New Document on Disability Insurance and Foot Pain
Vitamin C is extremely important for scar tissue to heal back strong. Vitamin C is required in several of the steps in collagen formation. At least 4,000 mg per day should be taken before, during, and after surgery, if it doesn't cause an upset stomach. Vitamin C used to always be used in surgery, but the anti-vitamin forces (the AMA, the FDA, and pharmaceuticals) have successfully influenced medical schools and the pharmaceutical advertising journals over the years to discredit vitamins.
Endoscopic Plantar Fasciotomy (EPF) is often the last resort. There are several other surgery options. Surgery has a success rate of 60% to 95%, depending on which source is quoted (or on which doctor performs it). EPF is the newest method. Other surgical techniques are still more common and require a larger incision (up to 2 inches) that takes longer to heal (8 to 12 weeks), but doctors may prefer the older methods to endoscopic plantar fasciotomy because it allows them to see better and cut more accurately (possibly to relieve nerve entrapment). Several sources say EPF surgery is ultimately required in about 10% of the cases. You may need to display symptoms a full year under proper treatment before a doctor will consider it. Endoscopic plantar fasciotomy is relatively new and requires equipment that some doctors may not have. Endoscopic plantar fasciotomy was first performed around 1991. It takes 20 minutes to an hour and does not require a stay in the hospital. The surgeon detaches (cuts) a portion of the fascia from the heel. A slotted tube is inserted through two small incisions (less than 1/2") in the skin on each side of the heel. Sometimes an incision is made only on the inside of the heel. A knife inserted down the tube pokes out of the slot, cutting the fascia. An endoscopic camera is inserted into the tube to allow the surgeon to see what he is cutting. The cut fascia usually relieves pain and pressure in the area. New fascia tissue grows into the gap created by the cut. Practice on cadavers is necessary. The two-portal (two incisions) method was patented by Dr. Barrett in 1993. Dr. Barrett says "Most patients return to their regular shoes in 3-5 days. Most return to work after the first week, and return to their normal activities by the end of the third week. Everyone heals slightly differently. Other factors such as age, weight, and occupation can contribute to healing times." The arch may fall some or have other problems after surgery. Using orthotics after surgery was recommended by one source. One journal article says surgery in those with flat feet may not be good (the exact quote is: "The data suggest that operations involving fasciotomy affect arch stability and should not be performed in patients with evidence of concomitant pes planus deformity, because of the likelihood of further deformation"). I have not seen any other article on EPF surgery that suggests those with flat feet should not get the surgery. A doctor informed me that he has seen about 500 cases of plantar fasciitis (heel spur) in the past two years. 50% of his patients get better with better shoes (New Balance-especially if you have wide feet, Nike, ASIC gels, Rockport dress shoes), rest, NSAIDs, frequent massage, ice, and stretching. He subjects the other 50% to the shots. Out of ten patients, 5 get the shots. 3 of those 5 are cured with the first shot. The other 2 get the second shot. One of those is cured. The last one (out of the initial ten) gets EPF surgery. He reports only 1 or 2 surgery failures out of 50 (?). After the surgery, patients are walking the same day without pain. In 4 weeks their activities are back to normal without pain. He no longer performs surgery on both feet at the same time. Dr. Lundeen (www.drlundeen.com) says "Beware if a surgeon says the spur needs to be removed, a cast or cast brace is needed after surgery, or if your doctor does not perform other arthroscopic procedures." See the surgery page for more information. Complications: The most pessimistic outcome I've read is that it causes the arch to drop some and/or cause other foot problems in addition to not curing the original problem. Two more sources say pain, infection, slow healing, and numbness due to nerve problems are more common. Dr. Lutter says "Surgical techniques that involve partial or complete resection of the plantar fascia are based on the erroneous premise that total release of the plantar fascia is necessary. Currently, removal of only a small (one third) portion of the plantar fascia is recommended."
Loss of sensation or tingling in the toes may indicate that the nerves in the heel have been damaged. The doctor may accidentally cut a nerve during surgery or inflammation from surgery may put pressure on the nerve and cause pain, loss of sensation, and/or tingling. The doctor may call it "peripheral neuropathy" without admitting any fault. It is not necessarily permanent damage.