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Considering EPF

Posted by Shannon S on 3/15/05 at 11:09 (171227)

I have had PF for about two years. I am on my 2nd podiatrist at this point. I have tried cortizone shots (I've had 7 in one foot and 4 in the other), icing, Strassburg sock, orthotics and a TENS unit. I wear only Birkenstocks and New Balance tennis shoes with orthotics.

So I went to my pod yesterday and he suggested that it's time to try surgery. He told me the success rate was around 75%. I asked him about ESWT and he said that the success rate is lower than that of EPF. He didn't come off as a big believer in ESWT. He wants to schedule EPF and he wants to do my feet one week apart.

I've been reading this board and I've come to the conclusion that, at the very least, I shouldn't do my feet so close together. I really am afraid (more like terrified) to have the surgery, and I have a 2nd opinion scheduled for next week.

I am overweight and I know that must be contributing. Can losing the weight cure PF? What else can I do short of surgery to fix this? Can you suggest any specific stretches or exercises? What are my options?

I am a stay-at-home mom to three children 5-and-under. I am able to function throughout the day, but the pain is severe in the morning.

I would appreciate any advice you can offer.

Thanks,
Shannon S

Re: Considering EPF

Dr. Zuckerman on 3/15/05 at 11:17 (171228)

Shannon S
When you are getting a second opinion which is very smart. That is alot of local steriod injections. Have you read the heel pain book or used the plantar fascia stretches?. See Julia foot yoga stretches and DR. Z plantar fascia stretches. I agree doing two releases so close together isn't in your best interest.

Re: Considering EPF

Shannon S on 3/15/05 at 11:22 (171229)

Thanks for your prompt reply Dr. Zuckerman.

In your opinion, can the PF be helped by losing weight? Have you seen a patient lose weight and eliminate their problems? I am trying to lose the weight, but obviously exercise is difficult. I don't have access to a swimming pool, so I do what I can.

Thanks again.

Re: Considering EPF

Julie on 3/15/05 at 11:57 (171232)

Shannon, please read the heel pain book for more information on conservative measures for treating PF.

A few things come to mind:

Don't go barefoot: keep your Birkenstock (sandals?) beside your bed and slip into them before your feet touch the floor in the morning. Even before that, do the foot yoga exercises and the plantar fascia stretch to ease out the calf muscles and the achilles tendons: they have tightened overnight, and that is why the pain is worse in the morning. Exercising first will help you. The yoga exercises will strengthen your foot muscles as well as stretch the muscles that need to be stretched, without making you worse. And you could try taping, which has helped many of us: there are instructions in part 2 of the heel pain book.

I would take your podiatrist's judgement of comparative success rates of ESWT and surgery with at least two grains of salt. The studies of ESWT have measured success rates differently and they don't all agree, but one thing is certain: if it doesn't cure you or help you, it won't hurt you, whereas there is a good chance that surgery will make you worse. Of course doctors who do surgery recommend surgery, just as those who do ESWT recommend ESWT. You have to do your research and make your own mind up - but in my view you should certainly try ESWT before even considering surgery.

EPF is not considered (by the doctors who post here) a good technique. Having no personal experience, I can only pass on what I've learned here. It does seem to have fallen out of favour. So if you do get to the point of considering surgery, you need to do your research about the different techniques, too.

There is a lot to consider. Don't just go with what your current podiatrist suggests: at least get another opinion.

Be careful with cortisone: you've had a lot of it. Two or three injections a year is considered to be the maximum because it can weaken tissue.

Getting rid of excess weight lessens the load on all the body's structures including the plantar fascia. So losing weight should help, but no-one would promise that it would cure you.

Good luck.

Re: Considering EPF

Shannon S on 3/15/05 at 12:42 (171237)

Thank you Julie. I really appreciate it.

Re: Considering EPF

Cori P on 3/17/05 at 09:16 (171387)

Hi Shannon,

It must be very difficult to deal with foot pain and take care of three children under the age of 5. In reading your post you mention that surgery is the only option at this point and that you have to have both feet done. This will make it difficult to be running after those three beautiful children. Although, losing weight will help a little it is not the primary cause of the foot problems and will not eliminate it completely. I understand you are going for a second opinion and are looking for alternatives to surgery. I would highly recommend and encourage you to research the ESWT procedure. The ESWT procedure is non-invasive and most times allows you to be mobile immediately following the procedure. This will definitely fit your lifestyle as you are a busy mom. If you are interested in the ESWT procedure there is wonderful information avialable and any questions you post will surely be addressed. Best of luck with your situation.

Cori P. PainFree ESWT, Toronto, Canada

Re: Considering EPF

Brian C on 4/28/05 at 00:13 (173864)

My experience with ESWT is not what is so commonly written about it. After my ESWT, I had to go on crutches for almost a week due to the severe pain right at the PF insertion site. Now 8 weeks later, it is still a little worse than before the procedure, but not much. I think this talk about how you can be mobile right after it is similar to when people used to say you could get back to work 3 days after EPF: don't believe it is true in all cases.