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Suggestions on surgery,...why should I wait any longer?

Posted by Christine F on 5/14/02 at 16:59 (083881)

I used to post on this board often (back in dec and jan) after seeing a second pod I got some orthodics that worked very well. I was still nnot able to run or do a lot of walking, but I wasn't in as much pain. The last 3 weeks I am gradually returning to how bad they were before, I am not back to crawling around the house or in a wheelchair, but the pain is getting worse and worse, I am getting an MRI next week, but other then that my 1st, 2nd, and 3rd pod have exhausted evry conservative measure in the last 9 months that I have been suffering from chronic bilateral p.f. I think I may do the open release surgery because as a used to be active 23year old more and more I feel as though I am 90. I can't even ride the stationary bike some days, and I think I may have to start taking days off of work again to sit in my house with my feet up. I do have jobs where they let me sit in a chair, but I feel like I am needing total rest,......again! Can anyone please tell me why I should wait any longer to get surgery? I know all about the 20% that come out worse or not better at all, but I just don't think I can wait this out anylonger, Aug will be a year. I am not a canidate for ESWT because my pain is all over my feet and most tender under the arch in my piano tight fascia. Any other suggestions or reasons why I should put this off anylonger? I know this will not heal with cont. streaching throughout the day, icing, night splints, ect...

Re: Suggestions on surgery,...why should I wait any longer?

J. King on 5/14/02 at 18:10 (083895)

That is a good question? I am 52 and have had PF for many years. If I was 23 I guess I would get the surgery since you have entire life ahead of you. If I was disabled as I am now at 23 I would be more apt to do something radical to help myself. However, I guess I would get a 2nd and 3rd opinion just in case.

Re: Suggestions on surgery,...why should I wait any longer?

SHIVELY9@PRODIGY.NET on 5/14/02 at 18:22 (083899)

hoW DID YOU GET DISABILITY?

Re: Suggestions on surgery,...why should I wait any longer?

BrianG on 5/14/02 at 18:36 (083902)

Hi Christine,

If you have the surgery, will you be able to take enough time off work, to heal properly? It could be up to 3 months, maybe more! If not, you could be setting yourself up for failure. Also, try to find the best doc you can afford. Ask around, in your area. Try to talk to patients that the doctor has cured. Ask him exactlly what to expect after the surgery. If he tells you not to worry, it'll be a piece of cake, keep looking. The EPF method is not working out that well, it seems. I'd look at open, minimal, or Baxter type. After the MRI, ask the doctor if you have TTS, you don't want a 2nd operation, just because they missed it the first time. Good luck

BrianG

PS What state do you live in, someone may be able to refer you to a good doc.

Re: Suggestions on surgery,...why should I wait any longer?

J. King on 5/14/02 at 19:46 (083914)

I was postal worker so I filed for workers compensation, disability retirement and social security disability. It took about 5 months and a lot of luck. Start building your case early.

Re: Suggestions on surgery,...why should I wait any longer?

adam p on 5/15/02 at 01:35 (083983)

I have a couple of reasons. You may suffer the im-
patience of youth. Were you able to rest your foot
for 9 months as opposed to doing other conservative
things for 9 months you might sing a completely
different tune.

You might be overstretching. Rest and hardly stretching
at all might be THE conservative thing to do.

The archive of posts to heelspur.com's message boards
and the other material on this site speak volumes.
I don't think you mentioned taping. Taping 'rests'
the pf too.

AP

Re: Suggestions on surgery,...why should I wait any longer?

Julie on 5/15/02 at 02:05 (083985)

Excellent advice, Adam. Christine, I hope you will think about it. I suspect that a great many people who post saying they have tried everything, all the conservative treatments, either haven't tried the right ones in the right combination, or haven't given them long enough to work.

I believe myself that overstretching is very common, and very counter-productive. I totally agree with Adam about rest, and hardly stretching. In fact, it's more useful to think in terms of strengthening the muscles that weaken through lack of use while resting, and that's an entirely different ball game.

Taping was a huge help to me. If you can't stay off your feet, as, for instance, Carole did for about two months (is that right, Carole?) with great results, then learn how to tape, and apply tape every day. I will be glad to help you if you have any problems with it (instructions are in part 2 of the heel pain book).

Give rest, taping, patience, and, possibly, another podiatrist, more time before you allow your foot to be cut. Many surgeries are successful, although we don't hear as much about them as about the failures, but - to turn your question around - why should you do something that may leave you worse off than you are now?

Re: Suggestions on surgery,...why should I wait any longer?

C Fuller on 5/15/02 at 09:17 (084003)

In the 9months that I have had this crippeling problem I have experimented with not streching as much, doing diferent streching, over streching, under streching, ect....... Right now the amount I am doing is the best for me, I feel so much better when I do strech. I have tried the taping many times, it doesn't really work that great for me, besides I don't want to live 60-70yrs of taping my feet everyday. I have tried countless combinations of streching, taping rest ect... I took 3 months of only working part time at a sit down job and basicly resting my feet everyday, that did help, but I wouln't qualify for disability, I wasn't working a job that I could quailify for workmans comp. If I did get surgery I would try to get unemployment to cover most of my bills, and I also have parents that would help out or even let me live in there now empty house because my brothers and I no longer there to help me out for a few months. I live in Colorado, Apsen to be exact, I am seeing my 3rd pod. and my 3rd opinion. They are all have been conservative docs, and the one I am seeing now is a specialist out of Vail, who after 9 months also thinks surgery my now be my only option. He would do the open procedure. I haven't discussed it with him in detail yet because I am waiting for the MRI, but he just did one on a gentleman 2 weeks ago (also on both feet) who is doing fine so far. And another woman who came in for her 5 week followup last week and she has never been so happy and pain free in 2 1/2 years. I want to feel like that. I understand the complications, but how can I go on like this?

Re: Suggestions on surgery,...why should I wait any longer?

Rick R on 5/15/02 at 13:10 (084036)

Christine,

As one who waited too long, I will offer a reason to wait. I was not much older than you, in my late 20's when I started the PF adventure. Surgery was my 40th birthday gift to myself. Don't wait that long!!! Ask yourself, how do you expect surgery to make you any better than you were to begin with? Until you find and understand the reason you have PF, I wouldn't have surgery. Be it lifestyle, bad shoes, flat feet, tight tendons or other anotomical idiosyncrasy, PF is the symptom. Surgery in my opinion addresses the symptom not necessarily the cause.

Best of luck,

Rick

Re: It's time to do some research

BrianG on 5/15/02 at 13:55 (084039)

Hi Christine,

Ask the doctor if you can speak with the person who was healed in 5 weeks. All doctors seem to have these stories. Why not talk to her and get the story right from her mouth. We want to be healed so badly, that we tend to believe anyhing the doctors tell us. I don't mean to sound like he isn't telling the truth, but I sure wish I'd talked to some of my doctor's other patients, before I let him cut me. This woman would be perfect, as he's already given you her story. Take the time to confirm it.

Good luck
BrianG

PS The only people I talked to at my doctors office, were people like myself, having a hard time healing.

Re: Suggestions on surgery,...why should I wait any longer?

adam p on 5/16/02 at 10:45 (084144)

To me 5 months let alone 5 weeks or two weeks is too short
a time to conclude something about the results/proficiency.

It seems I've heard that a person should not plan on losing
extra weight, safely, over less a period of time than they
gained that weight. So I would give conservative efforts
at least 9 months.

Last but not least, I've seen a '> 50%' figure on surgery
which, to be conservative, I would use as my benchmark.
AP

Re: Suggestions on surgery,...why should I wait any longer?

Christine F on 5/26/02 at 10:16 (085280)

Brian,...have you had surgery? Open Release? Tell me what happened? Also Adam, I don't need to loose weight, that has never been an issue for me. I was a very active 5ft7in 125lbs. although not being able to do much working out it does suck not being able to eat all I want now. I developed symptoms Aug,....so now it will have been 9 months, 8 months treating it.

Re: Suggestions on surgery,...why should I wait any longer?

Christine F on 5/26/02 at 10:17 (085281)

Rick,...what type of surgery did you have done, open release? How long ago was your surgery? How are you doing now?

Re: Suggestions on surgery,...why should I wait any longer?

BrianG on 5/26/02 at 20:28 (085319)

Hi Christine,

Yes, I had the Endoscopic release. It's supposedly a smaller cut, which takes practiclly no time to heal. It really bugs me that the doctors will always give you the best case scenerio. This was even after I told him I had a low tolerance to pain. He cut into both sides of my ankle, which made a hole clean thru it, (the ankle). He stuck the camera in, and cut what he could see. I had real bad pain for a week, and just plain bad pain for a month. It was abou 3 months before the pain from the operation finaly went away. At this time, my heel was absolutely no better, and I actually had more pain in my arch. I waited over 6 months to get a new pair of orthotics, which might have accounted for the additional arch pain. I feel lucky that I only had additional arch pain. Many people here developed different symptoms, TTS. They in turn then had to have an additional surgery, and not too many of them have been a success. I just hate to see anyone else join the group of failures we read about here. I'd do everything I could, to ensure you have the best doctor available. Good luck on which ever way you go.

BrianG

Re: Suggestions on surgery,...why should I wait any longer?

adam p on 5/26/02 at 22:17 (085328)

The factoid on weight loss was just to reinforce a message
of 'Patience'. You're nine months 'in' so I'd allow nine
months out. I'd look into using a cane and really giving
your body every chance to heal itself.

When you're older, nine months can fly by like nine weeks
does now. I'll never forget going back to my elementary
school as an adult. Those halls and desks had become
miniature.

AP

Re: Suggestions on surgery,...why should I wait any longer?

adam p on 5/26/02 at 23:15 (085330)

The factoid on weight loss was just to reinforce a message
of 'Patience'. You're nine months 'in' so I'd allow nine
months out. I'd look into using a cane and really giving
your body every chance to heal itself.

When you're older, nine months can fly by like nine weeks
does now. I'll never forget going back to my elementary
school as an adult. Those halls and desks had become
miniature.

AP

Re: Suggestions on surgery,...why should I wait any longer?

Brian on 5/31/02 at 22:07 (085966)

J king.. how did you start building your case early? Im a postal worker too and if this Pf doesnt get better I wil have to try to claim it as on the job.. as it is surely from working.

Re: Suggestions on surgery,...why should I wait any longer?

Joe S on 6/02/02 at 20:23 (086113)

If you've exhausted every conservative measure, then surgery is the next course. Surgery is successful in 85-90 percent of the time. Conservative management is also 85-90% siccessful. Most surgical failures are due lack of proper diagnosis. For example, you have a calcaneal stress fracture that has gone undiagnosed. Bone scan will show this. Also, lifestyle modifications after surgery also will help. Continue with the achilles tendon stretching. This is paramount. Open surgery is not as bad as you hear on this board. If you are suffering, then get the right diagnosis, and then proceed with the appropriate treatment plan.

Re: Suggestions on surgery,...why should I wait any longer?

DR Zuckerman on 6/03/02 at 21:23 (086202)

The problem with surgery is that when there is a problem you are in real trouble. Don't take surgery lightly. ESWT is a procedure that can't leave your foot in worse shape then before the procedure. Yes some do report 90% sucess for pf surgey but its the 10% cripples that we need to worry about.

Re: Suggestions on surgery,...why should I wait any longer?

Joe S on 6/03/02 at 23:18 (086213)

No surgery should be taken lightly. I am sure there will be complications with ESWT as well. It's still relatively new. it's a promising technology. Too bad insurance companies won't pay for it. However, I think you will agree, most failed surgeries are do to one of two different things. First, improper diagnosis. Not all heel pain is PF or 'Heel Spur Syndrome'. When this is the case ESWT will not work. Second, when an open release is performed, if the podiatrist or orthopedist who performs the surgery does not adequately release the medial 2/3 of the plantar fascia, the procedure is doomed to fail. Therefore, any person who truly has PF and has exhausted all forms of conservative therapy (orthotics, injections, NSAIDs, taping, casting, LOSING WEIGHT if they're obese) with little to no relief of the symptoms is now considered a surgical candidate. There is no benefit in removing the spur. There is no evidenced based clinical data that suggest that resection of the infracalcaneal spur is more beneficial than simply performing a plantar fasciotomy.

Re: Suggestions on surgery,...why should I wait any longer?

DR Zuckerman on 6/04/02 at 06:56 (086229)

ESWT is over ten year old and still no major complicatons have been reported. The cut of the plantar fascia is against all biomechanical princples . It is setting up future complications when you cut 1/3 or 2/3 or whatever. IF you have ever seen post op RSD from open plantar fascia release you would never want to do an open release. RSD has nothing do with improper diagnosis If you have ever seen an infection with the entire side of of the foot open with an open release.

Re: Suggestions on surgery,...why should I wait any longer?

J. King on 5/14/02 at 18:10 (083895)

That is a good question? I am 52 and have had PF for many years. If I was 23 I guess I would get the surgery since you have entire life ahead of you. If I was disabled as I am now at 23 I would be more apt to do something radical to help myself. However, I guess I would get a 2nd and 3rd opinion just in case.

Re: Suggestions on surgery,...why should I wait any longer?

SHIVELY9@PRODIGY.NET on 5/14/02 at 18:22 (083899)

hoW DID YOU GET DISABILITY?

Re: Suggestions on surgery,...why should I wait any longer?

BrianG on 5/14/02 at 18:36 (083902)

Hi Christine,

If you have the surgery, will you be able to take enough time off work, to heal properly? It could be up to 3 months, maybe more! If not, you could be setting yourself up for failure. Also, try to find the best doc you can afford. Ask around, in your area. Try to talk to patients that the doctor has cured. Ask him exactlly what to expect after the surgery. If he tells you not to worry, it'll be a piece of cake, keep looking. The EPF method is not working out that well, it seems. I'd look at open, minimal, or Baxter type. After the MRI, ask the doctor if you have TTS, you don't want a 2nd operation, just because they missed it the first time. Good luck

BrianG

PS What state do you live in, someone may be able to refer you to a good doc.

Re: Suggestions on surgery,...why should I wait any longer?

J. King on 5/14/02 at 19:46 (083914)

I was postal worker so I filed for workers compensation, disability retirement and social security disability. It took about 5 months and a lot of luck. Start building your case early.

Re: Suggestions on surgery,...why should I wait any longer?

adam p on 5/15/02 at 01:35 (083983)

I have a couple of reasons. You may suffer the im-
patience of youth. Were you able to rest your foot
for 9 months as opposed to doing other conservative
things for 9 months you might sing a completely
different tune.

You might be overstretching. Rest and hardly stretching
at all might be THE conservative thing to do.

The archive of posts to heelspur.com's message boards
and the other material on this site speak volumes.
I don't think you mentioned taping. Taping 'rests'
the pf too.

AP

Re: Suggestions on surgery,...why should I wait any longer?

Julie on 5/15/02 at 02:05 (083985)

Excellent advice, Adam. Christine, I hope you will think about it. I suspect that a great many people who post saying they have tried everything, all the conservative treatments, either haven't tried the right ones in the right combination, or haven't given them long enough to work.

I believe myself that overstretching is very common, and very counter-productive. I totally agree with Adam about rest, and hardly stretching. In fact, it's more useful to think in terms of strengthening the muscles that weaken through lack of use while resting, and that's an entirely different ball game.

Taping was a huge help to me. If you can't stay off your feet, as, for instance, Carole did for about two months (is that right, Carole?) with great results, then learn how to tape, and apply tape every day. I will be glad to help you if you have any problems with it (instructions are in part 2 of the heel pain book).

Give rest, taping, patience, and, possibly, another podiatrist, more time before you allow your foot to be cut. Many surgeries are successful, although we don't hear as much about them as about the failures, but - to turn your question around - why should you do something that may leave you worse off than you are now?

Re: Suggestions on surgery,...why should I wait any longer?

C Fuller on 5/15/02 at 09:17 (084003)

In the 9months that I have had this crippeling problem I have experimented with not streching as much, doing diferent streching, over streching, under streching, ect....... Right now the amount I am doing is the best for me, I feel so much better when I do strech. I have tried the taping many times, it doesn't really work that great for me, besides I don't want to live 60-70yrs of taping my feet everyday. I have tried countless combinations of streching, taping rest ect... I took 3 months of only working part time at a sit down job and basicly resting my feet everyday, that did help, but I wouln't qualify for disability, I wasn't working a job that I could quailify for workmans comp. If I did get surgery I would try to get unemployment to cover most of my bills, and I also have parents that would help out or even let me live in there now empty house because my brothers and I no longer there to help me out for a few months. I live in Colorado, Apsen to be exact, I am seeing my 3rd pod. and my 3rd opinion. They are all have been conservative docs, and the one I am seeing now is a specialist out of Vail, who after 9 months also thinks surgery my now be my only option. He would do the open procedure. I haven't discussed it with him in detail yet because I am waiting for the MRI, but he just did one on a gentleman 2 weeks ago (also on both feet) who is doing fine so far. And another woman who came in for her 5 week followup last week and she has never been so happy and pain free in 2 1/2 years. I want to feel like that. I understand the complications, but how can I go on like this?

Re: Suggestions on surgery,...why should I wait any longer?

Rick R on 5/15/02 at 13:10 (084036)

Christine,

As one who waited too long, I will offer a reason to wait. I was not much older than you, in my late 20's when I started the PF adventure. Surgery was my 40th birthday gift to myself. Don't wait that long!!! Ask yourself, how do you expect surgery to make you any better than you were to begin with? Until you find and understand the reason you have PF, I wouldn't have surgery. Be it lifestyle, bad shoes, flat feet, tight tendons or other anotomical idiosyncrasy, PF is the symptom. Surgery in my opinion addresses the symptom not necessarily the cause.

Best of luck,

Rick

Re: It's time to do some research

BrianG on 5/15/02 at 13:55 (084039)

Hi Christine,

Ask the doctor if you can speak with the person who was healed in 5 weeks. All doctors seem to have these stories. Why not talk to her and get the story right from her mouth. We want to be healed so badly, that we tend to believe anyhing the doctors tell us. I don't mean to sound like he isn't telling the truth, but I sure wish I'd talked to some of my doctor's other patients, before I let him cut me. This woman would be perfect, as he's already given you her story. Take the time to confirm it.

Good luck
BrianG

PS The only people I talked to at my doctors office, were people like myself, having a hard time healing.

Re: Suggestions on surgery,...why should I wait any longer?

adam p on 5/16/02 at 10:45 (084144)

To me 5 months let alone 5 weeks or two weeks is too short
a time to conclude something about the results/proficiency.

It seems I've heard that a person should not plan on losing
extra weight, safely, over less a period of time than they
gained that weight. So I would give conservative efforts
at least 9 months.

Last but not least, I've seen a '> 50%' figure on surgery
which, to be conservative, I would use as my benchmark.
AP

Re: Suggestions on surgery,...why should I wait any longer?

Christine F on 5/26/02 at 10:16 (085280)

Brian,...have you had surgery? Open Release? Tell me what happened? Also Adam, I don't need to loose weight, that has never been an issue for me. I was a very active 5ft7in 125lbs. although not being able to do much working out it does suck not being able to eat all I want now. I developed symptoms Aug,....so now it will have been 9 months, 8 months treating it.

Re: Suggestions on surgery,...why should I wait any longer?

Christine F on 5/26/02 at 10:17 (085281)

Rick,...what type of surgery did you have done, open release? How long ago was your surgery? How are you doing now?

Re: Suggestions on surgery,...why should I wait any longer?

BrianG on 5/26/02 at 20:28 (085319)

Hi Christine,

Yes, I had the Endoscopic release. It's supposedly a smaller cut, which takes practiclly no time to heal. It really bugs me that the doctors will always give you the best case scenerio. This was even after I told him I had a low tolerance to pain. He cut into both sides of my ankle, which made a hole clean thru it, (the ankle). He stuck the camera in, and cut what he could see. I had real bad pain for a week, and just plain bad pain for a month. It was abou 3 months before the pain from the operation finaly went away. At this time, my heel was absolutely no better, and I actually had more pain in my arch. I waited over 6 months to get a new pair of orthotics, which might have accounted for the additional arch pain. I feel lucky that I only had additional arch pain. Many people here developed different symptoms, TTS. They in turn then had to have an additional surgery, and not too many of them have been a success. I just hate to see anyone else join the group of failures we read about here. I'd do everything I could, to ensure you have the best doctor available. Good luck on which ever way you go.

BrianG

Re: Suggestions on surgery,...why should I wait any longer?

adam p on 5/26/02 at 22:17 (085328)

The factoid on weight loss was just to reinforce a message
of 'Patience'. You're nine months 'in' so I'd allow nine
months out. I'd look into using a cane and really giving
your body every chance to heal itself.

When you're older, nine months can fly by like nine weeks
does now. I'll never forget going back to my elementary
school as an adult. Those halls and desks had become
miniature.

AP

Re: Suggestions on surgery,...why should I wait any longer?

adam p on 5/26/02 at 23:15 (085330)

The factoid on weight loss was just to reinforce a message
of 'Patience'. You're nine months 'in' so I'd allow nine
months out. I'd look into using a cane and really giving
your body every chance to heal itself.

When you're older, nine months can fly by like nine weeks
does now. I'll never forget going back to my elementary
school as an adult. Those halls and desks had become
miniature.

AP

Re: Suggestions on surgery,...why should I wait any longer?

Brian on 5/31/02 at 22:07 (085966)

J king.. how did you start building your case early? Im a postal worker too and if this Pf doesnt get better I wil have to try to claim it as on the job.. as it is surely from working.

Re: Suggestions on surgery,...why should I wait any longer?

Joe S on 6/02/02 at 20:23 (086113)

If you've exhausted every conservative measure, then surgery is the next course. Surgery is successful in 85-90 percent of the time. Conservative management is also 85-90% siccessful. Most surgical failures are due lack of proper diagnosis. For example, you have a calcaneal stress fracture that has gone undiagnosed. Bone scan will show this. Also, lifestyle modifications after surgery also will help. Continue with the achilles tendon stretching. This is paramount. Open surgery is not as bad as you hear on this board. If you are suffering, then get the right diagnosis, and then proceed with the appropriate treatment plan.

Re: Suggestions on surgery,...why should I wait any longer?

DR Zuckerman on 6/03/02 at 21:23 (086202)

The problem with surgery is that when there is a problem you are in real trouble. Don't take surgery lightly. ESWT is a procedure that can't leave your foot in worse shape then before the procedure. Yes some do report 90% sucess for pf surgey but its the 10% cripples that we need to worry about.

Re: Suggestions on surgery,...why should I wait any longer?

Joe S on 6/03/02 at 23:18 (086213)

No surgery should be taken lightly. I am sure there will be complications with ESWT as well. It's still relatively new. it's a promising technology. Too bad insurance companies won't pay for it. However, I think you will agree, most failed surgeries are do to one of two different things. First, improper diagnosis. Not all heel pain is PF or 'Heel Spur Syndrome'. When this is the case ESWT will not work. Second, when an open release is performed, if the podiatrist or orthopedist who performs the surgery does not adequately release the medial 2/3 of the plantar fascia, the procedure is doomed to fail. Therefore, any person who truly has PF and has exhausted all forms of conservative therapy (orthotics, injections, NSAIDs, taping, casting, LOSING WEIGHT if they're obese) with little to no relief of the symptoms is now considered a surgical candidate. There is no benefit in removing the spur. There is no evidenced based clinical data that suggest that resection of the infracalcaneal spur is more beneficial than simply performing a plantar fasciotomy.

Re: Suggestions on surgery,...why should I wait any longer?

DR Zuckerman on 6/04/02 at 06:56 (086229)

ESWT is over ten year old and still no major complicatons have been reported. The cut of the plantar fascia is against all biomechanical princples . It is setting up future complications when you cut 1/3 or 2/3 or whatever. IF you have ever seen post op RSD from open plantar fascia release you would never want to do an open release. RSD has nothing do with improper diagnosis If you have ever seen an infection with the entire side of of the foot open with an open release.