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What are my options?

Posted by Nancy on 3/06/02 at 17:40 (075859)

I've had plantar fasciitis since 1993. I've had cortisone injections, anti-inflammatory meds, and just finished physical therapy including steroid medication put directly on the fascia transmitted by some electrical thing on my leg. I'm still in so much pain I can barely stand it. The podiatrist recommends surgery. I read an article on Medline that said the shock wave therapy is most effective for people with calcium deposits. My podiatrist says the nerve (Baxter's nerve) is involved which is why I'm not getting any relief from any treatment. Is surgery the only way to go with this? I'm going to get another xray (the first one got lost) to see if I have calcium deposits. Am I a candidate for the shock wave therapy or is surgery it? I'm scared and sick of having my goal for the day be to see how long I can go before taking a pain pill. Thanks.

Re: What are my options?

DR Zuckerman on 3/06/02 at 21:35 (075880)

Hi

If your first branch of the lateral plantar nerve ( Baxter's nerve ) is involved then ESWT isn't going to do the job. Physical examination is the best way to rule out the nerve problem. A placement of anesthetic in the area where the nerve is located is an excellent method to rule out baxter's nerve entrapement

Re: This is a good temporary solution

BrianG on 3/08/02 at 22:20 (076004)

Hi Nancy,

Another option for you is to take more pain pills. Why are you holding back until you are in agony before taking another pill? It is a poor way to manage your pain. It's best to keep some of the medication in your system at all times, when you need it. You can do this by taking them on a regular schedule. Why don't you talk to your doctor about this. There are many people who need pain medication when the pain gets this bad, why suffer?????

BrianG

Re: What are my options?

Ed Davis, DPM on 3/13/02 at 21:33 (076390)

I am not sure that the anesthetic can be placed with sufficient precision to definitely rule out or rule in involvement of Baxter's nerve. What is your experience?

I feel that the issue of Baxter's nerve is still a theory in need of further evidence of that being an actual culprit. I would need more convincing of the nerve actually being the culprit before moving away from ESWT.
Ed

Re: What are my options?

john h on 4/11/02 at 10:37 (079222)

Nancy: From all I have read about ESWT (I have had several treatments) nowhere have I heard that it is more effective if you have calcium deposits. The method that ESWT supposedly heals is to damage the tissue in the area where you have pain. In the process of healing new blood supply is sent to the area for better healing and pain is further reduced further by some effect that ESWT has on the pain receptors in that area. The procedure is relatively painless, non invasive, and with few side effects. It normally takes from 6 weeks to 12 weeks to achieve your maximum results. During that period you can continue with your normal activites other than overdoing exercising,etc.

Your doctor mentioned a possible problem with the Baxter Nerve. This nerve is named after Dr. Baxter from Houston who is a well known Orthopedic Surgeon. He developed a procedure which is consdered a PF release called the Baxter Procedure. Not many doctors have been trained in this procedure and probably nearly all would be an Orthopedic Foot and Ankle Surgeon. In this procedure a very small semi-circular (about 1/2'_ section of fascia is removed from directly over the Baxter Nerve where the fascia attaches to the heel. His thinking is this takes the pressure off of the Baxter Nerve. With this procedure probably no more than 10% of the fascia is released and there is little chance of loss of foot stability. The procedure is about a 25 minute procedure and you walk out in a surgical shoe and with a very small incision. As I stated not many surgeons are trained in this procedure. There were two in Little Rock who trained under Dr. Baxter who still practices in Houston. He is referenced in the Wheeless Book of Orthopedics which is sort of the bible for Orthopedic Surgeons.

Re: This is a good temporary solution

john h on 4/11/02 at 10:48 (079225)

Brian: I am with you in that if you can control your pain with meds then why suffer. The past few years even the medical community is coming to realize that to many people go through life suffering rather than taking pain reducing meds. No shame in this. people who are in pain are much less subject to addiction as someone not in great pain. If you had severe arthritis, diabetes, aids, or some forms of cancer you would be on meds for perhaps the rest of your life and not think a thing about it.

Re: What are my options?

john h on 4/11/02 at 11:20 (079233)

Dr. Ed: I think my Orthopedic Foot and Ankle Surgeon (Board Certified) to be very straight forward. He put me through the electrcal test for nerve entrapment and all the other little test. He said in the final analysis the only way you really know is to look. My test indicated some mild degree of nerve entrapment but my Doc says that is not unusual. When he performed the Baxter Procedure he said it was entirely up to me if I wanted him to explore the tarsal tunnel and follow the nerve on down. I did not make my decision unitl I was rolling into surgery when I told him to go ahead a look see. All he found was a small vericose vein which he removed but said it was unlikely to cause my foot pain. Yes I agree that the Baxter nerve being the culprit is still theory but in realty probaly is in some cases and not in others. A thought that occurs to me is that when I got an cortisone injection I was pain free for five days. Would that rule out the Baxter Nerve or would the injection have placed the cortisone around the Baxter Nerve as well as the fascia?

Re: What are my options?

DR Zuckerman on 3/06/02 at 21:35 (075880)

Hi

If your first branch of the lateral plantar nerve ( Baxter's nerve ) is involved then ESWT isn't going to do the job. Physical examination is the best way to rule out the nerve problem. A placement of anesthetic in the area where the nerve is located is an excellent method to rule out baxter's nerve entrapement

Re: This is a good temporary solution

BrianG on 3/08/02 at 22:20 (076004)

Hi Nancy,

Another option for you is to take more pain pills. Why are you holding back until you are in agony before taking another pill? It is a poor way to manage your pain. It's best to keep some of the medication in your system at all times, when you need it. You can do this by taking them on a regular schedule. Why don't you talk to your doctor about this. There are many people who need pain medication when the pain gets this bad, why suffer?????

BrianG

Re: What are my options?

Ed Davis, DPM on 3/13/02 at 21:33 (076390)

I am not sure that the anesthetic can be placed with sufficient precision to definitely rule out or rule in involvement of Baxter's nerve. What is your experience?

I feel that the issue of Baxter's nerve is still a theory in need of further evidence of that being an actual culprit. I would need more convincing of the nerve actually being the culprit before moving away from ESWT.
Ed

Re: What are my options?

john h on 4/11/02 at 10:37 (079222)

Nancy: From all I have read about ESWT (I have had several treatments) nowhere have I heard that it is more effective if you have calcium deposits. The method that ESWT supposedly heals is to damage the tissue in the area where you have pain. In the process of healing new blood supply is sent to the area for better healing and pain is further reduced further by some effect that ESWT has on the pain receptors in that area. The procedure is relatively painless, non invasive, and with few side effects. It normally takes from 6 weeks to 12 weeks to achieve your maximum results. During that period you can continue with your normal activites other than overdoing exercising,etc.

Your doctor mentioned a possible problem with the Baxter Nerve. This nerve is named after Dr. Baxter from Houston who is a well known Orthopedic Surgeon. He developed a procedure which is consdered a PF release called the Baxter Procedure. Not many doctors have been trained in this procedure and probably nearly all would be an Orthopedic Foot and Ankle Surgeon. In this procedure a very small semi-circular (about 1/2'_ section of fascia is removed from directly over the Baxter Nerve where the fascia attaches to the heel. His thinking is this takes the pressure off of the Baxter Nerve. With this procedure probably no more than 10% of the fascia is released and there is little chance of loss of foot stability. The procedure is about a 25 minute procedure and you walk out in a surgical shoe and with a very small incision. As I stated not many surgeons are trained in this procedure. There were two in Little Rock who trained under Dr. Baxter who still practices in Houston. He is referenced in the Wheeless Book of Orthopedics which is sort of the bible for Orthopedic Surgeons.

Re: This is a good temporary solution

john h on 4/11/02 at 10:48 (079225)

Brian: I am with you in that if you can control your pain with meds then why suffer. The past few years even the medical community is coming to realize that to many people go through life suffering rather than taking pain reducing meds. No shame in this. people who are in pain are much less subject to addiction as someone not in great pain. If you had severe arthritis, diabetes, aids, or some forms of cancer you would be on meds for perhaps the rest of your life and not think a thing about it.

Re: What are my options?

john h on 4/11/02 at 11:20 (079233)

Dr. Ed: I think my Orthopedic Foot and Ankle Surgeon (Board Certified) to be very straight forward. He put me through the electrcal test for nerve entrapment and all the other little test. He said in the final analysis the only way you really know is to look. My test indicated some mild degree of nerve entrapment but my Doc says that is not unusual. When he performed the Baxter Procedure he said it was entirely up to me if I wanted him to explore the tarsal tunnel and follow the nerve on down. I did not make my decision unitl I was rolling into surgery when I told him to go ahead a look see. All he found was a small vericose vein which he removed but said it was unlikely to cause my foot pain. Yes I agree that the Baxter nerve being the culprit is still theory but in realty probaly is in some cases and not in others. A thought that occurs to me is that when I got an cortisone injection I was pain free for five days. Would that rule out the Baxter Nerve or would the injection have placed the cortisone around the Baxter Nerve as well as the fascia?