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Slowtwitch Forums: Triathlon Forum:
plantar surgury

Nacly

Nov 19, 09 18:44

Post #1 of 21 (697 views)

plantar surgury	Can't Post

Anyone out there have plantar fashia surgery? How did it go? Any problems? Recommend it? How long to come back?

rroof

Nov 19, 09 19:30

Post #2 of 21 (669 views)

Re: plantar surgury [Nacly] [In reply to]	Can't Post

In Reply To:

Anyone out there have plantar fashia surgery? How did it go? Any problems? Recommend it? How long to come back?

It is "surgery" and Plantar Fascia.

About 5% or sufferers will go on to "aggressive" treatments options (i.e. other than stretching, ART, NSAIDs, steroid injections, orthotics, rest, immobilization, etc.) - assuming true plantar fasciitis without infracalcaneal heel bursitis, Baxter's nerve entrapment, tarsal tunnel syndrome, calcaneal stress fx, PT tendonopathy or any number of things that masquerade and generally get lumped into inferior heel pain syndrome.

By "surgery" there are several options, from newest to oldest: platelet rich plasma injection, Topaz radiofrequency coblation, extra corporeal schockwave treatment, endoscopic plantar fasciotomy, and open plantar fasciotomy with or without heel spur resection.

There are a million sites online re: inferior heel pain treatments/forums. A bump for you for some replies here and people's recovery and decision making process.
____________________________________
Fatigue is biochemical, not biomechanical.
- Andrew Coggan, PhD

johnpostmd

Nov 21, 09 16:19

Post #3 of 21 (588 views)

Re: plantar surgury [Nacly] [In reply to]	Can't Post

Nacly - rroof has given you an extensive list of the options once you've failed conservative care. If you ask any large group of your athletic friends, you'll find a good number have experienced this at one time or another. Our local running shoe store even has a bumper sticker of "Plantar Faciitis Survivor." So, to me, the take away lesson from his post is that 95% of PF sufferers get thru this without surgery. Patience is truly a virtue here.
John Post, MD
Medical Director, Training Bible Coaching
www.trainingbible.com
http://johnpostmdsblog.blogspot.com

PirateGirl

Nov 21, 09 18:41

Post #4 of 21 (551 views)

Re: plantar surgury [Nacly] [In reply to]	Can't Post

I have three friends who tried everything and after 2-3 years had the surgery. 2 of the 3 are still dealing with it and unable to run at least a year after the surgery

Nacly

Nov 21, 09 19:08

Post #5 of 21 (542 views)

Re: plantar surgury [PirateGirl] [In reply to]	Can't Post

Thanks for your responses. I'm an old hand with PF, actually having self-ruptured my other foot to good results. The information on the internet indicate that the surgery is hit and mess, so I thought I would see if any of the slowtwitch faithfull had experience with it. I don't plan on hitting it very hard the next couple of years, so I have time to mess around with the conservative approaches.

tribike

Nov 22, 09 8:07

Post #6 of 21 (468 views)

Re: plantar surgury [Nacly] [In reply to]	Can't Post

Each week, I see 5-7 new patients with plantar fasciitis. The vast majority of these patients recover without surgery. I maybe end up doing plantar fascia surgery once every 6 weeks.

I recommend a night splint, topical anti-inflammatories, and home based exercises. If this does not work, formal physical therapy is prescribed. Orthotics may be provided in the face of obvious biomechanical abnormality. Cortisone injections are used infrequently as they may lead to plantar fascia rupture, arch strain, and nerve irritaiton.

One less invasive intervention that is gaining some popularity is injection of platelet enriched plasma. Your own blood is processed and re-injected into the heel. My results are encouraging, although no controlled studies regarding this modality have been published.

Failing the above, extra corporeal shock wave therapy is a reasonable alteranative to surgery with 70% good to excellent results. Unfortuantely, most insurance is not covering this.

Finally, in select patients, plantar fascia release is a reasonable option. Expect return to impact type activity at 3 months and healing plateau at 6 months.

Good luck.

http://www.nyfootandankle.com/...sciitis-and-heel-spu

feman

Nov 22, 09 8:26

Post #7 of 21 (456 views)

Re: plantar surgury [Nacly] [In reply to]	Can't Post

After three years of PF suffering and having done all the usual treatment plans - night splints up to ESWT- my foot doc finally did a PF partial release- and apart from the crappy infection due to an op room failure - 8 weeks of IV!!!! = BUT the surgery itself was a wonderful success. Took about 3 months post op to get back into running and now - PF pain free.

So it worked for me - and I am happy with the results
Graham Wilson
USAT Level III Elite Coach
www.thewilsongroup.biz

triguy74

Nov 22, 09 8:32

Post #8 of 21 (455 views)

Re: plantar surgury [tribike] [In reply to]	Can't Post

i'm glad i came across this post. i just recently started showing signs of PF. i'd like to get aggressive with at home remedies. is there a good online resource that shows the best (or most current) stretches and personal PT products/instructions? Which night splint works the best?

i just bought the TP Therapy lower leg kit and have started using that. I know it takes time to fix, but man I want to get this resolved ASAP!

feman

Nov 22, 09 8:35

Post #9 of 21 (453 views)

Re: plantar surgury [triguy74] [In reply to]	Can't Post

I used this site for much of my info

http://heelspurs.com/index.html
Graham Wilson
USAT Level III Elite Coach
www.thewilsongroup.biz

tribike

Dec 19, 09 10:00

Post #10 of 21 (340 views)

Re: plantar surgury [triguy74] [In reply to]	Can't Post

Try this web page for simple, effective, and validated stretching exercises. They seem ridiculously simple, but they have been show to help:

http://bit.ly/51Vl8l

Nacly

Dec 19, 09 11:32

Post #11 of 21 (318 views)

Re: plantar surgury [tribike] [In reply to]	Can't Post

What is the process that stimulates repair via the platelet enriched plasma injection? Also, among your patients that have the surgery what is the recovery rate, and does their experience translate well to someone who will be very active post-surgery?

Thanks for your thoughtful response.

Nacly

Dec 19, 09 11:48

Post #12 of 21 (312 views)

Re: plantar surgury [tribike] [In reply to]	Can't Post

Another question, if you don't mind the indulgence. I have not read anything that explains why self rupture is discouraged. Anecdotally, it seems most people seem to recover pretty well after rupturing the fascia, so if you are able to induce rupture to good result it could be a cost-effective long-term solution to a problem.

rroof

Dec 19, 09 12:32

Post #13 of 21 (294 views)

Re: plantar surgury [Nacly] [In reply to]	Can't Post

In Reply To:

LOL! Interesting thought. That is pretty much what an endoscopic plantar fasciotomy is!
____________________________________
Fatigue is biochemical, not biomechanical.
- Andrew Coggan, PhD

tribike

Dec 19, 09 17:31

Post #14 of 21 (251 views)

Re: plantar surgury [Nacly] [In reply to]	Can't Post

regarding self rupture, that is probably what happens a lot after cortisone injection. Unfortunately, rupture can lead to problems including subtle (or overt) arch collapse with resultant arch strain, nerve problems due to altered stress on the foot and subsequent traction on the nerve, and posterior tibial tendon problems. These problems can also be seen after a surgical plantar fascia release.

Platelet rich plasma probably works by the platelets ability to release healing factors in the local tissue. It seems that about 75% of patients who have failed adequate conservative treatment may get good relief with one PRP injection. Not perfect, but not bad either. A little better percentage than ESWL.

Recommended post injection regimens include protected weight bearing in a removable cast for 2 weeks, early physical therapy and consider return to running 2-6 weeks post injection depending on response.

The Big Hoss

Dec 19, 09 19:18

Post #15 of 21 (227 views)

Re: plantar surgury [Nacly] [In reply to]	Can't Post

I tried all of the conservative treatments and was able to manage PF through PT, trigger point, and better running surface choices (no roads due to camber). I wound up rupturing my PF on an 18m training run in Aug and it was a different type of pain. I went to a podiatric surgeon recommended by my PT and got ultrasound and MRI. The MRI revealed a significant amount of scar tissue that was not accessible by normal PT/Graston techniques. I got topaz coblation surgery two weeks ago. The idea is to go in and burn little holes in the PF to break up the scar tissue, get blood flow, and heal. I am back on the bike and it seems to be somewhat better than pre-surgery. Will know more when I try to run again.

damien

Dec 19, 09 19:29

Post #16 of 21 (220 views)

Re: plantar surgury [Nacly] [In reply to]	Can't Post

i had some PF issues. started running barefoot for my easy and recovery runs. all went way. No injuries anywhere.

boothrand

Dec 19, 09 19:47

Post #17 of 21 (215 views)

Re: plantar surgury [johnpostmd] [In reply to]	Can't Post

This shit can get macabre. I'm not making up the foregoing story I read. I read an article about a man who "cured" his PF by intentionally rupturing his. I have the link bookmarked at work. He read all about what his problem was and in a pre-meditated manner, intentionally sought out to rupture his plantars fascie, I believe by jumping off a table, and ruptured whichever one was plaguing him with inflammation. I believe he was from Australia.

He claimed his pain then disappeared. I wish I had the link, I saw some podiatrists discussing this on a popular podiatry forum, of course, many of them said not a good idea because the function those fibers perform for the foot, but some admitted this is kind of what they do sometimes in surgery cutting those things.
Sincerely,

Booth Rand
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boothrand

Dec 19, 09 19:50

Post #18 of 21 (213 views)

Re: plantar surgury [rroof] [In reply to]	Can't Post

This is what I was talking about down below. Self Rupture
Sincerely,

Booth Rand
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boothrand

Dec 19, 09 20:06

Post #19 of 21 (207 views)

Re: plantar surgury [tribike] [In reply to]	Can't Post

I get immediate relief, I mean, immediate, after doing 200-300 yards of swimming kick sets, and that relief will last for 4-5 hours. I'm not sure if its the flexion involved or vibration, or whether its just me being off my feet, but it is amazing. It works better than ice.
Sincerely,

Booth Rand
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johnpostmd

Dec 19, 09 20:07

Post #20 of 21 (205 views)

Re: plantar surgury [boothrand] [In reply to]	Can't Post

BR - Not easy to respond to a case study of one. And, unless the jumper had "post jump" MR to confirm fascia rupture, complete, incomplete, bruised, etc. I'd be more than a little suspect of the claim.

You have a lot of bright people - rroof, tribike, etc. contributing to this thread and, in my mind at least, what's been presented works in most people so that most athletes get back to their chosen sport with the least down time/level of invasiveness/complications, etc. In other words, if I have a patient who tells me that he/she's going to jump off a table to rid themselves of PF because they read about somebody on another continents success with this technique, I'd probably bid them adieu.
John Post, MD
Medical Director, Training Bible Coaching
www.trainingbible.com
http://johnpostmdsblog.blogspot.com

S. Pinkfontaine

Dec 19, 09 20:23

Post #21 of 21 (198 views)

Re: plantar surgury [tribike] [In reply to]	Can't Post

Everyone has different reasons for PF and in my case, it was a weak posterior tibialis muscle that was causing my foot to pronate and put a lot of pressure on the inside part of my heel. I had to deal with it for over a year and it didn't get better until I went to see a quality PT, they figured out what exactly was wrong, and we worked on it and it is now gone (in that foot).
--
"You're awesome!" --Steve Pinkfontaine
Patience isn't a virtue. Patience is a waste of my time.
http://trainingoferic.blogspot.com/ (PM for permission)