Home The Book Dr Articles Products Message Boards Journal Articles Search Our Surveys Surgery ESWT Dr Messages Find Good Drs video

Surgery Decision ??

Posted by Gregory E Sturm on 2/10/02 at 16:17 (073276)

Hello and Thank You for answering my questions.

I have had foot pain(plantar fasciitis) for probably 15 years in varying degrees, but it has been getting persistantly worse. I'm a machinist/technician and am on my feet on concrete for 95% of an 8hr day and have been for 30 yrs. (51yrs old)

I have been seeing a podiatrist for over a yr now and we have exhausted all of the normal treatments: custom orthodics, stretching, exercises, ice, night splint ice boot and cortizone shot. All have helped slightly, but pain persists and is getting worse. I worked an extra night shift which put me out on the floor for a 13 hour day, two days a week for 4 months and it was a killer on my heels. A new pain evolved on the worst foot coming from the second to the little toe back causing a serious limp.
The podiatrist said it was from favoring the heels. He suggested shock wave treatments but area insurances have not yet approved. So we discussed EPF, endoscopic surgery.

I went for a second opinion to an orthopedic surgeon and when told of the extra foot pain he immediately took x-rays and discovered I had a stress fracture in just the bone I described. He is sugesting open surgery to release the fascia and he also cuts or removes a nerve that comes down from the ankle that may be entrapped to relieve pain. I seem to have more confidence in this man and methods but am not sure what to do.

I would appreciate a third e-mail opinion, realizing that it is based soley on what little information I have given you.

Thank You for your help and advice.
From a real 'pain in the heel'

Greg Sturm

Re: Surgery Decision ??

Dr. Zuckerman on 2/10/02 at 16:26 (073280)

Hi

My first choice would be ESWT, whether insurance covered it or not. With surgery you can have up to six months of time for healing. With surgery there are complications such as nerve damage, more pain then you started with, these are rare but can and do happen. If you must pick surgery I would go with the miminial incision surgery. Why does the orthopedic surgery want to release the posterior nerve. This is another surgery and will add more healing. Either way you better plan on alot of time off from work. The stress fracture as you know is from the extra weight being placed on the metatarsal bones from the heel pain.

Is your orthopedic surgery cutting the lateral plantar nerve or releasing the posterior tibial nerve?

Re: Surgery Decision ??

John k on 2/10/02 at 16:50 (073288)

Dr. Zuckerman

I have tremendous foot pain in both arches. This has been on and off for 16 years. Now I cannot walk two blocks without pain. What the hell do I do.

Re: Surgery Decision ??

Dr. Zuckerman on 2/10/02 at 17:19 (073291)

So what has been done so far for this problem. Seen any doctors. What did they say to you

Re: Surgery Decision ??

John k on 2/10/02 at 17:46 (073294)

I have seen a number of podiatrists and orthopedic surgeons. The diagnosis is PF and possible TTS. The case was accepted by worker's comp. and surgery was authorized, but I became nervous with the doctor's zeal for the knife. I had nerve conductivity studies done and they confirm some nerve entrapment, but I know this surgery is iffy at best. I am really suffering with this thing. Everytime I read about a bad outcome I think that if I was anymore disabled I would be confined to a wheelchair. I have other orthopedic problems and this is scary to me. Thanks for the response! I watched your video. Do you know Dr. Martin Port in Tampa,Fl.?

Re: Surgery Decision ??

Dr. Zuckerman on 2/10/02 at 16:26 (073280)

Hi

My first choice would be ESWT, whether insurance covered it or not. With surgery you can have up to six months of time for healing. With surgery there are complications such as nerve damage, more pain then you started with, these are rare but can and do happen. If you must pick surgery I would go with the miminial incision surgery. Why does the orthopedic surgery want to release the posterior nerve. This is another surgery and will add more healing. Either way you better plan on alot of time off from work. The stress fracture as you know is from the extra weight being placed on the metatarsal bones from the heel pain.

Is your orthopedic surgery cutting the lateral plantar nerve or releasing the posterior tibial nerve?

Re: Surgery Decision ??

John k on 2/10/02 at 16:50 (073288)

Dr. Zuckerman

I have tremendous foot pain in both arches. This has been on and off for 16 years. Now I cannot walk two blocks without pain. What the hell do I do.

Re: Surgery Decision ??

Dr. Zuckerman on 2/10/02 at 17:19 (073291)

So what has been done so far for this problem. Seen any doctors. What did they say to you

Re: Surgery Decision ??

John k on 2/10/02 at 17:46 (073294)

I have seen a number of podiatrists and orthopedic surgeons. The diagnosis is PF and possible TTS. The case was accepted by worker's comp. and surgery was authorized, but I became nervous with the doctor's zeal for the knife. I had nerve conductivity studies done and they confirm some nerve entrapment, but I know this surgery is iffy at best. I am really suffering with this thing. Everytime I read about a bad outcome I think that if I was anymore disabled I would be confined to a wheelchair. I have other orthopedic problems and this is scary to me. Thanks for the response! I watched your video. Do you know Dr. Martin Port in Tampa,Fl.?