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post op pf and still not right

Posted by judyml on 11/17/01 at 22:17 (064918)

hello again,
i am now 14 weeks post op open fasciotomy and still having problems. I just started PT the other day. I still have a numb, tingly feeling along the lateral edge of my foot and my little toe is still numb. I also have a swelling in the ball of my foot, directly underneath where the metatarsal heads would be. i have developed 'curved toes' (namely the 2nd through 5th toes) so when i am standing on my feet, these toes are bent and curved downward. I am so depressed with what is going on. I went to a new doctor because my operating docs answer was 'well, the pf pain is gone'... this is true, the original pain i had preoperatively is gone but now a new bunch of problems. the new doc believes I may have possible nerve damage but also says i need to give the healing process a little more time. he also mentioned something about the intrinsic muscles in my foot. my original doc ordered a 3 phase bone scan of my foot to rule out degenerative joint disease but i did not have this test as it is pretty invasive, i think, with the radioactive iodine, etc.
I had contacted Dr. Zuckerman's office and was going to make an appointment, but sorry to say, his office is just too far from my house.
Anyone have any ideas as to what is going on? I sometimes feel it was easier to deal with the burning heel pain of plantar fascitis.
Happy Thanksgiving.
Judy

Re: post op pf and still not right

wendyn on 11/17/01 at 23:00 (064921)

Judy, if your doctor has ordered a bone scan - please go.

It's not a big deal, I have had 3 of them over the last several years. I am not a big fan of tests, but I have never heard anyone express any concern about this one. When I asked the tech about the radiation, he said that I would be exposed to less than what you would get in a single xray.

Please discuss your concerns with your doctor.

Re: post op pf and still not right

Dr. Zuckerman on 11/18/01 at 06:55 (064931)

Hi,

The pain from an open plantar fasciotomy can take a very long time to heal . I just saw a patient who had an open plantar fasciotomy that took over two years to heal. I still remember her when she first cames to me with the pain and post op problems. She was out of work for six months.

We are using ESWT on Monday on her opposite foot. I asked do you remember the healing time for the other foot and she just smiled.

So lets say that there is nerve damage in your foot from the open plantar release . This is possilble but rare. More likely the Flexor Digortium Brevis tendons were cut in addition to the plantar fascia.

There is no treatment except strenghting of the foot and letting the foot heal which like I have stated could be six months to one year and in the case that I just told you about two years. I wish I had more advice but this the story with some plantar fascia surgery.

Re: post op pf and still not right

judyml on 11/18/01 at 10:07 (064940)

Wendy,
The operating MD is the one that ordered this test. I believe he is just grasping at straws for an answer as he has no clue to why I have developed these post-operative problems. I will ask the new doctor that I have started seeing if he believes that I should have this test...Maybe an MRI would be better but I am not sure.
Judy

Re: post op pf and still not right

judyml on 11/18/01 at 10:45 (064942)

Dr. Z,
Thank you for reply.
I know there is a long recovery period after an open PF, however, my concern was the new problems that cropped up. When I touch the ball of my operative foot with the left hand and push the toes up and away from the bottom of my foot with my right hand, I can feel that one of the metatarsal heads is protruding...there is a rounded bump (maybe the 3rd or 4th metatarsal). So when I stand up straight, that bump seems to be in the way and therefore my foot cannot be flat on the ground which makes the toes curl downward. What in the world caused the problem with that bone? I did not have that problem preoperatively. My foot is also very stiff especially when I try to turn it to the medial side as compared to the lateral side. I suppose PT will help with that.
I have a slight fibromyalgia which the operating MD tells me is slowing my recovery. The only symptoms I have are tenderness when you press those 'trigger points' but otherwise I am fine. The new MD I have begun to see tells me that fibromyalgia should not affect my healing at all.
Dr. Z, if there IS nerve damage which is causing the tingly feeling when I touch the lateral portion of the underside of my foot and the numb toe, will that really get better with PT or is that just a permanant result of my surgery? I am constantly aware of the feeling; just sitting her and spreading the toes on my operative foot, I feel that the little toe is way off somewhere because of the numbness.
Thanks again for your replies.
Judy

Re: post op pf and still not right

wendyn on 11/18/01 at 10:50 (064943)

Sounds like you have a good plan, I just would hate to see you put off a test that may help give you some answers. Let us know how you do!

Re: post op pf and still not right

Dr. Zuckerman on 11/18/01 at 13:46 (064950)

Nerve damage can improve with time. Physical therapy is something that can help to strengthen tendons and muscles. Help to improve your gait and reduce pain. The numbness if due to compensation or nerve damage can improve over a very long time. I wish I could be more specific but time will vary with each and every person. The response toward physical therapy is also very patient specific. I would strongly recommend a physical program

Re: post op pf and still not right

judyml on 11/30/01 at 19:41 (065778)

Dr. Z,
Is it possible that I have developed Reflex Sympathetic Dystrophy? Now I think I understand why the operating MD ordered a three-phase bone scan. At a physical therapy session today, the therapist was very perplexed at how my toes are curving and she also mentioned a discoloration on my little toe (which is numb). She then mentioned RSD.
Judy

Re: post op pf and still not right

DR Zuckerman on 12/01/01 at 07:21 (065794)

This is possible.

Remember the key to treatment for RSD is aggressive physical therapy and . mamnagement by a pain specialist Ask the doctor why the bone scan NOW

Re: post op pf and still not right

judyml on 12/01/01 at 20:39 (065867)

Dr. Z,
I think he mentioned the bone scan because he has no clue as to why I am having all these post-op problems. He only vaguely mentioned RSD when he gave me the RX for the scan, but when the therapist mentioned it to me on Friday, I remembered it being said by the doctor.
Today was a very tough day for pain; I think PT is also causing me lots of tenderness in my foot. I also believe that I am starting to develop PF in my left foot now as well. I would definately think twice before having any surgery on my left foot.
Most of my post op complications do not deal with pain, thats why I am a bit hesitant to think i have RSD. The original PF pain was relieved by the surgery, but now I have other problems such as the strange feeling on the lateral sole of my foot, the slightly numb little toe, and the bent toes. My foot has also become stiff. I did do a little bit of walking today and felt some pain over the incision site (medial side of foot). Can using a cam boot cause the toe problems that I have developed?
Thank you for listening.
Judy

Re: post op pf and still not right

wendyn on 11/17/01 at 23:00 (064921)

Judy, if your doctor has ordered a bone scan - please go.

It's not a big deal, I have had 3 of them over the last several years. I am not a big fan of tests, but I have never heard anyone express any concern about this one. When I asked the tech about the radiation, he said that I would be exposed to less than what you would get in a single xray.

Please discuss your concerns with your doctor.

Re: post op pf and still not right

Dr. Zuckerman on 11/18/01 at 06:55 (064931)

Hi,

The pain from an open plantar fasciotomy can take a very long time to heal . I just saw a patient who had an open plantar fasciotomy that took over two years to heal. I still remember her when she first cames to me with the pain and post op problems. She was out of work for six months.

We are using ESWT on Monday on her opposite foot. I asked do you remember the healing time for the other foot and she just smiled.

So lets say that there is nerve damage in your foot from the open plantar release . This is possilble but rare. More likely the Flexor Digortium Brevis tendons were cut in addition to the plantar fascia.

There is no treatment except strenghting of the foot and letting the foot heal which like I have stated could be six months to one year and in the case that I just told you about two years. I wish I had more advice but this the story with some plantar fascia surgery.

Re: post op pf and still not right

judyml on 11/18/01 at 10:07 (064940)

Wendy,
The operating MD is the one that ordered this test. I believe he is just grasping at straws for an answer as he has no clue to why I have developed these post-operative problems. I will ask the new doctor that I have started seeing if he believes that I should have this test...Maybe an MRI would be better but I am not sure.
Judy

Re: post op pf and still not right

judyml on 11/18/01 at 10:45 (064942)

Dr. Z,
Thank you for reply.
I know there is a long recovery period after an open PF, however, my concern was the new problems that cropped up. When I touch the ball of my operative foot with the left hand and push the toes up and away from the bottom of my foot with my right hand, I can feel that one of the metatarsal heads is protruding...there is a rounded bump (maybe the 3rd or 4th metatarsal). So when I stand up straight, that bump seems to be in the way and therefore my foot cannot be flat on the ground which makes the toes curl downward. What in the world caused the problem with that bone? I did not have that problem preoperatively. My foot is also very stiff especially when I try to turn it to the medial side as compared to the lateral side. I suppose PT will help with that.
I have a slight fibromyalgia which the operating MD tells me is slowing my recovery. The only symptoms I have are tenderness when you press those 'trigger points' but otherwise I am fine. The new MD I have begun to see tells me that fibromyalgia should not affect my healing at all.
Dr. Z, if there IS nerve damage which is causing the tingly feeling when I touch the lateral portion of the underside of my foot and the numb toe, will that really get better with PT or is that just a permanant result of my surgery? I am constantly aware of the feeling; just sitting her and spreading the toes on my operative foot, I feel that the little toe is way off somewhere because of the numbness.
Thanks again for your replies.
Judy

Re: post op pf and still not right

wendyn on 11/18/01 at 10:50 (064943)

Sounds like you have a good plan, I just would hate to see you put off a test that may help give you some answers. Let us know how you do!

Re: post op pf and still not right

Dr. Zuckerman on 11/18/01 at 13:46 (064950)

Nerve damage can improve with time. Physical therapy is something that can help to strengthen tendons and muscles. Help to improve your gait and reduce pain. The numbness if due to compensation or nerve damage can improve over a very long time. I wish I could be more specific but time will vary with each and every person. The response toward physical therapy is also very patient specific. I would strongly recommend a physical program

Re: post op pf and still not right

judyml on 11/30/01 at 19:41 (065778)

Dr. Z,
Is it possible that I have developed Reflex Sympathetic Dystrophy? Now I think I understand why the operating MD ordered a three-phase bone scan. At a physical therapy session today, the therapist was very perplexed at how my toes are curving and she also mentioned a discoloration on my little toe (which is numb). She then mentioned RSD.
Judy

Re: post op pf and still not right

DR Zuckerman on 12/01/01 at 07:21 (065794)

This is possible.

Remember the key to treatment for RSD is aggressive physical therapy and . mamnagement by a pain specialist Ask the doctor why the bone scan NOW

Re: post op pf and still not right

judyml on 12/01/01 at 20:39 (065867)

Dr. Z,
I think he mentioned the bone scan because he has no clue as to why I am having all these post-op problems. He only vaguely mentioned RSD when he gave me the RX for the scan, but when the therapist mentioned it to me on Friday, I remembered it being said by the doctor.
Today was a very tough day for pain; I think PT is also causing me lots of tenderness in my foot. I also believe that I am starting to develop PF in my left foot now as well. I would definately think twice before having any surgery on my left foot.
Most of my post op complications do not deal with pain, thats why I am a bit hesitant to think i have RSD. The original PF pain was relieved by the surgery, but now I have other problems such as the strange feeling on the lateral sole of my foot, the slightly numb little toe, and the bent toes. My foot has also become stiff. I did do a little bit of walking today and felt some pain over the incision site (medial side of foot). Can using a cam boot cause the toe problems that I have developed?
Thank you for listening.
Judy