Home The Book Dr Articles Products Message Boards Journal Articles Search Our Surveys Surgery ESWT Dr Messages Find Good Drs video

time till walking post-TTS release

Posted by elliott on 9/03/02 at 15:14 (094370)

A lot of people here indicate that post-standard-TTS release, it is many many weeks till they weightbear and walk again. If there's no tendon or bone repair involved, shouldn't it be more like two weeks? That's what it was for my left foot: soft wrap and no weightbearing for about two weeks, then walking right away. Not that I got 100% relief--not yet, anyway (gotta think positive)--but the tinge I still have problems with I felt upon waking up from surgery; going longer without walking would not have changed anything, at least for me.

Other than bone/tendon work or where an extended release outside the tarsal tunnel and further along nerve branches was necessary, if you had a standard release and did not weightbear for some time or required a walking cast after surgery, could you expound on the circumstances necessitating this? It might be helpful. Thanks.

---

Re: time till walking post-TTS release

Sharon W on 9/03/02 at 17:34 (094382)

Elliott,

No doubt, your comments will be very encouraging for those who are currently considering TTS surgery.

I think the experts might be the appropriate ones to answer the question about circumstances that necessitate using a cast or remaining non-weight bearing for a longer period after the surgery than your surgery required.

In my own case, I have simply followed my surgeon's orders as to when SHE felt I was ready to advance to a new stage in the recovery process after my surgery. I am not 'in a rush'; and I'd much rather err on the side of caution.

Sharon

Re: time till walking post-TTS release

Janet C on 9/03/02 at 18:05 (094383)

Elliott,

Although I had the opposite experience, I thought I would respond to your post, with some of my theories...

I had TT Release surgeries on both of my feet on the same day... which makes completely staying off your feet, and non-weight bearing, almost impossible. I remember the nurse telling me that she had a 'similar surgery', and she was able to go out dancing the very next night(!), and the Orthopedic Surgeon told me that I could begin to weight bear, just as soon as it was 'tolerable'. I was even encouraged to try to stand up before leaving the hospital... but it was extremely painful, and I immediately dropped to knees.

With the instructions that I received, I thought that I just needed to 'push myself' to recover more quickly. I finally was able to walk, with the aid of my crutches, at seven days post-op. But now, I think it was too soon.

Would I have recovered better, and not developed RSD if I hadn't pushed myself so quickly after surgery? I don't know... but I think that waiting a couple of weeks before any weight bearing with a minimal incision, or even longer for certain cases, is probably more beneficial for the patient's recovery, than being instructed to walk sooner.

Re: time till walking post-TTS release

cindyp on 9/03/02 at 19:59 (094392)

It is all dependent upon the individual, their healing abilities, the extent of the swelling and how drastic their damage is. I fail to understand what the rush is. Why not take your time and do it right so you won't damage yourself. My dr. told me when I was ready and when I felt comfortable.It was two months before I got my birkenstocks back on. I mean after all they go in there move stuff around, take stuff out and then sew you back up. You just are not going to hop right up and anybody that says they did is either a liar or crazy or didn't have tarsel tunnel syndrome.

Re: time till walking post-TTS release

Missy B on 9/03/02 at 21:07 (094398)

Elliott,
I was basically non-weight bearing for 2 1/2 weeks after surgery - until my stitches came out. I wore a cam walker on my foot to protect it and relied on a regular walker that you lean into and a wheelchair to get around my apartment. I stayed off my foot as much as possible during this time. After my stitches were removed, my doctor encouraged me to gradually begin putting some weight on my foot (while still wearing the cam walker) until I could comfortably get around my place without the aid of the regular walker or wheelchair. At 5 weeks he allowed me to begin wearing regular shoes and taking short shopping trips.

To make a long story short, I am now 7 1/2 months post surgery and have a 90 to 95% improvement over my presurgery pain. Do I think that by taking it slow and being very conservative in my recovery, this has helped me reach this improvement - you bet I do! Most people that I have been able to speak with that also had positive outcomes from PF/TT surgery have all followed a slow, conservative recovery plan - with plenty of rest during the first few months.

What is the hurry?? If you have spent months or years with foot pain, and have undergone surgery to hopefully relieve this pain, why risk compromising your recovery by being in a hurry? My doctor told me it could take up to one year for full recovery. Well, one year of taking it easy and sitting out of some regular activities along the way is a small price to pay if the outcome might be a life of pain-free or almost pain-free feet. And right now I feel that I have a very good chance of reaching that 100% by the end of the year.

Of course, there are several different causes for TT, doctors prefer different protocols for recovery, and we all heal at different rates. If you are happy with your outcome, then that is all that matters. But wouldn't it be better to err on the side of caution, rather than risk a setback?

Missy B.

Re: taking one's time also has risks

elliott on 9/03/02 at 21:17 (094402)

Failure to move around increases the risk of scar tissue formation and recurrence, defeating the very point of the surgery. A cast pressing on the nerve area probably isn't so good either. I'm not saying jump up and start dancing right away; more weeks of careful walking buildup would be still be necessary. What I am saying is that the standard release does not go in too deep, and many surgeons feel the sooner one walks post-op, the better. I can find such things in print if you insist. Of course, some of you were practically in wheelchairs before the surgery. Maybe that has something to do with it. I don't know. That was the idea behind starting the thread.

------

Re: taking one's time also has risks

wendyn on 9/04/02 at 06:59 (094422)

Elliott, I may have misunderstood your post (seems to be a common problem for me lately)...but are you saying that patients should disregard post op instructions given by their surgeons?

Re: Why does recovering mobility have to mean WALKING??

Sharon W on 9/04/02 at 07:26 (094423)

I did not stay immobile for 6 weeks, building up scar tissue. The cast I've been in for the last 3 weeks is REMOVABLE, and I remove it for physical therapy and at least twice a day to do a full set of PT exercises. I also rest (with my foot above my heart) without the cast, doctor's orders, and move my foot around during THAT time, too -- doing range of motion exercises while I watch the morning news, or whatever. (I do Julie's stretches, too, for good measure!) And I think it's worked out pretty well, because the PT LAST week told me I have already recovered a full range of motion.

But I think I am as worried about scarring, as anyone. I've been using Cica Care -- the silicon gel strip -- and it helps. The PT also massages out adhesions around my scar, every time I'm in there, and it WORKS -- I can feel the difference -- after he does it, movement doesn't pull at my scar area so much.

I just DON'T walk around with my cast, and I don't walk around very MUCH, in any case. (Perhaps it would be safer for me to do so, if I weighed 98 pounds, but I don't.)

Sharon

Re: Why does recovering mobility have to mean WALKING??

Sharon W on 9/04/02 at 07:29 (094424)

Make that TWO weeks after surgery, that I changed to the removable cast. I began trying to my foot around sometimes, as much as I could stand, even at that point -- but I didn't start PT until a week later.

Sharon

Re: I obviously need COFFEE!

Sharon W on 9/04/02 at 07:35 (094426)

That should have read, 'I began trying to MOVE my foot around sometimes...'

Sharon

Re: taking one's time also has risks

elliott on 9/04/02 at 08:00 (094429)

No, I didn't say anything so provocative (the new yogi in me won't let me :-)), but all the same, it doesn't necessarily mean their docs are right either. I hope there's no problem in asking the question. I wish others would ask more such questions. There is still quite a bit of uncertainty regarding how to handle TTS.

In the journal Current Therapy in Foot and Ankle Surgery, an article on TTS release says, 'The patients are instructed to remain off of the foot for 2 weeks following the surgery. During this time, they may use crutches or a walker as they feel comfortable...sutures are removed at 2 weeks, and then the patients may begin gradual weight bearing as tolerated. We encourage resumption of the heel cord stretching and increase in activities as tolerated.'

Then there's the passage in Foot and Ankle Disorders, a new and quite standard orthopedic reference, which takes a somewhat more conservative approach: 'At 10 days, the sutures are removed andhte patient is placed in a controlled-ankle motion walking boot locked at neutral dorsiflexion; physical therapy is used to establish motion and prevent adherent scar by massage of the soft tissues.'

-----

Re: I don't know; I'm not the doctor

elliott on 9/04/02 at 08:16 (094431)

Maybe to make the tissue settle properly around the nerve the way a foot is used, i.e., under normal walking conditions. Or maybe walking is more effective in diffusing scar tissue.

I'll add that it appears from the first reference that returning to activity and complete resolution of nervy symptoms are not exactly the same thing. It continues: 'Typical recovery should occur within 8 weeks; however, some patients improve within 3 weeks and others take years.'

Then in the next paragraph, dealing with complications, it says, 'In some situations a cast is helpful, but beware of overusing casts and immobilizations becasue this further increases the likelihood that a nerve may adhere to scar tissue. Generally it is better to encourage range of motion following the surgery.'

Some may find the next paragrpah interesting:

'It is not uncommon following any nerve release to have a patient initially experience relief of pain only to be disappointed subsequently as the pain partially or completely returns over the next weeks or months. Overall recurrent tarsal tunnel syndrome occurs in about 30 percent of patients. Some of these are a result of inadequate release, inadvertent superficial nerve transection, or repeat trauma, whereas others are idiopathic. It is best to advise patients before surgery [Pauline, this paragraph is for you :-)] that this nerve always will be somewhat more vulnerable to injury, even after a minor insult.'

-------

Re: no, just WALKING :-)

elliott on 9/04/02 at 08:18 (094432)

Sorry; can't strip the humor from the yogi in me. :-)

-----

Re: I did need coffee!

Sharon W on 9/04/02 at 10:31 (094435)

Found another typo. That should have read, 'I just DON'T walk around WITHOUT my cast' (I have been walking WITH it, and full weight-bearing while using it, since 4 weeks after surgery.) The cast holds my foot in neutral position while I walk, and provides compression on that leg (which I need because of the problem with my veins).

Anyway, I just got back from PT and today (6 weeks after surgery) was the day that I finally got to take the cast off and walk around a bit in both of my Birks.

Following this schedule for recovery seems to have worked out really well for me so far, and I intend to keep on following my doctor's orders.

I do realize that I could still develop scar tissue around the nerve, but right now I prefer to focus on the POSITIVE -- I feel much better than I did before my surgery, and I LOVE IT!

Sharon

Re: can I recommend decaf? :-)

elliott on 9/04/02 at 13:08 (094444)

It sounds like some are a bit too wound up and defensive about this. I'm not saying don't listen to your doctor. I'm happy if your surgery went well, whatever the rest period, which doesn't prove that a priori it was the most ideal. I was just asking if, post-standard-TTS release, there's an ideal interval before a return to walking, maybe some general rule to follow, which some docs may know and some may not. Maybe I shouldn't have asked. Sorry.

---

Re: But of course

wendyn on 9/04/02 at 14:16 (094453)

You will be happy to hear that I haven't had caffiene since my little heart episode.

I'm a much calmer individual without it.

;)

Re: can I recommend decaf? :-)

Sharon W on 9/04/02 at 15:28 (094466)

Elliott,

It's a legitimate question, and one that might be worth asking the doctors. I'm sure there ARE factors that they take into consideration, such as the condition that the patient was in BEFORE surgery, the extent of the surgery that was done, and probably the weight of the patient. If they are conscientious enough to ASK, they may even take into consideration the patient's surgical history,

If I reacted defensively, it's probably because I've gotten a LOT of people (in my 'real' life) looking at me sideways lately, people who know very little about TTS, sometimes asking why I'm still wearing the boot, and seeming to make the assumption that I've HAD the surgery, so that should be all there is to it.

Sorry if I overreacted.

Sharon

Re: It all depends

Julie on 9/04/02 at 16:11 (094471)

Surely post-op care depends entirely on the surgery that was done, whether it was straightforward or complex, and the individual condition, age, weight, and whatever other factors might pertain, of the individual whose foot was operated on.

And surely if the individual has trusted the surgeon to perform the surgery, s/he can trust the surgeon's post-op instructions and follow them.

Re: Depending on

wendyn on 9/04/02 at 19:29 (094479)

I think it's good to follow post op instructions, but healing is such an individual thing.

I was dancing 2.5 weeks post op from bunion surgery and skiing at the 6 week mark.

Would I suggest other people do the same?

No. I was only about 23 at the time, and weighed next to nothing. I healed fast.

Could I do the same thing now (10 years later?)

Probably not.

I think it's best to go with how you feel, and what your doctor suggests (based on your history, your medical state, and what was done in the surgery).

Re: Depending on

Sharon W on 9/05/02 at 09:17 (094514)

Wendy,

I think the important thing to do is to find a foot doctor that you CAN trust, someone that YOU KNOW ENOUGH ABOUT to trust him/her WITHOUT doing so blindly. I'm not the sort of person who puts blind trust in every doctor I see. I do very much respect the achievement involved in BECOMING a doctor, but when it comes to honoring a doctor's OPINION -- well, I will NOT follow what I KNOW to be bad advice.

There are times when I need guidance from an expert, and at those times I definitely want the person whose advice I'm following, to be someone that I know I can TRUST. For me, surgery post-op is like that.

Sharon

Re: time till walking post-TTS release

Sharon W on 9/03/02 at 17:34 (094382)

Elliott,

No doubt, your comments will be very encouraging for those who are currently considering TTS surgery.

I think the experts might be the appropriate ones to answer the question about circumstances that necessitate using a cast or remaining non-weight bearing for a longer period after the surgery than your surgery required.

In my own case, I have simply followed my surgeon's orders as to when SHE felt I was ready to advance to a new stage in the recovery process after my surgery. I am not 'in a rush'; and I'd much rather err on the side of caution.

Sharon

Re: time till walking post-TTS release

Janet C on 9/03/02 at 18:05 (094383)

Elliott,

Although I had the opposite experience, I thought I would respond to your post, with some of my theories...

I had TT Release surgeries on both of my feet on the same day... which makes completely staying off your feet, and non-weight bearing, almost impossible. I remember the nurse telling me that she had a 'similar surgery', and she was able to go out dancing the very next night(!), and the Orthopedic Surgeon told me that I could begin to weight bear, just as soon as it was 'tolerable'. I was even encouraged to try to stand up before leaving the hospital... but it was extremely painful, and I immediately dropped to knees.

With the instructions that I received, I thought that I just needed to 'push myself' to recover more quickly. I finally was able to walk, with the aid of my crutches, at seven days post-op. But now, I think it was too soon.

Would I have recovered better, and not developed RSD if I hadn't pushed myself so quickly after surgery? I don't know... but I think that waiting a couple of weeks before any weight bearing with a minimal incision, or even longer for certain cases, is probably more beneficial for the patient's recovery, than being instructed to walk sooner.

Re: time till walking post-TTS release

cindyp on 9/03/02 at 19:59 (094392)

It is all dependent upon the individual, their healing abilities, the extent of the swelling and how drastic their damage is. I fail to understand what the rush is. Why not take your time and do it right so you won't damage yourself. My dr. told me when I was ready and when I felt comfortable.It was two months before I got my birkenstocks back on. I mean after all they go in there move stuff around, take stuff out and then sew you back up. You just are not going to hop right up and anybody that says they did is either a liar or crazy or didn't have tarsel tunnel syndrome.

Re: time till walking post-TTS release

Missy B on 9/03/02 at 21:07 (094398)

Elliott,
I was basically non-weight bearing for 2 1/2 weeks after surgery - until my stitches came out. I wore a cam walker on my foot to protect it and relied on a regular walker that you lean into and a wheelchair to get around my apartment. I stayed off my foot as much as possible during this time. After my stitches were removed, my doctor encouraged me to gradually begin putting some weight on my foot (while still wearing the cam walker) until I could comfortably get around my place without the aid of the regular walker or wheelchair. At 5 weeks he allowed me to begin wearing regular shoes and taking short shopping trips.

To make a long story short, I am now 7 1/2 months post surgery and have a 90 to 95% improvement over my presurgery pain. Do I think that by taking it slow and being very conservative in my recovery, this has helped me reach this improvement - you bet I do! Most people that I have been able to speak with that also had positive outcomes from PF/TT surgery have all followed a slow, conservative recovery plan - with plenty of rest during the first few months.

What is the hurry?? If you have spent months or years with foot pain, and have undergone surgery to hopefully relieve this pain, why risk compromising your recovery by being in a hurry? My doctor told me it could take up to one year for full recovery. Well, one year of taking it easy and sitting out of some regular activities along the way is a small price to pay if the outcome might be a life of pain-free or almost pain-free feet. And right now I feel that I have a very good chance of reaching that 100% by the end of the year.

Of course, there are several different causes for TT, doctors prefer different protocols for recovery, and we all heal at different rates. If you are happy with your outcome, then that is all that matters. But wouldn't it be better to err on the side of caution, rather than risk a setback?

Missy B.

Re: taking one's time also has risks

elliott on 9/03/02 at 21:17 (094402)

Failure to move around increases the risk of scar tissue formation and recurrence, defeating the very point of the surgery. A cast pressing on the nerve area probably isn't so good either. I'm not saying jump up and start dancing right away; more weeks of careful walking buildup would be still be necessary. What I am saying is that the standard release does not go in too deep, and many surgeons feel the sooner one walks post-op, the better. I can find such things in print if you insist. Of course, some of you were practically in wheelchairs before the surgery. Maybe that has something to do with it. I don't know. That was the idea behind starting the thread.

------

Re: taking one's time also has risks

wendyn on 9/04/02 at 06:59 (094422)

Elliott, I may have misunderstood your post (seems to be a common problem for me lately)...but are you saying that patients should disregard post op instructions given by their surgeons?

Re: Why does recovering mobility have to mean WALKING??

Sharon W on 9/04/02 at 07:26 (094423)

I did not stay immobile for 6 weeks, building up scar tissue. The cast I've been in for the last 3 weeks is REMOVABLE, and I remove it for physical therapy and at least twice a day to do a full set of PT exercises. I also rest (with my foot above my heart) without the cast, doctor's orders, and move my foot around during THAT time, too -- doing range of motion exercises while I watch the morning news, or whatever. (I do Julie's stretches, too, for good measure!) And I think it's worked out pretty well, because the PT LAST week told me I have already recovered a full range of motion.

But I think I am as worried about scarring, as anyone. I've been using Cica Care -- the silicon gel strip -- and it helps. The PT also massages out adhesions around my scar, every time I'm in there, and it WORKS -- I can feel the difference -- after he does it, movement doesn't pull at my scar area so much.

I just DON'T walk around with my cast, and I don't walk around very MUCH, in any case. (Perhaps it would be safer for me to do so, if I weighed 98 pounds, but I don't.)

Sharon

Re: Why does recovering mobility have to mean WALKING??

Sharon W on 9/04/02 at 07:29 (094424)

Make that TWO weeks after surgery, that I changed to the removable cast. I began trying to my foot around sometimes, as much as I could stand, even at that point -- but I didn't start PT until a week later.

Sharon

Re: I obviously need COFFEE!

Sharon W on 9/04/02 at 07:35 (094426)

That should have read, 'I began trying to MOVE my foot around sometimes...'

Sharon

Re: taking one's time also has risks

elliott on 9/04/02 at 08:00 (094429)

No, I didn't say anything so provocative (the new yogi in me won't let me :-)), but all the same, it doesn't necessarily mean their docs are right either. I hope there's no problem in asking the question. I wish others would ask more such questions. There is still quite a bit of uncertainty regarding how to handle TTS.

In the journal Current Therapy in Foot and Ankle Surgery, an article on TTS release says, 'The patients are instructed to remain off of the foot for 2 weeks following the surgery. During this time, they may use crutches or a walker as they feel comfortable...sutures are removed at 2 weeks, and then the patients may begin gradual weight bearing as tolerated. We encourage resumption of the heel cord stretching and increase in activities as tolerated.'

Then there's the passage in Foot and Ankle Disorders, a new and quite standard orthopedic reference, which takes a somewhat more conservative approach: 'At 10 days, the sutures are removed andhte patient is placed in a controlled-ankle motion walking boot locked at neutral dorsiflexion; physical therapy is used to establish motion and prevent adherent scar by massage of the soft tissues.'

-----

Re: I don't know; I'm not the doctor

elliott on 9/04/02 at 08:16 (094431)

Maybe to make the tissue settle properly around the nerve the way a foot is used, i.e., under normal walking conditions. Or maybe walking is more effective in diffusing scar tissue.

I'll add that it appears from the first reference that returning to activity and complete resolution of nervy symptoms are not exactly the same thing. It continues: 'Typical recovery should occur within 8 weeks; however, some patients improve within 3 weeks and others take years.'

Then in the next paragraph, dealing with complications, it says, 'In some situations a cast is helpful, but beware of overusing casts and immobilizations becasue this further increases the likelihood that a nerve may adhere to scar tissue. Generally it is better to encourage range of motion following the surgery.'

Some may find the next paragrpah interesting:

'It is not uncommon following any nerve release to have a patient initially experience relief of pain only to be disappointed subsequently as the pain partially or completely returns over the next weeks or months. Overall recurrent tarsal tunnel syndrome occurs in about 30 percent of patients. Some of these are a result of inadequate release, inadvertent superficial nerve transection, or repeat trauma, whereas others are idiopathic. It is best to advise patients before surgery [Pauline, this paragraph is for you :-)] that this nerve always will be somewhat more vulnerable to injury, even after a minor insult.'

-------

Re: no, just WALKING :-)

elliott on 9/04/02 at 08:18 (094432)

Sorry; can't strip the humor from the yogi in me. :-)

-----

Re: I did need coffee!

Sharon W on 9/04/02 at 10:31 (094435)

Found another typo. That should have read, 'I just DON'T walk around WITHOUT my cast' (I have been walking WITH it, and full weight-bearing while using it, since 4 weeks after surgery.) The cast holds my foot in neutral position while I walk, and provides compression on that leg (which I need because of the problem with my veins).

Anyway, I just got back from PT and today (6 weeks after surgery) was the day that I finally got to take the cast off and walk around a bit in both of my Birks.

Following this schedule for recovery seems to have worked out really well for me so far, and I intend to keep on following my doctor's orders.

I do realize that I could still develop scar tissue around the nerve, but right now I prefer to focus on the POSITIVE -- I feel much better than I did before my surgery, and I LOVE IT!

Sharon

Re: can I recommend decaf? :-)

elliott on 9/04/02 at 13:08 (094444)

It sounds like some are a bit too wound up and defensive about this. I'm not saying don't listen to your doctor. I'm happy if your surgery went well, whatever the rest period, which doesn't prove that a priori it was the most ideal. I was just asking if, post-standard-TTS release, there's an ideal interval before a return to walking, maybe some general rule to follow, which some docs may know and some may not. Maybe I shouldn't have asked. Sorry.

---

Re: But of course

wendyn on 9/04/02 at 14:16 (094453)

You will be happy to hear that I haven't had caffiene since my little heart episode.

I'm a much calmer individual without it.

;)

Re: can I recommend decaf? :-)

Sharon W on 9/04/02 at 15:28 (094466)

Elliott,

It's a legitimate question, and one that might be worth asking the doctors. I'm sure there ARE factors that they take into consideration, such as the condition that the patient was in BEFORE surgery, the extent of the surgery that was done, and probably the weight of the patient. If they are conscientious enough to ASK, they may even take into consideration the patient's surgical history,

If I reacted defensively, it's probably because I've gotten a LOT of people (in my 'real' life) looking at me sideways lately, people who know very little about TTS, sometimes asking why I'm still wearing the boot, and seeming to make the assumption that I've HAD the surgery, so that should be all there is to it.

Sorry if I overreacted.

Sharon

Re: It all depends

Julie on 9/04/02 at 16:11 (094471)

Surely post-op care depends entirely on the surgery that was done, whether it was straightforward or complex, and the individual condition, age, weight, and whatever other factors might pertain, of the individual whose foot was operated on.

And surely if the individual has trusted the surgeon to perform the surgery, s/he can trust the surgeon's post-op instructions and follow them.

Re: Depending on

wendyn on 9/04/02 at 19:29 (094479)

I think it's good to follow post op instructions, but healing is such an individual thing.

I was dancing 2.5 weeks post op from bunion surgery and skiing at the 6 week mark.

Would I suggest other people do the same?

No. I was only about 23 at the time, and weighed next to nothing. I healed fast.

Could I do the same thing now (10 years later?)

Probably not.

I think it's best to go with how you feel, and what your doctor suggests (based on your history, your medical state, and what was done in the surgery).

Re: Depending on

Sharon W on 9/05/02 at 09:17 (094514)

Wendy,

I think the important thing to do is to find a foot doctor that you CAN trust, someone that YOU KNOW ENOUGH ABOUT to trust him/her WITHOUT doing so blindly. I'm not the sort of person who puts blind trust in every doctor I see. I do very much respect the achievement involved in BECOMING a doctor, but when it comes to honoring a doctor's OPINION -- well, I will NOT follow what I KNOW to be bad advice.

There are times when I need guidance from an expert, and at those times I definitely want the person whose advice I'm following, to be someone that I know I can TRUST. For me, surgery post-op is like that.

Sharon