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New here

Posted by Delrea K on 3/27/05 at 19:02 (172034)

Hello All
This is my third attempt at this post
My Name is Delrea K and I live in Southern Arkansas with my Husband and two yr old little boy.My story is long but I will condence it as much as I can
It all started in Nov of 01 With a batched heal spur and pf surgery .That Dr. was a butcher I ended up in Dallas in Feb of 02 to have second surgery to repair the damage.I now have to see pain management specialest and live on pain meds and muscel relaxers and anti depressants .I have been told by two Drs that I have RSD others say no it is hs pf And tt just worse because of scar tissue.I am due to have surgery again on April 18th So I am looking for understanding friends to help me through this They are doing all three surgerys at once so it is going to be a long slow process of healing So I hope I have found someone to talk me through it .
Looking forward to meeting all of you.
Delrea K

Re: New here

JudyS on 3/27/05 at 21:46 (172041)

Delrea you have come to the right place on this beautiful Easter Day! Understanding friends is exactly what you'll find here. Where will you be having surgery? What exactly is the surgical plan? Many folks have experienced more problems after PF surgery so you're not alone.
Lots of knowledgable and good folks here will give you good advice and will be here for you before, during and after your surgery. You'll be doing yourself a well-deserved favor by learning from what folks here will be able to tell you.
I'll let you know that the terms 'heel spur' and' Plantar Fasciitis' are somewhat interchangable. The inflation of your Plantar Tendon causes Plantar Fasciitis. That inflammation causes the tendon to pull at the spot where it attaches to your heel bone. It lays down deposits there (the docs here will describe that better than I)and the deposits form the 'spur'. The spur is not the real problem - the fasciitis is. Spurs are sometimes painful and sometimes not. It's likely that your surgeon clipped the spur a bit and also notched the Plantar tendon in order to effectively elongate the tendon - therefor taking some of the tension off it.
If you get a chance you might want to read Scott's Heel Pain Book here on this website - it's very informative.
Welcome! You're going to have an enjoyable time here!

Re: New here

John H on 3/28/05 at 10:26 (172052)

Delrea: I live in Little Rock. I have two Doctors to suggest. Dr. Ruth Thomas who is Chief of Foot and Ankle Surgery at the University Hospital for Medical Sciences in Little Rock. She is very conservative, so much so that she does not recommend surgery for PF. The other is Dr. Stepehen Kulik a Little Rock Foot and Ankle Surgeon with Arkansas Speciality Care Centers. I would see Dr. Thomas before I headed to surgery again. Both are highly regarded M.D.'s

Re: Welcome!

elliott on 3/28/05 at 11:21 (172055)

And good luck on that surgery.

elliott

Re: New here

Delrea K on 3/28/05 at 18:39 (172076)

Hi John
That is where I am going to have the surgery I live in Texarkana.I do go to Ark spec care And I see DR William Ackerman for the pain .And I have seen Dr Stephen Kulik.He is a real butt head He didnt know I was standing there and he said some very bad things about his wife and child .About how he didnt want the baby and she would be responsible And he called his wife the b word .It seemed to me he had no respect for women.He didnt even say he was sorry for me hearing him talk like that. He is one of the Drs who think I have RSD and he said he would not touch me but I think that is because he knows I tried to sue the butcher that hacked up my foot in the first place.
I am seeing Dr Nguyne at ortho Ark on Kanis Rd.His name sounds like Winn.He is also a specialist.He said he normally doesnt do surgery on this either but that he did belive I would benifit from it.
Thank you for the warm welcomes Judy and John & Elliott looking forward to getting to know you better
Delrea K

Re: New here

john h on 3/28/05 at 18:51 (172077)

I have seen Dr. Nguyne before. They had just got the Ossatron and he knew very little about it at the time and he had a lot of questions as he had never given a treatment. I had three at the time so was very familiar with the procedure. He is very nice. Probably in his mid 30's. He is a Foot and Ankle Specialist (MD). I will be interested to see if he suggest ESWT since they do have the machine. Ark Ortho is only a few blocks from my office. Yes Dr Kulik is a matter of fact sort of guy. He does not perform a true PF realease. He performs what is known as the Baxter Procedure which removes a 1/2' half moon section of fascia. What sort of surgery did you have? A PF release? If so how long ago and what are your current symptoms?

Re: New here

marie on 3/28/05 at 19:08 (172082)

Sorry to hear you've had such a tough time of it. Sounds like you have really been through it!Everyone here is very supportive so this is the right place!!!!!!! Welcome.:)

marie

Re: New here

Delrea K on 3/28/05 at 19:24 (172086)

Hello
Marie And John
Should I ask him about this eswt first are after the surgery.
I had a heel spur and planter release.I think that is what it is called in Nov of 01 and then again on Feb of 02 to repair the damage done by the first Dr. This Dr. nguye is good isnt he ??
Thanks
Delrea K

Re: New here

john h on 3/29/05 at 16:00 (172120)

I cannot tell you if he is 'good' or not. I can tell you he is nice, young, and a Foot and Ankle Orthopedic Surgeon who I think has a Fellowship in Foot and Ankle Surgery. If you have had a PF release I am not sure ESWT will do you any good. Dr. Z or Dr Ed can best answer that. Sounds like you have the same problems many have experienced after a PF Release. Did they release the entire fasica? I think you are going to a competent Doctor who should be up to all the latest techniques. Is you pain now on the outer part of your foot? Are you planing some sort of surgery and if so what and who recommended it? After two surgeries I would imagine you have some scar tissue issues and after a PF release it sometimes takes some months for problems to develop as you probably lost all your foot support when you had the release. I would suspect anyone with a PF release should be wearing orthotics to help pickup some of the lost support. Do you wear orthotics? Was your previous surgery done through a scope or was it an open surgery? I would make a written list of questions for your visit to the Dr at Little Rock. Ask some of the questions I am asking you or other question people on the board may suggest. Good luck. I drive by there nearly every day.

Re: New here

Delrea K on 3/29/05 at 16:50 (172124)

Hi John
My pain is all over my foot and I have radiating pain up my leg .Yes my surgery was open and he did a complete release and he removed he heel spur with a hammer and a chisel heel spur a PF release and tarsal tunnel surgery all athe same time.And of course he is going to remove some of the scar tissue. And no I dont have orthotics I wish I did specially when I have to shop .Wal- Mart is a night mare for me. Maybe the next time I go to Little Rock You can meet me and my husband for lunch.But I think the next time I go will be for the surgery.
Delrea

Re: New here

Delrea K on 3/29/05 at 17:02 (172125)

John
sorry about the last letter it was messed up
The surgery I am going to have isAlso to remove the heel spur A PF release
and tarsal tunnel surgery.That is sceduled for the 18th of April.But it may be sooner.
Delrea K

Re: New here

BrianG on 3/29/05 at 20:32 (172139)

Hi Delrea,

I hope your doing a little better this week. Just wondering if your new doctor has tested you before he gets into the TTS portion of the surgery? From what I've read, the patient is usually given a nerve conduction test, to prove the patient has TTS. If you haven't had this test, how can he (your doc) be sure of what he needs to do? If anything, this part of the surgery can lead to much worse pain down the line, as they are actually working with the nerves. I've mentioned RSD before, and I'll do it again. The slightest knick, or touch to a nerve, can lead to a life of terrible 'burning' pain. Right now there is no cure for it, which is why I'd like to see you take it easy with these procedures next month. You may think you have a 10, on the 1-10 pain scale, but if you don't already have RSD, and you get it, life will not be good, trust me. If you do have RSD, like one of your doctors thinks you do have, this could make it much worse, even eventually spreading through your entire body. It's one injury that you don't want to mess with, if at all possible.

I'm not trying to freak you out at all, I'd just like to see you slow down some, now that you have finally connected with some folks who can offer good advice, from their own experiences.

Good luck,
BrianG

Re: New here

john h on 3/29/05 at 21:50 (172144)

Derea I have also had a Tarsal Tunnel Release by your favorite Dr. Kulik. That was about 5 years ago. The scar extends 5' up the inside of my ankle from the edge of the foot over the ankle bone. It was only a 25 minute surgery. He found nothing except a vericose vein inside which he removed and it was not the problem. Crutches for 2 weeks. Stitches out in 10 days. Back to work on day 3 as I could drive since it was my left foot. Did have some swelling and not much pain as I kept my foot iced and elevated. If you have never seen your Doctor in Little Rock I am surprised he would do surgery without having examined you? Am I reading you correctly. I have been on this board almost from its inception and I have seen only 1 or 2 people who had TTS Surgery indicate it helped them. Of course the only true way eliminate the possibility of TTS is with surgery as all other test can give false positives and negatives. Consider this surgery very carefully. I would want at least 2 Doctors to advise me to have it before I would consider it knowing what I know now.

Re: New here

john h on 3/29/05 at 21:59 (172146)

Delrea: As you probably know the heelspur itself is rarely the source of pain. It is a symptom. Many people have heelspurs with no pain and many have pain and no heelspurs. Many Doctors do not remove heelspurs. The two heelspurs I have personally seen were actually sort of soft tissue as opposed to a bone (calcium) which many of us picture in our mind when we hear the word heelspur. I remain very surprised that your Doctor did not or has not prescribed an orthotic since your fascia has been completely released and you have nothing to support your foot. I would sure make a point to ask a Doctor about this. There are many good over the counter orthotics from $25 - $50 but with your surgery I strongly suggest you speak to a Doctor about the need for an orthotic and what type you might need. Your problem sounds like it has become more complex than PF and the clinic you are going to in LIttle Rock has an entire battery of Orthopedic specialist who address all orthopedic problems from neck to toe and a pain specialist.

Re: New here

Julie on 3/30/05 at 01:45 (172151)

Delrea I'd like to add my voice to John's and Brian's. Please think very, very carefully before you have more surgery. I'm not saying 'don't have it', but I am saying don't have it as soon as April 18. I know it's hard, when you're hoping this third surgery will solve your problems, but it may leave you with worse problems than you have now. So take your time. Talk to people here at heelspurs, read up here and elsewhere on the web about PF and TTS, so that you become well-informed and able to ask the doctors the right questions.
.

Re: New here

Suzanne D. on 3/30/05 at 07:46 (172157)

Delrea, I am sorry about your foot troubles and failed surgery. I don't have experience with foot surgery, but you stated you are looking for understanding friends, and I can be one of those!

Please listen carefully to the experiences and knowledge of others here, and 'do your homework' before any additional surgery. Through my almost 4 years posting and reading here, I have seen how that can pay off.

Best wishes,
Suzanne :)

Re: New here

elliott on 3/30/05 at 10:21 (172164)

Delrea, I'm going to join the chorus. I could be mistaken, but I get a nagging feeling from your writing that you view the surgery somewhat more casually than most. Any surgery has the potential to ruin your life. It can also give you a new lease on it. Buit it's not always as simple as one's a butcher, the other's a pro. Even if he's the best, there are inherent risks associated with certain surgeries, some more so than others, and those risks are always higher when it's a repeat. So it's not just, I'll give it another try and see where I end up.

You have different docs saying different things. That to me is a warning sign to take things slow and make sure you get it right. Just trying to help.

Re: TTS

elliott on 3/30/05 at 10:52 (172169)

john h, I'm going to disagree strongly with what I think is your overly pessimistic view of TTS surgery. You can count me as 1 or 2 people who had TTS surgery that helped. I am completely asymptomatic in my right foot and about 93% better in my left foot. I had clear space-occupying lesions bilaterally at surgery confirming the diagnosis, and in the foot that hurt 24/7 even without exercise, I had instant relief upon waking up (although a flareup of post-surg nerve trouble took quite some time to settle down). I can talk about my pre-surgical symptoms in detail if you like, but I had clear nervy problems pre-surgery that match the course of the TTS nerves.

I honestly believe the TTS success rates are around 75%, as frequently published. Of course, that leaves room for a lot of failures, and means that around one in four likely ends up on heelspurs. :-)

I think there are a few specific problems out there concerning TTS surgery:

1. A lot of docs who are too unfamiliar with it are performing the surgery. It requires meticulous technique.

2. Too often, a patient complaining of more general symptoms, e.g., undiagnosed inner ankle pain that does not show up on an MRI, is diagnosed as having TTS for lack of a better guess, and then TTS surgery is recommended for lack of any better ideas. Again, if you have specific nervy symptoms at the inner ankle area possibly radiating from there along the course of the nerve branches and it's driving you crazy, it can be rather easy to diagnose, and accurately, even without NCVs and surgical confirmation. It's that gray area that's the main problem. If one does not have clear nervy symptoms, I'd be real cautious about such surgery.

3. Even with a clear diagnosis, for various reasons one may not be a good candidate for surgery, yet is operated on anyway.

4. Patients often run to their next TTS surgery before giving their symptoms a chance to settle down or weighing the risks of a revision.

One thing I've been meaning to ask you about. You've posted at times your scar being anywhere from 5' to 7'. The literature puts it at around 10 cms, or just under 4'. Mine are closer to three inches, and yet my TTS releases did include the release of the first branch of the lateral plantar nerve. Is there a reason your surgeon made such a big incision?

elliott

Re: TTS

John H on 3/30/05 at 12:43 (172178)

Elliott: I measured my scar again just now. It is exactly 5' long. Probably part of this is because the surgeon did a Baxter Procedure at the same time and the incision runs to just under the edge of the foot. The incision served both the TTS release and Baxter Procedure. The Baxter procedure as you may know involves removing a 1/2' half moon section of fascia over the Baxter Nerve. This is in lieu of a PF release which he will not perfom. Dr. Baxter developed this procedure and is a recognized authority on PF. He performed the procedure on Carl Lewis who went on to run some world records after the procedure. I also had a Cheilectomy on the same foot at the same time so I had three different procedures at the same time. The surgeon is an Orthopedic Foot and Ankle Surgeon with a Fellowship and is one of the few in the state. I still caution anyone considering TTS surgery to get several opinions. The Doctor who performed the nerve conduction test on me did nothing but conduct such test. He said that a positive test did not always indicate you had TTS. My surgeon said that the only real way to know if the TTS had a problem was with surgery and he said it was my call as he could not positively tell me I had a TTS problem. I made the call as I was being rolled in for surgery. He found a vericose vein in the tunnel and removed it but later told me that would not have caused my symptoms. As you note this is a delicate surgery and one should be very picky as to who you let do this. My post indicated from what I have read on this board in the past 6 or so years I have seen only a couple of post indicating they had received relief from TTS surgery. The problem being that it is almost impossible to say that one has TTS without surgery. Clearly there would be many surgeries where there was nothing wrong in the tarsal tunnel. I cannot remember the raw data on the success rate of TTS but I really do not think it was anywhere near 70% +. I had checked that in previous years. I will do a little further research on that.

Re: TTS

elliott on 3/30/05 at 13:42 (172185)

john h, I think the TTS discussion inadvertently got thrown in to the meniscus thread. (What does either have to do with Social topics? :-)) I'll stay over here.

I can't either access that link you supplied without registering.

With TTS, you can find results all over the place. There was a famous study that found a 44% success rate; reading the breakdown in that study of the types of patients matched to their results can be fascinating. There subsequently and previously have been numerous studies. The ones I pay more attention to are the larger ones done by bigger names known to be selective in whom they choose for surgery. For example, here's one by the head surgical podiatrist at Temple:

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=8714673

Here's another by a known nerve specialist and former past president of the orthopedic society, who found overall predictable improvement:

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12627619

The following study, quoted in a chapter on nerve disorders of the current standard text on foot & ankle orthopedics, said 73% of patients were very or moderately satisfied with the procedure:

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=9498577

The doc who operated on my right foot, not a known TTS specialist, gave me 90% pre-surg odds of success. The doc who operated on my left foot, a known TTS specialist, gave me 75% pre-surg odds of success.

I totally agree with all your warnings. I gave a lot of reasons why avoidable failures may arise; there are more yet.

I take it from your writing that you have not experienced unbearable TTS nervy pain at the inner ankle. If you had it, you'd know what I'm talking about, and in such cases, the TTS diagnosis is easier (although the warnings still apply). To me such pain is more definitive than a test (of course, a patient could be faking or overblow the pain level). A very positive NCV adds comfort to the diagnosis.

Your doc said it is almost impossible to say that one has TTS without surgery. Oft-times, it is impossible to say so at surgery either, since it can happen that no obvious impingement or entrapment is observed. They still do the release, it gives the nerve more room to move, and that sometimes offers relief.

elliott

Re: TTS

john h on 3/30/05 at 16:39 (172200)

Over time 'pain' has sort of become a social topic on the board. Pain from any sort such as a nagging wife or husband or broken nose. The Treatments section has sort of remained the place primarly for PF. We have had many discussions on where something should or should not be posted in a particular section. Since this is sort of an informal board do not be surprised where any topic shows up. The main thing is to get the info out and hopefully answer peoples questions and better yet inspire them to think and question. I have had some serious PF type pain but since the Doctor found nothing in my tarsal tunnel then clearly I have not experienced serious TT pain. Of course pain is pain. I have never felt anything that even remotely matched the pain of my kidney stone. Of course in my mind I knew it would end at some point unlike PF pain. I have stated many times the big question with people who have pain they call PF is 'Where and what is the pain generator?' No one can clearly define that question and it is probably different for different people. I remain of the opinion that PF is not one disease but pain that can be created from one or multiple sources and is labeled by one name. Even among respected Doctors there is a difference of opinion as to how to cure PF and what the source of PF pain is.

Re: TTS

elliott on 3/30/05 at 22:11 (172236)

john h, I still get the impression from your writing that you tend to view all pain, or at least PF and TTS, as somewhat interchangeable and always nebulous. I'm not trying to emphasize that one pain is worse than another, I'm trying to say that if people have clear nervy pain at the inner ankle, such as numbness, burning, tingling, or electric shock, they know it. And that helps diagnose TTS. After all, TTS is an entrapped nerve at the inner ankle.

You look at quite a chunk of the posts of people here who are getting a TTS or a combined PF/TTS release, and they often make no mention of any nervy symptoms at all, because they often don't have any. I'm not saying it's impossible to have TTS without having clear nervy symptoms, but I am saying if you have them and it corresponds to the path of the nerve and branches, the TTS diagnosis is a more confident one, and if you don't have any nervy symptoms, you should be extra-cautious before assuming it is TTS. A chunk of the surgical failures are from people who never had it.

Re: TTS

John H on 3/31/05 at 10:51 (172275)

All pain is transmitted by nerves I assume Elliott. When I first developed pain in my foot I described it as a burning pain which most would say is a nerve type pain. As time went by my pain developed into something that I would now call an aching type pain. I sometimes wonder over time if my brains perception of the pain has changed or has the actual pain itself changed. Some nerve pain is very clear such as when a Doctor is testing for reflexes or hitting your funny bone. I have had low back surgery and am very familiar with pain down the sciatic nerve on back of the leg. It can be burning or at other times it can be an ache. Is it my perception of the pain or is it an actual change in the pain? Dr Baxter is quoted in the manual of Orthopedics used by Orthopedic Surgeons. He thinks PF pain is mainly caused by an inflamed fascia pressing down on the Baxter Nerve. Thus his procedures is to remove the small section of fascia directly over the nerve. Sometimes it works and sometimes it does not. Many of the medical journals note that patients presenting with PF symptoms should also be evaluated for TTS as both can produce the same symptoms. I can press down with some force in the area where I have 'PF pain?' and reproduce pain. You can also feel tightness and sometimes very small little nodules that can come and go. Some think this is inflamation some not. I think some pain we can clearly say it is nerve type pain although all pain is transmitted by nerves. Pain is really very subjective and hard to get a handle on and even hard to measure. My pain level 7 may very well be a pain level 4 to someone else. My nerve type pain may be an ache to some people. With so many cases of PF I am confident many of these people have multiple problems. PF may very well lead to TTS or the other way around. A bunion or an imobile great toe joint can lead to many other foot problems as you start to favor one foot. In the end you have a foot with multiple malfunctions and often the diagnosis may be just PF. No wonder so many PF surgeries fail. I would think the foot with all its bones and intrinsic muscles is one of the most complex structures in the body. Any problem with one part effects the other parts. If one wants to eperience some pure nerve pain then you can get it when you have some sort of spinal whereby the injecton effects the spinal chord and you get one of those shocks that feel like 220volts down you leg. I had a discogram whereby some liquid is injected into a disc and it is pumped full trying to reproduce the back pain you are experiencing. You have to be awake to report to the Doctor what you are feeling. No doubt about it when the disc bulges out and presses on a nerve.

Re: TTS

Delrea K on 3/31/05 at 14:22 (172303)

Hi
Sorry it took so long to get back to the list .Someone ask about my test I have had bone scans MRI'S nerve conduction test.Many many test.I have had pt that only made me curl up in a ball and cry like a two yr old.
My last surg was Feb of 02.I have had blocks in my spine I have also had an ablation where they severed the nerves in my back in six places I have streched and iced. At this point I would soak my foot in elephant dung if there was a remote chance it would stop even 10% of my pain .I was up until 4am this morning moaning groaning and wiping tears.I did not dare go to my bed.I have kept my poor husband up way to many nights.
Im am physicaly amd mentally exausted.All of you have gived me a lot to think about And I am not taking the surgery causually.All I want is for the pain to stop but I would settle for even a slight decrease in my pain level.All I want is a chance at a normal life.The Dr.gave me a 60% chance at that .And that is better than nothing.I understand and thank you all very much for your concern. But if I do nothing I know what im looking at And five yrs is long enough to suffer. And I may be doing the wrong thing but I have to try.I hope you can understand and still be here to help me through my recovery ,They have changed my surgery to the 5th of April.
I guess I can be a case study for the group since I am having all three done at once it should be interesting to see how it turns out.All I can do now is pray.Unless one of you have a miracle up your sleeve.
Delrea

Re: TTS

Ralph on 3/31/05 at 15:48 (172306)

Delrea,
Only you can make the final decision on what treatment you will have and when you will have it. I wish you the very best because unfortunately I have no miracles to offer you. May your surgery go well and provide you with pain relief.

Re: TTS

Delrea K on 3/31/05 at 21:24 (172340)

Thank You Ralph
Like I said All I can do how is pray that I have done the right thing.At least this way I feel like I have tried and not just given up .I have reshearched and tested and been retested for the past three years.
Now I feel like it is time to take action.
Thank You for your support.
Delrea K

Re: New here

Marcy G. on 10/05/05 at 17:19 (184167)

To whom it may interest: I accidently got on to this as I was looking for a doctor to give me an opinion about the surgery I have been recommended to have to stop the pain in my body that resulted from an accident. I had surgery on my foot after the accident. My foot exploded in a wreck where there was no talus bone or cartilidge. It has been recommended that I have my foot fused but I want to find out if there is a way it can be fixed and not fused. I cannot walk and of course my foot is swollen all the time. I have to use a walker and a wheel chair to get around. I am fortunate that my foot was not removed, because that was an option. Do you have any information that I could find out that would help my condition and choices? I have heard that Dr. Kulik in Little Rock is an excellent surgeon with the feet. Thank you for any help. MG

Re: New here

JudyS on 10/05/05 at 22:57 (184189)

Marcy - welcome to this website. It sounds as though you've got an awful lot on your plate right now and I hope you can find some support here.
You may have noticed that the message board area here has several sections - each section is titled per its content. You might want to re-post your question in the section called 'Ask the Doctor'.
Take good care of yourself - hope you can stick around here and let us know how you're doing!

Re: New here

John H on 10/06/05 at 09:29 (184197)

Marcy: I am from Little Rock and Dr. Kulik performed surgery on my foot. He performed a tarsal tunnel release, Baxter procedure, and Cheilectomy on the same foot. It took about 30 minutes for the entire procedures.

Dr. Kulik has excellent credentials. He is a board certifed Orthopedic Surgeon with a Fellowship in foot and ankle surgery. He also trained under Dr. Baxter who is a nationaly known Foot and ankle expert out of Houston. It usually takes a month or more to see him.

Another person to consider is Dr. Ruth Thomas who is Chief of Foot and Ankle Surgery at the University of Arkansas Hospital in Little . She also has great credentials and held this position for many years.

Good luck.