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Plantar Faciitis Surgery Next Week - Not EPF - HELP!

Posted by KarenR on 11/24/03 at 14:14 (138554)

I am having so much difficulty finding information on the web regarding the surgery and that is making me nervous!! My husband has battled PF in both feet for almost 10 years now. It has never gone away, but it has been better at times. He has an extremely high arch - slightly over 60 degrees on both feet. He has seen three different doctors over the years and has tried everything! His orthotics have helped keep it somewhat under control. The cortisone injections have never helped. He is currently under the care of 'the best foot doctor' in the area according to several folks we know, including medical professionals. He wanted to try high frequency ESWT, but cannot get the machinery in our area yet. In addition, our insurance considers it experimental and will not cover it. My husband has finally hit the wall and just wants some relief. He is a basketball coach for both our kids' teams and this condition is just impacting his life too much. His doctor does not prefer EPF as he cannot see the condition of the facia, nor how much he is cutting. He is planning on cutting 80% of the facia. Unfortunately, I didn't go with my husband to the visit and he didn't ask many questions at all. I'm feeling nervous about the whole thing. What is the downside ? What is the recovery and physical therapy like ? I really have no idea what to expect. I have called the doctor's office and they are going to get back to me - HIPA I think - gotta love it! Besides, I would prefer to hear from real experiences. All feedback would be extremely appreciated!!!

Re: Plantar Faciitis Surgery Next Week - Not EPF - HELP!

SteveG on 11/24/03 at 14:54 (138558)

Karen - I am not a doctor, but 80% sounds like a lot. Usually we hear of a 2/3 release on this site. I would definitely consider ESWT before I considered surgery. The surgery is a last resort and if all goes well, great; however, there are potential complications that can be painful and debilitating. Do you live near Canada? You can get it done in Canada for a lot cheaper than here in the US. Many posters on this board have made the trip up north. I know your husband wants some relief, but ESWT could be the answer, and there are little or no downsides to the procedure.

Re: Plantar Faciitis Surgery Next Week - Not EPF - HELP!

Rick R on 11/24/03 at 15:09 (138560)


To set the stage for what I am about to suggest; I went through 13 years of PF prior to surgery and consider it to have been quite successful. Please do not constrain your decision by geography. This is a decision that will have a significant impact on both of your lives forever, you may not want to settle on the best in your area. How far away is the nearest major metropolitan teaching hospital? If you haven't researched every bit of information on this site and yet some you/he have not done all of your homework.

If he isn't ready to concede that he will never be 'good as new' he's not ready to make the surgery decision. Also, keep in mind that 'good as new' was vulnerable to PF to begin with. The time to learn about various techniques that can mitigate that vulnerability such as tape, stretching, Yoga, night splints etc.. is now, not after surgery. Then after surgery, EWST or whatever route he takes, he'll be better prepared to prevent a recurrence. He may even find something less drastic makes the risk of surgery less attractive.

Again, I do not in the least regret making the decision to have surgery. I do to some extent consider myself to have simply been lucky. My recovery was 4 weeks with no weight bearing at all then I walked away as if nothing ever happened. I waited one year to try running again and did so with many prcautions learned prior to surgery. Massage and stretching is the only 'PT' I can remember which I did on my own.

Best of Luck,


Re: Plantar Faciitis Surgery Next Week - Not EPF - HELP!

Pauline on 11/24/03 at 18:41 (138578)

Something your husband should consider prior to surgery. I'm sure there are more abstracts and journal articles he can find on the subject. Here are three I found doing a quick search. LCS is real and something he should know about before his surgery not afterwards. You want no surprises. As Rick said do your homework well. The time you spend will be well spent.



One complication specific to plantar fasciotomies, regardless of how they are performed, is later column syndrome (LCS). LCS is sometimes a very difficult complication to understand, diagnose and treat. If we think of other endoscopic surgical procedures, such as a cholecystectomy (gall bladder) we tend to think of the first week or two as the time when we would have complications. The surgery is completed, we heal and move on. But consider the fact that you don't walk on your gall bladder surgery. The complications of LCS occur not in the first week or two after surgery but rather 2-4 month after a plantar fasciotomy.

Here's what happens in cases of LCS. As patients get 4 weeks or so out on their plantar fasciotomy, they start to feel more able to return to their normal activities. As they progressively increase their activities they begin to add an increase in load to the foot. Although the surgical site no longer is sore from the surgery, the biomechanical impact, or change to the joint structure of the foot is not complete for 4-6 months following the surgery. Early symptoms of LCS are a dull ache of the lateral (outside) of the foot and the top of the arch. This ache is a stiffness that if left untreated will result in small stress fractures if the lateral and dorsal aspects of the foot. LCS is a manageable complication of this procedure and should be thoroughly discussed before surgery so that patients are aware of the symptoms of LCS and can make their doctor aware should they experience problems.

Good luck with what ever decision you make.

Re: Plantar Faciitis Surgery Next Week - Not EPF - HELP!

Dr. Z on 11/25/03 at 11:49 (138629)

LCS is avoided by using ESWT. This is one of the reason why I do ESWT. There is no cutting with ESWT and therefore no chance of LCS.

Re: Plantar Faciitis Surgery Next Week - Not EPF - HELP!

Pauline on 11/25/03 at 13:34 (138639)

Dr. Z,
I know Brian had surgery prior to his ESWT treatments with you, but what do you do with your patients who like Brian were not helped by ESWT and now want to have P.F. surgery?

Re: Plantar Faciitis Surgery Next Week - Not EPF - HELP!

Dr. Z on 11/25/03 at 19:32 (138715)

I don't believe that Brian ever had classic plantar fasciitis. What I mean by this is that he didn't limped or have severe pain when first walking after sitting for any period of time. Brian correct me if I am wrong about this.
So I would never perform pf releases on any patients that didn't have classic first step pain after sitting for any period of time.
Now if a patient had first step pain after sitting for any period of time
and then had pf release that didn't work and then had ESWT that didn't work. I would repeat the pf release so long as the chief complaint was the pain with first step walking.

Re: Plantar Faciitis Surgery Next Week - Not EPF - HELP!

Pauline on 11/25/03 at 21:35 (138732)

Dr. Z,
Since first step pain after sitting is only one symptom attributed to classic P.F. how can you totally rule out the diagnosis out of classic P.F.

I'm not speaking about Brian's case because I don't know what he had or didn't have, but if a person has all the symptoms accept for one why don't they have classic P.F.?

When a person suffers from panic attacks there is a whole list of symptoms, but not all sufferers experience everyone of them yet the doctors still diagnosed their condition as panic attack.

What is the difference when more than one symptom is involved?

Re: check this out

Rochelle on 11/26/03 at 10:39 (138768)

You want to know the downside-here it is

This is my recovery..

Just request them to give you antibiotics RIGHT after surgery to lessen the chance of you getting an infection! You will be much happier without an infection - trust me.

Re: check this out

Pauline on 11/26/03 at 12:58 (138781)

I find myself torn when I say your web site is great because in all honesty, there should be NO need for such a site.

It's my belief that what has happened to you happens to many patients who undergo P.f. surgery, only we don't hear about it unless they find heelspurs.

For anyone considering P.F. surgery, your site serves a very important purpose. It should at the very least get people to stop and think about P.F. surgery before they say ' yes'. For the rest of us, it shows a different face to the 'snip and go' surgeries that are often offered to Podiatry patients to make them pain free.

Hopefully your now treating at a wound clinic. Beside the use of oral and topical antiobitics there is a relatively new treatment to heal wounds from the inside out.

I forget the exact name, but I know your own blood platelets are used in making the substance that is put directly on the wound. It's quite costly, but it certainly works very well.

My neighbor, a diabetic and a physician, told no one about the ulcer that was eating away the flesh of his heel. When he arrive at the wound clinic he had an opening down to the bone about the size of a $.50 cent piece.

Nothing seems to help, but the treatment I described above. If you are not making any progress in controling the infection or getting that wound healed make sure you ask them about it.

There is no question in my mind that P.F. surgery of any type should come under an investigation not merely for the type of experience you had, but because so many people experience many other complications that can be directly attributed to this surgery.

Because so many folks suffer from P.F., it's my opinion that P.F. surgery has become thought of as a huge office income producer by many doctors. Doctors who for the most part should not even be doing the procedure.

In every crate there is rotten fruit. The tick is to get rid of the rotten fruit before it spoils the rest, but in medicine it doesn't work that way. Less than competent doctors are still allowed to maintain their practice and often times are protected by their colleagues.

In closing, I thank you for taking the time to make your website. May it glow as a beacon for all patients who are considering surgery to cure their P.F.

I hope your wound heals quickly and you find yourself pain free after this ordeal.

Re: Plantar Faciitis Surgery Next Week - Not EPF - HELP!

Dr. Z on 11/26/03 at 15:59 (138805)

I agree there are other symptoms with pf but if you don't have the first step pain then surgery and or ESWT results may be less sucessful. I am talking about treatments . You can have pf but if you have pf without first step pain then the sucess and treatments will be different. You should also look for systemic causes including nerve associations and lower back problems when there is no first step pain

Re: check this out

Rochelle on 11/26/03 at 18:23 (138815)


Thank you for that wonderful reply. I hope many people read it prior to having PF surgery themselves.

Thanks again for the kind thoughtful words.

Re: check this out

Rose on 12/03/03 at 13:01 (139267)

Thanks for the pictures. Wow, I am fortunate as LI had no infection at all. My incision is on the botttom of the foot. Do you know the difference as to where they cut????

Re: check this out

Sher A on 12/10/03 at 18:13 (139768)

Rochelle, your website is excellent. Thank you for your time and effort to put it all together. I hope you keep it out there. Everytime I get desperate enough to consider surgery, I'm going to look at it again. Gee, and here I thought I was the only one in the world who is unable to find a podiatrist I'd trust, who is also sensitive to the pain issue. I've seen 3 podiatrists and not a one believes in giving medication for pain. The one I saw last Monday gave me a shot and both he and his receptionists couldn't get me out of there fast enough. I can't imagine how they would do surgery. All I want to know is how to find a pod that meets my 3 simple requirements: good, caring, treats pain. I live in northern Virginia. There are like a million of us just in this area, so you'd think there might, just might be a decent podiatrist around, yes? I am seriously sick and tired of being jerked around by podiatrists. I was a very happy person until I came down with PF 3 years ago. The pain is what turned me into an unhappy person, and my lack of success in finding a good podiatrist. With January me and my PF are entering our 4th year together. Maybe I could write a country hit about it - Me and My PF. I'm sorry folks, but when my heel feels like it is being crushed between a couple of cinderblocks, it is very very hard to think that I am walking through a beautiful spring meadow and the pain is gone. I cannot think this away. It has to GO away. My pick-3 number just hit in the lottery last Monday and I won $500. I was delighted when I picked up the money but that didn't defer the pain in my heel one iota.

Rochelle, I sure hate to see the downside of your surgery at your expense, but people need to know that this right here is one of the risks and seems to be the typical attitude of doctors, well, in the DC metro area anyway. Now that you've become a somewhat 'difficult' patient to treat, I bet they all just want you to go away. It's lovely, just lovely. You shouldn't have to request the antibiotics, they should suggest or offer them to you and tell you how to identify an infection. But they probably feel the same way about antibiotics as they do agony. What the heck, it isn't their heels.

Re: check this out

john king on 12/17/03 at 07:42 (140134)

My orthopedist was hot to trot about getting me to let him do surgery on what he said was TTS. Now if that workers compensation doctor of mine wants to do surgery there must be money in it. I declined the offer after seeing some of the scars on peoples ankles from TTS.