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Realistic recuperation period from PF Surgery

Posted by Debbie W. on 3/11/03 at 22:13 (112618)

On December 17th, I had open surgery for partial release of PF. Pain related to surgery was very manageable since I carefully followed doc's orders to ice, elevate and not bear weight on surgery foot for 6 weeks. However, getting back to 'normal' (not sure what that is any more) has taken sooooo much longer than I ever anticipated, and I think the doc is a bit surprised or perplexed as well. My foot has continued to swell with activity. I continue to take anti-inflammatories, but none seem to make a difference. I started physical therapy two weeks ago. Since doc was not in favor of injecting my foot so soon after surgery, the physical therapist is using iontophoresis to 'push' the cortisone into my foot. Swelling does seem to be reducing a bit in between physical therapy session. During and after (for first 24-36 hours)treatment and therapy, I am experiencing pain along bottom of my foot (note: incision was right in middle of my foot along arch), along medial side of foot and up into ankle. I have not been able to re-establish a routine. I am still on crutches, mostly two, but can use one around house, etc. if need be. I do 'pay the price' in soreness, swelling and pain if I do try to put pressure on the injured foot. It has become frustrating. I wonder if there is a realistic timeline for recovery from this type of surgery? It feels like as soon as it seems I may be getting better (reduced swelling and pain), I try to increase activity and weight bearing, then it gets worse again and I lose time on road to recovery and experience a setback. Any comments? I return to the doc in two weeks and Physical Therapy Rx expires the week before. How many weeks of PT do you recommend? I would LOVE to get away from relying on the metal crutches and regain use of hands in carrying things. Does a cane sound like a good idea? Any words of wisdom...this is getting really old! I have a conference in Boston and another in Dallas coming up the end of March and I need to decide how much travel I will be able to do. I have already cancelled one trip due to slow recovery. Is what I consider to be a VERY slow recovery period that much out of line? Should this be a 'red flag' for discussion with my doc? Help...

Re: Realistic recuperation period from PF Surgery

Ed Davis, DPM on 3/12/03 at 10:37 (112645)

Debbie:
The recovery period can range from 6 weeks to 6 months I would expect one to be off crutches by, at most, a month after the surgery. The amount of physical therapy needed is based on one's needs. Physical therapy should be sufficiently aggressive to include rehab, muscle strengthening and gait training. How much PT have you had? I would discuss your progress with the surgeon.
Ed

Re: Realistic recuperation period from PF Surgery

Debbie Watson on 3/12/03 at 20:58 (112703)

Dr. Davis...thanks so much for responding. I appreciate your input.

I have been in PT for about three weeks with one more left on my Rx. I return
to DPM on the 28th.

PT has included ultrasound, iontophoresis, PF and stengthening exercises,
exercises for balance and some attempts at gait training, although my injured
foot still sells when bearing too much weight.

At last visit, I sensed my doc was a little surprised that the foot was slow to
respond. The continual swelling seemed to concern him, but he was reluctant to
inject it with cortisone, so prescribed the iontophoresis as an alternative. I
am still taking antinflammatories too.

Had PT today and was really hurting so we didn't do too much. I not only have
soreness in arch and heel, but I seem to have increased pain on inside of foot
where arch meets ball at base of big toe. When putting too much weight on my
foot, pain goes from this area and becomes tingly along side of foot into
ankle. This is new since surgery.

Any thoughts? How do you know if the surgery 'failed'? When do you seek a
second opinion to know if this is an extraordinary situation and needs another
approach?

I really like my doc and he was very conservative in treating the injury, only
suggesting the surgery as last resort because my foot did not heal despite all
measures. I do trust him, but it seems that this has been going on waaaaaay
too long. He, while he appears a bit perplexed, keeps comparing my recovering
to that of Orlando Magic player Grant Hill (yes, it's in the news daily here in
Orlando)...it takes time, etc. Perhaps, if I was able to rest and make $92
million while doing so, I'd feel differently!!! On one hand, the doc's
comparison has indeed helped me realize how complex the foot is and how much of
a balancing act the rehab/healing is. Still, it's frustrating and I ma growing
very impatient as I am a very active person - personally and professionally.

I have dealt with knee injuries and challenges off and on for years, but
nothing as unrelenting as this. On one hand, I am tempted to just bear the
pain and start walking on it, but my PT has suggested this would cause an even
greater setback, etc, in long run. Perhaps, it is worth the risk? Who knows...
could it be any worse than just waiting for things to turn the corner, for an
indefinite amount of time?

Is there anything I am missing?

Thanks so much for listening and offering your perspective...

Debbie
>

Re: Realistic recuperation period from PF Surgery

Ed Davis, DPM on 3/13/03 at 12:06 (112757)

Debbie:
Beyond the swelling, do you have any color or temperature changes in the foot you had surgery on?
Ed

Re: Realistic recuperation period from PF Surgery

Debbie W. on 3/13/03 at 22:30 (112908)

Dr. Davis...my foot sometimes feels warm (from inside, if you know what I mean) and is indeed red and warm to touch (on top, not necessarily in arch where incision was made). Not all the time, but occasionally. What might this mean? Thanks again, Deb

Re: Realistic recuperation period from PF Surgery

Debbie on 3/18/03 at 21:56 (113421)

Dr. Davis, did you get this response to the question you raised to me last week?..my foot sometimes feels warm (from inside, if you know what I mean) and is indeed red and warm to touch (on top, not necessarily in arch where incision was made). Not all the time, but occasionally. What might this mean? FYI, I return to doc for next check-up next week. Thanks again, Deb

Re: Realistic recuperation period from PF Surgery

Dr. Z on 3/19/03 at 09:35 (113444)

Hi Debbie,

I will answer this for you. Dr. Davis is seeing another patient.Just joking. Anyway What this means is increased blood flow. I am assuming the incision is great no pus, healed well. You feel good, No temp. Very common to have increase temp ( slight) and increase color at times due to increased blood flow. Now if you are in alot of pain call your doctor and have him check it out. With plantar fascia foot surgery you are going to have pain off and on. Too much physical Therapy too quickly is not good. May have to adjuest the freg and what kinds of PT. The old saying no pain no gain is not true with this type of physical therapy

Re: Realistic recuperation period from PF Surgery

Debbie W on 3/20/03 at 21:50 (113691)

Dr. Z - thanks for responding. It does seem this recovery is a lot of trial and error. But, do you think it is 'normal' or acceptable to be where I am three months post-surgery? Seems like an awful long time. Should I be alarmed? Seek second opinion? Patience is running low. Thanks...Deb

Re: Realistic recuperation period from PF Surgery

Dr. Z on 3/20/03 at 22:11 (113693)

Hi

Heel spur/ plantar fascia surgery can be VERY FRUSTRATING to the patient and the doctor. I don't know how many times I have told patients that it can take up to six months or more for healing. This is with the minimial incision pf release. I even use to read it to the patient and have them sign that this is just how it works. Even with that patients still can
comprehend why it takes so long. I can't comprehend myself. IF you have had an open pf release it can take up to one year
Ok . So what do we do to make you feel better while nature take it !$!!$!
time to get you feeling better.

1. Physical Therepy . ultrasound with electric stim, whirlpool. contrast baths.
2. boot cast. taping, unna boot. Some time a wedge darby shoe, hard cast
All of these are used to get weight off the poor heel
3. NSAID, pain pills, medrol dose packet, local steriod injection
4. The hard cast maybe the answer if you can't get relief from any of the #3 choice

This is one of the reason why I got involved with ESWT. It is a much easier post-op recovery

One last thing . Must rule out stress fracture either by examination or mri
What method of surgery did you have for the plantar fascia relesase. OPEN?

Re: Realistic recuperation period from PF Surgery

Debbie W. on 3/22/03 at 18:36 (113925)

Thanks, Dr. Z...you have been so kind and reassuring. To answer your question, I had open PF surgery on December 17. I return to my doc this Friday and I am eager to hear what he will suggest at this point. More PT? Boot? I am just so eager to get off these crutches, but each time I try, it swells back up and/or I get significant pain in both foot and ankle. Almost feels like a nerve...same pain, but something more/different too. Can you get nerve damage or reaction from the surgery? Thanks again!

Re: Realistic recuperation period from PF Surgery

Debbie W. on 3/28/03 at 20:36 (114853)

Dr. Z...Went to the doctor today and he went ahead and gave me two cortisone injections - one near surgical site (open PF release - 12/17/02 - incision smack dab in middle of arch on bottom of foot), and one right beneatch my inner ankle bone where the tendons are so inflamed and I get that burning pain which causes tingling into my foot. He also discontinued Physical Therapy for the next two weeks and gave me a foot/ankle brace to wear - laces up with stablizing strips on either side of ankle. Doctor hopes this will calm things down so we can get back to therapy, etc. He suggested I rest as much as possible (will this EVER end?) and rely on the crutches again to keep stress off the foot. I go back to him in two weeks. If it has not calmed down at that time, he indicated next step might be to go back into some sort of cast - boot or regular (I hope not). If I have to go that route, do you advocate for one method of casting over another? In general, does this all sound reasonable? I appreciate your input...Deb

Re: Realistic recuperation period from PF Surgery

Dr. Z on 3/28/03 at 21:16 (114856)

hi,

I would use a pnuematic type cast boot. If no relief then hard cast. Being able to remove a cast will allow you to go to physical therapy

Re: Realistic recuperation period from PF Surgery

Debbie W on 3/28/03 at 21:28 (114857)

Thank you for the prompt response. So you agree with the injections today? You read so much about injections and concern that they can cause more harm than good. I was a little surprised when he wanted two inject second location (ankle). Hope it works. In general, it sounds like you think the treatment plan is logical and appropriate course of action at this time? Any other suggestions while I wait this two week period for things to calm down again? I forgot to ask if I was suppose to also discontinue home (stretching) exercises or not too. I guess if he suspended PT that also means hold off on any home exercise. On last question...if I go back into a cast in two weeks, do you think that means I could go without the crutches and just use the cast? (Reason I ask...I am supposed to go on business trip to Boston and Dallas in three weeks.)Thanks again for the extra validation and input...and for helping to answer the questions we always forget to ask when in our doc's office! Debbie

Re: Realistic recuperation period from PF Surgery

Debbie on 4/04/03 at 17:38 (115434)

Dr. Z - so far, no difference after a week of non-weight bearing again and the ankle brace. I am getting nervous about upcoming conference/trip (see previous post). See questions in previous email. Any advice? Deb