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What are the criteria for "successful surgery"?

Posted by Julie on 2/23/04 at 06:21 (145069)

What do the doctors consider constitutes 'successful surgery'?

Within the past couple of months a few people have said here that they regard their recent surgeries as having been successful, and I very much hope they are right. But what are reasonable criteria for success? When can we say that a surgery for PF has been successful? Can it be judged successful if the person who had it is in no pain, or considerably reduced pain, three months or six months later? A year later? For how long do, or should, trial follow-ups go on?

It has often been pointed out that surgery deprives a foot of its main supporting structure, or at least weakens it; and that this has effects, e.g. lateral column syndrome, that may appear later. If the individual who has had surgery develops one of these problems two or three or more years down the line, can the surgery still be considered successful?

Perhaps we should say 'yes', if it gave the person two or three pain-free or at least relatively comfortable years. On the other hand, perhaps not. I lean towards 'not', and wonder whether a surgical procedure that itself frequently causes problems should ever be performed.

I realise that there are different types of surgery, some more problematic than others, and am not making a distinction between them, simply asking at what point any surgery can be considered a 'success'.

I have been wondering about this for a while and would be glad of the doctors' thoughts.
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Re: What are the criteria for "successful surgery"?

Rick R on 2/23/04 at 07:39 (145073)

Julie,

I know you are looking for doctor feedback, but thought a patient might be of some value. I have spoken of my surgery as a success because it met my criteria and that's what matters for me. Suffering from PF from 1983 having surgery in 1996, I pursued every 'known' alternative at the time. My life was greatly enriched. I am in my first significant set back period now, which followed a work schedule driven secession of my exercise program which had included running. I suffered a non PF injury caused by being a klutz, missing a stair at home, that now seems to have been a major deal. I managed to run through it at the time and it seemed to have been behind me. I'm not so sure now. After I was off running for around a year the pain started to creep back in. Even in my current state I am far better off than prior to surgery.

As for a permanent weakening, I haven't attempted a flat out sprint since 1983 so there is no telling what effect I may have suffered beyond what old man time has done. I do believe my vertical jump has never been the same. I used to be able to grab the basketball rim but now or even in 1997 I couldn't get whthin 6 inches of the rim. But I'm not sure what a 40 something geezer should expect. My first time recovering from PF surgery happend to coincide with my first time getting old so there is no control to help sort out the variables. I think the down time killed off some residual youthful muscle tone, but it could be a permanent weakenig of the structure. I do believe my back problems were partialy due to the extended time taking it easy and a lack of appreciation for the fact I had to rebuild everything not just the wheels.

In general, I have to agree that surgery is merited only in rare cases. Now with EWST, perhaps the set of appropriate cases has grown even narrower. I find myself cautioning against surgery, or at least sharing that the downside is far greater than one might think, and that the recovery program needs to be far more comprehensive than anyone ever bothered to share with me.

Rick

Re: What are the criteria for "successful surgery"?

Pauline on 2/23/04 at 13:25 (145098)

Julie,
Very good point. Since success can be measured in many different ways one person's idea may not be satisfactory to another.

When surgical patients post about success it definitely would be helpful to hear how it's being defined.

Additionally, we often hear success stories posted a week or two following surgery when full activity levels have not been reached yet, only to hear set backs down the road at 2, 3, or even 6 months post op.

Just as it may take ESWT a full year to show it's true results, I think it would be helpful to hear follow up surgical posts following a full year of recovery time. This along with the activity level, degree of pain, and total over all foot response during everyday living might give us a true picture of an individual's successful surgery story.

Re: What are the criteria for "successful surgery"?

april l on 2/23/04 at 13:52 (145105)

I had the surgery twice and consider both successes. At this point though, my definition of success is different for each foot. I had the surgery on my right foot in january 1997. It took over a year but since then I am totally pain free in that foot. I have an arch and enough support in my foot to work on my feet. I don't wear orthotics, can wear any shoes, and can go barefoot without any pain. It feels 'normal'. I had surgery on my left foot last august. Even though i still have some pain at this point, it is better than before surgery. I am hopeful that eventually I will be totally pain free in that foot also. Personally, I would consider surgery a success if the outcome is significantly less pain than prior to surgery.

Re: What are the criteria for "successful surgery"?

Bud on 2/23/04 at 22:59 (145144)

Julie,
I consider surgery a succes when I can sit and watch TV pain free, sleep all night pain free,able to walk my Lab around the block relatively pain free,go to my 13yr old daughter's swim meet and sit all day pain free. If the PF was to come back right now after 3 months I would still consider my surgery a success because it gave me 3 months of my life back pain free.A successful surgery is in the feet of the beholder.

Bud

Re: What are the criteria for "successful surgery"?

Ed Davis, DPM on 2/23/04 at 23:30 (145150)

Julie:

That is an excellent question. The first consideration, in my view, is that we must supply patients with an alternate mechanism to 'back up' the plantar fascia which has been cut and that is best accomplished with orthotics.

One thing that many may not realize is that the fascia often grows back. It would be our hope that it grows back in a healthier, elongated fashion and that is why good physical therapy and/or massage therapy need be coupled with such surgeries.

I would consider 'success' to be an outcome which allows patients to be able to return to their prior occupations or avocations with either no pain or a minimum amount of pain. There is a subjective element here but we do have things like the VAS scale to help.
Ed

Re: What are the criteria for "successful surgery"?

Ed Davis, DPM on 2/23/04 at 23:36 (145151)

Pauline:
You have opened an interesting 'door.' The same door leads to measuring success in conservative means such as orthotics.

Initially I could not fathom how an insurance company could not favor ESWT over surgery. Soon, I noted that a percentage of patients whom we had pronounced as 'cured' via conservative means came out of the 'woodwork' and stated: 'The orthotics work great and help me get through the day at work and I can walk the mall but I still get sore after vigorous activity -- I heard there is a way to bring this problem to complete and total resolution. So now we have a second 'subset' of patients who could benefit from ESWT. A potential for high utilization. Is this what the insurance companies really are worried about?
Ed

Re: What are the criteria for "successful surgery"?

Dr. Z on 2/24/04 at 11:45 (145178)

I consider the surgery a success what there is no pain in the foot and the patient can resume whatever activity they could do before the foot surgery/ They call this the R/M/ If is sucess from the patients view point

Re: What are the criteria for "successful surgery"?

Pauline on 2/24/04 at 12:19 (145180)

I think insurance companies just want to make sure they are getting the bang for their buck.

They've already seen the misuse of treatments behind closed doors and in all honesty we haven't really seen ESWT embraced by the Orthopedic Community for P.F. usage. There are some, but Orthopedic guys are adopting it faster for elbow and shoulder use.

Maybe they learned from former mistakes and are seriously looking at this treatment as an easy fraud target. Who knows! It's all speculation at this point and what is gained by speculating on what the insurance companies are thinking? In my book that comes close to speculating what my cat is thinking.

Re: What are the criteria for "successful surgery"?

Dr. Z on 2/24/04 at 13:39 (145198)

ESWT isn't going to be braced by the orthopedic community from what I have seen. The doctors I talk to only want to hear about ESWT for Tennis Elbow due to this being the number one tendon problem they see. Podiatrists just see alot more feet then the orthpedic community in general.

Re: What are the criteria for "successful surgery"?

Pauline on 2/24/04 at 14:15 (145207)

Maybe that's why the insurance companies have a problem with it.

Re: What are the criteria for "successful surgery"?

Dr. Z on 2/24/04 at 14:41 (145209)

I wish that were the answer. They look at elbows with even less favor

Re: What are the criteria for "successful surgery"?

Julie on 2/24/04 at 16:37 (145224)

Thanks to all who have responded.

Dr Ed: your criteria sound good to me.

And Pauline, you understood exactly what I meant, although I seem to have buried the real point of my question, which was *when*, i.e. after what period of time has elapsed, can a surgery be considered a success. I too would like reports after at least a year.

Rick, if you've have had seven good years as a result of surgery, I would consider that a total success - though I'm very sorry about your current setback and hope it resolves soon.

April too - you've had six years, which is wonderful. And Bud, I very much hope that you will still be walking your Lab in 6-7 years time, pain-free.

Good luck to all.
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Re: Cheilectomy

Barry on 3/20/04 at 19:40 (147430)

I had a Cheilectomy 8 weeks ago and after surgery i was told that I had to move the toe myself but the toe was just to painful to move with the movements that the doctor told me to use. I tried to move the toe but it was very limited. 5 weeks post surgery, I called my doctor and requested physical therapy. he gave me a prescription for the pt and I began a regime of 3 times a week. I still have limted albeit better movement. My question is can i expect to eventually get full or almost full movement with this exercise program of physical therapy and my own almost hourly movement of the toe? I still have pain and swelling but both are not as bad as it had been. Thanks to anyone who can give me hope, Barry (email removed)

Re: spur removal and cortizone shots

carole f. on 3/25/04 at 08:30 (147735)

to april , what was the type of foot surgery ? shock type or release called endoscopic fasciatomy ? or was it the removal of the spur . i have seen a new foot md and he is the first one to say after taping and 3 shots a week apart i should think about removing the spur thru a 1' insision , i have a long standing 10 yr. problem with P.F> have seen 3 other pods thru the years and they always say the spur does not need removing . this pod disagrees with that theory . also does any one know is 3 shots of cort. to much in a 3 week span ??

Re: Cheilectomy

Amy S on 4/28/04 at 07:43 (149694)

Hello. I've had pain in my big-toe joint for a long time, and finally got it diagnosed -- turns out to be hallux rigidus. The doctor recommended a cheilectomy. He said that after the surgery, I'd need to be in bed with the foot elevated for a week, because sitting in front of my computer with the foot up would cause a kink at my waist. Has anyone had experience with this surgery? Were you in bed for a week? I've also read in some reliable Web sites that you can't drive for 2-3 weeks. Any thoughts? My doctor said recovery would be 1 week in bed with foot elevated, 2 weeks with wooden-soled shoes, and 3 months with sandals. I'd be interested to know if others have been throught this... or if there are any doctors who would concur or disagree with this recovery timetable. Thanks so much. -Amy in MN

Re: Cheilectomy

Pauline on 4/28/04 at 22:17 (149748)

Amy,
Please do your research on this surgery prior to having it done. So often patients are in such a big hurry to get rid of pain that they jump into surgery thinking that it will deliver the cure.

Unfortunately no guarantees come with any surgical procedure and often times patients are left with additional pain or with complications from the original surgery. Eventually to get rid of the pain again another surgical procedure is suggested and the patient finds themselves in what I call snowballing surgeries. One leading to the next and none of them really providing pain relief.

It's far better to understand the procedure you will be having, read medical abstracts on this procedure and it's results in Med Pub. and do a search here on the surgery board to see how other faired.

I've found doctors that promise snip and go surgeries never seem to deliver. If I remember correctly someone recently posted that she had the same surgery, you may want to search for her recent post.

Best of luck.

Re: Cheilectomy

Nita B. on 2/24/06 at 10:43 (194095)

I recently had this surgery about 16 days ago. I did not stay in bed but lounged on my couch with my foot up for about 5 days and went back to work the 6th day. I was able to walk on my foot although I favored it and tried not to bend the toe to let the incision heal. In the evening I would sit with my foot up until bedtime. I did not find driving a car to be a problem since it was my left foot. My stitches were taken out yesterday and although the joint is still swollen and somewhat stiff, I would say this has been a breeze. I am wearing my walking sneakers and my only complaint is that they are the only shoes that my swollen foot can wear. I couldn't imagine wearing sandels as the strap would go directly over the incision and that would bother me. I also did not like the shoe the office gave me to wear because the velcro straps go over the incision. Instead I wore slippers and kept my toe from bending by walking with the leg straight. The sixth day after surgery I was wearing my sneakers with a bandage over the incision. I would encourage you to go for it. I am very happy that I made this decision. Oh, the pain was not at all bad and I only took pain meds the first two days. After that Advil or Tylenol was enough. Good Luck!!