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UPDATE - post plantar incision, TTS, CPN

Posted by Sheila S on 2/25/04 at 04:52 (145275)

Hi all, it's been awhile.....I had my surgery Jan. 8th with Dr. A. Lee Dellon. Thought I'd update everyone.

Thought I'd update you on the results of my visit and surgery with Dr. A. Lee Dellon in Baltimore. First, he diagnosed me with true Peripheral Neuropathy based upon strong clinical symptoms as well as the QST testing showing the same. This includes strong symptoms of Tarsal Tunnel Syndrome (which also causes bottom of the foot pain). No one checked for these other problems (and even now I don't really know how much they affect my initial foot problem), but, I thought all these things, including burning heels, was something everyone experienced so I never mentioned them. I believe Dr. Dellon is right - he says in his experience with equestrians (which I am) they tend to overlook pain and problems until at a quite advanced stage, which I think applies to me.

In any case, Dr. Dellon did the plantar surgery - he dissected the nerves to the 3rd web space and implanted them into quiet muscle tissue in the arch of my foot - that worked, my foot is completely numb there now and the past horrible 'neuroma' pain (which continued unabated even after 2 dorsal surgeries) is completely gone from that area.

He also did a TTS release at the same time and CPN release also. All same leg. I don't know yet what the other two did for me, but the incisions are fine. The bottom of my foot is not fine yet. It's been 7 weeks and the scar has developed a hard ridge under it, almost an inch wide, and it is extremely tender to pressure so I am using a medical shoe instead of tennis shoe or other footware. I began using the steroid creme a week ago applying it twice a day to the scars, I don't know if it's supposed to help the hard ridge or not, but the scar itself has gotten somewhat tender since then.

The real bad news is, the numb area in the 3rd web space has shown, without doubt, that I have a problem in the 4th web space (which, by the way, a couple doctors on heelspurs said they thought could surely be my problem - they were right, but that wasn't the only problem). Since the pain was so horrible from the 3rd web space, I could not detect the 4th space had a problem - and it is against the 4th met. head as well, so was back-to-back with my main problem. As you can imagine, this was hugely disappointing to me when I discovered it and I lay in bed and cried for hours. Dr. Dellon encouraged me to give it time, be patient, and keep a positive attitude - he said it could be another problem; but it could also be where I've been walking on the outside of that foot so long that it may heal itself when I am walking correctly again and possibly a cortisone shot may assist in settling that nerve down. (He is absolutely against schlerosing injections - but I'm not, so I would be willing to try them if the cortisone doesn't help. Time will tell.) Until my foot heals well enough to try horseback riding again, I don't know how big a problem this 4th web space is.

While the surgery with plantar incision was hugely successful, I would only consider it as a last resort - the time off work (4 weeks) and the long healing process would keep it as a last resort for me. But it was worth it because the tremendous pain is gone. And if I had a similar 'unfixable' problem, I would definitely do it again.

Dr. Dellon was wonderful and spent considerable time with me as I had alot of questions and concerns. He even insisted I come to see him for a pep-talk before I returned home to Virginia after my husband told him of my tear-filled night when I discovered the 4th web space problem. His staff is excellent, the very best, and went a long way in easing my worries. I would recommend them to anyone with similar problems. Best have good insurance though, the cost of the surgeries was extremely expensive.


Re: UPDATE - post plantar incision, TTS, CPN

BrianG on 2/27/04 at 22:33 (145553)

Hi Sheila,

One thing you mentioned caught my eye, sclerosing injections. Are they the same as Prolotherapy? Prolo injections contain a saline solution somtimes. There are also other liquids that can be injected into the foot. The purpose is to inflame the area, which injures it, and your body supposedly heals it.

Myself, and others here have tried Prolo, without any help for our PF. I do think it will work better in shoulders, elbows, thighs, etc. Maybe it's not even the same thing, but I seem to remember Prolo being called Sclerosing when I was researching it.

Good luck

Re: prolotherapy vs. sclerosing

Sheila S on 2/28/04 at 05:14 (145563)

Hi Brian, I'm not certain but I don't think they are quite the same, though prolotherapy is indeed sometimes referred to as sclerosing. It seems, actually, that any method of injecting a liquid (there are several different one's used for different things) is called 'sclerosing' or 'sclerotherapy'.

In my studies (and from talking with my doctor) the sclerosing injections for foot neuroma is 4% diluted alcohol, where actual 'prolotherapy' is most commonly dextrose. Prolotherapy was done to initiate excessive scar tissue to 'coat' the nerve so it couldn't become inflamed. Alcohol injections do much the same but they say it will actually cause neurolysis, death of the nerve. Success runs from 60-90%. My local doctor said that since he started using the alcohol injections he has not had to do one single surgery - this covers about 1-1/2 years now. However, I'm the renegade - he tried them on my problem and it didn't work (he was quite disappointed and frustrated) - but I've also read that they do not work as well on recurrent neuroma (supposing the scarring is too thick for the alcohol to attach to the nerve and do what it does).

Dr. Dellon, being a plastic surgeon and nerve surgeon, is highly against them. As he should be. He says 'why would you inject something that kills stuff when you don't even know where it's really going?' I would expect no less from him; if he felt differently it would be likened to a vegetarian agreeing cows should be slaughtered.

However, I love steak. And I am the patient - the one suffering day in/day out pain...I don't care WHAT all is killed in there as long as I can get rid of this pain. Two different mind sets coming from two very different directions. If my whole forefoot is killed, I'd be happy to just be without pain. (and really, that's not an exaggeration...)

Here's what Dr. Dellon says about PF - 'If you still have pain in your heel after bone spur removal, or treatment of plantar fasciitis consider that your pain may be due to a nerve problem. This can be identified by Neurosensory Testing, and can be treated by surgery to decompress the calcaneal nerve...' Have you tried other nerve testing to see if your PF is caused by other factors? Dr. Dellon's testing machinery is painless. And though the results can vary greatly by the individual tester (there's alot of room for differences there - and it should be used to supplement physical symptoms/dx, not the sole method of dx) but it is quite accurate in overall results. My test results even showed the exact location of my back problem and right knee problem which I had NOT told them about. (in fact, as a result of his tests, I later had an MRI done on my back - sure enough there are bulging discs at L4/L5/S1 causing nerve pressure, exactly where his test results showed!)

I ramble.......anyway, those were my findings. Best of luck to you!

Re: prolotherapy vs. sclerosing

BrianG on 2/29/04 at 19:51 (145675)

Hi Sheila,

The way that you explained sclerosing made sense. I never did have any additional nerve testing after my failed surgery, and ESWT. I belong to an HMO, through a state funded program, and it's fine unless you need something out of the ordinary. I could always elect to appeal, and get more testing. I think in the long run, I should save the appeals for matters where I really need them. Too many appeals could have some negative results for me. I did go through the process once though, when I felt I needed an MRI of my worst heel. I won!

Are you taking anything for your pain? There are quite a few effecive meds for nerve type pain. You may want to see a pain doc, or clinic. Specialists like Dr Dellon, are not know for treating pain, for the long term.

Good luck with it,

Re: prolotherapy vs. sclerosing

Sheila S on 3/01/04 at 05:06 (145696)

Dr. Dellon has actually been very good at addressing the pain and recommended I try Neurontin. I haven't yet (another long doctor story, but someone in my local docs office has dropped the ball...I faxed them a letter yesterday, so should be getting a prescription soon). He also is still puzzling over some other symptoms I have (in fact just emailed me a question a couple days ago) to see if there could possibly be something that ties everything together. He diagnosed me with true Peripheral Neuropathy (something no other doc had done any physicial tests for - and I had no idea other people didn't have the same problems!). I have significant nerve deafness (first began when I was 29, I'm 40 now) and a neck scar from a rare illness when I was a child. He is the first and only doctor that has ever taken an interest in my whole self to see if there's a common factor. Blood tests showed nothing to cause the PN. I do have some arthritis and arthritic spurs in my hands.

The QST testing that Dellon does is about $340...might be worth it whether insurance covers it or not if you find a doc that will accept payments (I found a doc about 2 hours away with the equipment who agreed to perform the tests and send the results to Dellon). Have you gone to a Neurosurgeon to discuss your symptoms? Seems like, if normal dx and surgery don't work, then our best bet for nerve pain would be a nerve expert....that was my thinking anyway.

Best of luck and healing to you!

Re: prolotherapy vs. sclerosing

john king on 3/06/04 at 20:55 (146303)

PN is a well known complication of diabetes. Have you been tested for DMII?

Re: UPDATE - post plantar incision, TTS, CPN

carolyn on 3/14/04 at 13:27 (146947)

The bottom of my foot is exactly as you described post my surgery...Had injections extremely painful and did not help!!!
Doing the cortisone cream also..
never would have had surgery,know how you are suffering.
any advice from you might be helpful

Re: prolotherapy vs. sclerosing

Sheila S on 3/15/04 at 04:51 (147022)

oops sorry, I didn't see your post until today.....didn't get the email for some reason. Yes, I've been tested for everything possible - about $2000 worth of lab work. Ugh. Nothing showed - absolutely nothing. If you look at my blood, I'm in excellent health. haha!

Re: UPDATE - post plantar incision, TTS, CPN

Sheila S on 3/15/04 at 04:57 (147023)

How long ago was your surgery and how long have you been using the creme? Is the creme Betamethasone?

I've been using the creme since Feb.16 (surgery was Jan. 8) and only in the last week have I noticed that it's working - so it took awhile. The hard lump area under the scar is softening, the scar itself is softening and finally becoming less tender. I began soaking my foot at night in very warm water for about 10 mins. before applying the creme, and I put it on in the mornings after a hot shower...that has helped the skin absorb it much better.

I'm finally almost ready to begin trying a shoe again, but I don't want to push it, so will wait another 2 weeks or so and just stay in the lovely blue velcro surgical shoe a few more days.

What is your story (why the surgery, etc.)?