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debating pf and/or hammertoe surgery

Posted by AngelaC on 11/24/03 at 13:13 (138545)

I'm quite confused about what to do at this point, but maybe if I can figure out the questions to ask, I can figure out what I want to do. I'm 50 and this is at least my 3rd bout of pf, and definitely the most painful. It's been quite difficult since August, but I've noticed some relief with rest, night splint, non-weight bearing stretching, birkenstocks. At this point, it only hurts, even after stretching with, walking. I'm in the process of having my orthodics built up (I didn't know they'd wear out after 8 years!!! I bet Everyone Else knew that!)

When I walk, sometimes it's a real contest as to whether it's my pf that hurts, or the hammertoe of my little toe. I had a tendon removed 48 years ago, and the 4th & 5th toes curl under. The 4th is quite floppy, but not painful. The 5th is usually very painful because of the 'knuckle' rubbing against the left of any shoe, and the toenail is curves under my foot and faces the bottom of my shoe. It usually builds up a corn which is almost always painful. I worry about my long-term ability(you know, aging, eye-sight, reaching my foot)to keep removing it, every couple of days, and it sure would be nice to eliminate at least one source of pain.

My confusion is around my podiatrist's suggestions/options. As far as the pf, he thinks I'm heading toward surgery. I don't feel I'm improving much anymore, but I'm still willing to be conservative. I have not had cortisone shots, and am not eager to have them, or pf surgery, if I can avoid it. He thinks that shaving the knuckle & straigtening the 5th toe, possibly pinning the fourth and something-abt-the-tendon, and possibly fusing the 4th & 5th.

A surgery to straighten the 5th (little toe) sounds real appealing to me. My questions are, if I were to have such a surgery, would it make sense to see if I was actually needing the pf surgery and do them both at once? If I did the straigtening surgery, but not the pf, while the pf was actively-evil, would this be a good thing as in immobilizing and resting my foot more? Or a bad thing because I couldn't stretch my foot before standing on it? These days, I walk 'best' in my birkenstocks, partly because the toebar helps straighten my toes some. If I had surgery on the toes, would it be impossible to wear the birkenstocks? I'm not sure what I'd do then.

I'm very sorry this is so long, but I'd appreciate anyone's thoughts on this.
Thanks, Angela

Re: debating pf and/or hammertoe surgery

Dr. David S. Wander on 11/24/03 at 14:47 (138556)

I would recommend avoiding surgery for plantar fasciitis until all conservative care has been exhausted. That includes new orthoses, new Birks, physical therapy and extra-corporeal shock wave therapy. You may even want to talk to your doctor about custom Birkenstocks. These are Birks that are basically custom made, with your custom orthoses made specifically for this particular pair of Birks.

The surgery for the 5th toe is a relatively straight-forward and simple procedure. The surgery is usually very successful with minimal complications. Therefore, I wouldn't recommend trying to kill 2 birds with one stone. I'd highly consider surgery for the 5th toe, and I'd highly recommend trying all conservative care for the PF.