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

First step pain a requirement for surgery?

Posted by CarlW on 9/08/03 at 13:53 (129149)

I am 3 years + into my battle with PF and am ready to seriously consider sugery. I have tried it all including ESWT, ART, several orthotics, night splint, cotizone, NSAIDS,Acupuncture, Stretching & Strenthining, Jade Balm etc. Improvement has been minimal and the maximum I want to be on my feet is about 15-20 minutes. Needless to say at 35 years old and in fairly decent shape otherwise I am extremely frustrated.

I apprecaite the dangers of surgery but really feel like all options have been exhausted. My primary pain source is at the insertional point, medial side. My pain increases with activity. An X ray indicates a small spur and an MRI indicated nothing substantial. I have been tested for arthritis and many other systemic diseases.

I have seen Dr. Z several times indicate that first step pain was a requirement. I had this for probably about 1 month at the beggining of my bout but it is no longer the case. Is this a general consensus among all doctors that this is a definitive requirement? If it is a requirement for a plantar release, what type of surgery is indicated for lack of first step pain. Previous disccusions on this board by a Doctor 'Joe S' indicated that releasing the first branch of the lateral plantar nerve could be more effective. Is this a surgery that is 'typically available' or understood by most orthopeadic surgeons?

I have an appointment with a highly regarded surgeon next week and would like to know how to address this.

Sorry for the long winded story but any suggestions would be appreciated.

Carl W

Re: First step pain a requirement for surgery?

Dr. Z on 9/08/03 at 15:00 (129159)

This is a very good question. Lets see what the other doctors on this board think about first step pain. Good luck and let's us know how you make out with your appointment

Re: First step pain a requirement for surgery?

chrisb on 9/10/03 at 15:56 (129479)

Carl your symptom history sounds identical to mine (except that I've just tried ESWT and an waiting to see result). My doc suspects the nerve.
I hope you can post any info you get.

Re: First step pain a requirement for surgery?

Ed Davis, DPM on 9/11/03 at 16:28 (129629)


I cannot speak for how orthopedic surgeons understand or accept the Baxter procedure you are describing. The docs posting here, myself included are podiatric surgeons.

The majority of surgeons doing plantar fascial releases are not doing the Baxter procedure. Dr. Baxter has an interesting theory about the plantar fascia placing pressure on the first branch of the lateral plantar nerve but it is just that, a theory. He does release part of the fascia when doing his procedure so it is hard to say if the results he obtains are derived from the partial fascial release or from potential release of pressure on that nerve branch.

Re: First step pain a requirement for surgery?

CarlW on 9/12/03 at 13:12 (129716)

Dr. Ed

Thanks for the response. Have you performed releases on patients that have not had first step pain but have inserstional pain. If so is the probability of a positive outcome similar.?



Re: First step pain a requirement for surgery?

Dr. Z on 9/12/03 at 14:00 (129723)

This is an excellent question. Sure would like to hear from ALL of our doctors on heelspurs.com.

Re: First step pain a requirement for surgery?

jackiem on 9/17/03 at 15:11 (130359)

Hello-I had pf surgery 11/5/02, open surgery with partial release. The surgery was hard and paindul. I spent 1 week off work and 3 more on crutches. I wish I had started walking sooner as my Dr. advised but im a wimp. Bottom line is I had a successful surgery and a wonderful Dr. I have no more pain and an so glad I went thru with the surgery. Once I started walking without help, I was back in step aerobics class with in the week.I still have a little twinge of pain here and there, but its been well worth it. Good luck you dont have to suffer!

Re: First step pain a requirement for surgery?

wendyn on 9/17/03 at 22:50 (130402)

CarlW of Calgary? Who are you going to see? Sorry to hear that things are not going well with your feet.

Re: First step pain a requirement for surgery?

CarlW on 9/18/03 at 13:29 (130452)

Hi Wendyn,

Tis me. I saw our good buddy Dr. Russell. I am booked for sugery Nov 17th. A release and nerve examination. Scared @#$$%@# based on all of the stories I have read on here over the last 4 years. He gave me a 50/50 shot with a 20% risk of downside possbilities. Definitley did not sugar coat it.

I am at the point thought where I am ready to accept the risks.

How are you doing?


Re: First step pain a requirement for surgery?

CarlW on 9/18/03 at 13:33 (130454)

Hi Jackiem,

Thanks for taking the time to share your success. It must feel fantastic!!!. Did you have first step pain before your surgery?


Re: CarlW

wendyn on 9/18/03 at 23:21 (130495)

Carl will you have to stay in the hospital? I could bring you a latte or something.

Iain and I are not on speaking terms. He sent a follow up letter to my doctor - and half the information in it was wrong (all kinds of things from an exam that never happened - he never had me stand up). He thought that maybe the lumps on my shins were bruises (because it takes 12 years of med school to be able to recognize a bruise!)

Anyway, he want's me to see O'Brien (for the bunions) but there is a 3 year wait. He will not even look at the bunions because she has already operated on them once. I don't know if I will get in sooner to O'Brien since I've been ditched by my surgeon.

I have not bothered to phone her because I find it too frustrating to deal with doctors over my feet. I always end up feeling worse - and it's too hard to hear over and over that there's nothing they can do but wait for them to get so bad that I have no choice but to have surgery. Of course - because I have RSD now, no one will ever want to touch my feet again.

It is easier for me to take one day at a time - and not dwell on the pain.

My doctor thinks there are 2 new foot and ankle surgeons coming here soon (?). He is hoping to try me out on one of them.

I won't hold my breath. At least Dr. Russell is said to be an excellent surgeon (for all his personality faults), and he hasn't given you false expectations.

Did you have an MRI?