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

Surgery on 10-25-04

Posted by Marsha G on 12/14/04 at 07:37 (165602)

Happy Holidays!
I had surg on 10-25-04. I am still not able to walk without crutches or wheelchair. I obtained my operative report and this is what it states, A small incision was made posterior to the medial malleolus in a slight oblique angle along the course of the posterior tibial tendon. Blunt dissection was undertaken using tenotomy scissors. The neurovascular structures, including the nerve and posterior tibial artery were identified and carefully proximal distal these were dissected out. The fascial covering over the nerve was released. No significant soft tissue entrapment was left. The posterior tibial tendon sheath was incised. There was some significant fluid with in sheath but the posterior tibial tendon was intact. There were some marked inflammatory changes. This was excised sharply. The posterior tibial tendon was completely intact. I know this is long but I am scared I will never walk again....I have a history of RSD with some symptoms of it now. My question is, being 2 months post operative, where should I be in my progress? I am still in alot of pain., taking Neurontin and hating life.......in PT, I cannot wear the air boot. I am wearing a larger shoe on the post op foot. Please Please someone tell me when will I be able to walk without pain? My whole body is effected by this surgery. Hips, hands, shoulders etc due to using crutches etc. The bad thing is, my dr. painted a much prettier post op situation. (I was in a short cast 4 to 5 weeks)
Please someone respond. Thank you

Re: Surgery on 10-25-04

Norm on 12/14/04 at 13:33 (165619)

I had surgery 10/06/04 & I am worse now then before surgery. I could at least work a full day before the surgery. Luckily I have been given a 95% sitting job at work or I know I would still be off. My doc also painted this picture of 2-3 weeks off work then all is well. I am very upset that he was not straight up with me. Take care & good luck.

Norm

Re: Surgery on 10-25-04

Pat on 12/14/04 at 14:06 (165620)

Was your surgery for EPF or TTS?

Re: Surgery on 10-25-04

Marsha G on 12/14/04 at 15:25 (165623)

the pre-op diagnosis was Left foot posterior tibial tendon dysfunction versus tarsal tunnel. You got me???? I have found several errors within my records, he stated I had am MRI (I did not) he stated (MD) I had spinal anesthesia (I did not) I return to see him on Thursday and I am not sure how to approach these issues. All I am seeking is a pain free foot....and some straight answers...I really feel I have been 'stupid' in undergoing this surgery. You know, the, I should haves.....but he is a Dr. and is suppose to know what he is doing. I guess I have lost my trust in him. I would accept where I was prior to the surgery......at least I could walk.
What do you think about my progress thus far? I really would appreciate your and anyones opinion. Thank you for your reply...Marsha

Re: Surgery on 10-25-04

Pat on 12/14/04 at 16:25 (165624)

I think you should definitely discuss the report with the doctor - in fact, I would write down all my questions and ask them one by one. Sometimes when we're stressed out we forget some of the things we want to say. I had the PF surgery from hell ten years ago and another one on 11/3/04 - the latest one was completely different. The first one everything that could go wrong DID! Including the doctor doctoring the records (he said he cut only one side of my foot and both sides were cut). I was in alot of pain for a year and while I'm not in pain my foot has never been 100% again. I would also get a second opinion just on your medical records.

Re: Surgery on 10-25-04

denise g on 12/14/04 at 20:12 (165631)

I had tarsal tunnel surgery on 10-1-04 and am doing pretty well. I do have some discomfort from scar tissue but other than they I'm OK. I go for physical therapy 3xweek which really helps, are you going for therapy? You must be going crazy, can you get a second opinion. I had a bumch of idiot doctors before I chose the one who did my surgery, Dr. Deland who is head of the ankle orthopedic section of the Hospital for Special Surgery, NYC.
Good luck,
Denise

Re: Hi Denise

Darlene on 12/14/04 at 20:21 (165632)

Denise:

Are you finding that your gait is back to normal?

My gait is a big problem for me. I think I forgot how to walk normally.

Re: Hi Denise

Marsha G on 12/15/04 at 07:04 (165650)

I do not know if my gait is normal because I cannot walk. I am using a wheelchair and crutches. I go to PT 3x a week. They did get my foot moving after the cast was off. I am doing a TENS therapy for 40 minutes on the lower body and 20 minutes on the upper per day.I do this at home. I go today and am planning on asking what else can be done. When I wake up in the am. my foot is of normal color and size. Time I put my leg in the down position it turns red, purple, hot and cold. It is amazing. As if it has a mind of its own. Your surgery is a little ahead of me but I am not as progressed as you are.
I would love a response from a MD.....any got their ears on?
I do go to another city in Jan for 2nd opinion if I am not better. I just was not prepared physically or emotional for this disability. I am a very active person.........it has been terrible for me.
Doctors where are you?
I have a whole new respect for people that are disabled.
Marsha

Re: Marsha

Darlene on 12/15/04 at 08:04 (165654)

I'm so sorry to hear about your very difficult post surgical course. I hope it turns around soon.

Have you tried soaking your foot in very warm water with epson salts? I understand that it helps to get the circulation going which is important if RSD is suspected. Even without the salt it would be good. You probably already know - no ice. Also there is a natural supplement - L-Argenine which is a vasodilator to help bring oxygen to the area. Also, if you could find a warm pool (check with the local arthritis society), that would be very helpful for your body and spirit. You could use a flotation device and do some 'jogging.'

What does your doc say? Did you go to an ortho or a pod?

Re: Hi Denise

Ann L on 12/16/04 at 02:10 (165720)

Darlene,

I did forget how to walk - I wore ankle braces before I had surgery - for 1 year on my left foot, and 6 months on my right foot. I ended up going to physical therapy for 4 months after surgery (starting 6weeks post-op). And I probably would have gone to therapy for longer, but I aggravated a stress fracture in my left foot and developed a new one in my right. It took me a good while to walk like a normal person. I really had trouble with stairs - I lived in an upstairs apartment until a few months before my surgery and had to walk sideways down the stairs with my braces on. It was a hard habit to break - I found myself still walking down sideways even after 3mos of therapy, so we worked on fixing that. I still have problems with my feet, but I try to make sure I keep my gait normal - in the long run it just makes things worse - but it takes a conscious effort sometimes.

Ann L

Re: Ann L

Darlene on 12/16/04 at 08:45 (165723)

How are you doing now in your recovery? Was your neuroma surgery successful? That's on my to do list. I'm overlifting my leg to avoid pressure on the neuroma. What symptoms do you have now compared to your symptoms pre-surgery?

Thx.

Darlene

Re: Ann L

Ann L on 12/17/04 at 01:47 (165790)

Darlene,

I still have a ways to go in my recovery. I am back at work - after 8 1/2months off - and am on my feet for 8 hours or more a day. By the end of the day my feet hate me! My neuroma surgery was very successful. I have some residual numbness - on the bottom of my foot and between my third and fourth toes - but it is not bothersome. Pressure around my foot no longer hurts. Stress fractures are giving me alot of problems - I have one on each foot on the 5th metatarsal. They take a long time to heal. On the inside of my ankles, I am having pain. It almost feels like pain between each of the bones in my ankles, like I can feel each individual bone when I'm on my feet. My surgeon said it will take a while for things to settle in because he changed the support structure with the TTS release and partial plantar fascia release. I also have burning pain on the inside of my ankles that extends across the bottom of my feet when I am on my feet all day, tho I don't usually have the burning pain if I'm off my feet more. My pod prescribed lidocaine patches to put on my feet/ankles for when I get off work and they do help some. One really big difference from pre-surgery is that I no longer have heel pain from the bone spurs and plantar fasciitis.

Ann

Re: Marsha

wendyn on 12/20/04 at 13:47 (165889)

Marsha - was your RSD in your feet before? Did they do sympathetic nerve blocks as part of your sugery? I understand that surgery is a HUGE risk if you already have RSD. I have post tib tendon dysfunction as well as RSD diagnosis.

Re: Marsha

Marsha G on 12/22/04 at 09:32 (165975)

the RSD was Dx 7 years ago from a sprain. my foot never got 'normal' after that. I think because of the way I have walked on it for so long caused the tarsal tunnel and now very very painful plantar fasciitis. No one will accept the diagnosis of RSD so I am off for yet another opinion in another state. This experience has been the most painful thing I have ever encountered........root canal, child birth, etc does not compare.....to this. It will be a miracle if I still have friends and some family members when and if it is over.
I was informed about the risk of having surg. but I was told I would have spinal anesthesia and for somereason I did not....still trying to get to the bottom of that....I do not want to sue anyone, I do not want to even point the finger at anyone...I just want to be pain free and out of the wheelchair and crutches......and back to my life.....I have been in the house for 2 months (except PT) anyway, you probably know what I am talking about..we have alot in common...what treatment, drugs, etc are you doing for your problem????Please let me know what has helped you.
Marsha
ps Merry Christmas!

Re: Marsha

wendyn on 12/22/04 at 11:10 (165977)

Hi Marsha. If you reply back to me, please try to put my name in the body of the post. That way, I'll be sure to see it. (I feel bad if someone replies to me and I miss it somehow)

So, you had a diagnosis of RSD 7 years ago, and now your doctors disagree? I'm not doubting your story, just going through something similar myself.

That's really bizarre that they didn't give you a nerve block for sugery. I understood that surgery could cause RSD to either come back or get worse.

My story is very long, but I'll try to give you the abridged version:

Had foot problems since I was 11.
Many biomechanical problems: progressive flat feet, post tib tendon dysfunction, forefoot varus, shortened achilles tendons, a tibial tortion, and unexplained lumps on my toes (The Lumps Formerly Known as Bunions)

At 21, had sugery on the 'bunion' and recovered well.
At 23-29 had episodes of acute PF
At 30, everything sort of went to hell. Developed what was suspected as TTS, and then it later developed to RSD. Supposedly. Seems to make sense anyway.

I have improved a lot over the last 5 years. No thanks to the medical profession for the most part. I improved somehow from time, acupuncture, yoga, better orthotics, time, b12, time, and modified exercise.

I still have weird lumps and my feet still get hot and puffy sometimes. Shopping and standing are pretty painful, but I get by with most things.

My activity level is good now. I do yoga 2 or more times a week (both Hatha and now Ashtanga) I bike and use the eliptical trainer (which suprisingly no longer hurts my feet). I also do weight training and core work.

I get worse (as in pain level and stiffness) if I don't exercise. I have refused all of the drugs. I don't condemn their use for other people, but they are not right for me. I have more problems with drugs than without them. They affect my mind too much, and I work full time and go to school part time. My body doesn't always work that well, and I have learned to live with that. I'm not willing to put up with a foggy head, weight gain, and a host of medication side effects.

Anyway, that's sort of the condensed version of my long, weird story. My current rheumatologist has disagreed with both the diagnosis of TTS and RSD, but she doesn't know what I DO have (positively adorable isn't it?). All of the doctors are sure there is something very wrong (most of it's quite visable so at least they don't tell me I'm crazy) but no one agrees what it is.

I had given up on pursuing answers for my feet, because it just frustrates me and causes me to pay more attention to the pain. Unfortunately, the weird lumps have my GP excited and he has insisted that we try to figure out what's going on. 17 blood tests for various inflammatory conditions in the summer were all negative (at least we know that most of me is okay!)

She's ordered more xrays (soon I will glow in the dark) and MRI's of both my feet for February. She will also biopsy the lumps on my feet and one on my shin (if there's one there at the time).

Marsha, what type of doctor did your surgery this time? Which state are you going to for a second opinion?

Re: Marsha

Dorothy on 12/22/04 at 11:48 (165984)

Wendyn ~

I'm always butting into other people's conversations here, and I'm going to do it again. Forgive and/or ignore please if this bothers you. I read your post about your history - I was interested and did not know most of this before - and was struck by something in your descriptions. The 'lumps' on your feet and shins....
When Julie wrote about 'neurofibromas', I did not know what that was so I began to do some reading and came upon some very interesting websites. 'Lumps' on feet and shins (and other fairly consistent parts of the body, such as the spine) are apparently one of the things that signifies neurfibromas in the body. I don't know much about this still, but your description - and the difficulty diagnosing - caught my eye.
Maybe this is old info. to you/already ruled out, etc. - but if not, maybe something to consider. The MRIs might reveal something along this line if it is a factor.
I was very intrigued as I read about neurofibromas because I became pretty sure this is what my mother may have had on her upper spine/neck (undiagnosed) later in her life, at least it sure did fit the description.
Well,maybe something in this for your consideration - and I do hope you find even more restoration of good health.
Best wishes to you~

Re: Dorothy

wendyn on 12/22/04 at 13:14 (165991)

Dorothy, it's a bulletin board - so I don't consider any conversations to be 'butting in'!

And no, of course your comments do not bother me. Another insight or opinion can never hurt.

I don't know a lot (anything?) about neurofibromas, but perhaps I'll get around to reading up on them. I've had weird lumps since I was about 15 or so. The ones on my shin were at one time diagnosed as 'erythema nodosum'. I think that spelling is right, but it could be off. When they resurfaced about 8 years ago (after an absence of about 15 years...) I had xrays and bone scans that showed nothing. Then they disappeared. Periodically now, one or two will pop up. Always on my lower legs, sometimes over bone, sometimes over soft tissue. The lumps are sore and I never know what makes them show up or disappear. Typically, they stick around for 4-6 months at a time. My rheum. suspects they are still erythema nodosum, but they don't know why I'm getting it. Sometimes it can be linked to lupus etc. but all of my blood tests are normal. She asked to see them they next time they show up - she wants to take a biopsy. I will call her after the Chrismas holidays.

The lumps on my toes were long thought to be bunions. However, recent xrays show that they are actually soft tissue swelling (lots of it) but not bone. In the summer, for a period of about 3 weeks, the lumps on my toes almost completely disappeared. They (the doctors) would also like to take a biopsy of the toe lumps.

My toe lumps hurt a lot, and they make it very hard to wear shoes. Whatever they are from, the doctors refer to them as 'rheumatoid nodules'. I do have a digitial camera, and one of these days I should really get around to posting some feet pictures. I really need a pedicure though, so maybe not right now!

Re: Dorothy and Wendy

Julie on 12/22/04 at 14:15 (165994)

My turn to butt in :). According to my research, subcutanous neurofibromas are quite common: they appear as lumps on nerves under the skin and are visible (my kind, the spinal neurofibroma, is different, and apparently rare - trust me). One of the giveaway symptoms is 'cafe au lait' spots on the skin. Wendy do you have these? Did your mother, Dorothy?

Multiple neurofibromas are classified as Recklinghausen's syndrome which is what the Elephant Man had. I'm glad I only have one, albeit in a nasty, tricky place.
.

Re: Dorothy and Wendy

Marsha G on 12/22/04 at 14:51 (165998)

MERRY CHRISTMAS TO YOU ALL!

MARSHA

Re: Dorothy and Wendy

Dorothy on 12/22/04 at 17:03 (166002)

I wonder if cafe au lait spots would be what are often called 'liver spots'. I don't think my mother had any, but I have a few - however, I have assumed they were from sun damage and age. I'm in my fifties and used to 'live' in the sun. One of my sisters has a lot of spots - more like large-ish moles - on her trunk.

Re: Julie

wendyn on 12/22/04 at 22:44 (166022)

No Julie, I don't think I do. I have a friend at work - one of his sons has been diagnosed with neurofibromitosis (some sort of spelling like that, I've had friends over for dinner and I had a few cocktails...)

Anyway. He has 4 boys, and 1 of them for sure, but maybe 2 have this disorder. They have the cafe au lait spots and the freckles in their armpits. I understand from my reading this afternoon that maybe this is the same type of thing that you have?

Those spots are fairly distinct, and both boys have them on their cheeks. I do not think they are the type of thing that develop with age (these boys are under the age of 10)

Re: Julie

Julie on 12/23/04 at 02:52 (166023)

No, Wendy, sorry if I wasn't clear. I have a single spinal neurofibroma which is different. It only becomes neurofibromatosis if they are multiple, and subcutaneous (I could be wrong about some of this - this is a new learning curve).

Neurofibromatosis is apparently a genetic disorder, so it isn't surprising that two have it in one family. It seems to be fairly common in children. My kind is apparently rare: my GP said he has only seen one before mine (in around 20 uyears of opractice). As I said, trust me to pull a rare one. I hope the neurosurgeon I go to has seen and removed lots of them.

Re: Hello Marsha

angelas on 12/26/04 at 10:56 (166152)

HI Marsha,
Sorry I am not a doctor, but I just wanted to say I know a bit how you feel. I had what was diagnosed by 3 doctors as TTS and 2 more said they did not know what it was.
After 2 years of loosing almost all my ability to walk and be active ( I was very active also and it kept me happy and sane) I decided to have the surgery.

I knew the hard part would be the recovery. But even though it has been only 4 weeks I am having a very hard time.
I am in a wheelchair now also or using crutches a bit which is messing up my hands with Carpel Tunnel even worse than I had it before!

Before the surgery I could stand about 15 minutes tops or walk about 200 feet and pay like hell later in the day. I also took a lot of pain meds to be able to do this.

Now I can not walk at all. ARGGHHHHH!!!!!
MY doctor did not think physical therapy was needed. ( Will push more for that, fingers crossed!). But I am very worried that it will not get better than this :-( And I have it in both feet, plus Fibromyalgia and the Carpel Tunnel Syndrome.

I am not clear about your history of the RSD DX and all that it means, though I do know a little bit about RSD. I certainly hope they are wrong about that one!

There is a great chat on a pain site for RSD if you are interested. Hope it is ok to post that here!?!

Just wanted to vent a bit, and knew you would understand.
Thanks!
Angelas