susposedly plantar fasciitis

by Pam
(Norfolk, Nebraska)

I am a mail carrier and over 3 1/2 yrs ago I started having foot pain. Had all the symptoms of plantar fasciitis: morning pain, pain after rest, and pain after prolonged walking. I had a release done on both feet. No Help. Then was sent to a different doctor who did a stretching of my achilles tendon and an experiment thing that put over 50 holes in the bottom of my foot. (This was only done to my left foot). Then a 3rd doctor did a release on my left foot again, stating "It might have not been done right the first time." No help. I have always complained after the first surgery that the side (lateral) of my feet hurt the most after walking to much. The second doctor told me there wasn't anything there to hurt. Tonight I see there is...more fascia. I am on limited duty and walk about 3 1/2 hrs a day, I usually do about 2 hrs before I have to stop because my feet are killing me. I don't have severe heel or arch pain, just the sides of my feet. Did the release work but there's still a problem on the sides of my feet. Note: When the doctor stretched my achilles he cut me on both sides of my calf and damaged my nerve. After over 2 years I am still partially numb on the side of my foot. I need help....the post office is going to take away the duties I am doing in the office to get off my feet and this will cut my hours over 10 a week. Doesn't sound like much but it will add up to about $15,000 a yr. PLEASE HELP ME!

Note: I have had 2 different inserts and have had physical therapy 2 different times. I think the 2nd time I had therapy helped alot with the scar tissure in my left foot. You could feel the knot in my arch. One other Question: Before me 2 other mail carriers in my office had the same thing and the same doctor, they had the same surgury and both turned out great. After my first surgury I couldn't walk for almost 2 weeks....they said they could! My husband bought me knee pads because I got blisters on my knees from crawling. I am not a whimp, I can take alot of pain! Been living with it for almost 4 years.

ANSWER

Hi Pam,

My first question is did you have conservative care prior to having the plantar fascial release? Surgery should always be the last option, not the first. This is particularly true in your case for two reasons.
1. Did you have an MRI performed prior to either surgery. I hope your answer is yes and it was negative. If you never had an MRI then that is mistake one. There are other conditions that will call cause heel pain and they will not be improved by a plantar fascial release.
2. The reason you are having pain on the side of your foot is that the doctor more than likely cut too much of the plantar fascial ligament. This is a common pitfall of this type of procedure. It leads to what is known as lateral column instability whereby the outside of the foot is no longer stable when walking and typically people then get pain on the outside of the foot. So, you can see, your second doctor did not know what he is talking about.
Keep in mind that yes, you did have all the symptoms of plantar fasciitis, with one exception. Pain that occurs "the more you walk" in many instances is not plantar fascial pain but rather either an inflamed bursal sac (bursitis) or a heel neuroma.
In my section on heel pain I mention a recent conference I attended where the lecturer showed before x-rays and x-rays ten years later of a patient of his who had undergone a plantar fascial release. Clearly the patient's arch had dropped in that ten year period which as one can imagine is not a good thing.
What we are learning as the years go by is that surgery for heel pain, particularly for plantar fasciitis is no longer the best approach to this condition. You, unfortunately are living proof.
At this point you should find another doctor and work with him on a type of orthotic that gives you maximum support and relief. You might want to continue with physical therapy and if it helps, great, but keep in mind, the more time that passes, the less likely the physical therapy will be helpful.
You have a difficult problem that is compounded by your occupation. Unfortunately, I do not think there is a simple solution. One thing for sure: do not consent to any more surgery, at least not without having an MRI and getting a second opinion.

Marc Mitnick DPM
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