in the area surrounding the achillies. Doctor put me on Celebrex yesterday, it seems like it is helping so far. It is much better than all that Aleve and motrin everyday.

Thanks for responding. I really want so advice and input and I enjoy having someone to talk to about this. Anyone else please also chime in. I would love to hear from on of the docs as well.

Re: Saw the doctor today, new surgery recommended, what do you think?

BrianG on 10/31/01 at 19:15 (063900)

Hi Chad,

While I don't have TTS, I do have PF and did have failed surgery. I'd advise you to speak with your doc and get some names of people he has treated. Call them, find out if he is telling the truth. About your meds, no wonder four feet hurt. You are barely taking enough to help a hangnail. There are many doctors that are afraid to prescribe adaquate pain meds. It sounds like you have one. If you'd like to do a little reading on the subject, check out http://www.pain.com Good luck

BCG

Re: Saw the doctor today, new surgery recommended, what do you think?

Ed Davis, DPM on 11/01/01 at 16:18 (063953)

Lack of ankle dorsiflexion range of motion is a big culprit behind a lot of foot problems. Is this the same doc who performed the other surgeries?
New procedure to lengthen the achilles? What is the name of the procedure?
Tendo achilles lengthening procedures have been around for along time and they take a lot more than one week in a cast in order to heel properly.
Please consider a second opinion.
Ed

Re: Saw the doctor today, new surgery recommended, what do you think?

Chad H on 11/02/01 at 20:40 (064031)

The procedure is called a Gastroc Recession. I was not home today when the nurse returned my call and my wife took the message. She didn't find out any additional details about how it is performed.

The nurse said the recovery times can vary greatly based on each individual case, but that time in a non-weight bearing cast varied from 1 week to 3 weeks.

Dr. Thomas Lee in Columbus, Ohio is regarded as one of the finest foot and ankle surgeons in the area and is national known. He performed the arthroscopic surgery on my sprained ankle, he did not perform any of the TTS releases. He just isn't willing to try again on the TTS based on the success of the other doctors. He has discussed having in microvascular surgeon do a vein wrap.

I am more than willing to talk with other doctors and get second opinions. That is why I posted this thread on this board, just to get other opinions! The problem that I am finding with TTS and ankle problems in general is that EVERYONE has an opinion, and each person is sure they are right, and they say all the others are wrong. They are like salespeople, and they want you to buy their pitch.

Over the past 6 years I have seen 11 different doctors. I have been diagnosed with torn tendons, sprains, TTS, neronmas, neropathy, nerve damage, ankle instability, etc. I have had tests for rhematoid arthritis, MRI, bone scans, x-rays, emgs, nerve conductivity tests and others. I have orthotics, been through 5 rounds of PT, 3 surgeries, and the list goes on. (I don't claim that my story is any worse than anyone else, please understand). My point is that I feel like I need to put my faith in someone. I need to find a doctor who is willing, interested, and knowledgable enough to help me. I can't continue on the path I am on right now. Bouncing from doc to doc doesn't work either. I just end up going in circles. I need to be moving the ball down field!

Please understand I am just trying to put my thoughts down. I post hear because there are people who really understand listening. I am not trying to be a jerk with this post. I just want to make good decisions.

I will find out more from the doctor on Monday. I am also considering who I should go see for additional opinions. I have had surgery from 3 docs in central Ohio, and from the research I have done, they are the three best! I don't know where to turn.

Re: Saw the doctor today, new surgery recommended, what do you think?

Ed Davis, DPM on 11/03/01 at 14:59 (064060)

Chad:

I can certainly sympathize with your dilemna. This is certainly a good forum to present your thoughts as most individuals here are sympathetic.
A gastrocnemius recession is not a new procedure, it has been done for decades. It involves lengthening the larger of the two muscles that make up the achilles, the gastrocnemius. It is a fairly benign procedure although immobilization and healing do take substantially longer than a week.

Surgery is a serious matter and it should never be 'sold' to patients by doctors or others. My defenses tend to go up when I hear what sounds like exaggerated claims, claims of unreasonably short recovery periods or anything else that would give a patient expectations that may not be accurate.

Ultimately, if you have confidence in your physician, that is what is most important and you need to follow your instincts. One individual who could provide you with a second opinion is Gerard V. Yu, DPM of North Olmstead, Ohio, tel. 216-734-5662
Ed

Re: Thanks Dr. Davis

Chad H on 11/03/01 at 16:09 (064061)

Thank you for the referral and for listening and responding. Input, advise, and a kind ear is what this board is all about and you are a huge asset! I will likely give Dr. Yu a call.

I will also find out more about this procedure Dr. Lee is recommending and find out what part of it is 'new'. He made it sound like something had changed about 2 years ago in the way they did it which has increased the success and decreased the trauma. When I get more information I will post it.

It isn't so much being sold, it is that many of the doctors approach my ankle with complete confidence that their solution is 100% correct. After three surgeries, and zero success, two of the three doctors have basically seemed to run and hide. As if they don't want to admit that they are not perfect. I just can't seem to get consistant, straight answers. It is very frustrating.

Re: Thanks Dr. Davis

wendyn on 11/04/01 at 14:10 (064105)

Chad, it sounds to me as though you've done your homework and you're going to be very confident of your surgical decision if you chose to go that way.

I agree with I think (?)Brian that Motrin and Aleve hardly sound adequate for someone with your degree of pain and limitation. I hope the Celebrex is helpful.

Has anyone ever suggested that you may have RSD? I only ask because you mention sugery and atrophy - limited motion etc. As long as there is no possibility that you have RSD - I think I would continue to pursue the possible surgical options you're looking at (if I were you).

When was your last bone scan?

Re: Thanks Dr. Davis

Chad H on 11/04/01 at 18:11 (064120)

Wendy,

The bone scan was back in '97. I hate to admite this, but I have never heard of RSD until you just mentioned it. I did a search on Yahoo, so now I have plenty of info!

From what I have read so far, it seems very interesting. Not sure if I have it, but I can't rule it out.

How often have you heard of RSD being confused with TTS? I am going to keep reading and I may post more later.

Re: Thanks Dr. Davis

Laurie R on 11/04/01 at 20:55 (064125)

Dear Chad , Hi , I have PF and TTS and RSD and a fibroma and tenosynivitis , all in my right foot. You could have your doctor check for RSD , their is not a test for it , from what I understand. They also call RSD/CRPS which stands for cronic regional pain syndrome ... It is very painful . I am being treated right now for it . I have had three different doctors tell me that I do have it along with everything else. You can find all kinds of info on the web about it .

Now the RSD is what is holding up my much needed foot surgery . They have to get it under control before any type of foot surgery . If you don't the RSD can go crazy . If I did not have RSD then I could of had surgery a long time ago .

Please before you have surgery make sure you do not have RSD ....

My very best to you Chad , if I can help in any way please feel free to ask.

Laurie R

Re: Thanks Dr. Davis

wendyn on 11/04/01 at 22:31 (064136)

Chad - bear in mind that I'm not a doctor....just a patient.

I don't know how often the two (RSD and TTS) are confused or related, but I know it does happen. Laurie has been diagnosed with RSD, I have been diagnosed with it - albeit not an 'acute' form (?) We've had a few others here with it as well.

It seems to be difficult to diagnose.

From what I understand, it can eventually cause osteoporosis - and that part may be caught with a bone scan. I think - remember I'm not a doctor.

Any chance of repeating the bone scan to see if anything has changed after 4 years?

I am told that my occasional swelling, increased temperature, bright red color changes, and puffiness in my feet is related to RSD. Thankfully it does not happen too often any more.

When my pain was bad, the simple touch of a bed sheet was unbearable. I remember telling my son (six at the time) that if he looked at my feet it would hurt them. I was only sort of kidding.

I also understand that surgery is not a great idea if a person is suffering from RSD. That is why the doctor's are working so hard to bring Laurie's RSD under control - they need to do surgery but they have to get the nerve to settle down first.

In my case, the surgeon has pretty much refused to do surgery because of the RSD. Fortunately, I have improved a lot (for somewhat unexplained reasons)on my own. I imagene that if I was as bad off as I was - they would be treating my foot very similarly to what they're doing with Laurie.

Re: Thanks Dr. Davis

Chad H on 11/05/01 at 06:44 (064143)

Wendyn

I am glad to hear you have improved! I have been following the board on and off but I haven't heard you discuss that. That is fantastic!

Honestly, from the reading I have done, I don't think that I have RSD. However, I will discuss it with my family care doctor first, and then may go to a pain management specialist again.

From the reading, I don't think my condition is THAT bad. RSD sounds like hell! Maybe I am there and just don't know it! I have never had the redness or the temperature changes in my foot. I have never been so sensative that the wind would hurt my foot, (unless I touch that one spot, or I jarr it somehow).

I have had swelling since the first surgery 4 years ago. It has started to diminish, but still comes around at the end of the day. I haven't seen my ankle bone in years. Shooting pains, constant aches, atrophy, lack of ROM, yes, I have all of that.

Thanks for the replies, your messages mean a great deal to me. I will keep you posted on what I learn.

Re: Update on the surgery

Chad H on 11/05/01 at 16:48 (064174)

I spoke to the nurse today.

She says that what has changed as of about two years ago is that the doctor now uses the gastroc muscle rather than the tendon to create the 'lengthening'. She said that he makes an incision in the gastroc muscle and then manipulates the ankle to 'stretch' the muscle and thereby increasing the range of motion in the achillies. She compared it to stretching or creating a run in pantyhose.

She keeps telling me that normal cast time is 3 weeks in a non-weight bearing cast. She said she hasn't seen the doc's notes yet which may specify a shorter cast time based on the severity of my particular condition.

That is all I know at this time!

Re: Update on the surgery

Ed Davis, DPM on 11/05/01 at 19:35 (064185)

Chad:
Use of the gastroc muscle, again, is not anything new---it is known as a gatrocnemius recession and is one way of potentially giving more length to the achilles. It is somewhat 'safer' than lengthening the achilles itself because the achilles tends to be more delicate and dificult to heel than the gastrocnemius muscle. The gastroc recession has become more popular in the last few years because of the quicker recovery and lower complication rate. The achilles is made up of primarily two muscles, the gastrocnemius and the soleus. The gastroc is the bigger of the two muscles. A gastroc recession will not work if the soleus remains tight though so that needs to be measure carefully. Three weeks in a cast sounds a lot more realistic of an estimate. Considering what you have been through, I think that the second opinion would be very valuable before proceeding. Best wishes.
Ed

Re: Update on the surgery

momstv on 11/07/01 at 19:35 (064347)

I feel for you if you have RSD as I have it also along with TTS and PF I have had several bouts of PT and none of them were successful.. I have had 3 sets of spinal injections for the RSD and they have helped immensly.I still had to have the TTS surgery and the PF release but at least I feel like I'm on the right track. I also took OXYCONTIN twice a day for three weeks and it actually Hepled the pain. Really it DId. You have to know that it is an addictive drug and may not be right for you but it saved my life I feel because I was near suicide with the pain. And that is no joke. I feel for you as I have had all of the tests you have had and then the surgeries and then the spinal injections. I can walk some now and I hope that if I get the weight off I will be able to do more. Keep us posted and hang in there.

Re: Update on the surgery

Laurie R on 11/07/01 at 20:31 (064355)

Dear Momstv, I don't know who you were replying to ,but you and I sound a lot a like . I am so happy to hear that the spinal injections worked for you . I had my first one done two weeks ago . As soon as the meds wore off all the pain was back . In was in a few hours.

I saw my PM doctor today and they want to do another spinal injection. So I am to call tomarrow to set it up. They told me if the next two injections only give me the few hours of relief that will be all the will do . Which I am glad ,because I don't want to keep having them if they don't work.

I with you the RSD has been terrible , the pain is so bad. I am in pain 24?7 . I also have PF TTS and a fibroma and tenosynivitis in my FHL tendon . They did tell me from the start that the injections will not help all of these other problems . They are trying to get the RSD under control. I need surgery ,but I can not have it now ,until the RSD in ok. I am also happy to hear that the Oxy is working for you , I think that is wonderful .

To me whatever it takes to take some of the pain away . I really feel for you because I know what you are going through .

I would love to talk to you more . If you would like here is my email address . Please feel free to email me anytime .. ricoslady1108@yahoo.com

My very best to you , Laurie R

Re: Update on the surgery

BrianG on 11/08/01 at 09:11 (064396)

Hi Moms,

As one who takes daily pain meds I'm glad to her the Oxycontin worked for you. Yes, people in pain do become accomodated to the opiates. Studies have proved that 99% of those people can taper off the meds with little, or no problem, when necessary. Good luck

BCG

Re: Momstv

Tammie on 11/09/01 at 10:56 (064505)

I am so very sorry for your troubles it must be very difficult to live with so much pain for so long! I do hope that u find some comfort in your treatments and the continued care u recieve! I can understand that desperation of feeling pain 24/7 with no breaks it does sink u to a very low area a scary place to be some nights! Although I cannot begin to compare as I have been very lucky to only have to deal with the pf and tts stuff and not the RSD. I still can understand how it brings a person down with no feelings of ever recovering and having a sort of life we once new. Life hands out allot of hurdels and I guess this is a pretty big one for most here!

I just wanted to say how much I admire u for sharing your deepest feelings of where u were and where u are at in your search for freedom of pain! Please know that my prayers are with u for the finding of relief and the strenghth to keep your head up tall and your heart filled with happiness and love! And know that you are a very special person sent here to help others find a way to come thru without that dark side threatening to claim a lost and tired soul! Keep up the positive search and we are with u always! A great big hug for u!