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

Re: Post EPF recuperation

Posted by Kim S. on 9/25/03 at 07:14 (130961)

I would like to hear from anyone who has had EPF recently and how long post-op took, felt and anything they did that gave them relief.

I had EPF (50% release and scar tissue 'removed') done on 9/10 & spent two weeks casted. Now 2 days without the cast I thought I would be walking somewhat but heel is so bruised and painful I am still crutch assisted. Started PT yesterday but they were extremely conservative. I am icing 2-3x/day & taking Advil as much as allowed.

I have spent two years doing all conservative treatments, including ESWT (Ossatron) on both heels three months ago w/absolutely no relief (actually couldn't even tell I had anything done). They said if I was not 50% better with ESWT treatment #1, I am not a candidate for another.

Please respond! I am supposed to schedule EPF for the other foot (which of course is taking a beating throughout the first foot surgery) but can't imagine doing this again!

Re: Post EPF recuperation

Ed Davis, DPM on 9/25/03 at 16:23 (131016)


There may be something to the idea of not repeating ESWT if no relief occurs the first time. While I cannot state that there is a significant difference between ESWT results, you may want to consider a second opinion and looking into use of other technology. Take the opportunity to read Scott's Heel Pain Book to make sure that the conservative treatment you had was truly comprehensive. Also check out http://www.sonorex.com

Re: treatment philosophy

Ed Davis, DPM on 9/25/03 at 16:41 (131020)

This may be helpful:

Sonorex, Inc. has developed a philosophy and program of orthopedic extracorporeal shock wave treatment which it believes maximizes the advantages of this new technology while reducing clinical risks and enhancing cost effectiveness. Shaped by management's many years of clinical and administrative experience in the urological application of both high and low energy shock waves for kidney stones, and heavily influenced by our German orthopedic colleagues' experience with shock wave treatment techniques, the Sonorex, Inc. approach may be briefly summarized.

Key concepts of therapy:

Selection of proper energy level for shock wave treatment. Although both high and low energy may be used, Sonorex, Inc. believes that the use of low energy has significant advantages over high energy shock wave applications in the most cases of near bone pain. These include:

a) ability to treat patients without the necessity of regional or general anesthesia

b) reduces the clinical risk of tissue injury or bleeding into the skin, joint, or other tissues near the area being treated

c) allows highly individulized treatment at the exact site of pathology by allowing the use of precise clinical focusing rather than depending upon imaging with ultrasound, flouroscopy, or x-ray that may not adequately identify the exact site of the problem. ( Imaging devices cannot 'see pain'.)

Within the low energy range of energy treatment levels, the ability to adjust this level to each patient's tolerance adds to the concept of individualized treatment and safety. Although the use of low energy may require more treatment sessions (usually three) than higher energy (one to two) the reduced cost of eliminating the anesthesia and imaging expense allows the treatment to be more cost effective. Patients who have bone fractures or pseudoarthroses (nonunion) should be treated with high energy and imaging device focusing.

Proper patient selection. Only patients who have well localized painful areas should be treated. These painful areas should be able to be localized by digital pressure with the index finger. Patients with large or poorly localized areas of near bone pain should not be treated. With proper patient selection, 70 to 90 per cent of those treated should get significant improvement.

The Sonocur® Orthopedic Extracorporeal Shockwave system is available in Canada and other countries where regulatory approval has been obtained. The Sonocur® Basic is FDA approved in the United States for the treatment of chronic lateral epicondylitis (tennis elbow).

© 2000 Sonorex, Inc. All rights reserved. By using this service, you accept the terms of our Visitor Agreement. Please read it. The material sonorex.com is for informational purposes only and is not a substitute for medical advice or treatment for any medical conditions. You should promptly seek professional medical care if you have any concern about your health, and you should always consult your physician before starting a fitness regimen.

Re: treatment philosophy

Dr. Z on 9/25/03 at 17:45 (131035)

The important information is patient selection !!!!!. I use my thumb not my index finger when palpating. ha ha

Re: EPF recuperation

Kim S. on 9/25/03 at 18:54 (131039)

Will definetly consider Sonorex for the left foot which has only had ESWT w/the Ossotron.
However, first I have to be able to walk on the right foot (EPF 16 days ago).
I have done every treatment Scott listed except for the ibuprofen cream. Have been through 5 podiatrists and 1 orthopedist in the past 2 years (was a tennis player when pain began).
Each one gave me another suggestion and sent me on my way. I don't regret having the surgery since I had exhausted all other options.
Is recup time that individualized?
Some are walking almost pain-free in 2-3 wks. others 1 year?
Just want to get to the point I was at before surgery, that would be an improvement.

Re: EPF recuperation

Rose on 9/25/03 at 21:15 (131075)

I had release surgery July 1 and am walking with little or no pain, but not for very far. I have orthodics in New Balance shoes which work well. I was in the boot about 3-4 weeks following surgery. I have had no physical therapy. I roll a rubber ball under my heel and arch to hopefully break up any scar tissue. I don't take any pain killers at all now. I sleep about every other night with a boot on both each feet. That makes me totally pain free for at least the first half of the day. I have slight PF in the other foot, so it acts like a night splint and is helping that go completely away. I imagine the two months of rest has almost cured the milder PF in the other foot. I had surgery on both feet at the same time, which worked well, although I spent a month in a wheel chair out of the house. I had a neuroma on the other foot which is completely healed. The PF foot is healing slower, but I expected it. I feel that I should be back at aerobics in several months. I am already walking on the treadmill 10 minutes, which I could not do at all before surgery. So I feel it has been a success. I think it was a great idea to do both feet at once so neither foot was compromised and both had time to heal.

Re: EPF recuperation

april l on 9/28/03 at 10:01 (131429)

I just had my surgery on 8/22 on my left foot. It has been 5 weeks and I am in worse pain than I was before surgery. However, this is no shock at all to me because I had this same surgery 5 years ago on my right foot and it did take over a yr. for me to feel I hadn't made the worst mistake of my life! I am in PT and they are very aggressive with stretching and breaking up adhesions, scar tissue. If I hadn't been thru this before I would really be depressed right now because I, too, have heard about those people who are pain free right away. It makes me think my surgery failed. I just know that I have to be patient because today my right foot is totally pain free and 'normal'. The symptoms I have right now after surgery are severe pain when I bend over with my knees straight, i can't stand pulling my foot towards me unles my knee is bent. My toes ache when I stretch. The inside of my heel where the scope went thru is sensitive, and I still have pain in the morning like i did pre-surgery. I have achiness when I do the stretching exercises. Sometimes my pain is even so vague I can't pinpoint where it's coming from. Anyway, I just want to let you know my experience because I went thru this twice. It's normal for it to take time I believe. Everything that I'm going thru right now I went thru 5 yrs. ago. The end result was no pain, even tho it did take longer than i ever expected.

Re: For Kim, Rose and April

BrianG on 9/29/03 at 22:34 (131698)

Hi Ladies,

Could you take a minute to let us know if your EPF incisions were made from only one side of your ankle. Or both sides, meeting in the middle? I had the later, about 4 years ago, and it took a few months to recover from the pain.


Re: For Kim, Rose and April

Kim S. on 9/30/03 at 18:20 (131782)

My EPF incisions are on both sides of heel. Funny that would make a difference since I wasn't offer any other option. Still finding foot painful after 5 minutes on my feet, however, my left foot has PF just as bad as my right 'did' is in bad trouble due to the compensation.
I know one day I will know I made the right decision as Rose & April said, just running out of patience. . .
Brian, were you extremely sore for those few months?
I am also trying to find out info on scar tissue, which seems to be the culprit of many people's post-pain. How do you know if you have a build-up, do we just assume we do? Any info anyone?

Re: For Kim, Rose and April

april l on 9/30/03 at 21:37 (131804)

When I had the surgery 5 yrs ago, I had scar tissue and it was obvious by the large lump around the insion site on the inside of my foot. The lump itself was painful to walk on, not to mention all the other pain. But, it went away in time. I did have some physical therapy, ultrasound, and massage to break it up. It didn't seem to help at the time, but I think it did. I kept up the massaging myself...and hubby did it too because he could really put pressure on it. On the foot I had recent surgery on, I have only a small lump and I am working on it daily, doing massage. I also stretch my foot with a scarf, pulling the ball of my foot towards me while my knee is straight. That is helping too.

Re: For Kim, Rose and April

april l on 9/30/03 at 21:39 (131805)

Both my surgeries required two insisions on each foot, one on each side.

Re: For Kim, Rose and April

BrianG on 9/30/03 at 23:29 (131813)

The reason I asked is that the 2 portal method is made using the 'OLD' style kit. Some say it was almost impossible to make an accurate cut using this kit. A few years ago, the company came out with a newer 'kit', which makes only one incision. This is supposedly a better kit, making the correct incision easier. My BIG problem with these kits is that the old style kits were never recalled. There are still a ton of them out there in use. If you ask me, this is wrong!!!! Why not ask your doctors why he didn't use the most up to date equipment? See what he has to say. If he tells you that it doesn't make a difference, he is not bieng truthful with you! Something should be done, to recall all the original two portal kits !!!!!


Re: For Kim, Rose and April

Rose on 10/02/03 at 19:42 (132008)

I was cut on the bottom of the heel towards the inside of the foot, but definately on the bottom. It has been over three months and it is sore to walk too far, but it is getting better and better. I wear the boot to bed on both feet every few nights and that helps a lot and has made the PF that was starting in the other foot completely stop. I also do stretches using a strap regularly. I do a lot of water aerobics. Since I had the other foot operated on at the same time (neuroma) I was completely off my feet for a long time, which might have helped in the healing of the other PF open release foot.

Re: For Kim, Rose and April

Rose on 10/02/03 at 19:43 (132009)

I had just one cut.

Re: EPF surgery, 1 portal only !!!!!!

BrianG on 10/02/03 at 23:19 (132030)

One out of three kits was the NEW style. Pretty poor odds, wouldn't you say!

If anyone else is considering an EPF surgery, you would do your self a favor by finding a doc who uses a one portal, NEW style kit !!!!


Re: EPF surgery, 1 portal only !!!!!!

april l on 10/03/03 at 10:39 (132055)

That may be true, however, it appears the outcomes from reading here are not much different, maybe even better with the 2 portal type.

Re: EPF surgery, 1 portal only !!!!!!

Ed Davis, DPM on 10/03/03 at 19:34 (132114)

You are probably correct on this point. The single portal approach is less traumatic and uses better instrumentation although the success rate of the surgery does not change.

Re: EPF surgery, 1 portal only !!!!!!

Kim S. on 10/11/03 at 15:03 (133636)

My pod. used the 2-portal method on me. He said he is certified in the 1 portal due to certain facilities only carrying the 1 portal equipment. He prefers the 2 because he can visualize things better and has about the same success rate with each. Sound right Dr.'s?

Re: EPF surgery, 1 portal only !!!!!!

BrianG on 10/13/03 at 17:54 (133898)

Hi Kim S,

I don't think you'll get an answer, as the doctors who are now posting, do not perform EPF's.