PF surgery

ColleenM

Cathlete
Has anyone here had or know of anyone that had the PF surgery?? I had just assumed I would always been in pain instead of asking my dr. more questions. I went back in to get new insoles and he was suprised I am still in pain. He suggested another cortisone shot today and one more (a 3rd) in a month if that doesn't work. And if I am still in pain he suggests the surgery. I'm wondering if it helped and what the recovery was like. I already wear a night splint, do exercise, ice and take ibuprofen. It only hurts if I absolutely do nothing. Also if you know of someone who had the surgery, what kind? There apparently is an ultrasound that is not invasive but most insurance companies won't cover it. I am getting new insurance in a month so I don't know if they will cover it or if I'd have to do the invasive surgery instead.

Colleen
 
I had a Plantar Fasciotomy, which is the partial release from the place that the PF inserts into the heal, after 9 months of physical therapy and cortisone which did not work. Within 24 hours of surgery, I walked normally and have never had the trouble I had prior to the surgery. I am much less inclined to do impact exrcise and have never resumed running, out of fear, and because I can never run the 35 to 50 miles I once ran. But my foot is fine. It's aches at times due to poor biomechanics which caused the trouble in the first place. 90% of people with PF issues respond well to less invasive therapies like PT or cortisone. For those of us who don't, surgery is a viable option. I was astounded by how it worked and have no regrets.
Bobbi http://www.handykult.de/plaudersmilies.de/chicken.gif "Chick's rule!"

Tell me, what it is you plan to do with your one wild and precious life? -Mary Oliver
 
Colleen,

My husband had the ultrasound procedure on both feet a couple of years ago after suffering through all the shots, etc. He's been fine every since including running with me 3-5 days a week for 4-6 miles. His insurance, fortunately, did cover the costs after some firm insistence. He is careful to ALWAYS wear supportive shoes, even in the house; he never goes barefoot. You should definitely consider this option if you find insurance will cover the cost. Good luck.

Karen
 
Thanks both of you! If either of you happen to check this again, I forgot to ask if you were on crutches? I have carpal tunnel and crutches would be awful for me. But I'm sure I'd find a way around if I had to.

Colleen
 
By the way that's "heel" not "heal" :) although it did heal and nicely too. Don't fear surgery. Get the best podiatrist you can who has performed many; surgeries if you can't use the more conventional treatments.
Bobbi http://www.handykult.de/plaudersmilies.de/chicken.gif "Chick's rule!"

Tell me, what it is you plan to do with your one wild and precious life? -Mary Oliver
 
Colleen,

My husband was not on crutches. They taped his feet (and he continued to do this for some time, can't recall how long) and he took it easy for a couple of days but he was back to work (where he's on his feet for 8-10 hours a day)in 4 days. It was amazing. Good luck in whatever you decide to do!!

Karen
 
Collen

I has pf surgery a year and a half ago. My podiatrist did everything including physical therapy, shots, steriods, insoles... My insurace would not cover the non invasive surgery because they still classified it as experimental. The podiatrist went to bat for me, but the insurace comapny would not budge!! I was reluctant to have surgery because I had a 2 year old and a 5 year old at home. I was going to pay for the noninvasive, but he told me not to. A lady at my husbands office had the noninvasive and she was fine immediately.

The surgery was easy and I walked out of the hospital immediately afterwards. I limped around for about 4 days, no crutches, but some doctors do put you on crutches. I had a lot of residual pain after the surgery that I was not expecting. Because my tendon(pod. said in part due to my large calf muscles and step aerobics) was so tight my other tendons began stretching because the one was released. My heal pain was gone immediately, but I suffered with what felt like a really bad sprain for about a year. I really could not exercise for 7 months. I also limped for a long time. He even sent me back to PT, but that didn't help.

I am fine now, but not sure I would go through it again. I hope this helps. Good Luck!

Janet
 
Colleen,

I don't think you've gotten complete information from your doctor about your alternatives. I think that most podiatrists would recommend that you get physical therapy treatments which include ultrasound (the metal ball like pregnant ladies get) to see if they can get the swelling down. The exercises, stretches, inferential treatments (with tiny electric waves) and ultrasound are painless and done on a schedule - sometimes 2-3 times a week for 6 weeks or so.

Then if that doesn't work, your podiatrist should be suggesting shockwave treatments. Shockwave treatment is no longer considered 'experimental' and is now approved by most insurances (including Medicaid) for folks who have had PF not relieved by conventional treatment. Some insurance plans have restrictions - you cannot qualify if you haven't tried other treatments for at least a year, for example.

Highspeed shockwave treatment is like the lithotripsy they use to break up kidney stones - they send a bunch of soundwaves in through your skin to 'break up' the scar tissue. It is done under a local anesthetic or 'conscious sedation'. It would be painful to do this without numbing up. Then your foot swells quite a bit - part of the reason why shockwaves work is they bring a ton of blood and healing cells to your foot to take away the scar tissue and then the swelling goes down over a few days. Usually shockwave is done with one or maybe two treatments.

From what I've read shockwave treatments work for about 60% of folks with chronic severe PF.

Then there's a partial fasciotomy done laparascopically. Most podiatrists only recommend this if you've failed 2 years of other treatments. They cut part of the plantar fascia tissue and this takes some of the stress off the heel. These days they no longer scrape calcium deposits off your heels - heel spurs have been proven to have nothing to do with the seriousness of your pain.

Healing from a fasciotomy is definitely slower and you have to be off your feet for at least several weeks. And the success rate for surgery is not that great - some folks do very well, others develop more scar tissue related to the surgery itself, etc.

So you can see there's many alternatives and your podiatrist should be going over these with you and setting up a timeline for you. I recommend getting a second opinion. I would try to find a podiatrist who specializes in sports medicine. Find a local runner's club and ask folks there for the name of a good podiatrist.

I too have PF and have suffered about 7 months - taping, icing, stretching, prescription orthotics, physical therapy, ultrasound. I'm down to about 30% of the amount of pain I was in originally. I no longer do high-impact anything and limit the amount of step aerobics I do. I've also had luck with Z-Coil shoes (they have a steel coil in the heel) to help me with prolonged walking/standing. I will likely go in for shockwave treatments come December...

Good luck!

Dawn P.
 
Thanks Dawn. Part of the issue was me. I put off the PT because when I got the RX, my dad got ill. So now fast-forward to trying to get my life back in order. I see him next week and go over stuff. I believe if I understood him he does recommend the shock wave therapy if this round of PT and the cortisone doesn't help. And he highly recommends the shock wave vs. invasive surgery (depending on insurannce). I've been having problems since November 03. Finally got referred to him in about July 04 and then got my orthotics in October 04. From July 04 on, I've been doing ice, exercises, stretching and wearing Dansko clogs until I got the orthotics.

If I do absolutely nothing, I am ok and in minimal pain. But even if I just do the bike and work my dogs in agility, I'm in pain. Sigh.

Colleen
 
Colleen,

I'm wishing you all the best in getting treatment and healing. Your doctor may recommend the physical therapy first, which I found somewhat helpful. Others have sworn that the ultrasound brings down the swelling and they have miraculous results.

Here are the treatment codes for the other two treatments so you can ask your insurance company if they cover treatment:
CPT 0020T - extracorpeal shockwave treatment for Plantar Fasciitis
CPT 29893 - endoscopic plantar fasciotomy surgery

Keep us posted! I used to run a check-in over at the VF forums(www.videofitness.com) but I turned out to be the 'sickest' one there and I was getting the most serious treatment, so it wasn't so helpful. It is nice to 'chat' with PF sufferers from time to time to find out whether they've had any success.

Dawn P.
 

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