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Okay, let me run this by you again ....

Posted by NickR on 5/20/02 at 17:49 (084702)

I originally posted a question on 5/8 re:running 39 days after partial PF release (see entire thread from that date below). I was particularly interested in what the doctors who post on this board thought of this rehabilitation. ** Thank you Dr. Z for sharing your thoughts related to a malpractice suit.** Is there anyone else that could let me know what you think? Thanks -- Nick

Need a show of feet, er ... hands.
This is a thread posted in category: Ask the Foot Doctors . . View All Heel Pain Categories
Posted by NickR on 5/08/02 at 10:32
On an earlier posting, I mentioned that my surgeon had me start a running program 39 days after performing an open partial PF release on my foot. Has anyone else either had a doctor recommend this rehab or do you know anyone else who has tried it? What was their outcome? Thanks for your input. Docs ... what do you think of this?

Reply to Message # 83035

Re: Need a show of feet, er ... hands.
Posted by Carmen on 5/08/02 at 11:33
I posted earlier....I can't imagine why anyone would have you run after this procedure...can't imagine it!

Reply to Message # 83044

Re: Need a show of feet, er ... hands.
Posted by Pam B on 5/08/02 at 13:10
Well, I cant imagine this type rehab either :( I had the same procedure done in Feb and am just now starting PT....if someone would have told me I had to run, I would have laughed in their face :) no way, no how, not in this lifetime.....I have enough trouble walking :) Good Luck to you

Reply to Message # 83075

Re: Need a show of feet, er ... hands.
Posted by Carole C in NOLA on 5/08/02 at 16:26
That doctor who wants you to run so soon is a goofball!!

Well, just an opinion.... (smile)

Might I suggest that you seek a second opinion from another DPM? A third?

Carole C

Reply to Message # 83107

Re: Need a show of feet, er ... hands.
Posted by Carmen on 5/08/02 at 18:35
p.s. Ask HIM why he had you run. Get it in writing.

Reply to Message # 83121

Okay, so it didn't work so well.
Posted by NickR on 5/08/02 at 20:01
I do know why he wanted me to run; he wanted to try a new rehab technique that he thought up all by himself. His thinking was that, by putting my weight on my PF, it would stretch it/flatten it out. Unfortunately, I have had catastrophic results from his little test. My foot will never be the same and I have already had additional surgery to try and correct it (by another doctor). I will forever be haunted by this whole thing (obviously -- my foot will never be normal). But more than that, I am very curious to know if anyone, anywhere has ever had a surgeon recommend this type of rehab. It was -- walk on my foot the first day of surgery; start running on it 39 days later. Interestingly enough, although I had been a runner for many years in my 20's/30's, I hadn't run for about 10 years. It wasn't like I was begging him to let me do it. Has anyone else tried this or had it recommended to them by their surgeon? Thanks to everyone for their input.

Reply to Message # 83132

Re: Okay, so it didn't work so well.
Posted by Julie on 5/09/02 at 03:08

Nick, I remembered that you told us in your first post a few days ago that the results of this goofy rehab idea had been disastrous. I can't answer your question, but I can tell you that in almost two years of reading almost every post at heelspurs.com I don't think I have ever read one from someone who was told to bear weight (walking) immediately following surgery, and on a running programme so soon. If there was one, I missed it. It sounds totally stupid. Did this doctor screw up the surgery too, or can't you tell?

And when did all this happen? Are you really quite sure that your foot will never be normal? I'm tempted to say 'don't give up hope', but as I don't know the full extent of your injuries I'll refrain from saying anything that might raise false hopes.

I feel extremely sad for you. But perhaps it is some tiny comfort to know that your experience, posted here, may be of some help to others.

Reply to Message # 83166

Re: Need a show of feet, er ... hands.
Posted by lisa k on 5/09/02 at 03:45
second and third that i tore major part of fascia and detachment just from overestretching......when they finally figured this out put me immobilized cam cast 24/7 w NO activies so it could heal proper places sounds strange to run right after a surgical procedure dont ya think lis k.

Reply to Message # 83177

Thanks for your thoughts, Julie
Posted by NickR on 5/09/02 at 10:42
I have since had two additional operations on this foot; the last one a total reconstruction. Seven months postop for that one, I'm in more pain now than ever and am taking meds to control it. I've been to 12 different docs -- last one told me there is nothing more that can be done other than learn to deal with it and increase my medication. I'm not a meds kind of person, so am refusing to do so until it gets so bad I can't take it any more. Hopefully, my posting this will be remembered by others who ever have a surgeon push their recovery the way mine did to me.

Reply to Message # 83210

IS THERE A DOCTOR IN THE HOUSE??
Posted by NickR on 5/09/02 at 17:35
Could I please get a doctor's opinion regarding this posting (please read the thread). I really appreciate your taking the time to let me know your thoughts and experience related to this type of rehabilitation. Have you ever heard of it and/or tried it on any of your patients? If so, could you let me know how they did? Thank you!

Reply to Message # 83262

Re: Thanks for your thoughts, Julie
Posted by Julie on 5/10/02 at 01:24

Hi Nick

I am really sorry to hear this, and you have my sympathies. It does sound as though you now have to learn to deal with chronic pain, and it isn't easy. But there is help with that.

First: no, you're not a meds person, and that's quite a 'hump' to get over, but maybe a little lateral thinking about that would be a good idea. Brian G. who posts here, is our expert on pain management, and has been very helpful to people in the past. If you can keep the pain at a certain acceptable, or at least tolerable, level, through regular use of medication, you'll be better able to carry on with your life and avoid depression. It's worth thinking about.

Also, there are pain management clinics - have you investigated that?

And, as a yoga teacher, I would encourage you to learn relaxation techniques, and a few simple breathing exercises. These things can help enormously to deal with pain, and indeed any big life challenge. Briefly, they calm the sympathetic nervous system and help enormously to restore balance and peace of mind.

Please let me know if I can be of any more help. You can email me if you like at (email removed), but I always think it's better to keep discussions on the board, because you never know who else they might be useful to.

Reply to Message # 83319

Re: Nick: PS
Posted by Julie on 5/10/02 at 01:27

Nick, if you want a doctor's response, I think you ought to re-post your question on a new thread. Sometimes, if they're away or just not around for a day or so, they miss a post. It's very easy to do now that there are so many!

If you're going to do this, re-tell the whole story, so that it's clear what you've been through and what you want to know.

But I seriously doubt that any of them will tell you that 'rehab' idea was a good one, or that they have ever recommended it themselves.

Reply to Message # 83320

You have certainly been through a lot
Posted by BrianG on 5/10/02 at 15:27
Hi NickR,

I could be wrong, but I don't think it's an accident that no doctors will answer this particular question. It is too close to to being a malpractice case. There are Podiatrists that can be hired as expert witness's, if you decide to go that route. I don't think there is a person reading this, that would agree with your original doctor. I think you have to ask yourself how far you want to proceed with this. You haven't mentioned malpractice, but surely you must have thought about it, no?

About the pain meds, there is a big difference between NSAID's and narcotic type medication. If the pain has not completely taken over your life, I don't blame you for not wanting to take anything. I'm one of the people that finally reached a point where I could not go on without help from daily pain meds. If you want to talk, I have plenty of time. I do have access to quite a few websites that can help you with the decision making process. Please remember, chronic pain can, and will lead to depression. How long you wait for help, is up to you. Good luck

BrianG

Reply to Message # 83450

Re: You have certainly been through a lot
Posted by DR Zuckerman on 5/10/02 at 17:02
The obvious is the obvious. If you think you have an action you obtain a lawyer with an reputation as one that only takes a case that is true malpractice and then preceed with what you feel is justice

Reply to Message # 83456

Re: Okay, so it didn't work so well.
Posted by Tammie on 5/11/02 at 18:01
Julie, I was told to bear weight when I got up the day after surgery.Just Not total weight and he expected me to be walking fine in 10 days. He said that is his normal time that people can walk or return to life as normal! I was not a runner ,but I dont believe he would have told me to run that soon. Tho he did say walking on it was very important so scar tissue would not build up. He seemed to be as worried about possible scar tissue as he was of popping stitches inside my foot. He reminded me often that they were there even if I didnt see them they were inside!

I think Nick that someone somewhere didnt fully understand the what ifs or is it worth expiermenting on Your foot! He had a lot of nerve to do something that could have and seems to have done much more damage! I hope you get some answers so that this does not happen to any other person!

Reply to Message # 83561

Re: Okay, let me run this by you again ....

Ed Davis, DPM on 5/20/02 at 19:12 (084720)

Nick:

There is not one universally accepted protocol for care after PF release surgery. The issue is whether or not your doc's protocol was reasonable or not.

I allow my patients to walk the day after plantar fascial release surgery. I have them do so with a posterior splint (half cast) and surgical shoe in place. Time to running varies with the patient and circumstances but 60 days would be about the earliest that I would consider running and, again, that would depend on a number of factors including but not limited to.. patient weight, conditioning, degree of biomechanical correction (via orthotics and/or surgery), how much PT/rehab the patient has had, degree of healing...
Ed

Re: Okay, let me run this by you again ....

NickR on 5/20/02 at 22:59 (084744)

Thanks for filling me in on your routine. My surgeon had me walking the day of surgery with no cast (never had one). I was wearing regular shoes (walking shoes) 4 days later although the swelling made the pain unbearable. I had zero PT before the running program started, although he had me in various PT programs afterwards when I could not get the pain under control. Does this sound at all reasonable to you?

Re: Okay, let me run this by you again ....

Ed Davis, DPM on 5/21/02 at 18:52 (084802)

The plantar fascia is an important supporting structure in the foot so I feel that when it is released, a supportive device such as a cast must be used as healing occurs. I do not feel that it is reasonable to walk without a cast or splint after such surgery although a number of doctors allow patients to do so. If painful swelling occurred after surgery, I think that it would be wise to reconsider the post-op protocol and make changes. How did your foot feel immediately before starting the running program?
Ed

Re: Answer to you re:pain/running

Nick R on 5/22/02 at 15:45 (084886)

The surgeon pulled my stitches 6 days after surgery and the wound took forever to completely close (dripped a syrupy substance off and on for weeks). My foot was numb in some places and painful in others. Honestly, I thought the doctor was nuts when he told me he wanted me to start running after only 39 days. I did start running, however, and immediately experienced an increase in pain. He had me go to PT for weeks and had me try new orthotics, but told me to keep running. A year after surgery, I had to wear a cast for 2 months in an effort to get my foot/nerves to 'calm down'. Eventually, another surgeon operated and did a total release. 10 months later, I had to have a complete foot reconstruction. 7 months after that, I am now in more pain than I have ever been. What do you think about all this?

Re: Answer to you re:pain/running

BrianG on 5/22/02 at 17:09 (084899)

Nick,

Are you aware that the statutes of limitations, are different for all states. Some are as short as 2 years.

Good luck
BrianG, not a doc

Re: Answer to you re:pain/running

Nick R on 5/22/02 at 18:25 (084904)

Hi Brian, thanks for asking. The statute here is 3 years, which is quickly approaching. I'm working on this, though, and should be able to figure out if this is malpractice or not shortly (am also seeking the advice of surgeons in my town). Nick

Re: Answer to you re:pain/running

Laurie R on 5/22/02 at 20:25 (084932)

Hi Nick , Have you ever heard of RSD or CRPS? Please have a doctor check you for it . I have it in my right foot and it is very , very painful ... Wow you have had a lot of surgery . I don't agree with the first doctor you had that had you running so soon after surgery . But that was then is this is now... Can you tell us your symptoms in detail ? My heart goes out to you Nick . I have been dealing with PF and TTS and I also have other foot problems and RSD all in my right foot next month will make three years . I got hurt at work so I am a workers comp case..... Today I am 2 weeks post opp from my first surgery . My doctor did a PF release and a TT release and remove a groth I had on my fascia . I still have to be non weight bearring for another two weeks till I see him. He said maybe I can start to put weight .

I was a very high risk for surgery since I do have RSD ...

My very best to you Nick . Are you taking any pain meds for your pain ?

Laurie R

Re: Answer to you re:pain/running

Pauline on 5/22/02 at 22:15 (084942)

Nick,
I'm sorry to hear that you are another victim of a poor surgical outcome.
It doesn't surprise me because most people don't have any idea of the complexity that exist between each bone, muscle, tendon and nerve in the foot. They probably never think about how complicated foot surgery can be. Instead they think that every physician that hangs out a sign is qualified to perform foot surgery, and are easily talked into and reasured that surgery will get rid of their pain.

More often than not one surgery on the foot leads to additional pain and that pain is followed by more surgery and the cycle is repeated and repeated until patient finally comes to the conclusion surgery wasn't the quick cure they had hoped for, and are left in situations like yours.

I truly feel sad for what you have hand to endure. If there is anything that should begin to jump out at people reading the surgical postings on this forum is that not all physicians are capable of performing the surgeries they are doing, and there is never a guarantee that you will be pain free once the surgery is done.

I recently read several articles about how physicians continue to perform surgeries which they are not comfortable doing nor have any training in
doing , yet they refuse to refer their patients to physicians with more experience and who are more qualified. Podiatrist themselves have discussed this very issue.

The injuries you have sustained through surgeries may remain with you for the rest of your life. I hope you will continue to remind posters what you have gone through so that others may benefit from your unfortunate experience.

I truly hope a day will come when you will be void of pain. Thanks for sharing your story so others can learn from it.

Re: Answer to you re:pain/running

Diana on 5/22/02 at 23:07 (084948)

Did you have your surgery done in Tn.? My Dr. there told me he had people jogging after 3 weeks. this was on my post op visit where my foot was still hurting. He said I could go back to work standing all day 2 wks after surgery for TTS and PF release. That was a year ago and the surgery was not sucessful. diana

Re: Answer to you re:pain/running

Ed Davis, DPM on 5/22/02 at 23:17 (084950)

Sutures in the foot are left in for about 10 to 14 days, sometimes longer. A foot wound will almost certainly gap open if they are pulled in 6 days. What type of practitioner did your surgery? There are a lot more details that need to be filled in. There is no specific surgical procedure termed a 'complete foot reconstruction.' What procedures were done that you are using this term for and why were the procedures done?
Ed

Re: Answer to you re:pain/running

Pauline on 5/23/02 at 11:20 (084986)

Dr. Davis,
I think if you talk to Orthopedic Surgeon Dr. Arthur Manolli M.D. he will tell you he has pretty much reconstructed a foot upon severe injury. It may not be offically called 'complete foot reconstruction', but he has done a lot of reconstruction repairs.

Re: To Dr. Davis

Pauline on 5/23/02 at 12:09 (084991)

A little about Dr. Manoli's foot reconstruction interest.

Dr. Manoli is a member of fifteen different international, professional and scientific societies.Currently, Dr. Manoli is Chairman of the Trauma Committee of the American Orthopaedic Foot and Ankle Society (AOFAS). He is also Associate Editor of Foot and Ankle International and a consultant reviewer for two other peer- reviewed journals.

Dr. Manoli's research interests include the etiology and treatment of adult acquired flatfoot, screw fixation in traumatic and adult reconstructive surgery, and compartment syndromes of the lower extremities. As a clinician, his interests involve complex reconstruction of the foot and ankle, rheumatoid and diabetic foot care, and amputation surgery and rehabilitation. He has recently finished the development of a Foot and Ankle Severity Score (FASS) which is a rating scale of injury severity and long-term impariment of the various traumatic foot and ankle injuries

Re: Answer to you re:pain/running

DR Zuckerman on 5/23/02 at 17:59 (085025)

Hi

As I read Dr. Davis's comments, my understand is that there is no procedure called a complete foot reconstruction but it is used as a term to describe alot of surgical repair to the foot. So if you look in the CPT book you won't find a code for complete foot reconstruction. Or if you look in a textbook such as one edited /written by Dr. Manolli you will find the procedures but they will have specific names. I believe this is what he is saying.

Pauline I would like your opinion on something. I see this all the time on TV, in books, newspapers, etc and now I see you use this . Should it be one or the other but not both be used. ie David Zuckerman DPM or Dr. David Zuckerman or Dr. Manolli or Arthur Manolli. I think it is either but not both. So Dr. David Zuckerman DPM is wrong but David Zuckerman DPM is right.

Re: Okay, here's what the last surgery was....

NickR on 5/23/02 at 20:11 (085032)

This is what my surgeon called a 'total foot reconstruction': Tarsal tunnel release, gastrocnemius resection, and peroneus longus tendon transfer (supra malleolar). This was for moderate gastrocnemius equinus and severe peroneus longus overdrive; symptoms were significant tibial neuritis and mechanical deformities.

To answer an earlier question from a poster -- all surgeons were orthopods. Also, the pain I'm experiencing now is severe burning on the entire soles of both feet, with a very painful and persistent pulling sensation up the inside of my right foot (from the heel). Some places on this foot are extremely numb and others just ache, constantly.

I'm taking Neurontin, which seems to take the edge off of this, or I don't know how I'd make it through the day. I'm on my 5th pair of custom orthotics (every doctor thought I needed a different kind) and am going to see my 12th physician next week (a neurologist for treatment of peripheral neuropathy that has developed in both feet). To the poster who wrote re:RDS -- thank you for bringing that up, but it's been ruled out in my case. The PN is also unbelievably painful and there is no cure for it.

Okay, docs ... what do you think about me now???

Re: Answer to you re:pain/running

Pauline on 5/23/02 at 21:46 (085039)

Dr.Z,
I'm curious why you would select me to give you my opinion on this important matter. I think you are much closer with others that post on this board, and would probably trust their opinions to get an answer to this question. Go with what they say.

Re: Okay, here's what the last surgery was....

Ed Davis, DPM on 5/23/02 at 21:54 (085041)

That is a lot of surgery. We have to go through the procedures, one by one, and see what the rationale for performing them was. One would need to have fairly significant foot deformity to warrant such a string of procedures. Was that true in your case? How was the diagnosis of tarsal tunnel syndrome confirmed? NCV or EMG done?

Sorry to sound picky but 'peroneus longus overdrive' is really not a diagnosis. Peroneus longus transfer is a bit unusual of a procedure. Where was the peroneus longus transferred to?
Ed

Re: Answer to you re:pain/running

Pauline on 5/24/02 at 10:10 (085092)

If Manoli is writing and editing text books as you say, and they are being used by other physicians he must be highly skilled and well respected in his field.

Re: Dr. Davis -- Had to look at my op report for answers

NickR on 5/24/02 at 14:47 (085119)

Here is what my op report says: 'The leg was then turned and a 3 cm incision at the supramalleolar junction at the perineal tendons was made. Dissection was carried down sharply through the skin, and then to the level of the deep fascia, which was split longitudinally. There peroneus longus was identified and this was split longitudinally into a Z fashion. The longus was lengthened approximately 2 cm and then woven and Pulvertaft fashion through the brevis tendon after stripping the longus of its peritenon. This was then repaired to the brevis using 2-0 Tycron suture. The deep fascia was then repaired using 3-0 Monocryl suture, and the skin was closed using 3-0 Monocryl suture followed by 4-0 nylon suture.' Of course, there is much more to the op report, but I believe this is the part that describes the peroneus longus transfer (please correct me if I'm wrong).

Was my foot really deformed? Except for claw toes, there wasn't anything obvious, although apparently I was not transferring my weight correctly when I walked (although I don't know in what way). One surgeon I saw recently said that I now have no physical reason for the pain that I'm in -- that my foot is mechanically correct at this point.

TTS was never confirmed by EMG, although I was positively diagnosed with distal polyneuropathy in both feet last summer (previously suspected via EMG in 1998). I have since 'blossomed' into a whopping case of peripheral neuropathy (same as DPN??) -- much worse now than I was a year ago prior to this surgery.

The surgeon did tell me that the nerve was compressed and that I had an enormous amount of very dense scar tissue that he removed during the operation.

Okay, now what do you think? I appreciate your thoughts on this -- wish I seen you before all this happened. Nick

Re: Answer to you re:pain/running

DR Zuckerman on 5/24/02 at 18:13 (085131)

The reason I asked you for your opinion was two fold.

1. Your use of both DR/ MD/DPM made me think of it
2. You express yourself very well in writing

Thats all

Re: Answer to you re:pain/running

Pauline on 5/24/02 at 19:01 (085141)

Dr. Z,
Thanks for the compliment. I like clarity in my writing. Glad you appreciate it.

Re: Dr. Davis -- Had to look at my op report for answers

Ed Davis, DPM on 5/24/02 at 20:18 (085149)

It appears that the goal of the transfer was to augment the strength of the peroneus brevis by transferring part of the peroneus longus to it. That would be done if your foot was over-inverting (rolling outward). Do you remember if that was the case?

Tarsal tunnel surgery can be performed without first doing an NCV but I would prefer to have the NCV. Without the NCV it is hard to tell if the surgery was warranted. I am not sure why someone would not want to get an NCV before such surgery. The only reasons for not getting an NCV, in my opinion, is the presence of a space occupying lesion compressing the nerve or if there is not a reliable electromyographer available. Could you tell a difference after the TT release?

I think that your records would need to be studied carefully in order to really come to any reasonable conclusions. One function that an attorney would do is to send the records out to experts for a thorough study-- that would from the basis of a potential case as the attorney would rely on the experts to let him or her know if standards of care were violated.

I would certainly be willing to do a records review for your attorney. It is not a service that I perform often as I am not a fan of litigation. But, one thing is for sure--- if I feel that standards of care were not upheld my opinion will be most valuable since you will be getting an opinion from an individual with an anti-litigation bias. I am not a doctor who relies on litigation support for income and as such, my opinion will be very honest and objective. I fully support the rights of individuals who have truly suffered injury to recompense, it is the numerous frivolous, unwarranted cases that I have objected to.
Ed

Re: Dr. Davis!!

NickR on 5/25/02 at 19:20 (085223)

Is it possible to continue this conversation in a less public forum (i.e., via email?) I have some additional information I would like to share with you and don't really want to make it available for the rest of the world to read. You may email me at (email removed). I look forward to hearing from you soon. Nick

Re: Okay, let me run this by you again ....

Ed Davis, DPM on 5/20/02 at 19:12 (084720)

Nick:

There is not one universally accepted protocol for care after PF release surgery. The issue is whether or not your doc's protocol was reasonable or not.

I allow my patients to walk the day after plantar fascial release surgery. I have them do so with a posterior splint (half cast) and surgical shoe in place. Time to running varies with the patient and circumstances but 60 days would be about the earliest that I would consider running and, again, that would depend on a number of factors including but not limited to.. patient weight, conditioning, degree of biomechanical correction (via orthotics and/or surgery), how much PT/rehab the patient has had, degree of healing...
Ed

Re: Okay, let me run this by you again ....

NickR on 5/20/02 at 22:59 (084744)

Thanks for filling me in on your routine. My surgeon had me walking the day of surgery with no cast (never had one). I was wearing regular shoes (walking shoes) 4 days later although the swelling made the pain unbearable. I had zero PT before the running program started, although he had me in various PT programs afterwards when I could not get the pain under control. Does this sound at all reasonable to you?

Re: Okay, let me run this by you again ....

Ed Davis, DPM on 5/21/02 at 18:52 (084802)

The plantar fascia is an important supporting structure in the foot so I feel that when it is released, a supportive device such as a cast must be used as healing occurs. I do not feel that it is reasonable to walk without a cast or splint after such surgery although a number of doctors allow patients to do so. If painful swelling occurred after surgery, I think that it would be wise to reconsider the post-op protocol and make changes. How did your foot feel immediately before starting the running program?
Ed

Re: Answer to you re:pain/running

Nick R on 5/22/02 at 15:45 (084886)

The surgeon pulled my stitches 6 days after surgery and the wound took forever to completely close (dripped a syrupy substance off and on for weeks). My foot was numb in some places and painful in others. Honestly, I thought the doctor was nuts when he told me he wanted me to start running after only 39 days. I did start running, however, and immediately experienced an increase in pain. He had me go to PT for weeks and had me try new orthotics, but told me to keep running. A year after surgery, I had to wear a cast for 2 months in an effort to get my foot/nerves to 'calm down'. Eventually, another surgeon operated and did a total release. 10 months later, I had to have a complete foot reconstruction. 7 months after that, I am now in more pain than I have ever been. What do you think about all this?

Re: Answer to you re:pain/running

BrianG on 5/22/02 at 17:09 (084899)

Nick,

Are you aware that the statutes of limitations, are different for all states. Some are as short as 2 years.

Good luck
BrianG, not a doc

Re: Answer to you re:pain/running

Nick R on 5/22/02 at 18:25 (084904)

Hi Brian, thanks for asking. The statute here is 3 years, which is quickly approaching. I'm working on this, though, and should be able to figure out if this is malpractice or not shortly (am also seeking the advice of surgeons in my town). Nick

Re: Answer to you re:pain/running

Laurie R on 5/22/02 at 20:25 (084932)

Hi Nick , Have you ever heard of RSD or CRPS? Please have a doctor check you for it . I have it in my right foot and it is very , very painful ... Wow you have had a lot of surgery . I don't agree with the first doctor you had that had you running so soon after surgery . But that was then is this is now... Can you tell us your symptoms in detail ? My heart goes out to you Nick . I have been dealing with PF and TTS and I also have other foot problems and RSD all in my right foot next month will make three years . I got hurt at work so I am a workers comp case..... Today I am 2 weeks post opp from my first surgery . My doctor did a PF release and a TT release and remove a groth I had on my fascia . I still have to be non weight bearring for another two weeks till I see him. He said maybe I can start to put weight .

I was a very high risk for surgery since I do have RSD ...

My very best to you Nick . Are you taking any pain meds for your pain ?

Laurie R

Re: Answer to you re:pain/running

Pauline on 5/22/02 at 22:15 (084942)

Nick,
I'm sorry to hear that you are another victim of a poor surgical outcome.
It doesn't surprise me because most people don't have any idea of the complexity that exist between each bone, muscle, tendon and nerve in the foot. They probably never think about how complicated foot surgery can be. Instead they think that every physician that hangs out a sign is qualified to perform foot surgery, and are easily talked into and reasured that surgery will get rid of their pain.

More often than not one surgery on the foot leads to additional pain and that pain is followed by more surgery and the cycle is repeated and repeated until patient finally comes to the conclusion surgery wasn't the quick cure they had hoped for, and are left in situations like yours.

I truly feel sad for what you have hand to endure. If there is anything that should begin to jump out at people reading the surgical postings on this forum is that not all physicians are capable of performing the surgeries they are doing, and there is never a guarantee that you will be pain free once the surgery is done.

I recently read several articles about how physicians continue to perform surgeries which they are not comfortable doing nor have any training in
doing , yet they refuse to refer their patients to physicians with more experience and who are more qualified. Podiatrist themselves have discussed this very issue.

The injuries you have sustained through surgeries may remain with you for the rest of your life. I hope you will continue to remind posters what you have gone through so that others may benefit from your unfortunate experience.

I truly hope a day will come when you will be void of pain. Thanks for sharing your story so others can learn from it.

Re: Answer to you re:pain/running

Diana on 5/22/02 at 23:07 (084948)

Did you have your surgery done in Tn.? My Dr. there told me he had people jogging after 3 weeks. this was on my post op visit where my foot was still hurting. He said I could go back to work standing all day 2 wks after surgery for TTS and PF release. That was a year ago and the surgery was not sucessful. diana

Re: Answer to you re:pain/running

Ed Davis, DPM on 5/22/02 at 23:17 (084950)

Sutures in the foot are left in for about 10 to 14 days, sometimes longer. A foot wound will almost certainly gap open if they are pulled in 6 days. What type of practitioner did your surgery? There are a lot more details that need to be filled in. There is no specific surgical procedure termed a 'complete foot reconstruction.' What procedures were done that you are using this term for and why were the procedures done?
Ed

Re: Answer to you re:pain/running

Pauline on 5/23/02 at 11:20 (084986)

Dr. Davis,
I think if you talk to Orthopedic Surgeon Dr. Arthur Manolli M.D. he will tell you he has pretty much reconstructed a foot upon severe injury. It may not be offically called 'complete foot reconstruction', but he has done a lot of reconstruction repairs.

Re: To Dr. Davis

Pauline on 5/23/02 at 12:09 (084991)

A little about Dr. Manoli's foot reconstruction interest.

Dr. Manoli is a member of fifteen different international, professional and scientific societies.Currently, Dr. Manoli is Chairman of the Trauma Committee of the American Orthopaedic Foot and Ankle Society (AOFAS). He is also Associate Editor of Foot and Ankle International and a consultant reviewer for two other peer- reviewed journals.

Dr. Manoli's research interests include the etiology and treatment of adult acquired flatfoot, screw fixation in traumatic and adult reconstructive surgery, and compartment syndromes of the lower extremities. As a clinician, his interests involve complex reconstruction of the foot and ankle, rheumatoid and diabetic foot care, and amputation surgery and rehabilitation. He has recently finished the development of a Foot and Ankle Severity Score (FASS) which is a rating scale of injury severity and long-term impariment of the various traumatic foot and ankle injuries

Re: Answer to you re:pain/running

DR Zuckerman on 5/23/02 at 17:59 (085025)

Hi

As I read Dr. Davis's comments, my understand is that there is no procedure called a complete foot reconstruction but it is used as a term to describe alot of surgical repair to the foot. So if you look in the CPT book you won't find a code for complete foot reconstruction. Or if you look in a textbook such as one edited /written by Dr. Manolli you will find the procedures but they will have specific names. I believe this is what he is saying.

Pauline I would like your opinion on something. I see this all the time on TV, in books, newspapers, etc and now I see you use this . Should it be one or the other but not both be used. ie David Zuckerman DPM or Dr. David Zuckerman or Dr. Manolli or Arthur Manolli. I think it is either but not both. So Dr. David Zuckerman DPM is wrong but David Zuckerman DPM is right.

Re: Okay, here's what the last surgery was....

NickR on 5/23/02 at 20:11 (085032)

This is what my surgeon called a 'total foot reconstruction': Tarsal tunnel release, gastrocnemius resection, and peroneus longus tendon transfer (supra malleolar). This was for moderate gastrocnemius equinus and severe peroneus longus overdrive; symptoms were significant tibial neuritis and mechanical deformities.

To answer an earlier question from a poster -- all surgeons were orthopods. Also, the pain I'm experiencing now is severe burning on the entire soles of both feet, with a very painful and persistent pulling sensation up the inside of my right foot (from the heel). Some places on this foot are extremely numb and others just ache, constantly.

I'm taking Neurontin, which seems to take the edge off of this, or I don't know how I'd make it through the day. I'm on my 5th pair of custom orthotics (every doctor thought I needed a different kind) and am going to see my 12th physician next week (a neurologist for treatment of peripheral neuropathy that has developed in both feet). To the poster who wrote re:RDS -- thank you for bringing that up, but it's been ruled out in my case. The PN is also unbelievably painful and there is no cure for it.

Okay, docs ... what do you think about me now???

Re: Answer to you re:pain/running

Pauline on 5/23/02 at 21:46 (085039)

Dr.Z,
I'm curious why you would select me to give you my opinion on this important matter. I think you are much closer with others that post on this board, and would probably trust their opinions to get an answer to this question. Go with what they say.

Re: Okay, here's what the last surgery was....

Ed Davis, DPM on 5/23/02 at 21:54 (085041)

That is a lot of surgery. We have to go through the procedures, one by one, and see what the rationale for performing them was. One would need to have fairly significant foot deformity to warrant such a string of procedures. Was that true in your case? How was the diagnosis of tarsal tunnel syndrome confirmed? NCV or EMG done?

Sorry to sound picky but 'peroneus longus overdrive' is really not a diagnosis. Peroneus longus transfer is a bit unusual of a procedure. Where was the peroneus longus transferred to?
Ed

Re: Answer to you re:pain/running

Pauline on 5/24/02 at 10:10 (085092)

If Manoli is writing and editing text books as you say, and they are being used by other physicians he must be highly skilled and well respected in his field.

Re: Dr. Davis -- Had to look at my op report for answers

NickR on 5/24/02 at 14:47 (085119)

Here is what my op report says: 'The leg was then turned and a 3 cm incision at the supramalleolar junction at the perineal tendons was made. Dissection was carried down sharply through the skin, and then to the level of the deep fascia, which was split longitudinally. There peroneus longus was identified and this was split longitudinally into a Z fashion. The longus was lengthened approximately 2 cm and then woven and Pulvertaft fashion through the brevis tendon after stripping the longus of its peritenon. This was then repaired to the brevis using 2-0 Tycron suture. The deep fascia was then repaired using 3-0 Monocryl suture, and the skin was closed using 3-0 Monocryl suture followed by 4-0 nylon suture.' Of course, there is much more to the op report, but I believe this is the part that describes the peroneus longus transfer (please correct me if I'm wrong).

Was my foot really deformed? Except for claw toes, there wasn't anything obvious, although apparently I was not transferring my weight correctly when I walked (although I don't know in what way). One surgeon I saw recently said that I now have no physical reason for the pain that I'm in -- that my foot is mechanically correct at this point.

TTS was never confirmed by EMG, although I was positively diagnosed with distal polyneuropathy in both feet last summer (previously suspected via EMG in 1998). I have since 'blossomed' into a whopping case of peripheral neuropathy (same as DPN??) -- much worse now than I was a year ago prior to this surgery.

The surgeon did tell me that the nerve was compressed and that I had an enormous amount of very dense scar tissue that he removed during the operation.

Okay, now what do you think? I appreciate your thoughts on this -- wish I seen you before all this happened. Nick

Re: Answer to you re:pain/running

DR Zuckerman on 5/24/02 at 18:13 (085131)

The reason I asked you for your opinion was two fold.

1. Your use of both DR/ MD/DPM made me think of it
2. You express yourself very well in writing

Thats all

Re: Answer to you re:pain/running

Pauline on 5/24/02 at 19:01 (085141)

Dr. Z,
Thanks for the compliment. I like clarity in my writing. Glad you appreciate it.

Re: Dr. Davis -- Had to look at my op report for answers

Ed Davis, DPM on 5/24/02 at 20:18 (085149)

It appears that the goal of the transfer was to augment the strength of the peroneus brevis by transferring part of the peroneus longus to it. That would be done if your foot was over-inverting (rolling outward). Do you remember if that was the case?

Tarsal tunnel surgery can be performed without first doing an NCV but I would prefer to have the NCV. Without the NCV it is hard to tell if the surgery was warranted. I am not sure why someone would not want to get an NCV before such surgery. The only reasons for not getting an NCV, in my opinion, is the presence of a space occupying lesion compressing the nerve or if there is not a reliable electromyographer available. Could you tell a difference after the TT release?

I think that your records would need to be studied carefully in order to really come to any reasonable conclusions. One function that an attorney would do is to send the records out to experts for a thorough study-- that would from the basis of a potential case as the attorney would rely on the experts to let him or her know if standards of care were violated.

I would certainly be willing to do a records review for your attorney. It is not a service that I perform often as I am not a fan of litigation. But, one thing is for sure--- if I feel that standards of care were not upheld my opinion will be most valuable since you will be getting an opinion from an individual with an anti-litigation bias. I am not a doctor who relies on litigation support for income and as such, my opinion will be very honest and objective. I fully support the rights of individuals who have truly suffered injury to recompense, it is the numerous frivolous, unwarranted cases that I have objected to.
Ed

Re: Dr. Davis!!

NickR on 5/25/02 at 19:20 (085223)

Is it possible to continue this conversation in a less public forum (i.e., via email?) I have some additional information I would like to share with you and don't really want to make it available for the rest of the world to read. You may email me at (email removed). I look forward to hearing from you soon. Nick