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Tarsal Tunnel and Plantar Fasciitis Surgery

Posted by Cindy C. on 12/31/03 at 17:10 (141020)

Hi. I need some down to earth information please. My podiatrist wants to perform tarsal tunnel and plantar fasciitis surgery on my right foot. Xrays have shown several large bone spurs. All of this came to a head several months ago when my chiroprator ordered orthotics to help my back. They indeed have helped my back but have ruined my feet! Even though I have stopped using the inserts, my feet are giving me much grief. I've had several cortisone injections. The medicine helps for a day or two, then I'm back where I started.

My podiatrist says recovery for these procedures is only six weeks; 3 weeks in a cast and 3 weeks in a walking boot. Is this realistic? I have several extenuating circumstances that I must take into account and being immobilized basically for a long, long time will create big problems. Any advise you could provide would be greatly appreciated.

Thanks so much,
Cindy C.

Re: Tarsal Tunnel and Plantar Fasciitis Surgery

BrianJ on 12/31/03 at 20:39 (141024)

Cindy --

I am not a doctor, but I would strongly recommend you try ALL other options before considering TT/PF surgery. Treatments and tests would include thorough blood workup to rule out autoimmune disorders, X-Rays and MRI to rule out fracture/structural issues (look for spinal stenosis if low back pain preceded foot problem), nerve conduction velocity test to confirm tarsal tunnel syndrome, trying multiple types of orthotics, stretching, taping, icing, nightsplint (if heel cord is tight), and ESWT treatment.

TT/PF surgery is serious surgery. I think most doctors would say it is VERY unrealistic to expect full recovery from TT/PF surgery in just six weeks. More likely, full recovery would take 6-12 months. It is also possible that the surgery would make your pain worse rather than better.

Please take the time to research this issue yourself before getting surgery. Once you are cut, you cannot turn back the clock.

Re: Tarsal Tunnel and Plantar Fasciitis Surgery

Cindy C. on 12/31/03 at 20:47 (141027)

Brian, thanks for the advice. The reading I had done on these procedures led me to believe that recovery would take much longer than the podiatrist indicated. Problem is, if I wear the orthotics, my feet hurt and if I don't wear them, my back, hips and knees hurt. Kind of a Catch-22....
Thanks again and Happy New Year!

Cindy C.

Re: Tarsal Tunnel and Plantar Fasciitis Surgery

Julie on 1/01/04 at 09:56 (141063)

Cindy, your post gives rise to so many issues I hardly know where to begin. You have a lot going on here!

Your chiropractor ordered orthotics to help your back, but they have ruined your feet. That certainly ought not to have happened. What do you mean by 'ordered'? Did he cast them himself, or did he refer you to your podiatrist or a pedorthist? Whoever prescribed/casted/made them, they are clearly not right, and you were wise to stop wearing them.

If you really do have plantar fasciitis, and have had it for only a few months, and the only treatment for it has been poorly prescribed/constructed orthotics, I think you have a long way to go before considering surgery. Please do not agree to it.

Brian's gave you excellent advice. You now have a foot problem and a back problem, and you need tests and a diagnosis to pinpoint exactly what is going on. I'm not a doctor either, but I think that cutting your foot is the very last thing you want to do now. You're already in a situation where the 'solution' to one problem appears to have led to another problem; now another solution, surgery, is being offered which may lead to more problems. TTS surgery, as Brian says, is serious surgery; there is always the risk of damaged nerves and the success rate is not brilliant. It really is a last resort, and your question should not be 'how long will it take me to recover' but 'should I have it at all'? You are nowhere near answering it with a 'yes'.

Are you quite sure that you have TTS? What tests have been done to ascertain this? You say that xrays show bone spurs, but if you do your homework you will learn that spurs are very rarely the cause of pain .

Read the heel pain book (click on the link right here). It is informative and helpful, and describes a wide range of conservative treatments for PF. Much further down the road, after all else has been tried and failed to work, there is the option of ESWT, which is non-invasive and has helped many sufferers. Research it on this site.

But the first step is a full evaluation of, amonst other things, your biomechanics, and an accurate diagnosis. Given what you've told us (of course you may not have gone into the whole history) I am wondering whether you have had this. In any case, it doesn't sound as though your podiatrist has been totally informative with you. Unless you are really sure you trust him, I would say it's time for a second opinion.

Finally, you haven't said anything about the nature of your back problem (not surprising, as this is a foot pain forum, but it's all related!) What is the problem, and what are you doing to deal with it, besides chiropractic treatment? There is much that can be done to improve painful back conditions.

Re: Tarsal Tunnel and Plantar Fasciitis Surgery

Cindy C. on 1/01/04 at 11:22 (141065)

Julie, thanks for the reply. I think you and Brian are both right. This is something that needs further investigation. To answer your question about my back, I injured it originally when I was 16. I've had problems ever since. However, I had a herniated disk in my lumbar region two years ago. Since then, I've been diagnosed with degenerative disk disease also known as osteoarthritis. It is a long series of back, neck, knee and hip problems and now I have the foot problems too. Oh well......... Again thanks for the reply and I will definitely put this procedure off.

Re: Tarsal Tunnel and Plantar Fasciitis Surgery

john king on 1/02/04 at 17:02 (141178)

You might consider Nerve conductivity testing by a neurologist to see if you have other problems besides TTS. TTS surgery is serious and the outcome is iffy from what I have read and heard from all kinds of doctors. PF surgery has a better record.

Re: Tarsal Tunnel and Plantar Fasciitis Surgery

Julie on 1/03/04 at 00:52 (141202)


I've been puzzling over your situation. Maybe there are pieces missing from the puzzle, but what I can't understand is how/why the orthotics your chiropractor prescribed can have 'helped your back but ruined your feet'. It just doesn't make sense to me. The body works as an organic whole. Feet, legs, knees, hips and back are a continuum: whatever happens to one of those components affects the whole. Orthotics are needed when flawed biomechanics (the way one walks) need to be corrected. When that correction is made, and one is walking correctly, everything above the feet - knees, hips, spine, especially lower back - works better.

So if your chiro thought that the way you walk was contributing to your back problems and ordered orthotics to change that situation, a correctly casted and prescribed pair should have done you (the whole of you, I mean) good. And that is obviously not the case. I don't understand, and what I don't understand is how, if the orthotics really helped your back, they could at the same time ruin your feet.

You can tell that I'm thinking out loud. I have been brooding over this for days, and finally decided this morning to unveil my puzzlement. As I said, there may be pieces of the puzzle I am not aware of, but perhaps my thoughts will be useful in some way. I guess what I'm really wondering is: did the orthotics really help your back, or can the improvement you noticed have been a coincidence? Because what one would expect is that any orthotic device that threw your biomechanics out to the extent that your feet were so badly damaged, would also affect your lower back adversely.

Anyway: I'm relieved to know that you're pulling back from the idea of surgery!

Thank you for explaining about your back. If you've had problems since you were 16, I'm sure you have been prescribed strengthening exercises for your 'core', i.e. your abdominal and lower back muscles. Have you? There is so much that can help, in yoga (but only in the right kind of class, i.e. a remedial class) and especially in pilates. Even in osteoarthritic conditions, much can be done to strengthen those core supporting muscles and keep the area mobile.

Re: Tarsal Tunnel and Plantar Fasciitis Surgery

Cindy C. on 1/03/04 at 09:25 (141219)

Julie, thank you for your comments. Maybe I can fill in some of the missing pieces of the puzzle. I injured my back when I was 16 by falling backwards off the end of my bed and landing on my tailbone. That injury was NEVER treated although I sought help several times. It didn't show on an x-ray so therefore there was no injury according to the doctors I saw. Didn't matter that I would get 'stuck' in one position and couldn't get out of it without assistance. Ok, Jump forward about 30 years. I was in an accident in which I was rear-ended. That brought on the neck problems and so for the first time in my life, I sought the help of a chiropractor. While I was there for a neck adjustment, I asked him about my lower back because it was giving me lots of grief. I have been under chiropractic care ever since. I've had 3 herniated disks, one in the lower back, one in the mid section and one in my neck. Thankfully, I've never had to have back surgery. After the first disk herniation in my lower back, I've had more and more trouble overall. So my present chiropractor suggested the orthotics. Yes, they did a mold of both feet. I've had a great deal of trouble trying to adjust to the inserts but my chiro has told me repeatedly that folks that need them the most have the hardest time adjusting. So I have tried to adjust to them at a slow pace. No luck..... My feet were so sore I couldn't bear to have anything touch them. So finally I broke down and went to see a podiatrist.

I was thinking about all of this myself yesterday and I remembered back a few years ago when I had just returned to the work force. I had very flimsy shoes and I started having trouble with sore feet then. So I guess this has been building up for several years and the orthotics just pushed the problem over the edge. I've discussed the surgery with my husband and we decided to seek another opinion. If the two concur, I will probably have the surgery done.

Sorry this is sooooooooooooooooo long. Any feedback is welcome!!

Cindy C.

Re: Tarsal Tunnel and Plantar Fasciitis Surgery

Katy F on 1/04/04 at 12:47 (141334)

I can understand how your back trouble relates to your feet. I was diagnosed with PF over a year ago.
I was prescibed custom orthotics. After wearing them awhile I suddenly noticed that my right hip and knee did not hurt anymore. They had been bothering me for years but not my feet. Apparently my body was out of alignment and the orthotics corrected it. I have very high arches and a groove was added to accomodate it. After wearing the orthotics for about 8 months my PF started in again. I went back to the foot Dr. and he resurfaced my orthotics. This time the groove was made deeper. Needless to say it did not help me in my case. The tendon was so tight that it was constantly rubbing the orthotics keeping it irritated and inflamed. I had the EPF done about 2 weeks ago.
If your orthotics were made correctly, they should not hurt your feet. These grooves that I am talking about do not show up in the castings. Your Dr. has to tell them to add them and how deep etc. Before you give up have your orthotics checked for fit. You never know, the lab could have given you the wrong ones. Who made the orthotic castings? Chiro or Pedo? Katy

Re: Tarsal Tunnel and Plantar Fasciitis Surgery

Cindy C. on 1/05/04 at 19:32 (141449)

Katy, my orthotics were ordered by my chiropractor. They were meant to alleviate some of the strain on my back and knees. I do not wear them now since the podiatrist said to stop. My foot seems to be getting worse and my knee is really being strained because of the awkward way I walk or stand.

Oh well, back to the drawing board...........



Re: Tarsal Tunnel and Plantar Fasciitis Surgery

Julie on 1/06/04 at 01:14 (141465)

Hi Cindy

Thanks for the more detailed explanation of your back and feet problems. It sounds as though you've been unlucky in your treatment by your practitioners right through, and that is too bad. The fact that your xrays at the age of 16 didn't show anything is meaningless - the doctors should have been awake enough to understand that a heavy fall on your coccyx might have jarred your entire spine, and from your description of your later disc problems it probably did.

I think your chiropractor was wrong in telling you that 'folks that need them the most have the hardest time adjusting'. Orthotics generally do need a short breaking-in period, but a well-made orthotic should definitely not give the patient a hard time adjusting, and should certainly not give her more problems. Is the podiatrist who casted them the same podiatrist who now wants to perform surgery?

I'm glad you're going to seek a second opinion, but if the second doctor you see also recommends surgery, I think you should be very careful. There will always be doctors who are happy to cut your feet, but once they are cut there is no turning back. I know you are desperate to solve your problems and get out of pain, but you have to consider the very real possibility that surgery will make your situation worse than it is now.

There is a wide range of conservative treatments for plantar fasciitis and TTS (has TTS actually been diagnosed?) and surgery is considered to be the very last resort when all conservative modalities have failed. You said in your first post that your foot problems only began a few months ago with the orthotics, and from all you have said since, it doesn't sound as though very much else has been done to address them. Your current podiatrist casted ill-fitting orthotics and now offers surgery. That is not at all confidence-inspiring, and I would suggest that what you now need is to start over again with a different podiatrist, one who will be willing to spend time working with you on a treatment plan targetted to your specific problems. This will take time, but if you can resolve your problems without resorting to surgery, you will be infinitely better off in the end.

Re: Tarsal Tunnel and Plantar Fasciitis Surgery

John F on 1/21/04 at 00:45 (142503)

Your chat room is a god send. Here is my situation. Wife and I were in a 2 car accident 30 years ago. At such time my L4 and L5 were out of place. Did nothing for it. 20 years ago, my right foot was run over by front tire of a Datsun. Foot hurt, but no therapy. Similar time, right foot had ankle had a hairline fracture. Have been on and off with chiros last 7+ years for low back pain. 12 months ago, had flu, rid of it, but low back pain lingered. MD scripted celbrex, did not take it. LBP was intense, went to 2 chiros and a pain MD, had MRI where last chiro said, 'You need immediate surgery'. Did not for knife, but went to VAX-D, decompression, in Houston, for 40 treatments. Went from a 9 pain and hunched over pain, to a 2/3 pain with a good gait. But right foot was partially numb. VAX-D could not max on 95 lb. decompression due to some L or S was weak where my max decompress9ion was only 65 lbs. 95 lbs could have fractured one of my l's or s's. So a few months back, lbp returned. Went to an optimal type of chiro who said, in 52 treatments, i.e. 3 a week ultimately 2 a week, he would rid me of lbp. But partial numbness of right foot returned stronger. Chiro had me do an NCV and sonogram, came back I had 'tarsal tunnel.' He had me do an MRI today and next step would be send me to podiatrist. I am set vs. any type of surgery, as due to VAX-D and now Chiro I have avoided a laminoctomy and recently an ortho recommended spinal fusion of back, this is where new chiro came in. But this chiro is leaning to TT surgery through podiatrist. With this, of 30 years marriage, wife went through 17 ears breast cancer. I stuck w/her but as she would get diagnosis, treatments, I would pick up 'sympatic pains, where in a psycosomatic way I also 'had cancer' where I developed anxiety panic attacks. I would take paxil, ativan, valium etc. Where up to now, I am on paxil and now weaning off ativan, to be normal. I am now anti-allopatic. My wife died May, 2003 and I am experiencing somatics due to grief etc. But I will carry on with my life, am 60 and just retired as an educator and am seeking non-allopatic non Western type protocols to live optimally. Please respond if you may, to my various concerns primarily the TT where I will not accede to surgery but must have alternatives to live optimally. I am into meditation, prayer, fitness, diet, grief group, singles group etc. having been a high school counselor. Any good words would be welcome, as I could write a book on my wife's and mine ordeals. John

Re: Tarsal Tunnel and Plantar Fasciitis Surgery

Julie on 1/21/04 at 02:34 (142507)

Hello John

I've seen your post and am going to give it some thought and come back to you. Meanwhile, I suggest that you post it again at the start of a new thread. You've put it at the end of an old, 'dead' thread and, as people have diferent systems for reading messages, many may not see it.

To start a new thread, first copy your post. Then go to the home page - http://www.heelspurs.com - where you will find, a couple of inches from the top, various options including 'Post Message'. Click on that. A new window will open into which you can copy your post, first choosing the category in which you want your post to appear, and giving it a heading of your choice.

This sounds more complicated than it is.

See you later.

All the best, take care,


Re: Correction: for John F

Julie on 1/21/04 at 02:41 (142508)

When you get to the home page, first click on 'Message Boards'. That takes you to the page with the 'Post a Message' option.