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Post TTS,pPF pain and edema are getting worse - not better

Posted by messed up foot on 4/08/05 at 12:35 (172838)

I had peroneal tendon repair in early Dec. and simultaneous partial plantar fasciectomy and TTS release in early Feb (posted on TTS site). I am in a shoe and using my Jobst stocking religiously but to be honest, I cannot realistically keep my foot elevated at work. I can stay off of it but it is always in a dependent position.

My ankle is so sore and swollen on both sides! It looks like I've got two eggs under my stocking. The pain is on the lateral side inferior & posterior to the lateral maleolus but the swelling is above the lat and med maleolus. What's up? My ortho is out of town and the only advice I get from the office is to elevate it with ice. Well as I've said - I'm at work (nurse) and putting one's foot up is about as easy as getting a lunch break and ice is too painful. We are prohibited from asking staff doc about health concerns so I'm stuck for at least 2 weeks. Primary care clinic and neurologist won't touch it. I don't see or feel any subluxation so I don't think that the tendon has re-torn.

As I said in other postings - ugly color too. Purple/red up to my knee that resolves with massage. Yes, RSD is on my mind.

Anyone with deas? The boss is getting a little tired of my need to leave work...

Re: Post TTS,pPF pain and edema are getting worse - not better

sak on 4/08/05 at 13:44 (172840)

Hi, sorry to hear about your situation. But I do have one question relating to your partial PF release, maybe two. How bad was the pain, i.e. after a 12 hour shift or just walking around a wal-mart did it hurt? I know it must have hurt 'first few steps' in the morning, but did it throb and swell just sitting or driving? I did work in construction in a very physical trade and it got so bad that I had to call UNCLE. The PF was swollen from front of heel to arch and red. Had 6 cort. shots, naproxen, ice, orthotics, ultrasound, massage, weight bearing and then non-weight bearing stretches, night splint and now 2 months of rest. Was still working out using machines but no free weights then stopped all activity after it wasn't getting better. Then went on a 6 hour drive(pain on left foot)automatic drive car and it was swelling and throbbing. Then after resting a day walked around a Wal-Mart and I felt it acting up again. My question is this, given my statement above would you consider PF and heel spur surgery or try to rest for a year or more. Pain started 18 months ago. Thanks...Scott

Re: Post TTS,pPF pain and edema are getting worse - not better

messed up foot on 4/08/05 at 16:51 (172849)

I never had heel pain per se - my heel is and was numb (hence the TTS surgery and pPF) But I did have pain morning pain on either side of my heel up into the ankle and in the evening, walking was nearly impossible (and sometimes was impossible). The surgery isn't all that bad contrary to all the comments on this website just 2 weeks of pain that the medications handle. My arch is pain free and I suspect that my ankle would be as well if I hadn't gone back to work after 2 weeks. I've said in a previous thread that it is really too bad that the docs tell us 2 weeks out of work because that becomes 'law' to our employers. I hate my nightsplint (too hot!) and the shots did nothing for me at all.

You must be a saint because 18 mo is along time with pain like this! I had the PF surgery after 6 months of pain and that was plenty thank you. I don't think any of us with this joyous condition realize how all consuming the pain can become until it is gone. Take care!

Re: Post TTS,pPF pain and edema are getting worse - not better

sak on 4/08/05 at 17:24 (172851)

Hi, the pain was under control with naproxen and cortisone, I could work, go to the gym and lift free weights even stair master wasn't a problem. Then the warnings on Nap. and a GI warning from my tummy so I went to Relafin and same symptom. I am hoping that my HMO dr. remembers his Hippo-cratic Oath. That 2 weeks off after foot surgery is totally unacceptable to me. I had a neuroma removed on the other foot and spent 3 weeks feet elevated, then 3 weeks limited activity, this was right foot. Before I went back to work my left heel was still hurting enough that I had to request a cortisone shot in it. Too bad there isn't a Home Cortisone Shot KIT available...

Re: Post TTS,pPF pain and edema are getting worse - not better

messed up foot on 4/09/05 at 11:11 (172892)

I tried to get my ortho to extend my leave. He said that returning to work was possible after 2 weeks so her couldn't say that I was unable. He did put me on limited duty with - get this - only 5 min. per hour of standing and no more than 30 min. of walking in 8 hours. How does one shower in 5 min?

On top of that, my work location is not handicapped accessible (ancient building per ADA. Opening a huge entry door while on no weight bearing status was quite an adventure! Talk to your doc about Volataren for pain. Just be careful with the stomach!

So good luck to you and start now working on those muscles need for crutches! If I had one tip to share to all on this message group, it would be get your crutches at least 2 weeks pre-op and use them at home exclusively so you build up muscle and the lovely callouses on your palms before surgery.

Re: Post TTS,pPF pain and edema are getting worse - not better

sak on 4/09/05 at 20:13 (172903)

OK I'll try the crutches before the surgery if it is necessary. I can only think of one treatment not tried yet and that is immobilizing the foot with a plaster cast... but I'm not an Orthopedic Surgeon or a Podiatrist.. I am only a carpenter...it does seem to have gotten better but we are talking NO ACTIVITY,period. I like your Drs. two weeks recovery, I wonder if he has ever had foot surgery and if so, how soon was he back at work. I was walking quite weel after neuroma surgery after 3 weeks and my Podiatrist was more than impressed with my recovery time...Take care

Re: Post TTS,pPF pain and edema are getting worse - not better

messed up foot on 4/10/05 at 09:18 (172911)

My dad was a carpenter! Do you spend a lot of time on a ladder? Think about you pain and what part of your foot you are using. In my free time(ha) I like to paint - walls, not pictures. Right now I don't think that my foot or leg would support me on a ladder. Bummer....

Immobilization actually feels pretty damned good. I could still be using my aircast but I am choosing to push the issue and wear shoes. A cast is worth a try. Like I have said before, I want my life back.

I am quite sure that my ortho has never had surgery! He is really good with operative pain control - uses a nerve block to numb from the knee down and general anesthesia. Gives morphine for post op pain (you need it when the nerve block wears off in 12-36 hrs). He really pushes patients to get back to a normal life. Maybe he's had people who use this conditions as an excuse?

Re: Post TTS,pPF pain and edema are getting worse - not better

Suz D on 4/10/05 at 16:34 (172926)

Certainly seems as if RSD is a reasonable supposition at this point. All the symptoms you describe seem to fit. Have you thought of trying Pain Management, or even a Podiatrist, for a second opinion. Ice is about the worst thing you can do for RSD. Since you are a nurse, I am sure you are more knowledgable than I am re PF or TTS. However, since I have TTS, PN, and/or RSD, I suggest you get treated as soon as possible. Your only hope of RSD remission is to get it under control within the first 6mo to a year. Best of luck. S

Re: Post TTS,pPF pain and edema are getting worse - not better

messed up foot on 4/10/05 at 19:45 (172934)

HMO will only let me see the pod at my primary clinic and he is a little ticked with me. I returned my orthotics because they gave me a blister and he took it personally.

Thanks for the support - my friends/family can see the huge scars but don't see the day to day pain. In fact, it is probably the worst part of all of this - people think that it is just feet. But they don't realize how hard it is to use feet that hurt this much nor do they think about how much we all do each day that requires walking. Actually all of us with PF (and TTS) are pretty tough individuals!

Re: Post TTS,pPF pain and edema are getting worse - not better

Ed Davis, DPM on 4/12/05 at 18:42 (173088)

If you suspect RSD, rapid diagnosis and treatment significantly increases the prognosis.
Ed