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Foot Surgery

Posted by Ron B on 12/01/03 at 14:12 (139097)

Pauline
I just read your post from 11/25. about foot surgery. I agree with you it should be the last resort!! My Pod Refuses to do surgery for PF !!!!!!! he says its too RISKY !!!!!!!!! If someone is thinking about Surgery, PLEASE really think it over, even get a second opinion!!! my pod says surgery can even make things worst!!!!

Re: Foot Surgery

Pauline on 12/01/03 at 16:48 (139104)

Ron,
Give your doctor the address to this web site. We need him and his conservative ideals about surgery on this site especially in the surgery forum.

After that, I'd tell you to give the man a big hug, but your a guy so a hand shake will do, but tell him 'thank you' from all of us.

It's great to know that there is at least one Pod out there not seeing $$$$ signs written all over P.F. surgery.

Re: Foot Surgery

Dr. Z on 12/01/03 at 18:36 (139113)

Just so you know PF surgery pays so poorly about 3-4 hundred dollars, that I doubt that it is money that motivates the podiatrist. It is lack of understanding. When it comes to orthopedic surgeons well they probaby never did any type of pf surgery so they just say never without knowing why
Conservative therapy pays alot more money then foot surgery today. ESWT could be used instead of the two or three thousand dollars of physical therapy, orthosis and office visits that insurance companies spend, but that is another subject.
If there wasn't ESWT I would recommend Minimial incision foot surgery . I cured hundreds of patients but there were still a few that were worse off. There was no choice it was either foot surgery or live with the pain.

Re: Foot Surgery

Ron B on 12/01/03 at 18:55 (139116)

Dr Z
I think my pod is concerned with the nerves in the foot. I think he said there are just too many that you could disturb. I will be seeing him tomorrow so I will ask him. He says there are too many other ways to treat PF. I think all of them have been discussed on this site at one time or another.
If surgery cost only three or four hunderd dollars like you say, its probably A thousand here in Seattle LOL

Paulinne
I do like the fact that he's not gung-ho to start cutting. I do think he HAS done surgery but only after everything else has failed!

Re: Foot Surgery

Pauline on 12/01/03 at 19:11 (139118)

Dr Z,
Are you quoting what Medicaid or Medicare will pay? Custome orthotics from a Pod will set a patient back that much and an injection for a neuroma combined with the office visit also comes close to that price.

Maybe you just work cheaper than other Pods. You can check out the rates Medicaid pays of Podiatry Services in Texas on the net. You'd get a lot more in Texas. Heck a debrisment of tissue gets them $166.38 from Medicaid.

Private insurance companies have to pay more than Medicaid. No wonder your breaking ribs---your not eating right:*

Re: Foot Surgery

Dr. Z on 12/01/03 at 20:36 (139120)

I am quoting what Medicare pays in New Jersey . Most of your commerical and Blue Shield base their fee schedule on what Medicare pays. Yes there are some states that pay more especially Medicaid in Texas and California.
An injection is about $33 buck's from Medicare. Plantar Fascia Release is about $4oo. I am serious.

Re: Foot Surgery

Julie on 12/02/03 at 02:58 (139131)

Lack of understanding was my understanding too. Everyone does what they know how to do, and most people are reluctant to venture into anything new. So surgeons do surgery, and don't investigate ESWT, which requires not only investment in equipment and training, but the mental leap into a new field.

But the figures you've cited, Dr Z, are incredible. Money certainly can't be the motivation.

Re: Foot Surgery

Pauline on 12/02/03 at 06:38 (139132)

Dr.Z,
Podiatry is not the richest, nor the poorest occupation according to these 2002-2003 stats., but as an occupation because of changes in insurance and government regulation it's in constant evolution.

'Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, 2002-03 Edition

Median annual earnings of salaried podiatrists were $107,560 in 2000. The middle 50 percent earned between $77,440 and $134,900 a year. According to a survey by Podiatry Management magazine, median net income of podiatrists in solo practice, including the self-employed, was $89,681 in 2000. Those in group practices or partnerships earned median net income of $96,200 in 2000. Self-employed podiatrists must provide for their own health insurance and retirement.'

As more Pods begin to use ESWT I think we'll see an increase in these income figures. Your medical societies are also looking toward increased earnings from the surge of Baby Boomers, our aging population, to have a very positive impact on your salaries.

In addition, education in the form of seminars like the one below are also aimed toward income growth through new marketing techniqes. help.

'In-Office Dispensing of Over-the-Counter and DME Products

Create a residual stream of income in your practice while increasing patient service. Indentify those goods and services which your patients expect and which enhance your professional care. Learn how to comply with regulatory requirements as well as how to market these goods and services.

This seminar is made possible, in part, through a financial grant from Kinetic Concepts Incorporated (KCI).

Invited Faculty: Lecturers may be changed without prior notification.

Mr. Ernesto Castro, C.Ped., Mesa, AZ
Custom Footwear, Inc.

Richard Scott Levin, DPM, West Palm Beach, FL
Director, Podiatric Residency Program, J.F. Kennedy Medical Center (Florida), Past-President, ACFAS

Bret M. Ribotsky, DPM, FACFAOM, FACFAS, Boca Raton, FL
Past-President, ACFAOM, Consulting Editor, Podiatry Coding Alert, Former Chief of Foot Surgery; The Cleveland Clinic Foundation (Florida)'

Over all I'd say the future of Podiatry, as an occupation, looks pretty bright Dr.Z.

If you can just maintain your health, we're not going to find you or your colleagues on the bread line anytime soon. Besides right now you don't want anything, especially white bread, sticking to your ribs:*

Re: Foot Surgery

Pauline on 12/02/03 at 06:46 (139133)

The word 'help' after techniques in my former post shouldn't be there and holds no significance by it's location. It is simply a left over word from another sentence that was not edited out when that entire sentence was removed.

Please ignore it. I don't know how to edit it out of that post.

Re: Foot Surgery

Dr. Z on 12/02/03 at 07:53 (139134)

Pauline,
I agree podiatry is a very good profession with excellent finanical opportunity that depends on the skill, and business skill of the individual.
What led me to make the my statement about money and motivation to do surgery for pf releases. There is no finanical motivation for any podiatrist to do pf releases. That is what led Dr. Z to make the statement.
Medicare and other insurance carriers have switch finanical reward from
surgery to what is called evaluation and managment. Your research is excellence. I hope that most of my profession go to these seminars


surgeyr
surgery to mang


foot srugery

Re: Foot Surgery

Bud P on 12/02/03 at 08:00 (139137)

Some Pod. doctors know that surgery does work and see patients get better everyday.They took an oathe to help people and are very sincere and honest about surgery. Look at Dr. Z's numbers and it's obvious that it's not for money. I saw one Podiaytrist 2 times and he wanted to operate.My Podiatrist that I see now waited two years and tried everything he felt would work before he suggested surgery. So far I'm happy with my decision. Even if it doesn't work I'm happy and have confidence in my doctor. Bud

Re: Foot Surgery

john k on 12/02/03 at 09:50 (139145)

Bud

If you know the risks and want surgery anyway then I think that is O.K. because maybe it will work. Having confidence in your doctor is the main thing.

Re: Foot Surgery

Ron B on 12/02/03 at 21:09 (139217)

I had ESWT done today and I asked my pod about surgery. he does do it but only as a LAST resort. too easy to cut too much. he puts his patients in casts for 5 or 6 weeks

Re: Foot Surgery and pain afterwards

Sher A on 12/09/03 at 19:41 (139685)

I talked to my pod yesterday regarding a 'plantar fasciotomy'. I believe this is where they go in through the sides of the heel and lengthen the fascia. How they do this, I don't know. The girl I talked to there said she's done this type of surgery for 19 years and has had many more successes than failures.

I myself might consider this except for their insensitivity to pain. I am not at all pleased with the way they refuse to treat the pain of PF, after I've been in and out of there for the past 6 months. I mean if they won't give me one single thing to take the edge off the pain as it already is, they will probably tell me to just go take some motrin after the surgery. This is NOT acceptable and is not an option. There are people like me who cannot bear pain, and if the doctor is not willing to help in that area, then I can't imagine going through the surgery.

I just read Bluestella's posts on 'Ask the Doctor'. What is with them anyway? Asking if you've tried horse chestnut? Give me a break, but this is ridiculous. For many of us, this degree of pain requires strong medication, not freaking horse chestnut. I can't believe any doctor would even suggest such a thing. Who wants to go through any kind of surgery when they are going to turn a deaf ear to the period of suffering afterwards? I mean 20 tylenol 3's is just plain not enough, especially for those of us who have a low pain tolerance and a high medication tolerance. They just look at us like we're addicts. Don't they get it that some people need more? I'm so sick of this treatment out of doctors - they are supposed to be helping to relieve our 'discomfort' (the politically correct term for plain old pain), not refuse you relief if you ask for it. In my case, the pain has stripped my nerves raw, has altered my life, and I am sick and tired of this current attitude. I would love to have the surgery done after suffering for 3 years with this, but I sure won't love the 6 month's of pain afterward that they will just turn up their nose at and expect me to bear.

Does anyone have advice on this topic? Please, someone help me out here, in a kind way. I'm very serious. 3 years is enough of this. I can't get another shot for 6 months. This is the one hurdle in my way of getting the problem fixed. Like how do I find a doctor who actually understands that PF hurts and that you will undoubtedly be sore for awhile after surgery? I would rather be dependent on medication for awhile than feeling like I want to scream every second. I'm sure there are also medications to break that dependency too, *should* it occur.

How do I find a decent podiatrist? What are the questions I need to ask? I would be eternally grateful for any ideas, or if it's even in the realm of reason.

Re: Foot Surgery and pain afterwards

Pauline on 12/09/03 at 21:21 (139688)

I don't have the time to respond fully now, but if you don't like what you see in your Pod now, never, never have him/her perform surgery on you.

The way your being treated won't get any better.

Re: Foot Surgery and pain afterwards

Julie on 12/10/03 at 02:49 (139702)

Pauline is right, Sher. Don't let a doctor you do not like or trust do surgery on your feet.

Whether you eventually decide on surgery or not, pain is what you are clearly going to need to deal with for some time to come. It would help you to learn relaxation techniques. This is an area that has been well researched. Learning to relax would enable you to control your response to the pain, and put you back in charge, rather than being entirely dependent on doctors and being angry at their failure to help you. At present, the build-up of anger is probably fuelling and exacerbating your pain.

Give relaxation a try. There are good books and helpful audio tapes avaiable.

Re: Foot Surgery and pain afterwards

dave r on 12/10/03 at 07:37 (139712)

I will say that for me having a pf release was a piece of cake. The pain was minimal and I was happy that I did it. Its been ten months now and my pain levels have dropped 50%. Not sure if I will have another surgery to release the rest of the plantar fascia but the surgery doesnt scare me anymore....

Re: Foot Surgery and pain afterwards

Bud P on 12/10/03 at 07:49 (139714)

Sher,
I am now 4 weeks plus post op. the surgery was no worse than the PF. It was a different pain but controlled easier with meds. I'm not suggesting you have surgery,that's a decision you will have to come to on your own. Day 3 and 4 were the bad days after surgery. I just limited everything I did,used my meds and iced the hell out of my foot. I'm in less pain now than I was before the surgery and feel like I made the right decision.I'll know more in a couple months. If I continue to progress like I am I'll be completely satisfied. I have very little if any PF pain ,no first step pain. I do have soreness in the arch and some burning in the heel. It seems to be slowly going away. The procedure I had was what you described. I hope I was able to help you a little. I'll keep you posted on my progress.
Bud

Re: Foot Surgery and pain afterwards

dave r on 12/10/03 at 07:58 (139717)

Ron i may have asked you this before but do you know how much of the fascia was released by your doctor?

Re: Foot Surgery and pain afterwards

Bud P on 12/10/03 at 11:35 (139746)

Dave,
Approx. about 1/3 release

Re: Foot Surgery and pain afterwards

Rose on 12/12/03 at 18:21 (139878)

I saw my surgeon yesterday after four months as I am beginning to have some pain in other parts of the feet. I had the release surgery July 1. I talk no pain medication at all, although there is some pain if I am on my feet long. He said he can just do another surgery and but another cord; like it is nothing. What do you all think of that? He also recommended I have my orthodics tweeked a bit. He did put a wedge underneath that he said would take the strain off the fascia and arch and I nneded to make it permanent. He said I could do whatever I wanted, no restrictions. I have had no physical therapy. He did say I had very little scar tissue and he was quite pleased with the results. I welcome everybody's comments.

Re: Foot Surgery and pain afterwards To Rose

Bud P on 12/13/03 at 10:10 (139916)

Rose,
How do you feel about the surgery? Do you think it was a success? Are you happy overall?
Bud

Re: Foot Surgery and pain afterwards

john king on 12/13/03 at 10:48 (139925)

Rose

I think I would quit while I was ahead. Every surgery produces scar tissue and every surgery has risks. Don't let anyone fool you into thinking there are no risks. If you can live with it then live with it. I know I am conservative but being able to walk at all is a big deal. Being in chronic pain from a failed surgery is something you don't want.

Re: Foot Surgery and pain afterwards

Rose on 12/13/03 at 12:19 (139934)

Thanks everybody. I think you are right. Yes, I think it has been a success and I am glad I did it, but it is scary to do anymore. I am seeing a new podiatrist next week for a second opinion. I will have to pay, as she is not covered by insurance, but her opinion and recommendations are well worth it to me. She is the doctor Kaiser sent me to two years for the custom orthodics. I was very impressed with her and wished I could have continued going to her.

Re: Foot Surgery and pain afterwards

Pauline on 12/13/03 at 13:12 (139942)

Rose,
If I were you I'd quite while your ahead. You don't want to become part of a 'snowballing' chain of surgeries. With each and every surgery you are taking the chance it will bring on more complications. My guess is the pain you are experiencing now in other parts of your feet could more or less be considered one from your surgery already.

If you read the surgical board you will find others who have posted something very similar to yours. There is no magic in this. The pain is usually a direct result of having the major support of your foot cut. This action causes weight to be shifted to other places in the foot that formerly didn't have to bear it. The end result is pain in other parts of the foot.

The foot is a complicated part of the body. Tweek one area and another
which is related responds too. My suggestion boiles down to trying the least invasive treatments to control your remaining pain.

You'll know soon enough what can or cannot be done. If your still in pain when all the tweeking is done, a referal to a pain clinic would be a far better choice than having more surgery.

Re: Foot Surgery and pain afterwards

april l on 12/20/03 at 11:49 (140436)

Rose,
I had the surgery in august and I am also getting pain now in other parts of my foot. I think this is normal, because it also happened when i had the PF surgery 5 yrs ago on my other foot. Sometimes my toes ache, sometimes my big toe aches, other times the top of my foot aches. The inside part of mt foot hurts. I still have pain walking after i've been off my feet for awhile. All this i remember happening 5 yrs ago, so i am being patient. It took over a yr for the pain to go away, and it was very gradual. Over time i noticed it didn't hurt anymore.

Re: Foot Surgery and pain afterwards

Katy F on 1/04/04 at 09:59 (141324)

Sher,
I just had the EPF done on both of my feet at the same time 2 weeks ago. It is virtually painless. He numbed them before I woke up from surgery and it took 24-36 hours before there was any feeling in them.
My doctor did give me ample pain medication, but I could have gotten by with otc medications. If you keep them elevated and iced they will not hurt. It does hurt to walk on them, but prescription pain medication will not help brusing and soreness. My feet are very sore, but not in pain. There is a difference. The PF was more painful than the surgery was. My feet are far from healed, but I hope for the best. Attitude is everything. You will have better results with a positive attitude.