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Poll of 4 DPMs on Invasive Surgery

Posted by Scott Mc on 6/09/05 at 15:20 (176404)

After 4 years, nothing has given me PF relief. (That includes ESWT.) I am therefore considering surgery.

1 DPM suggests successful surgery is possible; 2 DPMs say that my foot structure (high arched) precludes successful surgery, and the 4th DPM is non-committal.

With such conflicting feedback, how do I decide?

I'm wondering if I need to consult with an orthopaedic surgeon. I suppose if he's experienced with foot surgeries, this surgeon might have the final word (??!!??).

Re: Poll of 4 DPMs on Invasive Surgery

Ed Davis, DPM on 6/09/05 at 19:26 (176413)

Scott:
Trying a lot of different things is not always the answer but tather it is how and when you combine modlaities to cover the treatment triad.
Ed

Re: Poll of 4 DPMs on Invasive Surgery

Ed Davis, DPM on 6/09/05 at 19:27 (176414)

PS. What is home for you?
Ed

Re: Poll of 4 DPMs on Invasive Surgery

Scott Mc on 6/10/05 at 15:47 (176470)

As far as 'treatment' triad, I have seen 4 DPMs and one PT over the past 3 years. I think we have more than covered the 'inflammation' leg (ice, coritisone shots, oral anti-inflammatories, rest, etc.) and the 'biomechanics' leg(stretching, orthotics, taping, massage, environment, activities,etc.).

The 3rd leg puts me in a quandry. I have no idea of the 'tissue' quality nor does it seems as if any of the 4 DPMs have an idea. I am awaiting a DPM to respond as to diagnotic ultrasound results, as one of you on this site said that this test is standard before ESWT. Or, with the failure of the ESWT, can I assume adequate tissue quality??

The current DPM has suggested an MRI (assess tissue quality) but the other 3 believe that this test is not necessary. Can ultrasound diagnosis be substituted for the outrageously expensive MRI? ($3,000) What is your opinion on these 2 tests?

I live in Helena, Montana. I have seen 2 DPMs in Helena, one in Missoula, and one in Billings. After 3 years, YES, I would travel for better treatment.

Re: Poll of 4 DPMs on Invasive Surgery

john king on 6/10/05 at 16:15 (176473)

Scott

Remember, a doctor's first duty is to do no harm. What is cut cannot be uncut. Imagine being worse off after surgery.

Re: Poll of 4 DPMs on Invasive Surgery

Scott Mc on 6/10/05 at 16:47 (176475)

John: One must consider surgery when all else fails, despite the risks and recovery time. The alternative is a lifetime of pain.

Dr. Davis: My tissues are 5.7 and 5.6mm thick, strongly indicating plantar faciitis. (3-4 is normal.) As far as using ultrasound for more than thickness, that all depends on the 'creativity' of the interpreter. The interpreter in my case only attempted to intepret the tissue thickness.

MRI not sounding like worth money. Not much to be gained. Could talk with radiologist re applicability to PF cases.

ESWT failed because ESWTs often fail. Could try again. Invasive/endoscopic surgery a possibility if all else fails.
SMc

Re: Poll of 4 DPMs on Invasive Surgery

Dr. Z on 6/10/05 at 17:51 (176484)

IF you don't have first step morning pain both ESWT and Pf release have a high chance of failure

Re: Poll of 4 DPMs on Invasive Surgery

Scott Mc on 6/10/05 at 18:20 (176488)

My pain is barely there in the morning, which is why some DPMs like to deny my PF. However, it had all the classic symptoms in first 6 months. I've had it 3 year now and pain is lowest after a night's rest and builds over the day to a high evening level.

You say both ESWT and PF release have a high chance of failure.

So? I am condemned to a life of pain and limited activity?? Nothing to be done but keep stretching and suffering until my death relieves the PF pain??

Re: Poll of 4 DPMs on Invasive Surgery

Dr Ben Pearl on 6/10/05 at 19:41 (176497)

I have not seen anything in the literature to suggest a high arch foot has a signifigantly worse
prognosis with fascial release.

Re: Poll of 4 DPMs on Invasive Surgery

Dr. Z on 6/10/05 at 21:20 (176510)

Hey,

If the correct diagnosis is made and you feel comfortable with the doctor then go for the procedure. I have cured many patients with MIS pf releases over the past 25 years. I would be very happy to do this for you

Re: Poll of 4 DPMs on Invasive Surgery

Ron on 6/10/05 at 21:35 (176512)

May I ask your techniques in stretching?

Re: Poll of 4 DPMs on Invasive Surgery

Dr. Z on 6/11/05 at 07:52 (176519)

Ron,

I am talking about Plantar fascia surgical release. When I use stretching. I like the plantar fascia stretch and personal foot trainers

Re: Poll of 4 DPMs on Invasive Surgery

Scott Mc on 6/13/05 at 13:35 (176673)

I will try to respond in order.

2 of 3 DPMs in Montana that I have seen tell me that my high-arched feet precludes successful fascia release. The 3rd DPM disagrees and the 4th can't make up his mind.

My symptoms for 1st few month were classic but have evolved over 3 years to hurting nearly all the time except when I can stay off my feet for hours at a time. Yes, I have heel pain in the morning but it is greater after a day of standing and walking. The pain is from heel thru arch thru metatarsal--i.e. the plantar fascia area. The thick tissue (5.6-5.7mm) indicates PF. The midiagnosis of neuropathy are attempts by poor DPMs to divert me from their failures. I have read extensively on neuropathy and have experienced it in my legs. My foot pain (PF) feels nothing like my leg pain (neuropathy). The onsets of the 2 different pains were 12 years apart. The PF can be traced to an incident with stiff-soled soccer shoes. The leg neuropathy is completely idiopatic. My ankle has neither PF or neuropathic pain (indicating no connection!). I HAVE PLANTAR FACIITIS !!

Dr. Z, where are you located? Would you do an MRI first? Would you operate on both feet? Would you use endoscopic or other methods? Please compare endscopic to other methods.

Every DPM or PT tells me to stretch according to THEIR WAY. So, I've done it all for past 3 years. Leaning against a wall, slant board, and heel hanging down from a step. I am currently alternating a Step/Pro stretch and a band or a towel over metatarsal with leg extended. 3 times, each side, 20-30', 2 or 3X/day. I see that Scott recommends 2X/day for 2'. I will soon be going to the double Step/Pro stretch. Latest DPM says hold stretch for 30' (not 30')! I will try the PF Stretch you describe but am reluctant to buy more equipment (ie the Foot Trainer). SMc

Re: Poll of 4 DPMs on Invasive Surgery

Dr. Zuckerman on 6/13/05 at 13:58 (176677)

Hi
I am located out side of Philadephia. Here is my plan
I would do a minimial incision partial release. See my web site http://www.thefootspecialist.com
You must have first step AM pain and or pain when you sit for any lenght of time and get up.
Pain the insertion
No joint surface damage with the ankle. Good range of motion at the ankle without pain or grinding is the best indicator.
I will have to speak with your and discuss your entire case over the phone if you want to go this way