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same as before surgery

Posted by chrisb on 6/18/04 at 16:56 (153436)

I think there are some of us on this list who have found that TTS surgery hasn't helped. I wonder if theres any collective wisdom that we can find.

After 3+ years of increasingly severe heel pain for over 3 years, I had tried everything including ESWT. Finally was diagnosed with TTS by one of the best surgeons in the business (Dellon), who was 98% certain of the diagnosis. Surgery in March/04 didn't find any mass or lesion but released 4 nerves in the tunnel. I'm now 3 months post-op and my heel pain seems to be the same as before (except of course with a scar, occasional swelling, and a slightly stiff ankle). As before, on good days I get around the house but going out means a cane and after 100 yards I have to sit for the rest of the day. I am still hoping that the next couple of months may bring improvment but so far I haven't felt anything to get my hopes up.
So I'm wondering what to think about this. Is the pain likely to be a result of post-op nerve adhesions that just happen to mimic the pre-surgery symptoms? Or was TTS minimal and peripheral to the real problem which is severe chronic PF? Is it possible that the pain is the result of a foot musculature weakened over 3 years? And what is to be done now? Are there any options?
I realise there are no clear answers to these kinds of questions but I figure I must not be the only one to be wondering.

Re: same as before surgery

Terri on 6/18/04 at 20:23 (153453)

Chris, I'm so sorry to hear you've had no relief at all. I did at least for awhile, then the scar tissue and tendonitis set in and now I'm looking at additional surgery, with an even longer incision planned, which I'm trying REAL hard to avoid.

Once you mess with the mechanics of the foot, it just never seems to be the same...which is what most of us are actually hoping for, but get more problems than we expected in the long run.

Have you been doing any p.t.? What's the dr telling you about this, does he think PF is the main reason for the heel pain? Are you wearing hard, semi-soft, or no orthotics? Maybe more time is needed, many here report it taking up to a year to get relief because those nerves do not like to be messed with. I sincerely hope you start feeling better very soon!

Re: same as before surgery

Marty in SLC on 6/18/04 at 21:29 (153465)

chrisb, do you only have pain in your heel? Does your whole foot and leg hurt at all? Like does the pain radiate up your leg? I would say that it might be to early to say that the heel pain won't subside. I had my surgery back in oct 2002 and I'm just starting to get some relief. We are all different and I think that mine has been a really long process. But you may have pf. I had both tts and pf surgery done. One seems to cause the other for some odd reason. Probably mechanics are at play.

Re: same as before surgery

mark-g on 6/19/04 at 02:32 (153478)

chris, i am 4 mos. post op. worse than before sugery. pain is more intense and in greater area. incision site, heel to toes and up calf with achey legs. like you 100 yds. and i'm done. i ice 3 times a day. i quit all meds a few weeks after surgery. they ruined my stomach after 2 years. i just deal with the pain as best i can. i am rudely awakened every night and must ice before i can get back to sleep. i'm told the pain should be subsiding. i'm waiting. also, yes i to feel that i have pf of the atypical sort. dr. hasn't diagnosed that yet. he thinks it is still from the tts. it does seem that many tts sufferers develop pf and also tts in the opposite foot, and then i guess pf in that foot. viscious cycle. feels like that is where i'm headed. being formerly extremely active, calling it a day after 100yd. walk or standing 5 minutes i'm going nuts. others recommend biking, which i normally bike 150 mi/week, i can barely pedal. the only activity i found i can do with the least pain is swimming. i did 2000 meters the other day and it wasn't so bad. atleast i've got that.

Re: same as before surgery

chrisb on 6/19/04 at 11:18 (153494)

Thanks for the good words folks. I'm at my wits end with this. I know some of you are too. After being given a 90% chance that surgery would fix my problem I seem to still be where I was before, i.e. seriously disabled. I'm trying to be patient that some improvement may come in the next 2-3 months. I want to help it along if I can. Those of you who have had some recovery only after a long post-op period, what kind of exercises or p.t. or supplements did you do?

Marty yes my pain is and always has been just in the heel. If you're just starting to feel improvement 2 years after surgery, do you think this might be due to something else you're doing now and not the surgery at all?

As for p.t. Terri, my surgeon said none was needed, and my local doc (who's been monitoring my post-op status) feels it won't be of much more help than the Theraband stretches I'm doing at home. Things are pretty delicate. My dorsiflexion is great, but when I push against the Theraband my fascia hurts at the insertion so I'm assuming its weak. Or maybe its something happening with a nerve - how do I know? My doc here suggests I could try walking more regardless of the pain to see what happens. Problem is whenever I push it even a tiny bit I'm set back for days in pain and back on crutches. Pushing through the pain has always been a disaster for me. But I remember you had a breakthrough a few weeks ago while doing weight training -- has it beeen holding? Do you have any idea what it means when some days a small bit of exercise seems to make things a little better, but other days makes it much worse?

Mark I find swimming is good also, its getting to the pool thats the hard part. I find biking posssible as long as I push almost entirely with my good foot and don't go far (2 miles) -- maybe this could work for you if you avoid hills? For me just being able to wheel down the street does wonders for my mental health.

I would not have minded if my surgeon had accidentally cut my calcaneal nerve and left me with a numb heel, but he's too good a surgeon for that. I wonder if that has been a solution for anybody after TTS surgery.

Re: same as before surgery

Geri on 6/19/04 at 14:33 (153505)

I so feel your pain!! There is hope, but it is so slow coming. I hope my story will give you hope, as I was at rock bottom for months before and after surgery with pain and no hope of ever having a walking life again. I am now 8 months post op tts surgery. I had a Plastic Surgeon trained by Dr. Dellon. After testing I had 3 incisions, ankle,top of foot and side of leg at the knee level for (6 nerves released in all). I am also much older than most of you, led a very active life, idopathic cause for tts and very impatient. I had serious pain for 1 1/2 years and did all the conservative treatments I could. I kept a diary for the first 6 months after surgery. After reading your post I checked where I was at 4 months.
1. Started to drive in neighborhood(with non surg foot). Could not have surgery foot down long due to pain and swelling.
2. Very limited walking in the house. Spent my days mostly resting with my foot up. Used crutches always outside of house.
Had a big setback after getting ready for a car trip to visit family. I walked to much getting ready and packed etc. Had to rent a wc and use in my daughters home for the next two weeks. I can tell you I was really frightened and thought I had undone my surgery. Up until this time my pain was as bad as before surgery 5 minutes after I walked and even when resting with my foot elevated.
3. Used a shower stool.
4. Used aleve at least 4 aday for pain and usually 1 or 2 Vicodin a day. Always at night.
5. From 4-6 months post op I had two set backs and reverted to a wc for a week each time in the house and crutches out. The setbacks were always caused by walking to much. Stopped using crutches out gradually at 6 months.
6.Husband did all the cooking. Made the bed on my knees. At 6 months I started cooking some a couple days a week. Used my stool.
Now the GOOD NEWS. I'm 8 months post op today.
1.I vacumed my greatroom yesterday
2.I cook most meals now sitting on a stool that I move from the sink to the stove. I have rubber mats from the sink to the refrig. which are a big help.
3.Still use a shower stool(cannot stand long).
4.I drive out of the subdivision now and use the cruise control whenever I can. Surgery foot is the driving foot.
4.I do aroebic exercises in the pool daily. At first only one or two of each one. I use a belt in the deep water and pool weights for upper body.
5.I park in handicap and can walk in any place I want to go. I went to Eckerds drugs today and walked to the back to the pharmacy. I have a folding stool I sit on when standing is involved.
6.I now take supplements and of course neurontin which has helped. I started all of this when I was 5 months postop.
7.Started riding my bike(no gears) at 7 months postop. At first 1/2 mile, now up to 3 miles with one small hill. I love this it makes me feel so free.
It has taken me a long time to realize I needed to change my goals.
I still want to play golf. I thought I'd be playing by now before
surgery, I now hope to be playing at a year or two after surgery. I probably will never do the malls again as this is how I hurt my feet to begin with. I now enjoy shopping on the internet or do not shop. The community of posters on this site have been so helpful. My husband always asks me on his way to the coffee pot every morning, 'how is your foot today'? Recently he said 'you seem to have more good foot days than bad now'. WOW! I'm beginning to see the light.

Re: same as before surgery

Ann L on 6/19/04 at 23:05 (153528)


I am 4 months post op also and am dealing with a large amount of pain. I attribute alot of that to the increase in usuage - I had surgery on both feet, so it is next to impossible to catch a break without being completely idle. I am in physical therapy, in my 11th week now. I consider it to be very vigorous, not only using theraband exercises, but also multiple exercises that require balance - standing on one leg doing toe raise, heel lifts, rocking back and forth, etc. They leave my feet and ankles extremely sore and I find my post tibial nerve awakening and causing burning pain. I revisited my podiatrist regarding pain management (therapy was ordered by and surgery done by a foot and ankle orthopedist) and on friday, we made some adjustments to my medication regimen. He added Ultracet back for pain control and switched me from Neurontin to Topamax to see if the change would make a difference. He does expect that I will have pain, but wants to do everything possible to control it to decrease limitations placed by pain.

In view of my experience, I disagree with your doctors on PT and also on their apparent lack of attempts at pain control. The muscles, tendons, ligaments, fascia will all be weak and overcoming that weakness is no easy job. And strengthening these tissues is bound to cause pain, and pain makes you not want to do what it takes to strengthen them.


Re: same as before surgery

chrisb on 6/20/04 at 13:37 (153547)

Thank you everyone for the feedback. It helps me put things in perspective, at least. I guess I'll try p.t. Ann I'm impresed that you're standing on one leg doing toe lifts. That would nosedive me very seriously right now.
Hoping for brighter days for all.

Re: same as before surgery

Claire on 6/21/04 at 09:10 (153587)

Hi Chris. We had the surgery within one week of each other so i thought i'd share my progress with you too. I am back at work 3 days a week, the rest of the time i lie at home by myself mostly, with my feet up. I've not had any relief from surgery to date and started physio 3 weeks ago, no obvious signs of change i'm afraid. I am also starting Pilates as part of my rehabilitation, excercise without any pressure on feet, YAY. On the whole i am mostly depressed, i don't have my own house or a boyfriend right now and my family are 1.5hours in the car, which i can only drive around the block really, so feel pretty alone and scared of what the future holds for me. Anyway i'm sure you understand where i am coming from. Hang in there, remember we are not even half way through our recovery yet and we must try to remain positive, although its ok to get p*ssed of at times through sheer frustration and pain. Take care and stay in touch, we've still got a long way to go.

Re: Claire

chrisb on 6/21/04 at 13:42 (153618)

Claire I'm sorry to hear you're not much further ahead than I am with recovery. Sounds like we are in a similar state.
Does your physio include electrical stimulation, etc or is it strictly exercise and stretches? By the responses on this board I think I'm a fool if I don't arrange to start physio this week, but I'm wondering what to avoid. 3 years ago when this whole thing started my physio included elec stim and ultrasound and infrared, but I'm wondering if all that can be detrimental after surgery.
Patience is apparently required and I could be more patient if I could feel even a slight improvement, but my recovery seems to have been more or less static since the 4 week mark really. Although yesterday I struggled with a rowboat, hobbling to the wharf, bailing and putting out the mooring. I was very worried about the pitching in the water, balance etc and the effect on my foot but today it seems not to be worse which is a surprise. Sometimes it seems as if a small exercise sets me back a week; other times it surprises me by NOT having a detrimental effect. It makes it hard to know what to do. Today I feel a few little tingly zaps (don't know how else to describe them) in my heel but no worsening of pain -- I'm wondering if this is nerves reorganising after surgery. Does this sound familiar to you?
Take care and keeep your spirits up.

Re: same as before surgery

Marty in SLC on 6/21/04 at 18:47 (153645)

Don't give up hope it's been along hard road for me almost 2 years now post op and I'm getting better slowwwwwwwwly. What have I done differant now? Nothing, nothing at all. I feel the nerve is healing from the screw up the doctor did, that's me best guess. I can tell those of you that are at 4 or 5 months post op, just keep going it will improve.


Re: Chris

Claire on 6/23/04 at 11:16 (153755)

Hi Chris. You should certainly try and do some form of physio, mine involves stretches and pilates mainly, no ultra sound or elec stim, i've not had any result so far, infact my pain at present is 50% worse than before surgery. I've not had any postive signs from surgery so far at all. I'm glad you managed to get out to the boat, it certainly helps to take your mind off things. The zings you are explaining sound familiar, although i've not felt it for a while, i believe it is the nerves reconnecting after surgery. Can i just ask you what benefit ultrasound and infa red are to TTS? Thanks and Take Care.

Re: same as before surgery

lauriel on 6/23/04 at 11:44 (153757)

I had TTS surgery 12/02 and am now battling PF. Chris, your symptoms sure sound like PF and not TTS. Heel pain is classic in PF. my recovery from my surgery has been good, but a long time! I still have my occasional electric shock zingers. I dont think the surgery was a success, but just found shoes that dont aggrivate it, I found some shoes gave me electric shock every time I put pressure and others dont.

Its only been 4 months since surgery and I wasnt feeling a lot better for almost a year. What helped me the first 3 months was PT, I think it was a godsend for my recovery.

I am now going to try accupuncture for my PF so Iwill keep my fingers crossed


Re: same as before surgery

Terri on 6/23/04 at 21:01 (153798)

Hi Chris. Sorry for the late response, my mother had an episode last weekend and landed in the hospital, kinda put me behind on emails and the board for a bit. She's home now and just fine, feisty 71 yr old!

I fully agree with Ann, you should be starting some p.t. by now. Like she said, and I'll paraphrase, 'use it or lose it'. The longer you go without trying to move the muscles, ligaments and tendons, the more it's going to hurt when you do, then you have a set-back....vicious circle.

I'm still doing pretty well overall, however the burning on the bottom of the feet is coming back again and I'm noticing I can't do the shopping as well as just a month ago. Talked to my trainer about that this week and we're going back to a regular p.t. session once a week and cut back on my wishes of the body-builder physique I was looking for. :-) What seems to help me the most are calf presses. It really stretches out my ankles and calves, just seems to release something. I can't explain how it feels but I have him work it into every session we do. But, as you know from reading this board, the same thing will devastate others. It's so strange, we all have this same condition but the variations in symptoms and treatments for each of us seem to grow as more people post here.