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Surgery

Posted by Pete on 2/21/04 at 13:31 (144929)

At what stage should I seriously consider surgery ?

EPF or open surgery ?

I have done everything to overcome my foot problems over the last 3 years. 9 x orthotics, eswt x 2, icing, stretching, injections etc

Re: Surgery

Pauline on 2/21/04 at 14:04 (144934)

Pete,
My first inclination is to tell you never. Keep in mind that I'm not a physician, but having read the surgery board, on this site, for about 3 years and hearing about the snowballing surgeries and complications that others have experienced I don't want to see another person have their PF cut because it may not end their pain at all.

My feelings are soooo strong about this I'd like to see the practice stopped all together.

Only you can decide when to a surgical approach to treating P.F. Some Orthopedic Foot and Ankle physicians like Dr. Manoli are now using a procedure where the Achilles tendon is cut to loosen and lengthen the tendon thus providing P.F. relief.

The procedure has a name and you may want to investigate this newer procedure.

I'm not familiar enough with it to provide details but perhaps a doctor here could explain it to you or you can write or call Dr. Manoli (248) 858 6773 Pontiac, MI for a referal to a physician in your area that does the procedure. Even discuss his method and reason for using it.

Many things to think about, especially the physician you choose. Best of luck.

Re: Pauline

Pete on 2/21/04 at 14:25 (144937)

Thanks Pauline. I'm inclined to agree with you about not have surgery but I am at the point where by if I can't walk very far, it maybe a chance worth taking. It's a balance and I'm convinced that there must be lots of sucesssful surgery's who never return here because they are cured.

Re: To Pete

Pauline on 2/21/04 at 16:30 (144956)

Pete,
Why not investigate the leg procedure? It could have some advantages, one being that it eliminates all possibility of having scar tissue develop on the sole of your feet and your primary support to the arch will still be intact.

Re: Surgery

Steve G on 2/21/04 at 19:46 (144980)

Pete - keep in mind that Pauline has a strong skeptical streak. She also regards ESWT as being, more or less, fraudulent. The surgery is thought to have about a 50-70% success rate. Several people on this board, including an old time poster Dave r, have had the surgery and benefited from it. In fact, I gather from Dave's recent post that he regrets that he did not have it done years ago. I also know of other people, via work, who have had success with the surgery after failed ESWT. However, Pauline is right that he does have to be approach with trepidation, since it does sometimes result in debilitating complications.

I would get a couple of opinions, and do some research on your own before you move forward. For example, Dr. Z claims that if you don't have 'first step' pain, you are not a good candidate. But to infer, like Pauline, that the surgery is bogus on the basis of this board is pretty misguided. The people that have had successful surgery are out walking their dog or at the mall; they are not posting on this message board

Re: Surgery

Ed Davis, DPM on 2/21/04 at 20:05 (144982)

Pauline:
I think that Dr. Manoli is taking his cue from a famous foot and ankle orthopod in Seattle who is a strong beleiver in the gastroc. slide.
The gastroc. slide has a relatively low complication rate so, unlike PF release surgery, the downside of the procedure is not great. It will help if and only if a tight gastrosoleus achilles complex is a contributory factor to the problem.
Ed

Re: Surgery

Ed Davis, DPM on 2/21/04 at 20:17 (144984)

Steve:

Plantar fascial release is a very quick and simple procedure. The results are just very unpredictable. As you note, those who have had success with the procedure can be very happy and usually are not on chat boards like these. There are several papers in the process of being published on ESWT and there is just more and more good news about ESWT.

The predictability issue is a medical mystery that I would love to have solved.

I recently saw a patient who had EPF in July by a local, reputable practitioner. I examined him with diagnostic ultrasound and conventional techniques and noted that the plantar fascia had re-attached itself.
I have scheduled him for high energy ESWT.

PS email me at (email removed) as there is some interesting information concerning our fight with Regence and L&I to obtain coverage -- things are heating up considerably which may open a temporary window of opportunity that is unique -- will give you details by email.
Ed