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answers?

Posted by milley on 3/24/05 at 09:01 (171873)

Can you tell me why when I ask the question, Is it normal to do two epf surgery's in 7 months on the same foot, I get no real answers? If both Dr.s cut 2/3 of the medial bands with 6 moths in between one would have to assume the first was not done right? Also after all this I can still feel the bone spur they rasp off when walking, It feels like I am walking on my bones with no meat aroud them?

Re: answers?

Dr. Zuckerman on 3/24/05 at 10:29 (171880)

I have never cut the foot twice in such a short time.

Re: answers?

milley on 3/24/05 at 10:50 (171882)

Thank you for your reply! I just cant get answers, the first was done on march 04, the second was done 11/04 both performed by the same office two different dr.s same practice. On april 04 I had a lipoma removed by the same Dr. who performed the first epf. None of the symptoms I had were relieved, on feb14/05 I had a new pod, perform surgery for an entrapped nerve, and the lipoma removed from the same spot, I am willing to bet the first was not completely removed. There was so much scar tissue he had to cut the old inscision site out larger with some bone concaving as well.
Now I still have tremondous heel pain it feels as if I am walking on the spur and bone in the heel with each step, I can feel the muscles in the sole of the foot just drawing up and cramping. I am in constant pain especially first steps in the morning and after 8 hours of work. Could it be my fascia is ruptured? It seems like there is a white coat of silence or something, how do I know if it was medical negligence or not! How can it be both Dr.s cut 2/3 of the fascia in such a short time the math doesn't add up?

Re: answers?

elliott on 3/24/05 at 11:29 (171884)

Milley, sorry for your predicament.

Here's how the math adds up: I believe when they do that procedure, they do not have complete visualization of the fascia since some other foot structures are in the way. So they sort of are guessing as to how much they are cutting. I am guessing that better docs guess better and stay closer to the desired percentage. If the first surgery provided insufficient relief, that practice may have theorized that the percentage cut was too low, hence a second procedure to obtain the proper percentage. So a better explanation than having 4/3 of a fascia is that maybe the first surgery provided less than the 2/3. A little late now, but it might have been better to ask that question before the second surgery. I'd be very hesitant to have two surgeries--let alone 4--in such short succession and all related to the same problem.

I know you're in pain, but maybe you need the passage of a lot of time and perhaps some other conservative measures to gauge where you're holding. Maybe a good orthotic will help at least with your new problems. Also suggest seeking some opinions well outside of that office to try and get a handle on what happened.

Re: answers?

Terri on 3/24/05 at 13:38 (171890)

I would find the best doctor in the state I lived in and make an appointment. A doctor that had no connection to the doctor's that did the surgeries. Just my opinion.

Re: answers?

april l on 3/24/05 at 21:41 (171916)

Isn't it possible that within the first 7 months that the fascia reconnected? That is what I thought normally happens, and has happened in both of my surgeries. The fascia is partially cut, but then heals in a lengthened position reconnected to the heel bone. I can feel the fascia is connected when I stretch my foot, but since it is longer I don't have the pain of PF anymore. I don't think that cutting the fascia means there is a flap of unconnected tissue inside the foot. If the fascia, after the first surgery, heals without proper stretching to promote a lengthening of the band, then I suspect it could still be tight like prior to surgery. Then, the second surgery would make sense to me...to redo it. Just a thought.

Re: answers?

Dr. Z on 3/24/05 at 21:44 (171917)

Yes the amount of fascia cut is judgement, An EPF doesn't cut the fascia at the insertion, it is just distal to the insertion. If you have degenerative tissue at the attachment all the EPF procedure does is off load the attachment giving the disease disease time to heal.
So the amount of cut has nothing to do with the result. What is your problem may have nothing to do with the fascia. Another opinion could be very helpful. Elliott recommendation of time and additional conservative treatment could be very benefical. The first thing to do is fine out why and what is going on.

Re: answers?

Dr. Z on 3/24/05 at 21:47 (171918)

Yes this is possible. There are alot of possiblities

Re: answers?

milley on 3/25/05 at 08:47 (171936)

It has been a year now, and I do have a 3rd poditrist, he is the one who re-removed the lipoma and released the nerve! He's a great doc but the only problem is he is in missouri about 1 week out of the month then is in Boston the rest of the time. Kind of reminds me of that song Please come to Boston, but it needs to be please come to missouri. Thanks for the advice and I think your right, it's come to the point to just ignore it and let it go, however it is to the point that the foot is pretty much disabled. I could walk prior to the 1st surgery, now I can't. I see the doc today so I see what he has to say!

Re: a corollary

Ed Davis, DPM on 3/26/05 at 14:33 (171985)

As a corollary, it appears that less pain may occur when a smaller percentage of the fascia is cut but the decrease in pain/recovery may correlate with the efficacy of the procedure. Considering this, it is just one more area of uncertainty to add to the mix when doing surgical treatment of the problem.
Ed

Re: answers?

Ed Davis, DPM on 3/26/05 at 14:45 (171987)

April:
We have long considered a surgical procedure to lengthen the fascia.
There are several obstacles:
1)we would need to know how much lengthening such that pain is mitigated but not too much strain is transmitted to the structures supported by the fascia. There is no data to tell us exactly how much length must be given to the fascia.
2)The fascia envelops muscles; it is not really a fee 'rope' or 'guidwire' as the diagrams that explain the biomechanics suggest.
Because of that there is a fairly strong degree of adherence between the fascia and the muscles so separation of the fascia from the underlying muscles is actually a fairly traumatic procedure.
3) the amount of lenghtening achieved on the surgical 'table' will not be the same as the amount of length gained in say, 2 to 3 months because as the fascia re-attaches and regrows, it will contract an unknown amount, some of re-aatachment and contracture being 'genetically programmed' although may be externally controlled via fialry agressive phsycial therapy...
Ed

Re: answers?

april l on 3/26/05 at 15:07 (171990)

I was only trying to explain why I thought milley's doctor might need to do a second surgery. Personally, I think it's outrageous that doctors keep wanting to do more surgeries on her foot, and so soon after other surgeries. Seems like that would be very traumatic to the foot and increase the chances of complications.

I am not a doctor, but I have had two EPFs that were successful. My fascia is lengthened. I don't understand what you mean when you say 'We have long considered a surgical procedure to lengthen the fascia.' I thought fascia release IS a procedure to lengthen the fascia.

Re: answers?

milley on 3/27/05 at 13:11 (172024)

That is what I thought as well! So would an open plantar fasciotomy be my next step or should I live in pain for some more time. What would happen if I had the entire thing just removed, so, say it never grows back, or never bother's me again? here is gotta be something short of amputation to relieve this pain!

Re: april ?

ray on 4/01/05 at 21:36 (172400)

you fat hamburger eating niger loving hole im back you 300pound fat feet pimple face hemaroid elephant ass

Re: april ?

julie on 4/01/05 at 21:40 (172401)

i just wanted you to know that after spreading all that fat and finding your hole that i enjoyed eating it dont tell my husband or yours

Re: MODERATOR AND SCOTTR

Julie on 4/02/05 at 01:38 (172417)

Moderator, please remove this post, which is of course not by me, and the one above it.

Scott, please ban this man, who has been increasingly 'not nice' for the past several days.
.

Re: MODERATOR

Julie on 4/02/05 at 01:50 (172419)

Moderator, I see you have removed some posts usive. So on second thoughts, please do NOT remove these posts until Scott has seen them. I have emailed this thread reference to him. I hope he'll decide to ban this person.

Thanks.
.

Re: MODERATOR ps

Julie on 4/02/05 at 01:51 (172420)

That should have read:

Moderator, I see you have removed some posts on another thread that were probably equally abusive. So on second thoughts, please do NOT remove these posts until Scott has seen them. I have emailed this thread reference to him. I hope he'll decide to ban this person.
.

Re: MODERATOR ps

milley on 4/03/05 at 21:48 (172526)

why what was said I missed that comment

Re: MODERATOR ps

Julie on 4/04/05 at 01:20 (172536)

Don't worry about it, Milley. The person made some stupid remarks that weren't in any way related to your situation, and it's good you missed them.
.

Re: MODERATOR ps

milley on 4/04/05 at 07:10 (172541)

Ok I was making sure that I didn't upset anyone! Thanks