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Surgery Candidate

Posted by Bobby W. on 7/03/02 at 13:28 (089041)

I have been dealing with heel spurs for over a year now and am seriously considering surgery. I've tried anti-inflamatory drugs (doctor prescribed of course), physical therapy, a huge decrease in activity and orthotics. Pain in my heels is now graduated from morning and post-activity, to constant. My podiatrist offered two procedures: Cortisone shots (considering the location of my spurs, makes me a high risk for tendon rupture) or surgery to remove the spurs. (Yes I have them on both feet. I sought a second opinion and got the same answer. Many of you appear to have had spurs removed from the bottom of your heel. Mine are on the back of my heels. Doctor described the procedure to me and it seems a little different (more drastic) from what I've read on this message board. I am tired of being in constant pain. I want some kind of relief. Should I seek another opinion? Is the surgery worth it?

Re: Surgery Candidate

Gail R on 7/03/02 at 16:38 (089048)

Hi Bobby, I am in the same boat you are in with the so called pump bumps. I had the surgery in dec. of last year. He did not detach the tendon. He was hoping he got enough to give me releif. Sorry to say I am worse now than before the surgery. I was out of work 8 weeks after the surgery. I am going to try going back this Friday. I have missed the last month in addition to the 8 weeks after surgery! My orthpaedic dr. says he needs to go back and detach the achilles tendon clean it up then re-attach it. Be sure if you have surgery to discuss with your doc what he intends to do. If they de-tach the tendon the recovery time is much longer but I would have been ahead if my doc had did it then! I have no bad feeling toward my doc ,he was trying to get me back to work asap!I am in so much misery I have got to do something. Hope this gives you some insight. Best wishes Gail R

Re: Surgery Candidate

Bobby W on 7/04/02 at 07:13 (089088)

Thanks Gail. Both doctors I have seen described the procedure to me and explained that detachment of the achilles would occur. Thank you for responding. It is reassuring to know that someone else is experiencing the same type of procedure. I hope all goes well for you. I have not decided completely on surgery yet. I have never been cut on before and am scared to death. However, I am extremely tired of walking like Fred Sanford all the time! The pain is very much unbearable. Let me know how your follow-up goes. Sincerely, Bobby W

Re: Surgery Candidate

Pauline on 7/04/02 at 10:33 (089104)

Bobby,
I know you said you've tried everything and I am wondering if you have continually used a backless slide for shoes instead of trying to put on a shoe that has a back and taped at the same time for additional support?

Unfortunately conserative treatments usually take a long long time sometimes over a year and they must be done many times a day, every day.

If you've only tried Pods you might want to visit and Ortho office to see what they tell you. Please remember no surgery comes with a guarantee that you will be pain free. If you read the surgical board a while you will find out for yourself.

My advice is to think about surgery long and hard---their will always be someone out there willing to cut your feet this is quaranteed, relief is not.

Re: Surgery Candidate

Dr. Zuckerman on 7/04/02 at 13:41 (089118)

another option is ESWT for this procedure. We have used ESWT for insertional achilles tendonitis with or without spurring for years. If you want additional information just e-mail Dr. Z at (email removed)

Re: Both orthopedic and podiatric pretty much the same

Dr. Zuckerman on 7/05/02 at 19:20 (089192)

I have found that most orthopedic surgeons with this specific problem will address this problem in one of three ways. PT, cast, heel lift. and surgery. Just did an ESWT last week on a patient that one of the top foot and orthopedic foot guys in the country had his knife all ready to cut and remove the achilles not saying its wrong but ESWT is the way especially with the high complication rate with achilles tendon surgery

Re: Surgery Candidate

Joe S on 7/06/02 at 17:16 (089221)

I perform this procedure fairly often. Maybe 8 times a year. Believe that is fairly frequent with this particular pathology. If you do not detach the achilles tendon the problem will more than likely return. There's a couple of different rationales for detaching the achilles. First, it affords greater exposure to the 'retrocalcaneal exostosis'. Usually this is most prominent directly over the achilles tendon. There is usually pain on directly overlying this aera. On xray it is hard to see but alot of the times the exostosis (spur) is actually fractured off of the posterior aspect of the calcaneus (heel bone). This is where the detachment comes into play. You usually have to fish that spur out of the achilles tendon. Once this is done, the back of the heel bone is remodelled and the tendon is reattached in a location that will not create as much friction as preoperatively. Now here is the tricky part. The post op recovery time. It takes tendon a good 8-12 weeks to heal itself back to bone. This is a major surgery. My patients are usually in a nonweightbearing cast for 6 weeks held in slight plantarflexion. Then the patients are casted with the foot at 90 degrees to the leg for an additional 2-4 weeks. After about 10 weeks, I transition them into a walking cast and begin aggresive physical therapy to help re-educate the achilles as well as strengthen the achilles. There are other treatment modalities like heel lifts etc, which you sound like you've used before. ESWT may help with your pain but I do not believe there are any published studies on the use of this modality for Retrocalcaneal exostoses. Good luck.

Re: Surgery Candidate

Dr. Zuckerman on 7/06/02 at 17:37 (089223)

The procedure that Dr. Joe described is an excellent treatment option. Go to the web for the International Society for Shockwave Therapy . There is a link on this web site. You can look under the literature section for articles and studies for ESWT for Insertional Achilles tendonitis. I have personally performed this procedure as have other USA podiatric Surgeons.
This procedure has also been performed in Canada. This is an excellent procedure that will soon have FDA approval in the USA. Right now it is considered off label in the USA. I would be very happy to put you touch with patients that have had ESWT for this procedure post three years

Re: Surgery Candidate

Joe S on 7/06/02 at 22:02 (089234)

Actually, most general orthopedists will not touch this surgically and will only tell you to wear a heel lift and sandals. If you are going to seek the advice of an orthopedic surgeon, make sure they specialize in foot and ankle. That is a completely separate specialty in the orthopedic community. Most orthopedists hate treating feet. I know, I work with three of them. That's why they hired me. They send me all of their foot cases. Most of the time, your problem can be successfully treated conservatively.

Re: Surgery Candidate

Bobby W. on 7/06/02 at 22:49 (089238)

Sorry I have been off the board for a few days. I truly appreciate all of the information given concerning my situation. It is difficult NOT to consider surgery when I can't even keep up with my 9 year-old son. I consider myself a young 39, but high school sports and the Army have given my feet a tremendous pounding.

I have been swimming, trying to get some type of exercise in, but my heels ache the same as if I have been running. The spurs on my heels are visible on xray. The doctors I have seen (one civilian, one Navy) are podiatrists. Both have done this type surgery before. I don't know squat abot ESWT? I will do some research and ask my doctor. Your comments seem right in line with his.

Re: Surgery Candidate

Gail R on 7/07/02 at 21:37 (089265)

It is difficult to know what IS the best treatment. The only thing I do know for sure is I want to get better! As I stated to Bobby on my previous post, I have tried all conservative treatments bar none. The haguland surgery I had in December kept me on crutches for 6 weeks. I am not looking forward to more of the same but I have to get to the point to where I can walk again! I am going for a second opinion with orthopaedic in Columbus Ga. Has anyone had the achilles tendon detached and reattached with a good amount of relief afterwards? I had great success with the 2 plantar release surgeries I have had!One open and other endosocpic.I want to get to the point I can walk a couple of miles one day and as Bobby said not have to walk like Fred Sanford! Thanks for the ear! Gail R

Re: Surgery Candidate

Karen W on 7/08/02 at 00:17 (089272)

Gail and others...
I've read yours and Bobby's posts as well as others and I like you just want to know where the most success is obtained-I realize that there is trade offs and costs regardless of the avenue chosen. We've just been down one with not very good results. My husband just turned 40 and has suffered with severe foot pain for at least the past 10 years. (Years of abuse in Football and now the business he is in being the culprit). He too has the large lumps on the rear of his heels. They tell us bone spurs in or around the achilles. These have pretty much crippled him alot of the time-he couldn't run if he had too, or walk very far. The pain is better at times but never any warning or full relief. He has seen two foot specialists who have put him through very stringent PT, orthodics, and prescribed anti-inflamatory over the past year. These seem to not help at all anymore. In his line of business he must push heavy loads up steep inclines which maginifies the problem. I know he is at his wits end and wants relief, I just don't like what I'm seeing with all the posts on the surgical avenue. I'd be interested in any advise you guys/gals may have as it appears you've already ventured down that surgical road. And certainly good luck in it. Thanks.

Re: Surgery Candidate

J. King on 7/08/02 at 07:28 (089279)

Pushing heavy loads on a concrete floor is what triggered my PF 17 years ago. That is the perfect activity to really aggravate PF. Sometimes a lifestyle change is the answer. Not easy when it is your job I know.

Re: Surgery Candidate

Gail R on 7/08/02 at 09:41 (089281)

Karen, I can symphathize with you and your husband. I was on my feet a good portion of yesterday wearing my air boot. Last night it was swelled a good bit around the ankle. I took a pain pill to get it eased off so I could rest. I am still waiting for orthpaedic to review my medical records and set me up for a second opinion. Will keep you all posted on what new doc says when I go. Oh yeah, did you ever wonder why some doctors have been charging $20 to get a copy of your x-rays? Seems to me if you want to see another doc the x-rays you paid for should belong to the patient! Thanks Gail R

Re: Surgery Candidate

Gail R on 7/08/02 at 10:04 (089284)

Karen, Sorry to hear of your husband's problem. It is really tough to keep trying to work on your feet when they are killing you! It is not always practical to change occupations especially if you have a great paying job with good benefits. I am required to wear steel toes on my job and have to flex my foot constantly driving a lift truck and walking on the concrete floors is even worse! I am waiting to get an appointment with another othopaedic for a second opinion concerning surgery. Hoping if I do go with it it will get me back to where I can do my job and walk for enjoyment again! Like I said before the two release surgerys I had worked great. If this 2nd procedure for this pump bump,( tho I have never worn pumps or heels much in my lifetime)where the tendon is de-tached will give me relief I will be willing to do the cast and crutch thing again. I need to get on with my life! Wishing you the best Gail R

Re: Surgery Candidate

Joe S on 7/08/02 at 12:40 (089293)

I have a very good , well trained podiatrist who did an extensive 3 year reconstructive surgical residency in foot and ankle. He is a podiatrist. He is in Columbus GA. A very good surgeon. If you would like I will give you his name.

Re: Surgery Candidate

Joe S on 7/08/02 at 12:44 (089294)

Also, if you are in Georgia, there are several excellent foot and ankle guys there. Atlanta is kind of like the thinking tank of podiatry. Just a few names in Atlanta to think about..

Alan Banks, DPM
Thomas Cain, DPM
John Ruch, DPM

These are a few that come to mind. they are in Atlanta however. If you want someone in Columbus then give Dr. Troy Espiritu a call. He is also excellent.

Re: Surgery Candidate

Bobby W. on 7/15/02 at 14:08 (089693)

Please!!!

I never had surgery before and this is an extremely important decision to me.

Re: Surgery Candidate

Gail R on 7/18/02 at 20:14 (090010)

Bobby, have you decided about the surgery? I go to the orthpeadic doc next Thursday. This will be a second opinion. I got two opinions before the hagulands surgery I had in December. This is a doc my nurse at work set me up with. Keep you posted. Best wishes, Gail

Re: Surgery Candidate

Bobby W. on 7/19/02 at 10:09 (090098)

Since I've never had any kind of surgery before, I am scared senseless. I have stayed off of my feet as much as possible, and although the pain has decreased somewhat, I still have annoying pain. I am beginning to believe surgery is inevitable. The two doctors I met with recommend surgery. Thanks for your email. It is nice to know that there are others experiencing what I am. Makes it easier to decide.

Re: Surgery Candidate

Gail R on 7/19/02 at 11:13 (090105)

Bobby and others; The worst part of the surgery I had for the Hagulands was being on dadblasted crutches for 6 long weeks. My hands were calloused. I finally got to the point I would crawl on all fours, at times to get around the house! I had a wheel chair but my house tho just a year old is not very handy for handicapped. It made me have a whole new awareness of what physically challenged folks have to deal with in shopping etc. So many items are out of reach for a wheel chair when shopping. I am a neat freak so trying to get around to do small chores was very difficult! I feel it would be even more difficult for a guy to be housebound a lot! It was hard on my hubby to try and get meals together but we managed. His clean standard and mine tho are very different! I plan to ask a LOT of questions when I go to the new doc. It is not something (surgery) to be entered into with out a lot of thought. Prepare to have a good deal of pain. The pain meds are great during this phase of recovery. I took them for about 10 days then went to tylenol etc. from there. Sorry about rambling, I guess I just like to talk! Thanks Gail

Re: Surgery Candidate

Gail R on 7/03/02 at 16:38 (089048)

Hi Bobby, I am in the same boat you are in with the so called pump bumps. I had the surgery in dec. of last year. He did not detach the tendon. He was hoping he got enough to give me releif. Sorry to say I am worse now than before the surgery. I was out of work 8 weeks after the surgery. I am going to try going back this Friday. I have missed the last month in addition to the 8 weeks after surgery! My orthpaedic dr. says he needs to go back and detach the achilles tendon clean it up then re-attach it. Be sure if you have surgery to discuss with your doc what he intends to do. If they de-tach the tendon the recovery time is much longer but I would have been ahead if my doc had did it then! I have no bad feeling toward my doc ,he was trying to get me back to work asap!I am in so much misery I have got to do something. Hope this gives you some insight. Best wishes Gail R

Re: Surgery Candidate

Bobby W on 7/04/02 at 07:13 (089088)

Thanks Gail. Both doctors I have seen described the procedure to me and explained that detachment of the achilles would occur. Thank you for responding. It is reassuring to know that someone else is experiencing the same type of procedure. I hope all goes well for you. I have not decided completely on surgery yet. I have never been cut on before and am scared to death. However, I am extremely tired of walking like Fred Sanford all the time! The pain is very much unbearable. Let me know how your follow-up goes. Sincerely, Bobby W

Re: Surgery Candidate

Pauline on 7/04/02 at 10:33 (089104)

Bobby,
I know you said you've tried everything and I am wondering if you have continually used a backless slide for shoes instead of trying to put on a shoe that has a back and taped at the same time for additional support?

Unfortunately conserative treatments usually take a long long time sometimes over a year and they must be done many times a day, every day.

If you've only tried Pods you might want to visit and Ortho office to see what they tell you. Please remember no surgery comes with a guarantee that you will be pain free. If you read the surgical board a while you will find out for yourself.

My advice is to think about surgery long and hard---their will always be someone out there willing to cut your feet this is quaranteed, relief is not.

Re: Surgery Candidate

Dr. Zuckerman on 7/04/02 at 13:41 (089118)

another option is ESWT for this procedure. We have used ESWT for insertional achilles tendonitis with or without spurring for years. If you want additional information just e-mail Dr. Z at (email removed)

Re: Both orthopedic and podiatric pretty much the same

Dr. Zuckerman on 7/05/02 at 19:20 (089192)

I have found that most orthopedic surgeons with this specific problem will address this problem in one of three ways. PT, cast, heel lift. and surgery. Just did an ESWT last week on a patient that one of the top foot and orthopedic foot guys in the country had his knife all ready to cut and remove the achilles not saying its wrong but ESWT is the way especially with the high complication rate with achilles tendon surgery

Re: Surgery Candidate

Joe S on 7/06/02 at 17:16 (089221)

I perform this procedure fairly often. Maybe 8 times a year. Believe that is fairly frequent with this particular pathology. If you do not detach the achilles tendon the problem will more than likely return. There's a couple of different rationales for detaching the achilles. First, it affords greater exposure to the 'retrocalcaneal exostosis'. Usually this is most prominent directly over the achilles tendon. There is usually pain on directly overlying this aera. On xray it is hard to see but alot of the times the exostosis (spur) is actually fractured off of the posterior aspect of the calcaneus (heel bone). This is where the detachment comes into play. You usually have to fish that spur out of the achilles tendon. Once this is done, the back of the heel bone is remodelled and the tendon is reattached in a location that will not create as much friction as preoperatively. Now here is the tricky part. The post op recovery time. It takes tendon a good 8-12 weeks to heal itself back to bone. This is a major surgery. My patients are usually in a nonweightbearing cast for 6 weeks held in slight plantarflexion. Then the patients are casted with the foot at 90 degrees to the leg for an additional 2-4 weeks. After about 10 weeks, I transition them into a walking cast and begin aggresive physical therapy to help re-educate the achilles as well as strengthen the achilles. There are other treatment modalities like heel lifts etc, which you sound like you've used before. ESWT may help with your pain but I do not believe there are any published studies on the use of this modality for Retrocalcaneal exostoses. Good luck.

Re: Surgery Candidate

Dr. Zuckerman on 7/06/02 at 17:37 (089223)

The procedure that Dr. Joe described is an excellent treatment option. Go to the web for the International Society for Shockwave Therapy . There is a link on this web site. You can look under the literature section for articles and studies for ESWT for Insertional Achilles tendonitis. I have personally performed this procedure as have other USA podiatric Surgeons.
This procedure has also been performed in Canada. This is an excellent procedure that will soon have FDA approval in the USA. Right now it is considered off label in the USA. I would be very happy to put you touch with patients that have had ESWT for this procedure post three years

Re: Surgery Candidate

Joe S on 7/06/02 at 22:02 (089234)

Actually, most general orthopedists will not touch this surgically and will only tell you to wear a heel lift and sandals. If you are going to seek the advice of an orthopedic surgeon, make sure they specialize in foot and ankle. That is a completely separate specialty in the orthopedic community. Most orthopedists hate treating feet. I know, I work with three of them. That's why they hired me. They send me all of their foot cases. Most of the time, your problem can be successfully treated conservatively.

Re: Surgery Candidate

Bobby W. on 7/06/02 at 22:49 (089238)

Sorry I have been off the board for a few days. I truly appreciate all of the information given concerning my situation. It is difficult NOT to consider surgery when I can't even keep up with my 9 year-old son. I consider myself a young 39, but high school sports and the Army have given my feet a tremendous pounding.

I have been swimming, trying to get some type of exercise in, but my heels ache the same as if I have been running. The spurs on my heels are visible on xray. The doctors I have seen (one civilian, one Navy) are podiatrists. Both have done this type surgery before. I don't know squat abot ESWT? I will do some research and ask my doctor. Your comments seem right in line with his.

Re: Surgery Candidate

Gail R on 7/07/02 at 21:37 (089265)

It is difficult to know what IS the best treatment. The only thing I do know for sure is I want to get better! As I stated to Bobby on my previous post, I have tried all conservative treatments bar none. The haguland surgery I had in December kept me on crutches for 6 weeks. I am not looking forward to more of the same but I have to get to the point to where I can walk again! I am going for a second opinion with orthopaedic in Columbus Ga. Has anyone had the achilles tendon detached and reattached with a good amount of relief afterwards? I had great success with the 2 plantar release surgeries I have had!One open and other endosocpic.I want to get to the point I can walk a couple of miles one day and as Bobby said not have to walk like Fred Sanford! Thanks for the ear! Gail R

Re: Surgery Candidate

Karen W on 7/08/02 at 00:17 (089272)

Gail and others...
I've read yours and Bobby's posts as well as others and I like you just want to know where the most success is obtained-I realize that there is trade offs and costs regardless of the avenue chosen. We've just been down one with not very good results. My husband just turned 40 and has suffered with severe foot pain for at least the past 10 years. (Years of abuse in Football and now the business he is in being the culprit). He too has the large lumps on the rear of his heels. They tell us bone spurs in or around the achilles. These have pretty much crippled him alot of the time-he couldn't run if he had too, or walk very far. The pain is better at times but never any warning or full relief. He has seen two foot specialists who have put him through very stringent PT, orthodics, and prescribed anti-inflamatory over the past year. These seem to not help at all anymore. In his line of business he must push heavy loads up steep inclines which maginifies the problem. I know he is at his wits end and wants relief, I just don't like what I'm seeing with all the posts on the surgical avenue. I'd be interested in any advise you guys/gals may have as it appears you've already ventured down that surgical road. And certainly good luck in it. Thanks.

Re: Surgery Candidate

J. King on 7/08/02 at 07:28 (089279)

Pushing heavy loads on a concrete floor is what triggered my PF 17 years ago. That is the perfect activity to really aggravate PF. Sometimes a lifestyle change is the answer. Not easy when it is your job I know.

Re: Surgery Candidate

Gail R on 7/08/02 at 09:41 (089281)

Karen, I can symphathize with you and your husband. I was on my feet a good portion of yesterday wearing my air boot. Last night it was swelled a good bit around the ankle. I took a pain pill to get it eased off so I could rest. I am still waiting for orthpaedic to review my medical records and set me up for a second opinion. Will keep you all posted on what new doc says when I go. Oh yeah, did you ever wonder why some doctors have been charging $20 to get a copy of your x-rays? Seems to me if you want to see another doc the x-rays you paid for should belong to the patient! Thanks Gail R

Re: Surgery Candidate

Gail R on 7/08/02 at 10:04 (089284)

Karen, Sorry to hear of your husband's problem. It is really tough to keep trying to work on your feet when they are killing you! It is not always practical to change occupations especially if you have a great paying job with good benefits. I am required to wear steel toes on my job and have to flex my foot constantly driving a lift truck and walking on the concrete floors is even worse! I am waiting to get an appointment with another othopaedic for a second opinion concerning surgery. Hoping if I do go with it it will get me back to where I can do my job and walk for enjoyment again! Like I said before the two release surgerys I had worked great. If this 2nd procedure for this pump bump,( tho I have never worn pumps or heels much in my lifetime)where the tendon is de-tached will give me relief I will be willing to do the cast and crutch thing again. I need to get on with my life! Wishing you the best Gail R

Re: Surgery Candidate

Joe S on 7/08/02 at 12:40 (089293)

I have a very good , well trained podiatrist who did an extensive 3 year reconstructive surgical residency in foot and ankle. He is a podiatrist. He is in Columbus GA. A very good surgeon. If you would like I will give you his name.

Re: Surgery Candidate

Joe S on 7/08/02 at 12:44 (089294)

Also, if you are in Georgia, there are several excellent foot and ankle guys there. Atlanta is kind of like the thinking tank of podiatry. Just a few names in Atlanta to think about..

Alan Banks, DPM
Thomas Cain, DPM
John Ruch, DPM

These are a few that come to mind. they are in Atlanta however. If you want someone in Columbus then give Dr. Troy Espiritu a call. He is also excellent.

Re: Surgery Candidate

Bobby W. on 7/15/02 at 14:08 (089693)

Please!!!

I never had surgery before and this is an extremely important decision to me.

Re: Surgery Candidate

Gail R on 7/18/02 at 20:14 (090010)

Bobby, have you decided about the surgery? I go to the orthpeadic doc next Thursday. This will be a second opinion. I got two opinions before the hagulands surgery I had in December. This is a doc my nurse at work set me up with. Keep you posted. Best wishes, Gail

Re: Surgery Candidate

Bobby W. on 7/19/02 at 10:09 (090098)

Since I've never had any kind of surgery before, I am scared senseless. I have stayed off of my feet as much as possible, and although the pain has decreased somewhat, I still have annoying pain. I am beginning to believe surgery is inevitable. The two doctors I met with recommend surgery. Thanks for your email. It is nice to know that there are others experiencing what I am. Makes it easier to decide.

Re: Surgery Candidate

Gail R on 7/19/02 at 11:13 (090105)

Bobby and others; The worst part of the surgery I had for the Hagulands was being on dadblasted crutches for 6 long weeks. My hands were calloused. I finally got to the point I would crawl on all fours, at times to get around the house! I had a wheel chair but my house tho just a year old is not very handy for handicapped. It made me have a whole new awareness of what physically challenged folks have to deal with in shopping etc. So many items are out of reach for a wheel chair when shopping. I am a neat freak so trying to get around to do small chores was very difficult! I feel it would be even more difficult for a guy to be housebound a lot! It was hard on my hubby to try and get meals together but we managed. His clean standard and mine tho are very different! I plan to ask a LOT of questions when I go to the new doc. It is not something (surgery) to be entered into with out a lot of thought. Prepare to have a good deal of pain. The pain meds are great during this phase of recovery. I took them for about 10 days then went to tylenol etc. from there. Sorry about rambling, I guess I just like to talk! Thanks Gail