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3 weeks Post-Op Heel Spur Removal & PF Release

Posted by Sarah T. on 1/04/02 at 22:07 (068773)

I've read postings on this site a hundred times over the past year but this is the first time I have written in. I've suffered for 2 years with heel pain and didn't seek medical attention until it was very debilitating. I think I waited too long. I tried all the anti-inflammatory meds & had 4 cotizone shots in each foot. Nothing worked at all. I tried all the advice on the website - icing, stretching, rest, etc. I finally decided to go with the surgery. My doctor performed bunion surgery on both my mother and sister and I have a great deal of confidence in him. He prefers the more invasive surgery where he actually makes a 3-4 inch incision and literally folds back the heel to see what is causing the problem. My surgery took 2 1/2 hours. I was put in a cast for the first week then had it redressed, banadged and put in a removable brace that goes up to my knee. I have strict orders to not put any weight on it at all. I've basically stayed in a chair except to go to the bathroom! I'm off pain medication now and have very little pain. My heel is very tender to the touch but I no longer have the sharp, shooting pains I had before surgery. I am hopeful. I've been told I'll be off my foot for 6-8 weeks and will then graduate to an orthopedic shoe. My doctor says my recovery could easily take 4-6 months. Then I'll make a decision about having the other foot done! I'm hoping all the rest will help the left foot even though when I do get up I have to put all my weight on it. I appreciate everyone who does write into this website because it has really helped me see that I'm not alone in this painful ordeal.

Re: 3 weeks Post-Op Heel Spur Removal & PF Release

Paula on 1/05/02 at 08:14 (068791)

Sarah, glad to hear you are doing so well. Hate to say it, but with this kind of problem we seem to always have to try every treatment possible first, including the shots and so on. Good that you are doing just what your doctor orders. That will help with recovery time. Yes, it takes probably a good 6 months to know where you stand recovery wise. I had my surgery in September and still have hard times when I am busy, but I would go through it again. Hang in there. I think most of recovery has to do with commitment because of the long period of time. It gets very impatient and wanting to hurry things along after being so bad for so long. I still use crutches and don't care because it helps. I still use wheelchairs when I am in stores because I cannot walk long ways. Do what you can do and no more...At least with surgery you have that chance to recover. You are right, the pain is different after surgery. More after surgery pains rather than the other pain.

Re: 3 weeks Post-Op Heel Spur Removal & PF Release

Pam on 1/07/02 at 15:57 (069099)

Sarah, I am glad to hear you are doing well.......I too suffer from the same thing you do and know how it feels.......I also waited until the pain knocked me down.......I just had a cast on my leg for a little more than a month......it was removed on Thursday of last week.......it was the last attempt to get this under control prior to surgery......my pod says he believes I will be having surgery and I think he is right......my foot has hurt a little more each day since they took the cast off.......we have already discussed me having it done the open way and not endiscopic......I told him one time only if I can help it......he agrees with me that the other way is less painful with quicker recovery but stated he has better results with the open procedure......I hope you will keep us posted on your progress so maybe I will know what to expect.....it seems that most people opt for the endiscopic procedure......good luck

Re: EPF not all it's cracked up to be !

BrianG on 1/08/02 at 21:57 (069281)

Hi Pam,

As someone who has had failed Endoscopic surgery, I'd advise you read a lot of information before having an EPF. Use the 'search' feature here, and check it on the Net. More and more doctors are admitting it is not as good as first touted. The EPF docs wil tell you that you'll be back on your feet in a week or so, B.S. I also had much more pain than I was led to believe I would have.

The endo camera can only see so much. Yes, it ensures that part of the fascia will be cut. From what I'm reading this is where the problem lies. There is so little space in the incision, it is very hard to tell exactlly how much of the fascia will be cut. In my case I don't think enough was cut. So, now I have a partially cut fascia, scar tissue, and more pain in my arch.

One positive thing I can say, it is set up so that when the incision is made properly, it is not near the nerves, which can sometimes lead to TTS in other types of surgery. It's a trade off. The EPF works sometimes, but I don't think it's anywhere near the 80% the Pods are claiming. Do your homework, and good luck.

BCG

PS Ask for an x-ray, or film, of the nerves. That way you will have something to go back on if you run into further (nerve) trouble like one of our other posters.

Re: EPF not all it's cracked up to be !

Dr. Zuckerman on 1/09/02 at 08:21 (069307)

With an EPF the relief is probaby around 80% plus . The problem is the complications and or secondary new problems that it can create.

Re: Dr. Z, clarification on the 80%

elliott on 1/10/02 at 10:06 (069487)

If I'm reading this right, I gather BrianG and you are disagreeing about the 80% success rate. Fair enough; you two can step outside and settle this thing once and for all. :-) But from your last post I can't figure out exactly what you mean. Are you saying that the success rate is 80%, or are you saying that when you get success, it is to the tune of 80% relief on average? Furthermore, do you mean to say that the complications and/or secondary new problems created comprise the failed 20% or are you saying that they're included within the 80% success rate. If the latter, I'm not sure a technical success that leaves one with TTS and a weakened foot should be ruled a success. If you could clarify. Thanks.

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Re: EPF not all it's cracked up to be !

Dr. Zuckerman on 1/10/02 at 11:57 (069514)

What I am saying is that approximately 80% of patients are satified with the results. Now about 20% either had some kind of complication or failure. TThese 20% weren't satified for whenever reason There are also probaby temporary complication within the 80% of the pateints that were happy even when they experienced some type of temporary complication they were still satified after this compication resolved

There are reports of serious complications after EPF nerve damage, cuboid syndrome, conlapse of arch , hammer toe deformity. worse pain then before.

This is why I wish that all on this board would fax a request that ESWT machines be dropped to a class one medical device and there fore the price for eswt treatment should come down . ESWT is a much better choice then any type of pf cutting.

Re: EPF not all it's cracked up to be !

BrianG on 1/10/02 at 17:47 (069569)

Elliott, I agree with Dr Z that ESWT should be tried before any cutting is done. What I am saying is that in all my research I have neve seen any unbiased reports quoating that 80% of the patients are helped. There is no one group out there, checking and watching to see which procedures are working and what the percentages are. I have only read these numbers on doctor's web sites, etc. I'm still looking, if anyone has these numbers. Please point me to the website and I'll be glad to eat my crow.

BCG

Re: EPF not all it's cracked up to be !

Dr. Zuckeman on 1/10/02 at 21:24 (069597)

Here is the problem with literature such as EPF . The DOCTOR is reporting the results. There needs to be a third party independent evaluation of the patients. I have a study in my hands right now one that was done by a group of podiatrists in my area. The evaluation was done by a resident. It was never published. Here are some of the conclusion .
84%of the patients were satisfied with the procedure. This was defined as all of their expectation were achieved The report also states that in Barrett studies that 87% of the patients had less pain after the surgery then before the surgery.

Other interesting and very important information
100 patients were surveyed only 45 patients responded. Ok I am not a scientist but there is bad !!

Out of the 45 patients there was a 45% complication rate. BAd BAD

The only reason that I have this report is the resident give it to me.
This report was never submitted for publication. Why not!!

Re: Re:Brian take a look at this one !!

Dr. Zuckeman on 1/10/02 at 21:25 (069598)

This is bad !!

Re: eat crow!

elliott on 1/10/02 at 21:38 (069602)

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10949799&dopt=Abstract

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Re: eat crow!

Dr. Zuckeman on 1/10/02 at 21:52 (069604)

Elliot,

I would like to know how many surveys were given out and how many were returned. Let's say for example that 100 were given out and only 67 were
returned. I think that that is too small of a number and really doesn't reflect the satisfaction rate at all.

Re: it's good enough for him to eat crow, isn't it? :-)

elliott on 1/10/02 at 22:11 (069605)

I urge you to contact the authors of this and many other studies and/or go to a medical library (you can't expect me to :-)) and read the article in its entirety; if the article appears in a reputable journal, it always answers this question. I'll point out that, even assuming no selective or other bias, any study doing followup must rely on surveys being returned, and the number will not be 100%.

If BrianG thinks there's some group out there that's going to spend much money and time independently studying PF surgical results to his satisfaction, he's mistaken. Anyway, a careful reading of his post suggests that all he wants to see is that 80% figure on something other than docs' websites and the like. A journal article suffices. I found it. He must eat crow. :-)

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Re: PS--human nature question

elliott on 1/10/02 at 22:21 (069606)

Who is more likely to return a survey, one who had a successful surgery or one who had a failure? While I can hear an argument for both sides, I would guess the failure, as he is so angry that he wants to express his dissatisfaction, whereas the success is too busy enjoying life to bother filling out surveys. Your 45% example seems to confirm this. If you accept that a failure is at least as likely to return the survey as a success, then the true success rates would be even better than reported!

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Re: PS, BrianG

elliott on 1/10/02 at 22:32 (069607)

After you're finished eating, you may want to glance at this link:

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10884111&dopt=Abstract

It suggests that bilaterals have lower EPF success rates than unilaterals, so maybe, just maybe, you fit into that pattern whereas others may not (it would be nice to know all this pre-surgery, of course). This report again shows high EPF success rates, albeit with a small sample size. In general, I'm often suspicious that some of these journal studies are secretly biased to select patients in the authors' favor (e.g. don't count those 5 cases we botched outright, start counting the patients only after 3 patients in a row give good success, etc.).

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Re: 3 weeks Post-Op Heel Spur Removal & PF Release

Sarah T. on 1/11/02 at 20:02 (069694)

Thanks for writing. I tried wearing a cast for a month before my surgery too. It didn't help, obviously. My biggest problem has been that I have this in both feet so all of my weight has been on one foot during this recovery. I had surgery on the right foot and I noticed that my left foot felt much, much better while I've been so inactive. Now that I'm gradually doing more and more it is starting to flare up again. I had my sutures removed today and got a look at my foot. It looks pretty wicked. It is very tender to the touch and numb on the bottom of my heel. The dr. said this was normal and that it may stay numb for about a year because of the nerves that are cut during the surgery. He put steri-strips across the incision today and bandaged it with an ace bandage. He told me to wear my 'boot cast' all the time when I am up and I can start gradually putting weight on my foot as it feels good. I go back in 3 weeks with the goal of walking with the boot and no crutches by that time. I'll let you know how it goes.

Re: 3 weeks Post-Op Heel Spur Removal & PF Release

Pam B on 1/11/02 at 20:10 (069697)

Good Luck to you.......I am about to have the surgery and I also suffer from this in both feet......I am worried about that too........it already hurts from hobbling around since June.......I gather you had the open surgery instead of the EPF.......is there a particular reason why????? your decision or your pod????? I am also having it that way by both my choice and docs.......I hope you are feeling some relief from the pre surgery pain????? good luck and keep me posted......Pam

Re: Sorry, not enough to eat crow !

BrianG on 1/11/02 at 23:37 (069711)

Sorry Ellott, but these two little studies are not going to convince me of anything. I want to see a large amount of procedures, with the results reported by an impartial group. I've already seen the results of a couple Dornier trials that were held two years ago. They were reported to the FDA for product approval. This is still to small of a group. I'd like to see someone like the FDA include a card with all procedures. The patient sends it directly to the reporting authority sometime after the procedure. It's the only way it's going to be impartial. Do you think the FDA doesn't have the resources to do this? Of course it can, but it's too political, it will never happen. The two links you posted are practilly usless to me. In spite of that, I will probably put my money down when the Dornier is approved.

I would like the odds much better if I could 'really' see which procedures were having the best results. I'm sorry, but I do not see that happening in the states, and I think it's a shame. I can do all the research I want, and I still will not be able to get the information I would like.
BCG

Re: 3 weeks Post-Op Heel Spur Removal & PF Release

Sarah T on 1/12/02 at 09:08 (069730)

When we started discussing surgery my doctor said he only did surgery in less than 5% of his patients with PF. He said most everyone responded to meds. Of course I wasn't that lucky. I think the best results come if you go to the doctor as soon as it begins. I had never heard of PF and just thought it would get better with time. Wrong. Anyway, my doctor said he really didn't do the EPF surgeries anymore because he didn't get as good of results and that he had treated so many patients that came to him after having someone else perform the EPF where they weren't satisfied and he would end up having to go back in and perform surgery this more invasive way. He said that unless he could actually see with his own eyes what was going on in there he didn't feel like he could make sure he was correcting all that was wrong. The surgery itself was a breeze. Outpatient, they used this anesthesia they called the 'MAC' ?? I had never heard of it but they said you are asleep but they don't use gas and you are not sick when you get up. I woke up like I had just had a quick nap....2 1/2 hours later. I was not sick at all. I wasn't even groggy. The hardest part has been not being strong enough to work with these crutches. I am 5'7' and weigh 180 - not athletic by any means. My stomach and arm muscles have hurt a lot. I would definitely suggest some pre-op exercising to prepare for this. My foot seems a little better every day and the pain I have is not the same pre-op pain I had before. I am still very hopeful that this will work.

Re: here's a bigger study, maybe the biggest

elliott on 1/12/02 at 20:52 (069812)

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7488999&dopt=Abstract

Certainly satisfies problems associated with the Law of Small Numbers. You'll have to dig it up yourself if interested. Maybe that will satisfy the crow test.

Look, I don't deny that not all these studies are an accurate portrayal of what's really going on out there. Heck, you can often find contradictory results between studies. But often, with better selection of journals, authors and contents, you can get a better, if not perfect idea, of what's going on. If the FDA is so political, are you sure you would trust its results?

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Re: No closer to that crow

BrianG on 1/13/02 at 11:05 (069856)

Hi Elliott,

Of all the studies, this is the one I trust the very LEAST !!!! It is authored by the two Pods who developed the technique. Need I say any more on that.

I do thank you for looking this information up, but your never going to get what I'm looking for, because it's not out there. About the FDA, I think I said I'd like someone 'LIKE' the FDA to do the studies. It doesn't have to be them, but has to be someone reputable. I'm definatly not looking for statistics compiled by the very people who are doing the procedure.

About a year ago, there was a discusussion about EPF on the boards here, talking about cadavers. Some of the Pods who were posting mentioned they were present when cadavers were used to 'practice' the EPF method. When they were all done, the cadaver feet were opened up and and not one of the fascia's were cut in the right area. There thought the kit was responsible, and would not cut as advertised. Ever since I read that, had my own failed EPF surgery, and talked to others who had failed surgery, I've been convinced the numbers are not correct, they are INFLATED. Fortunatly ESWT is close, for a lot of us, and I'm hoping this procedure will go by the wayside.

BCG

Re: 3 weeks Post-Op Heel Spur Removal & PF Release

BrianG on 1/13/02 at 11:13 (069857)

Hi Sarah,

I'm glad to hear you are doing better day by day. I think you were fortunate to have a doc who operated on you like he did. I have a suggestion about the crutches, ditch them for now. You can rent one of those small, light weight, 4 wheel walkers that you hang on to, and push them around. I've seen bunches of them in nurseing homes, I'm sure you know what I mean, right. Look in the yellow pages for medical supplies. Keep us advised. Good luck

BCG

Re: 3 weeks Post-Op Heel Spur Removal & PF Release

Sarah T. on 1/14/02 at 06:14 (069946)

Hey Brian - The crutches are very cumbersome. I do have a walker and I use it some too. The crutches were a must when I wasn't able to put any weight on the operated foot but now that I am starting to put some weight on it the walker is easier. I did quite a bit yesterday around the house and thought I might be sore today but I wasn't! It seems like walking on my foot is actually working out some of the soreness. I am so excited! Even so I plan to take it a little easier today. I teach preschool 3 mornings a week and want to make sure I'm ready for tomorrow. I hired an aide to help me during my recovery. Last week was our first week back after the holidays and it went great. Thanks for the encouragement. I'll let you know how it goes.

Re: EPF not all it's cracked up to be !

Al K DPM on 1/16/02 at 05:37 (070150)

I have had great success with EPF as a first line surgical option to heel pain syndrome. I have had a few that did well over a year, and got recurrant heel pain. In those patients, I did an open heel spur resection with 100% improvement in those patients. EPF is highly dependant on surgeon technique as is every surgery, and even then, not all surgical procedures are 100% successful.

Re: 100% improvement?

BrianG on 1/16/02 at 12:00 (070196)

Dr K,

In one sentence you say that you have 100% improvement in your patients. In the next sentence you say that not all surgical improvements are 100% successful. Which is it? I'm betting that the 100% improvement you first mentioned is a bit of an overstatement.

BCG

Re: 100% improvement?

Dr. Zuckerman on 1/16/02 at 14:06 (070205)

Here is what I though this meant. In the failed EPF surgical patients there was 100% improvement after open pf/heel spur excision. So the second time around the the surgery was 100% sucessful.

Re: 100% improvement?

Janet C on 1/16/02 at 23:47 (070233)

If a patient doesn't return to your office, do you assume that their surgery was a success?

Re: furthermore, he said "a few"

elliott on 1/17/02 at 10:54 (070268)

That could mean all two got 100% better after their second surgery.

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Re: 3 weeks Post-Op Heel Spur Removal & PF Release

Julie C on 1/17/02 at 18:14 (070316)

Sara, I had my suregery on 12/21/01, my situation was probably not as sever as others. I started right after the surgery with a post op boot, wich is basically a removable cast, I started putting weight on that gradually. My Dr. wanted me walking without the crutches after the third week, however, here is a suggestion and he said this is ok, try using one crutch or a cane. You have to walk even if you gimp to strengthen yourself up again. I'm exactly the same height and weight as you so I understand. Your right it does improve daily, and I still feel some pain, but its a healing pain. As far as not being strong enough for the crutches, I got tired very quickly. But I also had to adjust mine, they try initially, but it was not quite right, make yourself comfortable, but like Brian said, you should really loose the crutches.

Re: Yes, all two probably felt a little better :*)

BrianG on 1/17/02 at 22:39 (070347)

Elliott, I think this is probably about as close to agreeing on this subject that we will get!

BCG

Re: 3 weeks Post-Op Heel Spur Removal & PF Release

Paula on 1/05/02 at 08:14 (068791)

Sarah, glad to hear you are doing so well. Hate to say it, but with this kind of problem we seem to always have to try every treatment possible first, including the shots and so on. Good that you are doing just what your doctor orders. That will help with recovery time. Yes, it takes probably a good 6 months to know where you stand recovery wise. I had my surgery in September and still have hard times when I am busy, but I would go through it again. Hang in there. I think most of recovery has to do with commitment because of the long period of time. It gets very impatient and wanting to hurry things along after being so bad for so long. I still use crutches and don't care because it helps. I still use wheelchairs when I am in stores because I cannot walk long ways. Do what you can do and no more...At least with surgery you have that chance to recover. You are right, the pain is different after surgery. More after surgery pains rather than the other pain.

Re: 3 weeks Post-Op Heel Spur Removal & PF Release

Pam on 1/07/02 at 15:57 (069099)

Sarah, I am glad to hear you are doing well.......I too suffer from the same thing you do and know how it feels.......I also waited until the pain knocked me down.......I just had a cast on my leg for a little more than a month......it was removed on Thursday of last week.......it was the last attempt to get this under control prior to surgery......my pod says he believes I will be having surgery and I think he is right......my foot has hurt a little more each day since they took the cast off.......we have already discussed me having it done the open way and not endiscopic......I told him one time only if I can help it......he agrees with me that the other way is less painful with quicker recovery but stated he has better results with the open procedure......I hope you will keep us posted on your progress so maybe I will know what to expect.....it seems that most people opt for the endiscopic procedure......good luck

Re: EPF not all it's cracked up to be !

BrianG on 1/08/02 at 21:57 (069281)

Hi Pam,

As someone who has had failed Endoscopic surgery, I'd advise you read a lot of information before having an EPF. Use the 'search' feature here, and check it on the Net. More and more doctors are admitting it is not as good as first touted. The EPF docs wil tell you that you'll be back on your feet in a week or so, B.S. I also had much more pain than I was led to believe I would have.

The endo camera can only see so much. Yes, it ensures that part of the fascia will be cut. From what I'm reading this is where the problem lies. There is so little space in the incision, it is very hard to tell exactlly how much of the fascia will be cut. In my case I don't think enough was cut. So, now I have a partially cut fascia, scar tissue, and more pain in my arch.

One positive thing I can say, it is set up so that when the incision is made properly, it is not near the nerves, which can sometimes lead to TTS in other types of surgery. It's a trade off. The EPF works sometimes, but I don't think it's anywhere near the 80% the Pods are claiming. Do your homework, and good luck.

BCG

PS Ask for an x-ray, or film, of the nerves. That way you will have something to go back on if you run into further (nerve) trouble like one of our other posters.

Re: EPF not all it's cracked up to be !

Dr. Zuckerman on 1/09/02 at 08:21 (069307)

With an EPF the relief is probaby around 80% plus . The problem is the complications and or secondary new problems that it can create.

Re: Dr. Z, clarification on the 80%

elliott on 1/10/02 at 10:06 (069487)

If I'm reading this right, I gather BrianG and you are disagreeing about the 80% success rate. Fair enough; you two can step outside and settle this thing once and for all. :-) But from your last post I can't figure out exactly what you mean. Are you saying that the success rate is 80%, or are you saying that when you get success, it is to the tune of 80% relief on average? Furthermore, do you mean to say that the complications and/or secondary new problems created comprise the failed 20% or are you saying that they're included within the 80% success rate. If the latter, I'm not sure a technical success that leaves one with TTS and a weakened foot should be ruled a success. If you could clarify. Thanks.

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Re: EPF not all it's cracked up to be !

Dr. Zuckerman on 1/10/02 at 11:57 (069514)

What I am saying is that approximately 80% of patients are satified with the results. Now about 20% either had some kind of complication or failure. TThese 20% weren't satified for whenever reason There are also probaby temporary complication within the 80% of the pateints that were happy even when they experienced some type of temporary complication they were still satified after this compication resolved

There are reports of serious complications after EPF nerve damage, cuboid syndrome, conlapse of arch , hammer toe deformity. worse pain then before.

This is why I wish that all on this board would fax a request that ESWT machines be dropped to a class one medical device and there fore the price for eswt treatment should come down . ESWT is a much better choice then any type of pf cutting.

Re: EPF not all it's cracked up to be !

BrianG on 1/10/02 at 17:47 (069569)

Elliott, I agree with Dr Z that ESWT should be tried before any cutting is done. What I am saying is that in all my research I have neve seen any unbiased reports quoating that 80% of the patients are helped. There is no one group out there, checking and watching to see which procedures are working and what the percentages are. I have only read these numbers on doctor's web sites, etc. I'm still looking, if anyone has these numbers. Please point me to the website and I'll be glad to eat my crow.

BCG

Re: EPF not all it's cracked up to be !

Dr. Zuckeman on 1/10/02 at 21:24 (069597)

Here is the problem with literature such as EPF . The DOCTOR is reporting the results. There needs to be a third party independent evaluation of the patients. I have a study in my hands right now one that was done by a group of podiatrists in my area. The evaluation was done by a resident. It was never published. Here are some of the conclusion .
84%of the patients were satisfied with the procedure. This was defined as all of their expectation were achieved The report also states that in Barrett studies that 87% of the patients had less pain after the surgery then before the surgery.

Other interesting and very important information
100 patients were surveyed only 45 patients responded. Ok I am not a scientist but there is bad !!

Out of the 45 patients there was a 45% complication rate. BAd BAD

The only reason that I have this report is the resident give it to me.
This report was never submitted for publication. Why not!!

Re: Re:Brian take a look at this one !!

Dr. Zuckeman on 1/10/02 at 21:25 (069598)

This is bad !!

Re: eat crow!

elliott on 1/10/02 at 21:38 (069602)

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10949799&dopt=Abstract

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Re: eat crow!

Dr. Zuckeman on 1/10/02 at 21:52 (069604)

Elliot,

I would like to know how many surveys were given out and how many were returned. Let's say for example that 100 were given out and only 67 were
returned. I think that that is too small of a number and really doesn't reflect the satisfaction rate at all.

Re: it's good enough for him to eat crow, isn't it? :-)

elliott on 1/10/02 at 22:11 (069605)

I urge you to contact the authors of this and many other studies and/or go to a medical library (you can't expect me to :-)) and read the article in its entirety; if the article appears in a reputable journal, it always answers this question. I'll point out that, even assuming no selective or other bias, any study doing followup must rely on surveys being returned, and the number will not be 100%.

If BrianG thinks there's some group out there that's going to spend much money and time independently studying PF surgical results to his satisfaction, he's mistaken. Anyway, a careful reading of his post suggests that all he wants to see is that 80% figure on something other than docs' websites and the like. A journal article suffices. I found it. He must eat crow. :-)

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Re: PS--human nature question

elliott on 1/10/02 at 22:21 (069606)

Who is more likely to return a survey, one who had a successful surgery or one who had a failure? While I can hear an argument for both sides, I would guess the failure, as he is so angry that he wants to express his dissatisfaction, whereas the success is too busy enjoying life to bother filling out surveys. Your 45% example seems to confirm this. If you accept that a failure is at least as likely to return the survey as a success, then the true success rates would be even better than reported!

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Re: PS, BrianG

elliott on 1/10/02 at 22:32 (069607)

After you're finished eating, you may want to glance at this link:

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10884111&dopt=Abstract

It suggests that bilaterals have lower EPF success rates than unilaterals, so maybe, just maybe, you fit into that pattern whereas others may not (it would be nice to know all this pre-surgery, of course). This report again shows high EPF success rates, albeit with a small sample size. In general, I'm often suspicious that some of these journal studies are secretly biased to select patients in the authors' favor (e.g. don't count those 5 cases we botched outright, start counting the patients only after 3 patients in a row give good success, etc.).

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Re: 3 weeks Post-Op Heel Spur Removal & PF Release

Sarah T. on 1/11/02 at 20:02 (069694)

Thanks for writing. I tried wearing a cast for a month before my surgery too. It didn't help, obviously. My biggest problem has been that I have this in both feet so all of my weight has been on one foot during this recovery. I had surgery on the right foot and I noticed that my left foot felt much, much better while I've been so inactive. Now that I'm gradually doing more and more it is starting to flare up again. I had my sutures removed today and got a look at my foot. It looks pretty wicked. It is very tender to the touch and numb on the bottom of my heel. The dr. said this was normal and that it may stay numb for about a year because of the nerves that are cut during the surgery. He put steri-strips across the incision today and bandaged it with an ace bandage. He told me to wear my 'boot cast' all the time when I am up and I can start gradually putting weight on my foot as it feels good. I go back in 3 weeks with the goal of walking with the boot and no crutches by that time. I'll let you know how it goes.

Re: 3 weeks Post-Op Heel Spur Removal & PF Release

Pam B on 1/11/02 at 20:10 (069697)

Good Luck to you.......I am about to have the surgery and I also suffer from this in both feet......I am worried about that too........it already hurts from hobbling around since June.......I gather you had the open surgery instead of the EPF.......is there a particular reason why????? your decision or your pod????? I am also having it that way by both my choice and docs.......I hope you are feeling some relief from the pre surgery pain????? good luck and keep me posted......Pam

Re: Sorry, not enough to eat crow !

BrianG on 1/11/02 at 23:37 (069711)

Sorry Ellott, but these two little studies are not going to convince me of anything. I want to see a large amount of procedures, with the results reported by an impartial group. I've already seen the results of a couple Dornier trials that were held two years ago. They were reported to the FDA for product approval. This is still to small of a group. I'd like to see someone like the FDA include a card with all procedures. The patient sends it directly to the reporting authority sometime after the procedure. It's the only way it's going to be impartial. Do you think the FDA doesn't have the resources to do this? Of course it can, but it's too political, it will never happen. The two links you posted are practilly usless to me. In spite of that, I will probably put my money down when the Dornier is approved.

I would like the odds much better if I could 'really' see which procedures were having the best results. I'm sorry, but I do not see that happening in the states, and I think it's a shame. I can do all the research I want, and I still will not be able to get the information I would like.
BCG

Re: 3 weeks Post-Op Heel Spur Removal & PF Release

Sarah T on 1/12/02 at 09:08 (069730)

When we started discussing surgery my doctor said he only did surgery in less than 5% of his patients with PF. He said most everyone responded to meds. Of course I wasn't that lucky. I think the best results come if you go to the doctor as soon as it begins. I had never heard of PF and just thought it would get better with time. Wrong. Anyway, my doctor said he really didn't do the EPF surgeries anymore because he didn't get as good of results and that he had treated so many patients that came to him after having someone else perform the EPF where they weren't satisfied and he would end up having to go back in and perform surgery this more invasive way. He said that unless he could actually see with his own eyes what was going on in there he didn't feel like he could make sure he was correcting all that was wrong. The surgery itself was a breeze. Outpatient, they used this anesthesia they called the 'MAC' ?? I had never heard of it but they said you are asleep but they don't use gas and you are not sick when you get up. I woke up like I had just had a quick nap....2 1/2 hours later. I was not sick at all. I wasn't even groggy. The hardest part has been not being strong enough to work with these crutches. I am 5'7' and weigh 180 - not athletic by any means. My stomach and arm muscles have hurt a lot. I would definitely suggest some pre-op exercising to prepare for this. My foot seems a little better every day and the pain I have is not the same pre-op pain I had before. I am still very hopeful that this will work.

Re: here's a bigger study, maybe the biggest

elliott on 1/12/02 at 20:52 (069812)

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7488999&dopt=Abstract

Certainly satisfies problems associated with the Law of Small Numbers. You'll have to dig it up yourself if interested. Maybe that will satisfy the crow test.

Look, I don't deny that not all these studies are an accurate portrayal of what's really going on out there. Heck, you can often find contradictory results between studies. But often, with better selection of journals, authors and contents, you can get a better, if not perfect idea, of what's going on. If the FDA is so political, are you sure you would trust its results?

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Re: No closer to that crow

BrianG on 1/13/02 at 11:05 (069856)

Hi Elliott,

Of all the studies, this is the one I trust the very LEAST !!!! It is authored by the two Pods who developed the technique. Need I say any more on that.

I do thank you for looking this information up, but your never going to get what I'm looking for, because it's not out there. About the FDA, I think I said I'd like someone 'LIKE' the FDA to do the studies. It doesn't have to be them, but has to be someone reputable. I'm definatly not looking for statistics compiled by the very people who are doing the procedure.

About a year ago, there was a discusussion about EPF on the boards here, talking about cadavers. Some of the Pods who were posting mentioned they were present when cadavers were used to 'practice' the EPF method. When they were all done, the cadaver feet were opened up and and not one of the fascia's were cut in the right area. There thought the kit was responsible, and would not cut as advertised. Ever since I read that, had my own failed EPF surgery, and talked to others who had failed surgery, I've been convinced the numbers are not correct, they are INFLATED. Fortunatly ESWT is close, for a lot of us, and I'm hoping this procedure will go by the wayside.

BCG

Re: 3 weeks Post-Op Heel Spur Removal & PF Release

BrianG on 1/13/02 at 11:13 (069857)

Hi Sarah,

I'm glad to hear you are doing better day by day. I think you were fortunate to have a doc who operated on you like he did. I have a suggestion about the crutches, ditch them for now. You can rent one of those small, light weight, 4 wheel walkers that you hang on to, and push them around. I've seen bunches of them in nurseing homes, I'm sure you know what I mean, right. Look in the yellow pages for medical supplies. Keep us advised. Good luck

BCG

Re: 3 weeks Post-Op Heel Spur Removal & PF Release

Sarah T. on 1/14/02 at 06:14 (069946)

Hey Brian - The crutches are very cumbersome. I do have a walker and I use it some too. The crutches were a must when I wasn't able to put any weight on the operated foot but now that I am starting to put some weight on it the walker is easier. I did quite a bit yesterday around the house and thought I might be sore today but I wasn't! It seems like walking on my foot is actually working out some of the soreness. I am so excited! Even so I plan to take it a little easier today. I teach preschool 3 mornings a week and want to make sure I'm ready for tomorrow. I hired an aide to help me during my recovery. Last week was our first week back after the holidays and it went great. Thanks for the encouragement. I'll let you know how it goes.

Re: EPF not all it's cracked up to be !

Al K DPM on 1/16/02 at 05:37 (070150)

I have had great success with EPF as a first line surgical option to heel pain syndrome. I have had a few that did well over a year, and got recurrant heel pain. In those patients, I did an open heel spur resection with 100% improvement in those patients. EPF is highly dependant on surgeon technique as is every surgery, and even then, not all surgical procedures are 100% successful.

Re: 100% improvement?

BrianG on 1/16/02 at 12:00 (070196)

Dr K,

In one sentence you say that you have 100% improvement in your patients. In the next sentence you say that not all surgical improvements are 100% successful. Which is it? I'm betting that the 100% improvement you first mentioned is a bit of an overstatement.

BCG

Re: 100% improvement?

Dr. Zuckerman on 1/16/02 at 14:06 (070205)

Here is what I though this meant. In the failed EPF surgical patients there was 100% improvement after open pf/heel spur excision. So the second time around the the surgery was 100% sucessful.

Re: 100% improvement?

Janet C on 1/16/02 at 23:47 (070233)

If a patient doesn't return to your office, do you assume that their surgery was a success?

Re: furthermore, he said "a few"

elliott on 1/17/02 at 10:54 (070268)

That could mean all two got 100% better after their second surgery.

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Re: 3 weeks Post-Op Heel Spur Removal & PF Release

Julie C on 1/17/02 at 18:14 (070316)

Sara, I had my suregery on 12/21/01, my situation was probably not as sever as others. I started right after the surgery with a post op boot, wich is basically a removable cast, I started putting weight on that gradually. My Dr. wanted me walking without the crutches after the third week, however, here is a suggestion and he said this is ok, try using one crutch or a cane. You have to walk even if you gimp to strengthen yourself up again. I'm exactly the same height and weight as you so I understand. Your right it does improve daily, and I still feel some pain, but its a healing pain. As far as not being strong enough for the crutches, I got tired very quickly. But I also had to adjust mine, they try initially, but it was not quite right, make yourself comfortable, but like Brian said, you should really loose the crutches.

Re: Yes, all two probably felt a little better :*)

BrianG on 1/17/02 at 22:39 (070347)

Elliott, I think this is probably about as close to agreeing on this subject that we will get!

BCG