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EPF surgery

Posted by tam on 5/13/02 at 20:30 (083757)

I had EPF surgery March 1 2002 and I am beginning to wonder if I did the right thing. Had PF in both feet for around 5 years. Tried stretching, night splints, cort. shots, yoga (helped the most)et al. Doctor led me to believe I would be up and around in no time. 2 and half months later and foot hurts much worse than it did prior to surgery. (sharp pain in heel where fascia connects and pain in outside edge of foot and dull numb feeling in heel pad.) Is this common. How long to heal. My doc. never undertood why I had problem to begin with. Now he is still perplexed. Any other chronic sufferers out there?I also have heel spurs in both feet despite removal of one a few years ago. I hate being such a complainer but I am getting extremely worried.

Re: Opps, another EPF failure!

BrianG on 5/13/02 at 22:12 (083773)

Hi Tam,

Just scroll back, or use the search feature. There are many people here with failed EPF's. And like you, our doctors would like us to believe we are the only one's that are not healing, and they can't undrstand it. I would keep very good records of everything you do concerning this procedure. It could help someday. You are not alone !!!

BrianG

Re: EPF surgery

Julie on 5/14/02 at 02:18 (083780)

Tam, as Brian says, EPF is often unsuccessful. The doctors who help us here are pretty much not in favour of it, and prefer techniques that allow them to see what they are doing. To all surgery, they mostly prefer ESWT.

The mistake almost everyone makes concerning EPF and other endoscopic surgeries, (even the doctors who perform these procedures, apparently) is that because there is no cutting, there is no damage. This simply isn't. When an instrument is digging around inside you, for whatever reason, there is going to be irritation and damage to tissues, and it is going to take time for them to heal. I had endoscopic surgery on my knee (partial removal of cartilage) some years ago, and although the surgery itself was almost painless and I no pain in normal activity afterwards, it was a year before I could kneel (fully flex my knees). I teach yoga, so that was a bit of a disadvantage!

I don't think your doctor should have led you to believe you'd be up and about in no time. But having said all that, two and a half months is very little time, and you may still find that you are ok in the end. Be patient, and cut back walking, standing, and other weight-bearing activities. And it would be a good idea, I think, to consult another doctor - a podiatrist trained in foot and ankle surgery. Where do you live?

Re: EPF surgery - PS

Julie on 5/14/02 at 02:33 (083786)

That was supposed to read 'This simply isn't the case'. (That there is no damage.)

Re: EPF surgery

Karen G. on 5/14/02 at 12:13 (083841)

I had PF and TTS surgery on my left foot on March 4th,2002...open procedure.
I still get severe pain when I try to be on my feet a lot. I too have tried everything. I had been advised that it could take up to 4 months to heal.

I go to PT twice a week. I don't limp as much but I can sure get that same old pain going when I try to do too much. I hope it's from the surgical assult and not a return of the presurgery condition.

I have the same thing in my right foot and it is getting worse by the day. I wish the ESWT was covered by insurance. I'd try it in a minute if it was!

Good Luck!

Re: EPF surgery

BrianG on 5/14/02 at 21:38 (083939)

Hi Julie,

Just a small correction, there is cutting with the EPF, just not as much as with the open surgery. The go in from the side, cutting in, half way through your heel. They then use a small camera / scope to try and visualize the PF band. Another cutting tool is then stuck in there, and it is pre-set as to how much of the fascia is cut. Hopefully it's enough, most of the time it isn't. The newer kits use the one portal cut. When I had mine done 2.5 years ago, it was two portal. They cut half way through my heel, from both sides. Yep, now I had a cut that went clear through my heel!!! The cut part of the fascia, and scraped out a little scar tissue type 'stuff'. No wonder it hurt like hell for weeks, and took months to heal. And they have the nerve to say you'll be back in your athletic shoes in less than a week, with very little pain, BS !!!!

BrianG

Re: EPF surgery

john h on 5/14/02 at 22:09 (083953)

Karen: I think it is generally accepted that it can take a year for the PF surgery to completely heal after surgery. Way to early to make a judgement.

Re: EPF surgery

john h on 5/14/02 at 22:12 (083956)

Also there are reported cases of nerve damage as the scope goes in.

Re: EPF surgery

Julie on 5/15/02 at 00:05 (083975)

Hi Brian

Wow. That sounds like an awful lot of cutting for an endoscopic surgery, and no wonder it took months to heal. From all I've heard here about this procedure (much of it from your unfortunate experience) it sounds like something that ought soon to be wholly discredited.

I have been following your history for a long time now and would like to say that I am praying for ESWT to be the answer for you. You've been so patient with so much pain for so long, and yet still manage to give good information and counsel to so many.

Bless you.

Re: EPF surgery should probably be banned !!

BrianG on 5/15/02 at 13:37 (084037)

Thanks Julie, I hate being one the regulars, believe me. I'd much rather be off fishing, hiking, working, all the good old stuff. But, since I can't, I don't mind sharing what I've learned. The internet has been an invaluable tool for me. Without it, I'd have gone crazy by now, or at least become an alcoholic :*) There is so much information out there, that sometimes I actually think I know more than my doctors, NOT!!!!!! hahaaaa

I personally think the EPF method should be looked at by the surgeon's who are performing it. They should be honest with themselves, looking at the actual results, and either figure out how to ensure the procedure works most of the time, or just do away with it. Unfortunatly it probably won't happen, too many doctors are making good money performing it, and no one is actually compiling results, either positive, or negative. I would bet my last dollar the results are not any where near what we are being told!

Wow, didn't know it was going to be a 'soap box' day :*)
BrianG

PS: The insertional pain from the ESWT treatment is just about gone. Now is the time to begin some healing!!!

Re: Opps, another EPF failure!

Ed Davis, DPM on 5/16/02 at 16:05 (084185)

One of the problems with EPF is that it hit the medical 'market' with a lot of hype--- implying a great new high tech procedure with minimal disability. That is one of the reasons why many of us stood away from it.
It was oversold and abused in the sense that all appropriate conservative treatments were not being done before considering EPF. Surgery is not something to be 'sold' (usually). The selling of EPF, in my opinion, obscured the consequences of cutting the plantar fascia. One is sacrificing a supportive structure-- a procedure of last resort.
Ed

Re: EPF surgery should probably be banned !!

Ed Davis, DPM on 5/16/02 at 16:10 (084186)

The implication that two portal endoscopic surgery is less traumatic than other methods is questionable.

The amount of fascia to cut is still being debated so one cannot be sure that that is the issue in your surgery. Some, like Baxter, cut even less of the fascia. I generally favor a complete release of the fascia from the calcaneal tuberosity and prefer the minimal incision technique.
Ed

Re: EPF surgery should probably be banned !!

DR Zuckerman on 5/16/02 at 17:03 (084198)

Hi

Just to point out different methods of cutting the fascia. I do the mis release with miminial cutting of the fascia. I only do this after al treatments including ESWT. It is my opinion that someday ESWT will do done in all cases before any type of release

The amount of release is a professional opinion. There have been many many EPF procedures done sucessfully but we must consider the worse case situation and with EPF and any type of pf release it can be terrible

Re: EPF surgery

tam on 5/16/02 at 21:42 (084235)

Thanks for your comments. I live in Baltimore area.

Re: EPF surgery

john h on 5/17/02 at 09:11 (084287)

Dr. Z and another Doctor explained to me that the actual cutting of the fascia is done much by 'feel' rather than visually seenig the fascia. I assume they dorsiflex the foot which makes the fascia protrude out and they can feel which bands they are cutting. Is this right or wrong Dr. Z?

Re: EPF surgery should probably be banned !!

john h on 5/17/02 at 09:17 (084288)

A Podiatrist from the largest clinc in our state told me that EPF was very much a selling tool. You could tell a patient just one or two small incisions, they would walk out, and be back to normal activities in a short time. One doctor actually told me that. Most Podiatrist in our area have dropped EPF entirely for MIS. I do not think I have heard of an Orthopedic Surgeon who does EPF. As a matter of fact we have a couple of foodt and ankle surgeons at our University Teaching Hospital who will not do a fascia release under any circumstances. It would interesting to see some actual data on EPF as to its success and failure rates.

Re: Opps, another EPF failure!

john h on 5/17/02 at 09:23 (084289)

A good take on EPF Dr. Ed---

Some of the the same hype is now taking place with scope surgery on the back. We had some heavy advertising in our paper from a Florida clinc who would be in town to conduct a seminar on both low back and thoracic endoscopic surgery with a laser (another magic word for the public). People were encourgaged to bring their MRI's to the seminar where they would be read on the spot. They claim you have surgery and go out to dinner that night. They may be reputable but you have to wonder. Their website is http://www.bonati.com

Re: EPF surgery

DR Zuckerman on 5/17/02 at 13:47 (084320)

Hi

John that is exactly how I do it. I am so sure with the EPF procedure. I saw an EPF once and they were all eyes on the video screen that shows the plantar fascia

Re: Opps, another EPF failure!

Pamela S on 5/17/02 at 14:00 (084325)

Actually, Bonati is very well known (and reputable) for endoscopic back surgery. It beats a discectomy (if you're stuck getting one). I had a discectomy/laminectomy in 1990 for horrible left leg sciatica. The disk semi-recovered, and then collapsed in 1999. After 2.5 years of horrible pain, I paid out of pocket and went to Germany (Alpha Klinik) and had a prosthetic disk implanted last June. Alpha Klinik also does endoscopic discectomies, like Bonati. I've been off of pain killers since, and despite the big debt I have, I am very glad I did what I did.

One can compare this to my philosophy with PF - I have had it for 3 years, and I consider myself 99.999% cured. I used stretches, ART, new orthotics (I had orthotics before PF, but after many years of use they developed a case of 'fallen arches'!), personal foot trainers, self-massage, golf ball massage, tennis ball massage. I can now stand at work all day without any pain whatsoever, I go to the gym regularly (elyptical trainer) without problems, and I do calf raises regularly. I'll consider myself cured when I can Scottish dance for hours at a time completely without pain, and I'll be testing that this fall.

At 9 months, I would *not* be looking at PF surgery - I'd be looking at aggressive conservative care.

Re: EPF surgery should probably be banned !!

J. King on 5/17/02 at 18:14 (084367)

I never knew had tricky a fascia release was until I came on this board. I was all set for surgery about a year ago and I backed out. Now I am glad I did but if the doctors nurse had have been more cooperative I would have done the release. Constant pain and disability will drive a person to make rash choices.

Re: EPF surgery should probably be banned !!

Ed Davis, DPM on 5/17/02 at 20:52 (084396)

A friend of mine in Louisiana is performing plantar fascial releases in the arch area--- sometimes called the 'arch procedure.' He described several failed EPF patients whom he successfully resolved with this procedure. He feels that those patients had medial fibers that were missed with EPF. Since the fibers converge as they course distally in the thick central band, he feels he is obtaining a complete release with the new procedure.
Ed

Re: Opps, another EPF failure!

john h on 5/19/02 at 12:13 (084581)

Pamaela: Thanks for your take on the Bonati Institute. I always get worried when I see Doctors traveling around the nations giving seminars and soliciting patients from state to state. I guess in this Brave New World that is the way you do it. Certainly any surgery on the back where they do not cut through the large muscles sounds better than the traditional disectomy but I have not seen any data on these procedures.

Re: Opps, another EPF failure!

Pamela S on 5/20/02 at 15:27 (084690)

You can check out http://www.alphaklinik.com for their discussion on endoscopic nucleotomy. Bonati has a site as well; you'll have to search.

Re: Opps, another EPF failure!

BrianG on 5/13/02 at 22:12 (083773)

Hi Tam,

Just scroll back, or use the search feature. There are many people here with failed EPF's. And like you, our doctors would like us to believe we are the only one's that are not healing, and they can't undrstand it. I would keep very good records of everything you do concerning this procedure. It could help someday. You are not alone !!!

BrianG

Re: EPF surgery

Julie on 5/14/02 at 02:18 (083780)

Tam, as Brian says, EPF is often unsuccessful. The doctors who help us here are pretty much not in favour of it, and prefer techniques that allow them to see what they are doing. To all surgery, they mostly prefer ESWT.

The mistake almost everyone makes concerning EPF and other endoscopic surgeries, (even the doctors who perform these procedures, apparently) is that because there is no cutting, there is no damage. This simply isn't. When an instrument is digging around inside you, for whatever reason, there is going to be irritation and damage to tissues, and it is going to take time for them to heal. I had endoscopic surgery on my knee (partial removal of cartilage) some years ago, and although the surgery itself was almost painless and I no pain in normal activity afterwards, it was a year before I could kneel (fully flex my knees). I teach yoga, so that was a bit of a disadvantage!

I don't think your doctor should have led you to believe you'd be up and about in no time. But having said all that, two and a half months is very little time, and you may still find that you are ok in the end. Be patient, and cut back walking, standing, and other weight-bearing activities. And it would be a good idea, I think, to consult another doctor - a podiatrist trained in foot and ankle surgery. Where do you live?

Re: EPF surgery - PS

Julie on 5/14/02 at 02:33 (083786)

That was supposed to read 'This simply isn't the case'. (That there is no damage.)

Re: EPF surgery

Karen G. on 5/14/02 at 12:13 (083841)

I had PF and TTS surgery on my left foot on March 4th,2002...open procedure.
I still get severe pain when I try to be on my feet a lot. I too have tried everything. I had been advised that it could take up to 4 months to heal.

I go to PT twice a week. I don't limp as much but I can sure get that same old pain going when I try to do too much. I hope it's from the surgical assult and not a return of the presurgery condition.

I have the same thing in my right foot and it is getting worse by the day. I wish the ESWT was covered by insurance. I'd try it in a minute if it was!

Good Luck!

Re: EPF surgery

BrianG on 5/14/02 at 21:38 (083939)

Hi Julie,

Just a small correction, there is cutting with the EPF, just not as much as with the open surgery. The go in from the side, cutting in, half way through your heel. They then use a small camera / scope to try and visualize the PF band. Another cutting tool is then stuck in there, and it is pre-set as to how much of the fascia is cut. Hopefully it's enough, most of the time it isn't. The newer kits use the one portal cut. When I had mine done 2.5 years ago, it was two portal. They cut half way through my heel, from both sides. Yep, now I had a cut that went clear through my heel!!! The cut part of the fascia, and scraped out a little scar tissue type 'stuff'. No wonder it hurt like hell for weeks, and took months to heal. And they have the nerve to say you'll be back in your athletic shoes in less than a week, with very little pain, BS !!!!

BrianG

Re: EPF surgery

john h on 5/14/02 at 22:09 (083953)

Karen: I think it is generally accepted that it can take a year for the PF surgery to completely heal after surgery. Way to early to make a judgement.

Re: EPF surgery

john h on 5/14/02 at 22:12 (083956)

Also there are reported cases of nerve damage as the scope goes in.

Re: EPF surgery

Julie on 5/15/02 at 00:05 (083975)

Hi Brian

Wow. That sounds like an awful lot of cutting for an endoscopic surgery, and no wonder it took months to heal. From all I've heard here about this procedure (much of it from your unfortunate experience) it sounds like something that ought soon to be wholly discredited.

I have been following your history for a long time now and would like to say that I am praying for ESWT to be the answer for you. You've been so patient with so much pain for so long, and yet still manage to give good information and counsel to so many.

Bless you.

Re: EPF surgery should probably be banned !!

BrianG on 5/15/02 at 13:37 (084037)

Thanks Julie, I hate being one the regulars, believe me. I'd much rather be off fishing, hiking, working, all the good old stuff. But, since I can't, I don't mind sharing what I've learned. The internet has been an invaluable tool for me. Without it, I'd have gone crazy by now, or at least become an alcoholic :*) There is so much information out there, that sometimes I actually think I know more than my doctors, NOT!!!!!! hahaaaa

I personally think the EPF method should be looked at by the surgeon's who are performing it. They should be honest with themselves, looking at the actual results, and either figure out how to ensure the procedure works most of the time, or just do away with it. Unfortunatly it probably won't happen, too many doctors are making good money performing it, and no one is actually compiling results, either positive, or negative. I would bet my last dollar the results are not any where near what we are being told!

Wow, didn't know it was going to be a 'soap box' day :*)
BrianG

PS: The insertional pain from the ESWT treatment is just about gone. Now is the time to begin some healing!!!

Re: Opps, another EPF failure!

Ed Davis, DPM on 5/16/02 at 16:05 (084185)

One of the problems with EPF is that it hit the medical 'market' with a lot of hype--- implying a great new high tech procedure with minimal disability. That is one of the reasons why many of us stood away from it.
It was oversold and abused in the sense that all appropriate conservative treatments were not being done before considering EPF. Surgery is not something to be 'sold' (usually). The selling of EPF, in my opinion, obscured the consequences of cutting the plantar fascia. One is sacrificing a supportive structure-- a procedure of last resort.
Ed

Re: EPF surgery should probably be banned !!

Ed Davis, DPM on 5/16/02 at 16:10 (084186)

The implication that two portal endoscopic surgery is less traumatic than other methods is questionable.

The amount of fascia to cut is still being debated so one cannot be sure that that is the issue in your surgery. Some, like Baxter, cut even less of the fascia. I generally favor a complete release of the fascia from the calcaneal tuberosity and prefer the minimal incision technique.
Ed

Re: EPF surgery should probably be banned !!

DR Zuckerman on 5/16/02 at 17:03 (084198)

Hi

Just to point out different methods of cutting the fascia. I do the mis release with miminial cutting of the fascia. I only do this after al treatments including ESWT. It is my opinion that someday ESWT will do done in all cases before any type of release

The amount of release is a professional opinion. There have been many many EPF procedures done sucessfully but we must consider the worse case situation and with EPF and any type of pf release it can be terrible

Re: EPF surgery

tam on 5/16/02 at 21:42 (084235)

Thanks for your comments. I live in Baltimore area.

Re: EPF surgery

john h on 5/17/02 at 09:11 (084287)

Dr. Z and another Doctor explained to me that the actual cutting of the fascia is done much by 'feel' rather than visually seenig the fascia. I assume they dorsiflex the foot which makes the fascia protrude out and they can feel which bands they are cutting. Is this right or wrong Dr. Z?

Re: EPF surgery should probably be banned !!

john h on 5/17/02 at 09:17 (084288)

A Podiatrist from the largest clinc in our state told me that EPF was very much a selling tool. You could tell a patient just one or two small incisions, they would walk out, and be back to normal activities in a short time. One doctor actually told me that. Most Podiatrist in our area have dropped EPF entirely for MIS. I do not think I have heard of an Orthopedic Surgeon who does EPF. As a matter of fact we have a couple of foodt and ankle surgeons at our University Teaching Hospital who will not do a fascia release under any circumstances. It would interesting to see some actual data on EPF as to its success and failure rates.

Re: Opps, another EPF failure!

john h on 5/17/02 at 09:23 (084289)

A good take on EPF Dr. Ed---

Some of the the same hype is now taking place with scope surgery on the back. We had some heavy advertising in our paper from a Florida clinc who would be in town to conduct a seminar on both low back and thoracic endoscopic surgery with a laser (another magic word for the public). People were encourgaged to bring their MRI's to the seminar where they would be read on the spot. They claim you have surgery and go out to dinner that night. They may be reputable but you have to wonder. Their website is http://www.bonati.com

Re: EPF surgery

DR Zuckerman on 5/17/02 at 13:47 (084320)

Hi

John that is exactly how I do it. I am so sure with the EPF procedure. I saw an EPF once and they were all eyes on the video screen that shows the plantar fascia

Re: Opps, another EPF failure!

Pamela S on 5/17/02 at 14:00 (084325)

Actually, Bonati is very well known (and reputable) for endoscopic back surgery. It beats a discectomy (if you're stuck getting one). I had a discectomy/laminectomy in 1990 for horrible left leg sciatica. The disk semi-recovered, and then collapsed in 1999. After 2.5 years of horrible pain, I paid out of pocket and went to Germany (Alpha Klinik) and had a prosthetic disk implanted last June. Alpha Klinik also does endoscopic discectomies, like Bonati. I've been off of pain killers since, and despite the big debt I have, I am very glad I did what I did.

One can compare this to my philosophy with PF - I have had it for 3 years, and I consider myself 99.999% cured. I used stretches, ART, new orthotics (I had orthotics before PF, but after many years of use they developed a case of 'fallen arches'!), personal foot trainers, self-massage, golf ball massage, tennis ball massage. I can now stand at work all day without any pain whatsoever, I go to the gym regularly (elyptical trainer) without problems, and I do calf raises regularly. I'll consider myself cured when I can Scottish dance for hours at a time completely without pain, and I'll be testing that this fall.

At 9 months, I would *not* be looking at PF surgery - I'd be looking at aggressive conservative care.

Re: EPF surgery should probably be banned !!

J. King on 5/17/02 at 18:14 (084367)

I never knew had tricky a fascia release was until I came on this board. I was all set for surgery about a year ago and I backed out. Now I am glad I did but if the doctors nurse had have been more cooperative I would have done the release. Constant pain and disability will drive a person to make rash choices.

Re: EPF surgery should probably be banned !!

Ed Davis, DPM on 5/17/02 at 20:52 (084396)

A friend of mine in Louisiana is performing plantar fascial releases in the arch area--- sometimes called the 'arch procedure.' He described several failed EPF patients whom he successfully resolved with this procedure. He feels that those patients had medial fibers that were missed with EPF. Since the fibers converge as they course distally in the thick central band, he feels he is obtaining a complete release with the new procedure.
Ed

Re: Opps, another EPF failure!

john h on 5/19/02 at 12:13 (084581)

Pamaela: Thanks for your take on the Bonati Institute. I always get worried when I see Doctors traveling around the nations giving seminars and soliciting patients from state to state. I guess in this Brave New World that is the way you do it. Certainly any surgery on the back where they do not cut through the large muscles sounds better than the traditional disectomy but I have not seen any data on these procedures.

Re: Opps, another EPF failure!

Pamela S on 5/20/02 at 15:27 (084690)

You can check out http://www.alphaklinik.com for their discussion on endoscopic nucleotomy. Bonati has a site as well; you'll have to search.