Home The Book Dr Articles Products Message Boards Journal Articles Search Our Surveys Surgery ESWT Dr Messages Find Good Drs video


Posted by Pat on 9/02/04 at 21:19 (159193)

This is my second go round with the same foot and Plantar Fascia (I had surgery in the left foot 10 years ago with the old method - not EPF - and that was a nightmare). Last year I went through physical therapy, wrapping, icing etc. and finally ended with a cortisone shot because I couldn't stand it anymore. This year I got the damn PF back almost a year to the day I got it last year. I went through the stretching, icing, physical therapy for 5-6 weeks, taping, ultrasound, ionfresis (I know that's not spelled right), massage etc and the PT told me all of that wasn't helping (and I knew that). Today i went back to the Orthopedic Surgeon (who had the bedside manner of a FISH) and he basically told me that I have 4 choices - do nothing (live in pain so bad I can't walk), pay for ESWT (my insurance doesn't cover it), get a cortisone shot (which they don't want to give me any more of since I've had a ton of them throughout my body) or try a hard cast. He doesn't do surgery - anyway, I opted for the hard cast which is suppose to stay on for 4 weeks. It's day one and it's terrible already. If I could rip it off I would! And I'm not sure it's going to help much anyway. I did make an appointment with another Ortho that does this type of surgery. I'm 53 and have neurological problems that makes it virtually impossible to stretch that muscle the way that it needs to be (calf muscle) and I know the surgery isn't always successful (been through that) but I can't live my life crying all the time from the pain. Anyway, I know I'm blabbering on here but has anyone had a hard cast and did it help? I hate to have this freaking thing on for 4 weeks and lose time when they could just operate on the darn thing. Needless to say with all the other stuff that is going on in my life I am at my wits end and don't think I'll last a month with this thing on. Thanks for any replies in advance.


Julie on 9/03/04 at 02:50 (159203)

Pat, the fact that your PF returned suggests that whatever was causing it wasn't dealt with in your treatment. If a biomechanical fault in the way you walk was the cause, that needs to be addressed. Orthoses are meant to correct biomechanical faults such as overpronation, but you don't mention orthoses in your list of treatments.

Surgery for PF removes or weakens the main supporting structure of the foot. When that is done, additional support, from orthoses and the best possible supportive shoes, is needed. I suggest that you research the podiatrists in your area, find a good one, and start again. I hope you can get the help you need, and meanwhile, I hope the cast helps.

You've had two surgeries. Please don't even consider a third to 'operate on the darn thing'. You don't want to make the situation worse.


john h on 9/03/04 at 09:54 (159219)

Pat I have seen post on this board that a hard cast made them worse and post that it made them better. We have some Orthopedic Foot and Ankle Surgeons in my city that refuse to do a PF release under any condition. They think it can cause more problems than it helps then we have some who will do a complete fascia release. If one wants surgery you can sure find someone who will do it. There is a type of surgery that only a few foot and ankle orthopedic surgeons do and are trained in. It is called the Baxter Procedure and is much less likely to make your foot worse as only about 10% of the fascia is released and your foot structure stays in tact. It is a 25 minute procedure. You will probably have to go to some city to find a Doctor trained in this procedure to consult with.


Pauline on 9/03/04 at 10:49 (159225)

I could be wrong but didn't long time P.F. sufferer Brian G. have the Baxter procedure done and saw no improvement. I think I even remember him saying he thought the equipment was bad.

Brian, calling Brian.


Dr. Z on 9/04/04 at 08:36 (159272)


Brian had EPF done. He felt that the since the equipment was an 'older model' that may have been the reason for his severe chronic pain


john h on 9/04/04 at 14:36 (159300)

Dr.Z: My understanding problems with EPF came mainly from damaging nerves as the scope was inserted. I am not familiar with this equipment but new or old you have to blindly insert a scope into the foot to access the fascia?? Is that right or wrong? I talked to couple of PODS here in town who said when EPF first came out their group of 7 Pods used EPF but found after a while they had much fewer complications with minimal invasive procedure. They bluntly told me it was a marketing tool. When I first heard about EPF it sure sounded like a good deal to me. I sort of compared it to arthroscopic knee surgery. Wrong again.


Dr. Z on 9/04/04 at 14:42 (159303)

You are right on the mark. In addition you are making a tunnel with the scope which can leave track pain ( scaring)


john h on 9/04/04 at 14:52 (159304)

I am rather sure Brian had EPF and he feels certain that was his downfall. I think I am the only one I have seen post who had the Baxter procedure. I know Carl Lewis had it and was back to his world class running. This is really not a procedure designed to release the fascia but you get about a 10% fascia release as a by product of the procedure. It is really very simple and straight forward. You remove about a 1/2' moon shaped piece of fascia where it attaches to the heel and directly over the Baxter Nerve. Dr. Baxter a PF guru and Orthopedic Surgeon in Houston developed this procedure. He is quoted in many major medical publications and I think I read about his procedure in the major teaching manual for orthopedic foot and ankle surgery. Very small incision and probably a 20 minute procedure in the hands of a skilled surgeon. The object is to remove presssure on the Baxter Nerve. There are many Orthopedic Foot & Ankle Surgeons who refuse to do a fascia release. The Chief of Orthopedic Surgery in our University teaching medical center here in Little Rock will not do them. She thinks there are to many down sides. On the other side of the ball one of the Pods I have seen in Little Rock told me he has done over 1000 releases with great success. You pay your money and you take your chances?????


Ed Davis, DPM on 9/04/04 at 18:30 (159338)

If you witnessed an EPF and compared it to the minimal incision approach, you would note that the EPF ia more traumatic. The EPF, unfortunately, was a way to 'repackage' a simple plantar fascial release as a new high tech procedure -- marketing.


Pat on 9/06/04 at 19:12 (159432)

Actually I only had one surgery on my left foot and I don't have pain with that though it was a long healing process - the problem is with my right foot and I do have orthodics that I got from Temple University Foot and Ankle Clinic in Philadelphia. They've never been comfortable and I've always worn shoes with good support with them which is hy I can't believe that the darn thing has come back. Besides the problem with my foot I have some type of neurological thing going on (I had an MRI done last week) where the nerve impulse isn't contacting the muscle correctly or whatever so it's hard to stretch out the plantar faschia. This is day 6 in the cast and I'm ready to cut it off myself!


Pat on 9/06/04 at 19:14 (159434)

Thanks for the information. I did some research on Baxter (wasn't he the guy in Colorado that invented it or am I getting that mixed up) but tomorrow I have an appointment with a Podiatrist that's suppose to be very good and I'll see what he says. I also made one with another one on Thursday just in case I don't like the one tomorrow. I know that sounds crazy because I've been to alot of doctors with various problems but this is the first time I saw one (orthopedic surgeon) that was so obnoxious I don't even want to go back to get the cast cut off.


Pat on 9/06/04 at 19:18 (159435)

At this point I'm willing to try anything because I'm so depressed I can't live like this. I live by myself (I know lots of people do) and am in a state with no friends or family and I spent my summer basically confinded because I couldn't deal with the pain. Right now I'm trying to get some opinions on what to do because I am so fed up and I feel this cast thing isn't helping. True, I don't have the pain when I walk but I'm sure once it's off and I put all my weight on it I'll have pain. If this was a removable cast I could have lived with it better but the Ortho basically didn't want to be bothered unless all my bones were broken! LOL!


Dr. Z on 9/06/04 at 20:48 (159456)

Where do you live?


john h on 9/07/04 at 09:14 (159479)

Pat Dr. Baxter is an MD, Foot and Ankle Surgeon from Houston. I think he trains on MD's in this procedure and there are not that many of them trained in the procedure. It is unlikely your Podiatrist will be very familiar with this procedure although he may have read about it.

Re: Dr D

Pat on 9/07/04 at 18:02 (159516)

What is the minimal incision approach as opposed to an EPF? I actually had the old way of doing the PF surgery 10 years ago (cutting the bone spur and all that) and it was a nightmare. Now I'm looking at something else with my other foot and I'm not a happy camper


Pat on 9/07/04 at 18:03 (159517)

I live in Delaware - a little over an hour from Philadelphia.

Re: Dr. Baxter, Houston, TX - Referral???

MHM on 2/27/05 at 23:00 (170096)

I was wondering if anyone in Houston,TX has been treated by Dr. Baxter Orthopedic Surgeon - I am going to visit with him this coming Wednesday.. for the first time - for a fourth opinion to an ongoing toe problem.

I have had two toe surgeries, for what was supposed to be a mortons neuroma... (I have a painful hard something or other... on the end of my little toe, which was a result of standing on something on the beach whilst running), the last OS I went to see said I had a mortons neuroma, which from my understanding a mortons neuroma is supposed to be between the 3rd and 4th toe... not on the end or your 5th toe... Three months later, my toe is now partially numb I had a nerve removed - Yet the initial pain and now more is still there... I was referred to Dr. Baxter - Has anyone been to him and had a good or negative experience..

Your comments are greatly appreciated,

(email removed)