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  • 726.73 To operate or not to operate

    Why yes, that IS the ICD-9 code for a heel spur.

    Two of which I have on my R foot that have been hurting since APRIL. SIX MONTHS of pain that isn't severe, but constant and annoying. It starts to wear on you.

    After ice, rest, TWO cortisone shots AND a course of oral steroids, Aleve not even helping anymore, a walking boot that threw out my back so bad I was worried and almost had an MRI...no better.

    Went from a podiatrist who wanted to do plasma rich platelet injections to a REAL ortho doc who said he'll be glad to take it off like it's nothing, despite the fact he'll need to split my Achilles down the center to get to it. My previous podiatrist acted like it would be a tragedy and HUGE ordeal.

    8-12 week total recovery, I have to pay only 20% of all the professional charges, but it's a PERMANENT fix. 2-4 weeks in a cast and 6-8 in a boot. He said I'll have some calcification but it'll never get to this level again.

    The operation will be in a same day facility right behind my parents house and five minutes from my house, done by a faculty member of a major medical school.

    Thoughts of if I should go for it? Has anyone in here had it done or know someone who has? Not trying to get medical advice so much to see if anyone has been through this and their perspective.
    Last edited by Hermione; 10-09-2013, 03:30 AM. Reason: add'l info

  • #2
    What you have is probably plantar fasciitis. It's an inflammation of the plantar fascia tendon that runs along the sole of your foot. The heel spur is a calcification that builds up as a response to the irritation; it is not the cause of the problem.

    The surgery to remove the spur will probably help but the recovery period is very long and it weakens the tendon. You may build up scar tissue that results in the problem coming back.

    What you do is entirely up to you, but I would get another opinion, and explore other treatment options. There are two that I know of: there's an ultrasound procedure (not available everywhere, alas) that is non-invasive. Then there is the TOPAZ procedure, which I had done last May. Basically, my podiatrist made about 20 holes in the part of my foot where I had the pain and inserted a wire into each hole through the fascia, then ran an electroradio wave through it. I was in a walking boot for 6 weeks after, and totally non-weight bearing for the first two weeks.

    It helped; that pain has completely healed. I have had complications though; I developed peroneal tendonitis on the outside of my foot. It is healing with stretching and anti-inflammatories, but has taken a long time to get there (probably because I went back to doing Tae Kwon Do as soon as I got out of the walking boot).

    If I could have done the ultrasound procedure, I would have. My insurance won't cover it, and it's no longer available in my area anyway. But it was non-invasive, which is why I wanted to try it.

    I'm not familiar with the platelet therapy. My podiatrist told me the TOPAZ procedure would stimulate blood flow to the tendon (tendons are not very vascular) to allow it to heal. I'm thinking the same theory may apply. Ask your podiatrist to explain how and why it works.

    This is just my personal opinion, not a professional opinion: I would try the least invasive procedure possible first before letting someone split the major tendon that makes my foot work open.

    Just sayin'.
    They say that God only gives us what we can handle. Apparently, God thinks I'm a bad ass.

    Comment


    • #3
      I was beginning to wonder about this myself. I've had plantar fasciitis since about 1999. Foot Levelers orthotics and SAS shoes have pretty much made that pain go away and I'm walking without a cane, but I do have heel spurs, and lately if I roll my foot to the outside, it feels like someone is stabbing me from the inside out, and I'm afraid one day I'll see the tip of the spur protruding from the skin. I was wondering what the surgery would be like, and this gives me a few points for research on. Thanks.

      (Would personally like to avoid surgery if at all possible. It only hurts when I roll my foot, so I just try not to do that...)

      Comment


      • #4
        I had plantar fasciitis in my right foot about 10 years ago. I bought a better quality pair of shoes, and it went away within a few weeks.

        I had no more trouble until about 3 years ago, when I started using an elliptical to try and lose weight. I immediately started having pain in my left heel; it felt like razorblades in the soft tissue of the heel. I tried new shoes with no effect, stretching, but it never got better and gradually got worse. I was doing Tae Kwon Do by this point; the pain would actually vanish during my workouts, but the next morning I would not be able to bear weight on that foot because of the pain.

        Anti inflammatories helped some.

        I tried a variety of shoe inserts, none worked.

        When I went to Korea last summer, we did a lot of walking. By the last day I could barely walk at all. As soon as I got home, I went to see my doctor, who put me on oral steroids (Prednisone). The pain vanished, and I felt really, really good: lots of energy, and my chronic knee pain went away as well.

        Of course, my blood sugar shot through the roof.

        As soon as the steroids were done, the pain came back. So I tried two injections. You have to wait several months between injections. The first one worked well, the 2nd one not so well. After the 2nd one my doctor referred me to a podiatrist, who decided conservative management had run its course, and it was time for surgery. She recommended the TOPAZ procedure.

        I researched it; read a peer reviewed article on it (it's fairly new, and so there hasn't been a lot of research on it), and watched a You Tube video of the procedure. Every ortho I read on the subject dismissed the TOPAZ procedure, and podiatrists in general. I think the differing approaches are a pissing contest between the two specialties (podiatrists don't go to medical school; they go to a specialty podiatry school and their practice is strictly limited to the foot and ankle).

        I decided the procedure was worth trying. Other people may be put off by the lack of research on it.

        I had to stop taking all anti-inflammatories (aspirin, all forms of ibuprofen such as Motrin, and naproxen or Alleve) for about a month before my surgery. I also had to stop using a specially compounded pain creme I use on my knees because it contains an NSAID (ketoprofen). I could not take any of these drugs after my surgery until I got out of the boot.

        My podiatrist told me pain management should not be a problem; I would have pain for the first two days and then it should drop way off as the swelling went down. Here's where I had a complication regarding pain: I am allergic to many narcotics. I'm allergic to Hydrocodone (Vicodin, Norco, Anexia) and Oxycodone (Percocet). As in my body swells up, throat swells shut full blown anaphalaxis allergic. Morphine I can take, but it makes me very anxious; I have panic attacks that I can't breathe. I can take it but have to take Ativan to control the anxiety.

        That doesn't leave a lot of options for narcotics. Tylenol #3 (with codeine) was the only choice. I usually do well with this; it's what I took after I had my gallbladder out, and I did fine. I take it for kidney stones and do fine. So my doctor and I figured that would work fine for this; she thought the pain would be minimal.

        After the surgery, I start having excruciating pain in post op. The anesthesiologist gives me IV Demerol, and I immediately have an allergic reaction to it. So I can add one more narc to my list.

        But I feel better, and my friend Dan takes me over to Evil Empryss's house to recuperate (because of all the drugs, I could not be home alone). I slept for a couple of hours, then woke up because my foot was hurting. I took 2 T3's and tried to go back to sleep but the pain wasn't getting much better.

        So I call my doctor and tell her what's going on. I ask for a prescription for Ultram, but she didn't think that would help if T3 wasn't helping. She told me the pain shouldn't last that long and to keep taking the T3.

        Now, because the point was to improve blood flow to the surgical site, I could not take Motrin or ice it.

        I toughed it out over night; eventually was alert enough to go home. I hardly slept and was taking the T3 and hour early (overdosing) because I could not bear the pain. I thought about going to the ER, but I knew all they would do was give me an IV or IM shot and send me to my doc since I'm allergic to what they normally would give me a script for. And I didn't want to spend a couple of grand for that. I called EE first thing, and she agreed to take me to the doctor's office after dropping the kids off at school.

        My plan was to be on the doc's doorstep to insist for a prescription for oral Dilaudid (hydromorphone), which I've had before and do well with. You can get it in pill format (they don't combine it with tylenol), but most doctors will not write for it because it is so addictive. However, I have a lot of hospice patients on it, and knew it was available, and which pharmacies carried it.

        The doc was nice about it when she saw me; she was very concerned about giving me what I wanted (I don't blame her--this drug has such a high potential for abuse, and is more than what I should have needed), but she also saw how much pain I was in. She gave me what I asked for and said that most people don't have the amount of pain I was having, but some people do. She was sure the pain would only last another day or so.

        She was right. I spent the rest of that day pretty doped up; I was taking 2 tablets (the max she said I could have--she wrote for 1mg tablets if anyone cares) most of the day, but by night time I was able to drop down to 1 tablet and stretch out the time between taking them. I took a couple on the third day, but by the end of that day I could manage with T3. The fourth day I took nothing at all.

        I went back to work a week after my surgery. I had a knee walker (a kind of scooter) and crutches and could not put any weight at all on my foot for two weeks. I also could not get it wet, so I had this latex sock that I slipped over my foot so I could shower (it was a pain to use, but better than stinking). After two weeks I could partially weight bear with crutches (toe touch, basically). After four weeks I could weight bear and walk without crutches (that was a big relief--crutches were a pain). Six weeks out, I came out of the boot. I wasn't supposed to start back to Tae Kwon Do for 2-3 months post up; I went back exactly 8 weeks post op. I took it easy for the first few weeks; going just enough so I could test on schedule so I will be able to test on time for my black belt this December.

        A couple of weeks after I was out of the boot I started having a burning pain on the "blade" (outside) of my foot. A friend of mine who's a physical therapist said it's peroneal tendonitis and is probably from being in the boot so long. I probably could have followed up with the podiatrist, but my PT friend said stretching, ice, and rest should fix it. I didn't want to stop TKD, so it's taken longer to heal than it should. However it is TONS better than it was, and the plantar fasciitis is also tons better.

        One note about the boot; I had to wear it continuously for those 6 weeks: 24/7. I thought that would be a problem but it wasn't. It was actually just fine. I propped it up on a pillow and hardly knew it was there.
        They say that God only gives us what we can handle. Apparently, God thinks I'm a bad ass.

        Comment


        • #5
          Oh yes, definitely have the plantar fasciitis to go with my two GIANT spurs. One at the bottom and one at the back. Of BOTH feet actually. The Xrays look practically identical, except the one on the back of this right foot is bigger. My podiatrist even laughed.

          The left foot responded well immediately to one cortisone shot. It's the right one that won't let up.

          The platelet rich plasma does have the same theory. Get that "good stuff" in the blood for healing directly to the area. I'm gonna pass on that one though.

          I wouldn't mind him doing a plantar fascia release while he's in there, but with the trouble you had I'm not so sure.

          My big concern is once he gets in there, in particular when he slices through that Achilles, that's it. It'll heal but it'll never truly be the same. On the flip side though, I like the elliptical and do a workout with SOME lunges in it, but I'm no marathon runner, so the Achilles might not be such an issue.

          Comment


          • #6
            Quoth Hermione View Post
            Oh yes, definitely have the plantar fasciitis to go with my two GIANT spurs. One at the bottom and one at the back. Of BOTH feet actually. The Xrays look practically identical, except the one on the back of this right foot is bigger. My podiatrist even laughed.

            The left foot responded well immediately to one cortisone shot. It's the right one that won't let up.

            The platelet rich plasma does have the same theory. Get that "good stuff" in the blood for healing directly to the area. I'm gonna pass on that one though.

            I wouldn't mind him doing a plantar fascia release while he's in there, but with the trouble you had I'm not so sure.

            My big concern is once he gets in there, in particular when he slices through that Achilles, that's it. It'll heal but it'll never truly be the same. On the flip side though, I like the elliptical and do a workout with SOME lunges in it, but I'm no marathon runner, so the Achilles might not be such an issue.
            Bear in mind the complications I had could still happen to you with a plantar fasciitis release. The peroneal tendon is an unrelated tendon that runs on the lateral aspect, anterior portion (ie outside and on top) aspect of the foot. I had problems with it because I did not get any physical therapy for my foot post op (my doc didn't think I needed it) and didn't do any stretching on my own once the dressings came off. If I were to do this again, I would remove the boot long enough to do stretches (it's a simple stretch that consists of you holding your foot and twisting the most distal part of it near the toes one way and the other) a couple of times a day so the tendon doesn't stiffen.

            I've had no problems with where I had the plantar fasciitis pain. And the peroneal tendonitis is taking so long to heal because I refuse to give up Tae Kwon Do (I take ownership of this); getting my black belt on time is important enough to put up with a little foot pain. It is healing though, so I expect in a few more weeks to have no pain at all.

            My pain issues were, I think, one in a million. But pain management could still be an issue no matter what you do if a surgical procedure is involved.

            A friend of mine at work is undergoing the exact same issue as I had, and you have. Her doctor is using nitroglycerin patching on the affected area. She cuts a 0.2mcg patch in quarters and applies them to the painful spot. The idea is it improves bloodflow to the area. There are NO studies on this at all, so I don't know where her doc got the idea. She does get headaches from the nitro that Tylenol fixes. She has to do this for a month (it's only been two weeks) so we have NO idea if it will work. But I thought I'd mention it. If you're otherwise healthy, this should have minimal risks, other than a headache.
            Last edited by Sapphire Silk; 10-10-2013, 02:20 PM.
            They say that God only gives us what we can handle. Apparently, God thinks I'm a bad ass.

            Comment


            • #7
              Oh wow, a nitro patch? Never heard of that! Huh...learn something new every day.

              I'm leaning at this point towards PT, particularly with the plantar fasciitis. Friend of mine has similar issues, and we have the same podiatrist, lol. He did fix a tendon for her, but won't do her spur in the OR. She says the PT makes a huge difference.

              I just keep coming back to the fact that once he takes that scalpel to that Achilles, it'll technically heal, but it'll never be 100% the same.

              Comment


              • #8
                Quoth Hermione View Post
                Oh wow, a nitro patch? Never heard of that! Huh...learn something new every day.

                I'm leaning at this point towards PT, particularly with the plantar fasciitis. Friend of mine has similar issues, and we have the same podiatrist, lol. He did fix a tendon for her, but won't do her spur in the OR. She says the PT makes a huge difference.

                I just keep coming back to the fact that once he takes that scalpel to that Achilles, it'll technically heal, but it'll never be 100% the same.
                I hear you. I did everything I could to avoid surgery.

                I have bad knees, too. I know I'll need knee replacement surgery eventually, but I'm doing everything I can to put that day of reckoning off.
                They say that God only gives us what we can handle. Apparently, God thinks I'm a bad ass.

                Comment


                • #9
                  This surgery was the best thing I ever did. Now if I can get the money to get the other foot done I will. No more shots or pain in the one that had surgery. Still have to get shots in the one without surgery but the shots last like 1.5 years so no biggie.
                  ''Sugar cane and coffee cups, copper, steel, and cattle. An annotated history the forest for the fire. Where we propagate confusion primitive and wild. Welcome to the occupation''

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