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

Does anybody have anything useful to say for those of us who have complications following PF rupture or release?

Posted by Debra H. on 4/09/03 at 18:49 (115791)

Since ESWT is no longer an option, what ELSE can be done for those people who have 'complications' from PF rupture. More specifically, what can be done about an acutely fallen arch?

Re: I have read about PF ruptures

SteveG on 4/10/03 at 10:09 (115841)

Debra - Sorry to hear about your rupture. I don't know about the arch, but I have read about ruptures. From what I have read, your pod is probably right that your symptoms will improve with time. However, I don't know if you will ever be completely pain free. The article I read stated that often the symptoms improve as the torn fascia heals over time. At that point, I don't see why ESWT might not be of benefit to help repair the torn and damaged tissue. You will need to be pretty agressive in your treatment plan - lots of PT, possible cast, etc. I have not read your earlier posts - did you have an MRI or ultrasound and, if so, what did it reveal about the extent of the rupture? You might consider getting a second opinion from anothe pod or ortho to see what they would recommend and to see if they are in agreement with the treatment plan your current doctor has outlined for you.

There is regular poster to these boards (dave r?) who rupture his fascia several years ago and still has problems, but he has improved over time. In fact, he recently had surgery and is seeing some definite improvement.

Re: I have read about PF ruptures

Dr. Z on 4/10/03 at 12:43 (115854)

Steve,

Did you have bilateral ( both feet ) ESWT done ?

Thanks

Dr. Z

Re: I have read about PF ruptures

dave r on 4/10/03 at 13:05 (115860)

Thanks for the kind words Steve. Yes my fascia on my right foot did rupture from a cortizone shot. I remember the day that it happened like it was yesterday. It felt like a balloon exploding under my foot. I went down like a ton of bricks. that was six years ago. I have eswt twice on both feet. I just recently had foot surgery and i am finally seeing an improvement. My foot still gets sore but i can do more now than i did before surgery with out any pain. I also want to mention that after that rupture you could clearly see the damaged area on my heel. I had bruising and swelling for over a year.

Re: Where have you read about them?

Debra H on 4/10/03 at 13:17 (115863)

Hi Steve,

I would be interested in any references to the articles you have read about PF ruptures (specifically therapy for the complications afterwards). Also, perhaps I wasn't clear. The rupture was a complete rupture (so I'm told it will never heal by reattaching itself to the calcaneous). The pain at the insertion site (where it use to hurt from just the plantar fasciitis) is completely resolved. My pain is now in different parts of the foot (dorsal metatarsals, medial mid-arch, lateral band, and cuboid areas). I'm told that ESWT is not indicated in these areas. What I'm trying to say is that my problem is no longer with the plantar fascia. Rather, it is a result of the stresses placed on my foot due to the change in biomechanics of walking. My arch has flattened and I think the bones have shifted placing different strains on the tendons and ligaments than they are accustomed too. I would be very interested in outcomes in other people who have had these problems, but I can't find literature about it. The only literature I can find is to say that they exist and not the ultimate outcomes or therapy, etc. I did go to an orthopedist who specializes in foot problems and his response was that he knew it existed but that he didn't know much about it. That's why I've stuck with the podiatrist. What I would really like to do is to find a podiatrist that can say that they have actually treated someone with these problems. So far, everyone just says they've heard about it and that it is rare. I would be interested in hearing from the other poster (dave r), if he is still watching. What kind of surgery did he have and what else did he try?

Thanks for your input!
Debra

Re: Where have you read about them?

Debra H on 4/10/03 at 13:20 (115864)

Hi Dave,
I just saw your response. Did you have ESWT before or after the rupture? Where was the ESWT applied? Did it help? What surgery did you have?

Debra

Re: Dr. Z

SteveG on 4/10/03 at 13:53 (115869)

Yes - I had both feet done by Dr. Davis in late December. I would say that, so far, I have had about a 50% reduction in heel pain

Re: Does anybody have anything useful to say for those of us who have complications following PF rupture or release?

SteveG on 4/10/03 at 14:11 (115872)

Debra - you are right. The material I read discussed partial tears and ruptures. With the fascia no longer attached to the heal, you case is different and has, no doubt, resulted in other biomechanical problems. I live near the med school at the University of Washington, next time I am over there I will see if I can find any articles that discuss a case like yours. Best of luck to you, and it they pain and anxiety are getting to be a real problem, don't hesitate to discuss this with your doctor. There are plenty of meds out that that can help.

Re: Where have you read about them?

dave r on 4/10/03 at 14:22 (115873)

Debra, i had eswt after the rupture had occured. I didnt get any improvement form the treatments. i have done it all. Physical therapy for two years and wearing nightsplints for 4 years.My original doctor told me that the rupture itself would be like having surgery and that my foot should be fine after a year. But it never was the same. I believe that after the rupture happened my tissue quality of the fascia went down to nothing. I could feel micro tearing and magor swelling for a very long time. It was horrible.I was forced to leave the job that i loved, i took a major paycut and lost contact with most of my friends. It seemed that noone understood.I had doctors tell me that they have never heard of this happening and that i was making it up. Until they saw my mri pictures and what the bottom of my foot looked like. I am not kidding you when i say that my heal has had a bruise on it for years. i finally found a doctor that had seen this before and was very understanding. I had surgery on february 7th of this year. I had the traditional open approach type surgery. I dont have any regrest either. It was a cake walk. It really wasnt painful at all. I will be having surgery on my other foot in two months to. So enough about me. Is there anything that i can do to help you?

Re: Where have you read about them?

Debra H. on 4/10/03 at 15:33 (115886)

Steve,
Thanks for your suggestions and efforts.

Dave,
Thanks also for your response. It helps to know of someone else who has experienced this. What kind of surgery did you have? Did they do a fasciotomy, or something else?

Thanks,
Debra

Re: Where have you read about them?

dave r on 4/10/03 at 15:38 (115887)

Debra, i had a plantar fasciotomy. Have you had an ultrasound done on your foot. this will also show inflamation of the fascia and probably will show it better than an mri... You can email me if you like. (email removed)

Re: Where have you read about them?

Debra H. on 4/10/03 at 19:05 (115905)

Hi Dave,
I just re-read your prior statement again as well and I'm sorry to hear about your troubles and for so long. No, I haven't had an ultrasound yet. What would I be looking for if I had one? In other words, how do you think it would help direct my treatments? We are pretty sure the fascia has detached in that foot. Are you thinking for the other areas that hurt? Also, was your rupture complete or partial? I'm thinking it must have been partial since they were still able to do a fasciotomy. Is this correct or am I totally misunderstanding? And, did you continue to have pain in the area around the insertion site or in other areas or both? Sorry for all the questions. And thank you for your willingness to share your story so far.

Sincerely,
Debra

Re: Where have you read about them?

dave r on 4/11/03 at 07:35 (115923)

it was hard to tell how much of it had ruptured the mri showed something but an mri can also be not a very good tool. I would bet that an ultrasound of your foot would show alot more. The only reason why i say this is because when i had eswt with inline ultrasound you could clearly see the fascia along with inflamation. I didnt have eswt done till four years after the ruptue had happened. Plantar fasciitis is thickening of the fascia and inflamation of the fascia.It can be on the medial side the lateral side or even in center of its origin.I had pain at all of these locations for a very long time. It took a long time for that cycle to break.Everytime one part of my foot felt better i would have pain somewhere else. In my case i believe that all of the trauma that i had caused a very large amount of scar tissue.Scar tissue doesnt stretch causing more trauma to other areas. I believe this resulted in the plantar fascia actually shrinking some. I had lost all the ability to do any type of stretching because of this. Anytime i stretched i would have pain. I wasnt able to break that cycle. I still have pf after all this time in both feet. My left foot really isnt to bad and is very managable. My right foot is another story. Like i said before i just had a plantar fasciotomy to relieve the tension and help restart the heeling process of the damaged fibers. 90% of my pain was with the central bands of the fascia. Most of that pain is gone now. The only trouble that i have now is pain along the incision path which is really minimal right now. I would also like to say that i am able to strtech my foot now without causing alot of discomfort. I am not sure if my foot will ever be pain free but for now i am at least able to make the dreaded trip to the grocery store and spend more time with my dogs. I have also noticed myself being able to go to lunch at work now at least twice a week. It may not sound like much but you need to understand that i havent been able to do anything at all for years.

Re: Where have you read about them?

SteveG on 4/11/03 at 13:40 (115950)

Dave - It's good to hear you are doing better after this long and difficult struggle, and I am glad you are able to do some of the things you used to do. Best of luck and continued healing

Re: Where have you read about them?

Terri on 5/09/03 at 19:28 (118204)

Hi Debra, I actually gasped when I read your post. I too had a PF rupture right after surgery. I repeatedly told my Dr. about the pain I was having in the cuboid area. He took an x-ray and said nothing was wrong. This went on for about 7 months. He taped my foot, gave me cortisone injections, etc. Finally when I'd had enough, he went back to the original x-ray from months earlier and lo and behold, my cuboid was dislocated. It had been dislocated and bopping around in there for so long, that I have since had 4 corrective surgeries. The cuboid had to be fused as It would not stay where it was supposed to be. As a result of locking this area of my foot, other bones and joints took up the play and last July I had to have a subtalar heel fusion. I am still in alot of pain, ankle and behind the ankle very swollen, getting up on my feet is awful, and walking is done only when necessary as every step hurts me. I went to a pain management Dr. last week and he said 'cuboids do not dislocate'. I am living proof that they do! Find a good Dr. and see what exactly is going on in your foot. I hope things work out well for you.