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

Dr Ed and others PF and TTS : surgery for PF

Posted by Jane T on 9/13/02 at 20:11 (095295)

I've had PF in both feet for 20 years with a PF release in 1984 on the l foot which made it somewhat better. My R foot has been a problem for 2 years after a pregnancy. I got Foam type orthotics (custom) from a pedorthist 14 months ago which seemd to calm it down. In the spring we moved and I worked more and the R. foot became much worse--first with PF in March, and now with TTS since July . I have been off shift work ( Emergency Doctor) since August. I had ESWT in Toronto, Siemons 3 treatments in early August. I am on Neurontin 1800/day. I had an MRi today .
I tape daily, use the cam boot and crutches, ice with contrast baths, massage, and gentle stretching --stretching can make it worse. I also use a night splint. I had accupunture in June (no help) and I am on homeopathic treatment--currently Ledum.
Question: Should I agree to surgery for PF: open approach with release of PF and some calf muscle as well? What is your opinion on success rate? Should I have new, different orthotics made now or after surgery?
I am very thin, and overpronator with high arches. I can't understand why this biomechanical problem can not be corrected.
Re. Orthotics: I have had 4 custom orthotics made with the first three rigid. I could either not tolerate them or they did not help. Although the custom foam type (mold taken) are highly criticized, for awhile they helped before this exacerbation. Taping definitely helps.

Re: Dr Ed and others PF and TTS : surgery for PF

Ed Davis, DPM on 9/14/02 at 11:13 (095316)

Jane:
Sometimes high arched feet are more difficult to control but it CAN be done. A semi-rigid device often works best. One trick is to cast the foot in a mildly pronated position (that increases tolerance of the orthotic) but to make the orthotic conform closley to the contours of the foot.

Limited ankle dorsiflexion is a major exaccerbating factor in PF and one of the main causes of difficulty tolerating more rigid orthotics. The fact that you have mentioned surgery on the calf implies that you have that restriction. The softer orthotic is more tolerable because it does not fight the equinus but it may not give you as much control as you need.

You may be a candidate for surgery based on your description but... consider another round of ESWT and, if possible, a better orthotic ( I would rather see you go to an individual with good biomechanical exertise as opposed to 'trial and error').
Surgery, done with the utmost expertise will lead to resolution about 60% of the time, mitigation about 20% of the time, 10% no change, 10% worsening.

Where do you live -- I will see if I know an individual in your area for a referral.
Ed

Where

Re: Dr Ed and others PF and TTS : surgery for PF

Jane T on 9/15/02 at 21:35 (095391)

Thank you for your input. I did see Dr Roger Mann who thought that I had 90 degress of ankle dorsiflexion, and that this was not the problem; however, my own podiatrist, Dr Ford, thinks that this is the problem. I at times had been on an aggressive stretching program, but almost any stretching currently exacerbates the TTS symptoms. I had seem one podiatrist prior to the TTS developing who said that I needed hamstring stretching more than ankle/calf. I started yoga, aggressive hamstring stretching and was even suspicious that I overstretched the posterior tibial nerve. Given this amount of time,however, I don't think that this is the case.
Oddlly enought, the night after the late afternoon mri (40 minutes in the mri) my foot felt better. I wasn't sure if this was a fluke, or whether the electormagenetic forces could have had something to do with it. I have had magnets suggested to me, but at this point I am tired of spending money on things unrelated to biomechanics (accupunture, eswt, homeopathy, I've done them all).
I live in Oakland, Ca. It is just east of San Francisco--SF Bay Area.
Thanks

Re: Dr Ed and others PF and TTS : surgery for PF

Ed Davis, DPM on 9/14/02 at 11:13 (095316)

Jane:
Sometimes high arched feet are more difficult to control but it CAN be done. A semi-rigid device often works best. One trick is to cast the foot in a mildly pronated position (that increases tolerance of the orthotic) but to make the orthotic conform closley to the contours of the foot.

Limited ankle dorsiflexion is a major exaccerbating factor in PF and one of the main causes of difficulty tolerating more rigid orthotics. The fact that you have mentioned surgery on the calf implies that you have that restriction. The softer orthotic is more tolerable because it does not fight the equinus but it may not give you as much control as you need.

You may be a candidate for surgery based on your description but... consider another round of ESWT and, if possible, a better orthotic ( I would rather see you go to an individual with good biomechanical exertise as opposed to 'trial and error').
Surgery, done with the utmost expertise will lead to resolution about 60% of the time, mitigation about 20% of the time, 10% no change, 10% worsening.

Where do you live -- I will see if I know an individual in your area for a referral.
Ed

Where

Re: Dr Ed and others PF and TTS : surgery for PF

Jane T on 9/15/02 at 21:35 (095391)

Thank you for your input. I did see Dr Roger Mann who thought that I had 90 degress of ankle dorsiflexion, and that this was not the problem; however, my own podiatrist, Dr Ford, thinks that this is the problem. I at times had been on an aggressive stretching program, but almost any stretching currently exacerbates the TTS symptoms. I had seem one podiatrist prior to the TTS developing who said that I needed hamstring stretching more than ankle/calf. I started yoga, aggressive hamstring stretching and was even suspicious that I overstretched the posterior tibial nerve. Given this amount of time,however, I don't think that this is the case.
Oddlly enought, the night after the late afternoon mri (40 minutes in the mri) my foot felt better. I wasn't sure if this was a fluke, or whether the electormagenetic forces could have had something to do with it. I have had magnets suggested to me, but at this point I am tired of spending money on things unrelated to biomechanics (accupunture, eswt, homeopathy, I've done them all).
I live in Oakland, Ca. It is just east of San Francisco--SF Bay Area.
Thanks