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EPF, ESWT, ANY THING ELSE??? need advice..

Posted by rochelle on 7/02/02 at 21:44 (088981)

Question:

I have done plenty of research on EPF and it sounds like there can be plenty of probs with it (ie, nerve damage, fallen arches after surgery, not being able to see all the fascia when cutting it during surgery, ect). I have also done research on ESWT (I dont think that its covered on my insurance tho-unicare) and I really havent heard of a local podiatrist offering it in Austin, Texas. (know of any?)

Are there any other types of surgeries that can be performed on my PF (I need it done in both feet) that can be very effective with less contra-indications ??? Am I missing something??

History:

I have been in pain for a year and the pain has gotten considerably worse. I have also seen 3 podiatrists. The first one wanted to do surgery without even looking at my feet or x-raying them. The 2nd, was good but only does about 5 surgerys a year and just wants me to come in for LOTS of therapy and prescribes anti-inflammitories (I am a therapist and have done LOTS of therapy on myself & it hasnt helped) the 3rd came recommended by a friend, He did x-rays, prescribed anti-inflamitories and I told him that I am tired of all of this I want the surgery-he has agreed to let me have it (I am just ready for all of this to end).

Currently:

I am now highly considering surgery in Mid-Sept (after my summer vacation is over). And I am still considering seeing one more podiatrist because the 3rd one doesnt totally except my insurance (only 80% and I want my surgery covered 100%). I have taken 4 different anti-inflammitories and even been on a 16 day cortisone pack-nothing helped. But, I am still on Vioxx-still in pain.

**Sorry I rambled, I just want to make sure you have ALL the info.

If I cant stop this pain, I am just going to gnaw off my feet-ha!

Re: EPF, ESWT, ANY THING ELSE??? need advice..

phyllis R on 7/02/02 at 22:59 (088988)

My you sound like me.
I read about a pro-baseball player having surgery and he was never able to play again after it, so that worries me.

I had my 1st cort. shot yesterday at 2 pm, killed me last night. Tonight it feels like I must have someone else foot, very little pain, just sore from the shot. Did you shots never work? Have you tried this night splint? Taping? I was just told to try it, would like to hear from others who have. I can't live like this, my quality of life has really changed due to the constant pain. I live in Montana, afraid to hike the mtns anymore because I can't get back!!!
I have tried BEXTRA and it helps if I take it everday.
Please let me know what you do, reading yours just sounds like me.
Thanks

Re: EPF, ESWT, ANY THING ELSE??? need advice..

Ron P. on 7/03/02 at 00:32 (088998)

To: phyllis R Why don't u try Dr Kiper. He has a special Silicone liquid orthotic...worked for me after all elsed failed. He also consults for 30min. or so to discuss your case...ask him about money back trial & good luck... 800 dr kiper. Ron P fromSunnyvale.

Re: EPF, ESWT, ANY THING ELSE??? need advice..

Julie on 7/03/02 at 03:08 (089003)

Phyllis, I hope one of the doctors will reply. Meanwhile, my recollection is that they are not keen on Endoscopic Plantar Fasciotomy, and prefer MIS (Minimal Incision Surgery) because it gives them a better, clearer view of what they are doing and is more likely to have a successful outcome. (The impression I've had over two years of following this site is that EPF is falling out of favour generally.)

I doubt that any of our doctors would agree to do surgery on a patient who had not followed a regime of conservative treatments for a period of time. I would be suspicious of a podiatrist who offered surgery so quickly, and 'on demand', as your Number 3 has done.

Your history doesn't say what conservative treatments you have followed, but from your reports of your three podiatrists I guess that none of them has given you a comprehensive treatment package geared to your own condition and needs. You oughtn't even to think about surgery until all appropriate conservative treatments have been tried and have failed. Among other contributory factors you need to consider are your lifestyle (does your work require you stand a lot, for instance?) and your shoes (are they the right size, are they giving your feet the support they need?)

If you haven't yet read the heel pain book, please do so, to inform yourself about the many non-surgical options available to you.

Please do your research and consider very carefully whether to have surgery at all, which type to have, and why. Surgery isn't the easy option it may seem, and although it works in many cases, in others it leaves the patient worse off than before.

ESWT should be considered if and when conservative treatment has failed (that includes all necessary adjustments to your lifestyle). If there is no one in Austin who does it, you might be able to travel to someone who does - many have done so.

Good luck!

Re: Rochelle, my post was to you, not Phyllis

Julie on 7/03/02 at 03:18 (089004)

Apologies to both of you!

Re: EPF, ESWT, ANY THING ELSE??? need advice..

Dr. John Cozzarelli on 7/03/02 at 06:04 (089006)

Hi Rochelle:

I agree with the responses that were given to you. I would have a conservative regimen of PT, night splints, NSAIDS and orthotics before I would opt for surgery. The only other surgical procedure offered is Stereotactic Radio Frequency Thermal Lesioning. Basically the patient must ceate a pain map of where the pain is. Once that is done needles are inserted under fluoroscopic guidance and the pain sites are desensitized basically in a pin-point fashion. There is down time of one day. There are no incisions and or stitches. This is covered on insurance. We use this modality when nerve pain is predominately present. On our web site in the technology section it explains more about RF.

Dr. John Cozzarelli

Re: EPF, ESWT, ANY THING ELSE??? need advice..

Rachel W. on 7/03/02 at 09:04 (089017)

Afraid to hyke the mtns??
I feel like that about the stairs. lol.

Re: EPF, ESWT, ANY THING ELSE??? need advice..

rochelle on 7/03/02 at 10:26 (089024)

My feet hurt to much to sit thru a shot in the foot (there are not enough people to hold me down to have that shot-ha). But, I did take a 16 day cortisone pack in its place-it gave me about 2 days of comfort, but that was it. I also had my feet taped up for about 5 weeks. It didnt help me out eigther. At one point I even stayed off my feet for 3 days (doctors request), it didnt help eigther. (sigh)

Bextra is something that I have yet to take-I am taking Vioxx daily. I still am in pain-but, I am getting used to it-I am starting to think that its just going to be a daily thing for me now. But, if I dont take it the pain is SOOO much greater that I cant even walk well on my feet or barely walk at all.

Re: EPF, ESWT, ANY THING ELSE??? need advice..

rochelle on 7/03/02 at 10:35 (089026)

Since doctor #2 did all the therapy with me, I will consider going back to him and show him a print out of your recommendations. I think that it may be something that I am interested in. I have not done the night splints, but I have been taped up for 5 weeks straight (did not get relief). NSIADS is something that I am unfamilar with (is that the same as the vioxx that I am taking?). Iam not keen on getting a cortisone shot in my foot, but since I am taking a vacation soon and will have to walk alot, I may be up for it as long as I am restrained-ha.

Thanks for all this info doc, I really appreciate it!

Re: EPF, ESWT, ANY THING ELSE??? need advice..

Dr. Zuckerman on 7/04/02 at 19:58 (089143)

Vioxx is an nsaid

Re: EPF, ESWT, ANY THING ELSE??? need advice..

phyllis R on 7/02/02 at 22:59 (088988)

My you sound like me.
I read about a pro-baseball player having surgery and he was never able to play again after it, so that worries me.

I had my 1st cort. shot yesterday at 2 pm, killed me last night. Tonight it feels like I must have someone else foot, very little pain, just sore from the shot. Did you shots never work? Have you tried this night splint? Taping? I was just told to try it, would like to hear from others who have. I can't live like this, my quality of life has really changed due to the constant pain. I live in Montana, afraid to hike the mtns anymore because I can't get back!!!
I have tried BEXTRA and it helps if I take it everday.
Please let me know what you do, reading yours just sounds like me.
Thanks

Re: EPF, ESWT, ANY THING ELSE??? need advice..

Ron P. on 7/03/02 at 00:32 (088998)

To: phyllis R Why don't u try Dr Kiper. He has a special Silicone liquid orthotic...worked for me after all elsed failed. He also consults for 30min. or so to discuss your case...ask him about money back trial & good luck... 800 dr kiper. Ron P fromSunnyvale.

Re: EPF, ESWT, ANY THING ELSE??? need advice..

Julie on 7/03/02 at 03:08 (089003)

Phyllis, I hope one of the doctors will reply. Meanwhile, my recollection is that they are not keen on Endoscopic Plantar Fasciotomy, and prefer MIS (Minimal Incision Surgery) because it gives them a better, clearer view of what they are doing and is more likely to have a successful outcome. (The impression I've had over two years of following this site is that EPF is falling out of favour generally.)

I doubt that any of our doctors would agree to do surgery on a patient who had not followed a regime of conservative treatments for a period of time. I would be suspicious of a podiatrist who offered surgery so quickly, and 'on demand', as your Number 3 has done.

Your history doesn't say what conservative treatments you have followed, but from your reports of your three podiatrists I guess that none of them has given you a comprehensive treatment package geared to your own condition and needs. You oughtn't even to think about surgery until all appropriate conservative treatments have been tried and have failed. Among other contributory factors you need to consider are your lifestyle (does your work require you stand a lot, for instance?) and your shoes (are they the right size, are they giving your feet the support they need?)

If you haven't yet read the heel pain book, please do so, to inform yourself about the many non-surgical options available to you.

Please do your research and consider very carefully whether to have surgery at all, which type to have, and why. Surgery isn't the easy option it may seem, and although it works in many cases, in others it leaves the patient worse off than before.

ESWT should be considered if and when conservative treatment has failed (that includes all necessary adjustments to your lifestyle). If there is no one in Austin who does it, you might be able to travel to someone who does - many have done so.

Good luck!

Re: Rochelle, my post was to you, not Phyllis

Julie on 7/03/02 at 03:18 (089004)

Apologies to both of you!

Re: EPF, ESWT, ANY THING ELSE??? need advice..

Dr. John Cozzarelli on 7/03/02 at 06:04 (089006)

Hi Rochelle:

I agree with the responses that were given to you. I would have a conservative regimen of PT, night splints, NSAIDS and orthotics before I would opt for surgery. The only other surgical procedure offered is Stereotactic Radio Frequency Thermal Lesioning. Basically the patient must ceate a pain map of where the pain is. Once that is done needles are inserted under fluoroscopic guidance and the pain sites are desensitized basically in a pin-point fashion. There is down time of one day. There are no incisions and or stitches. This is covered on insurance. We use this modality when nerve pain is predominately present. On our web site in the technology section it explains more about RF.

Dr. John Cozzarelli

Re: EPF, ESWT, ANY THING ELSE??? need advice..

Rachel W. on 7/03/02 at 09:04 (089017)

Afraid to hyke the mtns??
I feel like that about the stairs. lol.

Re: EPF, ESWT, ANY THING ELSE??? need advice..

rochelle on 7/03/02 at 10:26 (089024)

My feet hurt to much to sit thru a shot in the foot (there are not enough people to hold me down to have that shot-ha). But, I did take a 16 day cortisone pack in its place-it gave me about 2 days of comfort, but that was it. I also had my feet taped up for about 5 weeks. It didnt help me out eigther. At one point I even stayed off my feet for 3 days (doctors request), it didnt help eigther. (sigh)

Bextra is something that I have yet to take-I am taking Vioxx daily. I still am in pain-but, I am getting used to it-I am starting to think that its just going to be a daily thing for me now. But, if I dont take it the pain is SOOO much greater that I cant even walk well on my feet or barely walk at all.

Re: EPF, ESWT, ANY THING ELSE??? need advice..

rochelle on 7/03/02 at 10:35 (089026)

Since doctor #2 did all the therapy with me, I will consider going back to him and show him a print out of your recommendations. I think that it may be something that I am interested in. I have not done the night splints, but I have been taped up for 5 weeks straight (did not get relief). NSIADS is something that I am unfamilar with (is that the same as the vioxx that I am taking?). Iam not keen on getting a cortisone shot in my foot, but since I am taking a vacation soon and will have to walk alot, I may be up for it as long as I am restrained-ha.

Thanks for all this info doc, I really appreciate it!

Re: EPF, ESWT, ANY THING ELSE??? need advice..

Dr. Zuckerman on 7/04/02 at 19:58 (089143)

Vioxx is an nsaid