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scar tissue fromation following epf

Posted by Stacey on 9/30/03 at 11:23 (131740)

Hello All,
Is there anyone out there who has had the EPF surgery and had a larger than normal mass of scar tissue form in the fascia-making the pain worse?
My questions are:
Other then just being more prone to this, I am wondering if more scar tissue will form if you hurry your recovery?

I already know methods to prevent the formation-but I am considering open surgery to cut out the scar tissue and want to make sure there is a way to prevent it from happening again. I just do not understand why I should have the surgery a second time if the scar tissue will probably just grow back just as badly.
Thanks for your input.

Re: scar tissue fromation following epf

Ed Davis, DPM on 9/30/03 at 14:15 (131758)

Surgical removal of scar tissue can simply result in more scar tissue so consider non-surgical means: ultrasound, deep tissue massage, ESWT, injections of hyaluronidase and/or triamcinolone acetonide.

Re: scar tissue fromation following epf

april l on 9/30/03 at 21:49 (131807)

I had scar tissue that was a large lump at the insision site when I had my first surgery 5 yrs ago, and it made walking very painful...felt like a knife being stuck into my ankle bone. I had PT, ultrasound, and massage to break it up. I only did that about 4 times and the lump was still there but eventually it went away on it's own. I don't know if that's normal but I don't have it anymore and my foot is pain free. I did continue to massage it almost daily for a long time. On my other foot. which I had surgery on 5 weeks ago, the lump is very small and I am doing all the same things. I have been walking and doing pretty normal activities since 3 days post-op. Not that I don't have pain...I have to take breaks frequently. I am doing all the same things I did with my previous surgery so I don't know why I had more scar tissue with the first.

Re: scar tissue fromation following epf

BrianG on 9/30/03 at 23:14 (131812)

Hi Stacey,

I'm not sure the scar tissue is caused from hurrying your healing time. I had the old stlye EPF (dual portal), and y Pod had me walking from day #2, increasing the amount of walking every few days. I did walk, but eventually could not keep up with his schedule. At the time, I actually thought his walking time line was way too agressive. Now I'm not to sure. I didn't wear a cast, did you? That may have had something to do with it. I also took large amounts of Vit. C, for about 6 weeks, as I heard that it helped in the healing process. It did cause some cramps, but I dealt with them. I also insisted he give me an antibiotic, which was Clindamycin.

Good luck, and try to talk to you doc about Dr. Ed's suggestions.


Re: scar tissue fromation following epf

Kim S. on 10/04/03 at 07:43 (132154)

I had ESWT in both feet in April 2003 and just had EPF on right foot on Sept. 10, 2003. My pod found an unusal large amount of scar tissue for someone who has never had any type of foot surgery before. He is assuming it is from the ESWT. The ESWT pod and surgery pod both 'suggest' the ESWT didn't relieve my symptoms at all because so much scar tissue has formed.
None of this is an exact science but as recommended by Dr. Ed I am researching the Sonorex machine (my ESWT was done on the Ossotron) for my non-EPF foot.

Re: scar tissue fromation following epf

Pauline on 10/06/03 at 08:36 (132413)

According to studies ESWT isn't suppose to cause any injuries to tissue following treatment. Many posts by treating doctors posting here say just the opposite of what your doctors are telling you. How did they come to the conclusion that ESWT was the cause of the scar tissue they found? Have they seen the same results in some of their other surgical patients as well?

This is an interesting theory, because I don't think we've heard from patients that had ESWT and followed it by surgery report what their doctors found inside at the time of surgery. Were both feet treated by the Ossatron when you had ESWT in April of 2003?

Re: To Kim scar tissue fromation following epf

Pauline on 10/06/03 at 08:39 (132414)

My questions were meant for Kim, who had the surgery following ESWT. Sorry Stacy, just saw your name first.

Re: scar tissue fromation following epf

Sharon W on 10/06/03 at 17:04 (132492)

Hi, Pauline!

It's great to see your post!

I certainly always had the same impression that you did ~ in fact I thought I had read somewhere about someone having ESWT done to try to BREAK UP scar tissue, although perhaps I misunderstood. (You're more on top of this stuff than I am, Pauline...) I know that ultrasound is used that way sometimes. But of course, ESWT is much stronger and more powerful than ultrasound.

Like you, Pauline, I certainly thought that ESWT is NOT supposed to cause scar tissue injuries as a possible side effect of treatment.

...Still, if there is anything that I've noticed as a rule of thumb for people with foot pain, it is that we are all different, and we respond to these treatments differently. So it is conceivable that what heals one person, might harm another. You just never know.

I hope we'll see a lot more of your posts here again now, Pauline!!


Re: scar tissue fromation following epf

Stacey W on 10/09/03 at 08:48 (133030)

I said EPF (endoscopic plantar fasciotomy) surgery had caused the scar tissue-not ESWT.
Yes, ESWT is supposed help break up scar tissue.

Re: scar tissue fromation following epf

Sharon W on 10/09/03 at 10:33 (133077)


Yes, it was Kim who said her problem was from ESWT - Pauline had confused your name with hers... sorry about that.

The ESWT you had was to try to break up scar tissue from the EPF? Was THAT when you had that problem with the injection? (Or am I confusing you with another Stacey...?)


Re: scar tissue fromation following epf

Kim S. on 10/11/03 at 14:57 (133635)

I had the Ossotron on both feet in April.
Just saw Pod. for 4-week post-op visit and he further explained he and his associates feel there can be scar tissue build up post ESWT since any manipulation of the fascia can cause scar tissue, regardless of the technique; even though you are not 'touching' the fascia with an instrument you are traumatizing it. This is just what they believe.
I was their first patient who had ESWT before EPF.
Must report that 4 weeks post-op I am walking with a slight limp, doing p.t. 3X/week however still can't walk more than 20-30 minutes without needing to rest a while. I am optomistic :)

Re: scar tissue fromation following epf

Dr. Z on 10/11/03 at 15:13 (133637)

Hi Kim,
So you had failed ossatron ESWT then you had EPF . Is that correct?

How is the range of motion at your ankle joint. It is referred to as Ankle equinus if there is a lack of up movement

Re: scar tissue fromation following epf

Kim S. on 10/11/03 at 17:33 (133648)

Dr. Z:
Correct: failed Ossatron ESWT in both feet, then had EPF in rt foot 9/10.

Range of motion in ankle is excellent. Ankle does ache after walking more than 15 minutes at this point and pain in center of heel at that point also.
Note: I have been in P/T 2-3x/week for 2 years prior to surgery and continue to be now so I credit wonderful range of motion to P/T.
Need to make a decision re: Sonocur vs. Dornier for the left foot. I have my choice here on L.I. of either machine. I know Sonocur is not FDA approved but the facility will do the treatment if I pay (which I could).
I printed out your discussion with the other dr. re: this subject and am just as confused. Seems there is no cut and dry answer. I am leaning toward the highest shockwaves since I had no response to the Ossatron; meaning I didn't feel any different when I woke up and never could tell I had anything done to either foot (one foot done then other one 3 weeks later). Neither foot had any impact whatsoever.
Any new thoughts, Dr's?

Re: scar tissue fromation following epf

Dr. Z on 10/11/03 at 18:01 (133649)

So you have first step morning pain or pain after sitting for any lenghth of time? Is your pain all the time. That's what it sounds like. These are very important question to answer before you have any ESWT done.
Now here is my take on which should you go for Sonocur or Dornier.
I am guessing your insurance won't pay for Dornier so that is one of the reason why you are going for the Sonocur. Is that correct.? What is the cost of the Sonocur in your area? What is the cost of the dornier in your area? I am going to help you make your decision. I have no idea where this will lead but I will use some logic and not include the non-FDA aspect for the Sonocur.
With these questions answered I will try to move you in a direction that MEETS your needs