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Orthodics after surgery????

Posted by rose on 7/30/03 at 14:29 (125691)

I just had surgery a month ago on both feet...one for plantar fasciitis and the other for a neuroma. I am about ready now to use my orthodics. Would my old ones be ok? One has a neuroma pad? Or do you think I would new new ones of a different kind? Right now I am using soft Spencos that the doctor gave me because they are soft. I have hard ones that were custome made for me several years ago. I also have a softer more flexible pair that I bought at a fair not long ago. They felt the best before the surgery. I welcome your comments.

Re: Orthodics after surgery????

Dr. Z on 7/30/03 at 14:51 (125696)

I would think that your foot is swollen and the orthosis would fit differently. Ask you physician if he feels the swelling is reduced enought to allow your to wear the old orthosis. You may need new orthosis since the shape of your foot has changed from the bunion surgery

Re: Orthodics after surgery????

Dr Kiper on 7/30/03 at 15:15 (125706)

You should use the most comfortable orthotics you have. The surgery done did not affect your biomechanics, unless possibly the entire plantar fascia was released, but even then that would be minimal.

Re: Orthodics after surgery????

Dr. Z on 7/30/03 at 17:24 (125715)

Hi Dr. Kiper,

I am confused. Are you saying that the cutting of the plantar fascia has a miminial effect on the biomechanics of the human foot? Please explain I have just the opposite view point.

Re: Orthodics after surgery????

Dr Kiper on 7/30/03 at 18:12 (125720)

Well, let me ask you the question, what effect does it have?

Re: Orthodics after surgery????

Ed Davis, DPM on 7/30/03 at 22:13 (125738)

Dr. Kiper:

I am assuming that you have asked that as a rhetorical question and know the answer. For the benefit of readers: The plantar fascia is a supporting structure of the foot. It acts as a strut for the bones that comprise the medial longitudinal arch and midfoot. It aids in the action of the foot as a shock absorber for the body. It, upon loading stores potential energy which is converted to kinetic energy at toe off (recoil).
Ed

Re: Orthodics after surgery????

Dr. Z on 7/30/03 at 22:40 (125743)

Cutting the plantar fascia can and has created SEVERE biomechanical weight transfer causing collapse of arch, calcaneal cuboid syndrome, Hammer toe deformity, neuroma's, forefoot metatarsal pain, stress fracture,
Degenerative joint disease did I leave anything else out?

Re: Orthodics after surgery????

Dr Kiper on 7/31/03 at 14:11 (125798)

are you a podiatrist or orthopedist?
I'm wondering if we are talking about two different things.
Rose stated she had surgery for PF and a neuroma, I stated that 'cutting'
the PF would be minimal if at all biomechanically. Are you aware that cutting the PF surgically generally refers to cutting the medial slip of the PF?
Are you telling me that cutting the medial slip will cause the effects you listed?

Re: Orthodics after surgery????

Dr Kiper on 7/31/03 at 14:29 (125799)

Let me go a little further here. I also stated that even if the PF were severed that it would not make a severe impact on the biomechanics. While the PF is an integral part of the structure and aids as a shock absorber, the remaining structure of muscles, ligaments and articular ranges of motion would still not cause the effects you've listed. Not to say it couldn't happen in a few cases, generally not.

Re: Orthodics after surgery????

Dr. Z on 7/31/03 at 20:23 (125824)

Not only does the literature point out what I stated, I have seen all of these problems. When I first started to do ESWT in 1999,many patients from around the country rushed to my office in hopes of finding a solution to the problems that plantar fascia surgery created. Trust me cutting the plantar fascia can and does causes many other foot problems. Did I mention RSD? I have seen at least ten cases of RSD caused by pf foot surgery.

Re: Orthodics after surgery????

Dr. Z on 7/31/03 at 20:27 (125825)

Try cutting just the medial band. Anyway What I am saying is that cutting portions of the medial band and does cause these problems. It is something taht does happen every day. No one reallly knows the percentage. But it does happen and I have seen it in open pf surgery, EPF surgery and mis surgery. It is a bad idea to cut the pf if you can avoid it. Why is it that we were taught in podiatry school to try to avoid pf surgery?

Re: Orthodics after surgery????

rose on 7/31/03 at 22:28 (125833)

My foot was cut on the bottom of the heel about three inches on the inside half of the heel. I believe it was either a 1/3 or 1/2 release. I am not sure, but will ask. There is very little pain, actually none at all when I walk in the boot. When I walk in shoes it is not painful until I have been on my feet for an hour or so. I had the surgery four weeks ago. I have read about all the terrible things that can go wrong on this board and desperately want to avoid them if possible. Any recommendations?

Re: Orthodics after surgery????

Dr Kiper on 7/31/03 at 23:35 (125839)

You're getting out of hand here. I do not advocate PF surgery. I am aware that post op PF surgery is frought with complications. My issue was in addressing Rose that her biomechanics was not affected. This was based on her question about wearing orthotics she had. Based on her post I determined that she did not complain of her foot flattening out (and quite frankly I'm not aware of such a case even existing). My opinion remains that in most cases, in fact the great majority of cases where PF surgery is performed, the biomechanics is hardly affected. By this I mean that the biomechanical angles are insignificantly affected, the vertical motion and degree of pronation are hardly affected.

Re: Orthodics after surgery????

Ed Davis, DPM on 8/01/03 at 12:40 (125893)

Rose:
I believe that the need for an orthotic may increase after a plantar fascial release since a supporting structure has been removed, albeit, partially in your situation. Make sure you are wearing well cushioned, supportive shoes; if possible, a motion control type running shoe such as the New Balance 1122 and possibly an orthotic in that shoe.
Ed

Re: Orthodics after surgery????

Ed Davis, DPM on 8/01/03 at 12:46 (125894)

Dr. Kiper:
I believe that your opinion that the biomechanics of the foot not being substantially affected by a plantar fascial release would place you in the minority as far as the podiatric and orthopedic communities are concerned.

One must keep in mind that patients with severe cases of PF, may already have altered biomechanics before surgery. Such patients may demonstrate a less dramatic change than individuals with 'healthy' foot function.
Ed

Re: Orthodics after surgery????

rose on 8/01/03 at 12:49 (125895)

I have New Balance 608, which is a cross trainer. Do you think this is good, or should I look for the 1122 running shoe that you mentioned?

Re: Orthodics after surgery????

Dr Kiper on 8/01/03 at 15:27 (125911)

I am already in the minority, because of my work with the Silicone orthotic. I have performed many procedures on the PF when I was in practice. And never did I have any significant change in mechanics. Nor had I heard or read of any dramatic changes (I do suppose there are some out there). Perhaps you could direct me to literature that would correct my position.
In my opinion it is a fallacy to believe that patients with PF have a greater altered biomechanics. Everyone has altered biomechanics. The difference is those individuals with pain. Their wear and tear of normal living has simply come to the surface sooner. Patients who are not in pain do not have 'normal' biomechanics. Individuality is what seperates someone getting symptoms of any biomechanical condition in their teens or their 50's, 60's, or whenever.
Look at any pressure test with any of the modern systems on the market today and you will see that almost everyone has altered biomechanics (balance). I have seen tests that look almost perfect, but found that even their balance can be improved.

Re: Orthodics after surgery????

Ed Davis, DPM on 8/01/03 at 19:59 (125945)

Rose:
The 1122 is a much better all around with substantially more support than the 608. If you are using an orthotic with the 608, that could be enough support but cannot answer your question better without seeing your feet.
Ed

Re: Orthodics after surgery????

Ed Davis, DPM on 8/01/03 at 20:14 (125946)

Dr. Kiper:

I like the F-scan and have used it but am not convinced that a two dimensional pressure mat system can measure all relevant biomechanical issues in the foot. For example, there is no device that I know of that will measure tension on the plantar fascia. That tension is the real issue when it comes to PF. When you state that almost everyone has 'altered' biomechanics via pressure mat measurements it is important to define what you mean by 'altered.' There is a range of measurements that must be considered normal, ie. within a certain area about the mean of the bell curve.

PF is caused by a combination of factors -- occupation, avocation and biomechanical problems. A person with a minimum of biomechanical faults can engage in activities that strain the plantar fascia without leading to PF longer than one with such problems.

I do not have any good studies available to provide you at this point but much can be shown via simple demonstration of how powerful the windlass mechanism (the effect of bowstringing the plantar fascia) is. I recently talked to a visiting TUSPM student who discussed a video tape in which a professor demonstrated the effect of the windlass mechanism on a cadaver, then cut the plantar fascia demonstrating dramatic change in foot function in the absence of an intact fascia. Seeing is beleiving.

Ed

Re: Orthodics after surgery????

Dr Kiper on 8/02/03 at 23:38 (126065)

While the Tekscan does not satisfy all the information we would like (like measuring the PF tension), it gives me the most important information which is the balance of the alignment. When I have an individual balanced with an orthotic (like any orthotic should) I may not know the quantitative values of shear and tension, but I do know that those values are significantly improved when alignment is optimal.
I do believe however that there is a system either in development or out there that does register that information. I think it is a Canadian system.

I don't agree that the tension on the PF is the real issue. I maintain that the primary cause of most any 'naturally occurring' injury (in the lower extremity) is simply repetitive in nature over time. Some people fall prey to it sooner than others. I am aware that the ontogeny of the lower extremity is definitely more radical in certain people and therefore we see some strange things (some maybe with more PF tension) that probably (in many cases) are the cause of some of the chronic and irreparable patients we see. Overall when we refer to 'mechanics', well we are a living machine and machines over time break down.

As for 'normal' measurements I see this as an individual who breaks down more slowly over time. This is the 'healthy' foot, but this individual still has poor alignment characteristics (normal) that will eventually fall into some biomechanical disrepair.

The factors you list for the causes of PF is in my opinion correct, but not that by themself create PF, only that they cause it to come to the surface sooner, rather than later. In my opinion every range of pronation is excessive for the range of motion allowable to absorb normal incoming shock. So the individual who can strain their PF and not get PF'itis, will probably get something else. After all, knee, hip/low back functional shortage are all a result of poor alignment characteristics in the form of overpronation.

As for the studies regarding the biomechanics and fasciotomy, perhaps Dr Z can direct me. He stated the literature is 'full' of these accounts.
I for one would like to know if I am right or wrong. Let me clarify something, I would expect that a fasciotomy wold allow a greater degree of pronation in that foot, but I don't accept Dr Z's statement of it collapsing.

I am aware that my concepts fall outside the norm, but I am a free thinker and do not rely on just the literature. This of course comes from my work with the SDO. We have all seen literature that has been corrected over time in many things

Re: Orthodics after surgery????

Barbara S on 8/03/03 at 18:57 (126126)

Hi Rose
I bought 991 New Balance last Aug. when I finally could start wearing a shoe with my orthotics. I just had my surgery in APril of 2002 and my foot was still swelling up. The swelling has settled down some, so this year I ordered another pair of 991 New Balance in med width. I have found out that I can wear these for awhile without my orthotics. I found them on line for $119. Good Luck. Barbara S. Milw, Wi

Re: Orthodics after surgery????

Barbara S on 8/03/03 at 19:18 (126130)

Hi Rose

The sight I bought my New Balance 991 was onlineshoes.Barbara S

Re: To Rose and Other New Balance Seekers

Dorothy on 8/03/03 at 20:27 (126138)

Another great source for New Balance shoes and NB information and foot/shoe information is Browns New Balance Shoes or Browns New Balance Catalog at http://www.brnshu.com . A very nice company with a huge inventory.
Best wishes ~

Re: Orthodics after surgery????

BGCPed on 8/03/03 at 21:14 (126148)

It may be anecdotal but 95% of pf release pt I see have a lower arch on the side that was done. If one cute 1/3 of the fascia it stands to reason that the foot would become less stable and collapse some over time. While there are other factors such as ptt, wt etc. it stands to reason that it would have some structural affect on the foot....its there for a reason

Re: Orthodics after surgery????

Dr Kiper on 8/04/03 at 11:26 (126199)

I stated that one may see a greater degree of pronation.
How much lower do you see it? Have you seen any x-rays and measured the biomechanical angles or the vertical drop of the talo-navicular joint?

Re: Orthodics after surgery????

Carole C in NOLA on 8/04/03 at 17:10 (126223)

Thanks for the link! I have bookmarked it for later. :)

Carole C