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EPF

Posted by Bob W on 10/15/02 at 08:23 (097515)

Dr Z: I believe you said a while back in a message during a debate on surgeries/types, that you would not recommend EPF to someone who has PF but no first step pain. What's the thinking behind this?

Thanks!

Re: Dr Z's original message

Bob W on 10/15/02 at 08:38 (097518)

Here's the message I was referring to.

Re: cure rates View Thread
Posted by DR Zuckerman on 6/11/02 at 20:35

One of the major reasons for failure of plantar fascia surgery is due to cutting a structure that was never suppose to be cut in the first place. Another reason is that you should only do pf releases for heel spur syndrome and no other reason in a heel pain patient. If you cut the plantar fascia in a patient that has no first step morning pain you are could have additional pain and foot problems. As podiatrist we talk about biomechanics and how important bimechanics are then we go ahead and cut a very important biomechanical structures .Makes no sense to me.

There is so much degenerative joint disease in the foot from pf releases down the road. Most physicians either don't recognize this or treat this as a new problem. Yes there are alot of pain free results but the idea to cut the fascia makes no sense to me.

Message Number 87089

Re: EPF

Dr. Zuckerman on 10/15/02 at 15:13 (097551)

We know that first step morning pain is one of the classic signs of degenerataive traction disease know as plantar fasciitis. So if you do a procedure that has specific indications such as first step morning pain you could create new painful problems and at the same time not resolve the original heel pain. Does this make sense

Re: EPF

Bob W on 10/15/02 at 16:30 (097560)

Not really. I know there can be complications with release of the PF. Are you saying surgery is generally only indicated if first step pain is present? If so, what is the last resort for those, like me, who have tried virtually everything else for the heel pain at the so called insertion point?

Re: EPF

Ed Davis, DPM on 10/15/02 at 20:59 (097580)

ESWT is the procedure of choice for pain at the insertion point.
Ed

Re: The "open" method should be looked at

BrianG on 10/15/02 at 23:10 (097590)

Hi Bob,

If you look down at the posting below this one, you'll see some of the problems arising from the EPF surgical method. I do believe that most knowledgeble doctors will want to try ESWT before any surgery. If ESWT is not a success, then surgery is still the last resort. I think you should be looking at other types of surgery, not the EPF method. Some patients have recently had good luck with the 'open' type of fascia release. This is much more traumatic, and invasive, compared to the EPF. BUT, at least the doctor can see exactly what he is cutting. There is no excuse for not cutting the correct area.

The EPF method was developed to get the patient back on his / her feet quicker. Unfortunatly this is a very flawed procedure, in my opinion!

Regards
BrianG

Re: to doctor z

dave r on 10/16/02 at 08:09 (097606)

If a patient doesnt respond to eswt after a year what options are left?
I typically never had morning pain but i know that the tissue quality of my fascia is poor. At 13mm thick and most of the pain being at the bottom of the heel what options are left? Sunny from bayshore commented that there are 15% of people that dont respond to anything. That can be hard to swallow. Are there doctors that will release the Achilles Gastro complex to
help patients with pf with out cutting the plantar fascia?

Re: to doctor z

Bob W on 10/16/02 at 08:17 (097607)

When I said I tried virtually everything, that included two ESWT treatments from Dr. Z and an open procedure to release a nerve (abductor digiti quinti) plus all the conservative treatments you can name.

Re: to doctor z

Dr. Zuckerman on 10/16/02 at 10:11 (097618)

I would investigate Stereo tactic radio frequency. What is does is destroy the specific nerve if any that is causing the pain. I am told it is sucessful in many patient. I have no experience with this specific procedure.

Re: to Bob W.

Pauline on 10/16/02 at 10:35 (097621)

I think Dr. Manoli is doing this type of a procedure. You should contact him. If I'm not mistaken I believe he posted once about his procedure so you may find something by using Scott's search site.

Manoli is in Michigan. His office number is (586) 858-6773. I'm sure he'd talk to you by phone or FAX or you get his address and send your history to him for review.

He is listed in a book called American's Top Doctors, highly respected and well published.

Re: The "open" method should be looked at

Ed Davis, DPM on 10/16/02 at 21:42 (097688)

EPF is a high tech way to do a low tech procedure. It added 'glamour' to a fairly mundane, simple procedure. It is really not that atraumatic....
watch a video of the procedure... the first step involves making an incison and pushing a trocar through the incision and out an opening on the other side of the heel. The minimal incision procedure is much less traumatic but does not allow visualization. Keep in mind that with the open procedure, the incision on the medial side is only about 2 cm long so the view is very limited.

The two big problems with EPF was the 'selling' of the procedure with overutilization and I believe, the frequent failure to cut all the medial fibers of the plantar fascia.

Plantar fascial release surgery is a procedure which should have been done at a very low frequency and now, because of ESWT, it should be a rare procedure.
Ed

Re: The "open" method should be looked at

Pauline on 10/17/02 at 15:22 (097758)

No excuse why EPF isn't more precise,refined and visual. If a Vitreous Specialist can open the back capsule of the eye and do the delicate work required in that small area with full visual range surely the same could be achieved with a less complicated EPF surgery.

Re: Dr Z's original message

Bob W on 10/15/02 at 08:38 (097518)

Here's the message I was referring to.

Re: cure rates View Thread
Posted by DR Zuckerman on 6/11/02 at 20:35

One of the major reasons for failure of plantar fascia surgery is due to cutting a structure that was never suppose to be cut in the first place. Another reason is that you should only do pf releases for heel spur syndrome and no other reason in a heel pain patient. If you cut the plantar fascia in a patient that has no first step morning pain you are could have additional pain and foot problems. As podiatrist we talk about biomechanics and how important bimechanics are then we go ahead and cut a very important biomechanical structures .Makes no sense to me.

There is so much degenerative joint disease in the foot from pf releases down the road. Most physicians either don't recognize this or treat this as a new problem. Yes there are alot of pain free results but the idea to cut the fascia makes no sense to me.

Message Number 87089

Re: EPF

Dr. Zuckerman on 10/15/02 at 15:13 (097551)

We know that first step morning pain is one of the classic signs of degenerataive traction disease know as plantar fasciitis. So if you do a procedure that has specific indications such as first step morning pain you could create new painful problems and at the same time not resolve the original heel pain. Does this make sense

Re: EPF

Bob W on 10/15/02 at 16:30 (097560)

Not really. I know there can be complications with release of the PF. Are you saying surgery is generally only indicated if first step pain is present? If so, what is the last resort for those, like me, who have tried virtually everything else for the heel pain at the so called insertion point?

Re: EPF

Ed Davis, DPM on 10/15/02 at 20:59 (097580)

ESWT is the procedure of choice for pain at the insertion point.
Ed

Re: The "open" method should be looked at

BrianG on 10/15/02 at 23:10 (097590)

Hi Bob,

If you look down at the posting below this one, you'll see some of the problems arising from the EPF surgical method. I do believe that most knowledgeble doctors will want to try ESWT before any surgery. If ESWT is not a success, then surgery is still the last resort. I think you should be looking at other types of surgery, not the EPF method. Some patients have recently had good luck with the 'open' type of fascia release. This is much more traumatic, and invasive, compared to the EPF. BUT, at least the doctor can see exactly what he is cutting. There is no excuse for not cutting the correct area.

The EPF method was developed to get the patient back on his / her feet quicker. Unfortunatly this is a very flawed procedure, in my opinion!

Regards
BrianG

Re: to doctor z

dave r on 10/16/02 at 08:09 (097606)

If a patient doesnt respond to eswt after a year what options are left?
I typically never had morning pain but i know that the tissue quality of my fascia is poor. At 13mm thick and most of the pain being at the bottom of the heel what options are left? Sunny from bayshore commented that there are 15% of people that dont respond to anything. That can be hard to swallow. Are there doctors that will release the Achilles Gastro complex to
help patients with pf with out cutting the plantar fascia?

Re: to doctor z

Bob W on 10/16/02 at 08:17 (097607)

When I said I tried virtually everything, that included two ESWT treatments from Dr. Z and an open procedure to release a nerve (abductor digiti quinti) plus all the conservative treatments you can name.

Re: to doctor z

Dr. Zuckerman on 10/16/02 at 10:11 (097618)

I would investigate Stereo tactic radio frequency. What is does is destroy the specific nerve if any that is causing the pain. I am told it is sucessful in many patient. I have no experience with this specific procedure.

Re: to Bob W.

Pauline on 10/16/02 at 10:35 (097621)

I think Dr. Manoli is doing this type of a procedure. You should contact him. If I'm not mistaken I believe he posted once about his procedure so you may find something by using Scott's search site.

Manoli is in Michigan. His office number is (586) 858-6773. I'm sure he'd talk to you by phone or FAX or you get his address and send your history to him for review.

He is listed in a book called American's Top Doctors, highly respected and well published.

Re: The "open" method should be looked at

Ed Davis, DPM on 10/16/02 at 21:42 (097688)

EPF is a high tech way to do a low tech procedure. It added 'glamour' to a fairly mundane, simple procedure. It is really not that atraumatic....
watch a video of the procedure... the first step involves making an incison and pushing a trocar through the incision and out an opening on the other side of the heel. The minimal incision procedure is much less traumatic but does not allow visualization. Keep in mind that with the open procedure, the incision on the medial side is only about 2 cm long so the view is very limited.

The two big problems with EPF was the 'selling' of the procedure with overutilization and I believe, the frequent failure to cut all the medial fibers of the plantar fascia.

Plantar fascial release surgery is a procedure which should have been done at a very low frequency and now, because of ESWT, it should be a rare procedure.
Ed

Re: The "open" method should be looked at

Pauline on 10/17/02 at 15:22 (097758)

No excuse why EPF isn't more precise,refined and visual. If a Vitreous Specialist can open the back capsule of the eye and do the delicate work required in that small area with full visual range surely the same could be achieved with a less complicated EPF surgery.