Runner Had Heel spur resection and plantar fasciotomy 3 weeks ago

by Tina Ann
( CT)

I am 23 years old and I am a runner. I am 5'1 and 105lb without significant weight changes or changes in physical activity. I began having intense bilateral heel pain after a vacation in the outer banks. I was walking on the beach quite a bit and wearing flip flops... I now will probably never be able to wear them.


I have tried physical therapy, antiinflammatory meds, ice, rest... nothing worked. I went to a podiatrist and discovered through xray I had heel spurs. I then tried custom orthotics, exercise/stretches and several rounds of cortisone injections.

They worked very temporarily (couple days max). I decided to go forth with surgery. At this point it has been 6 months since the start of my symptoms and I am very eager to get back to my normal physical activity. I had a heel spur resection and plantar fasciotomy on February 2, 2012.

The surgery itself was an outpatient procedure. I was not under general anesthesia but I was out. My (L) foot didn't bother me at all. No pain though I'm sure the pain meds helped. I did have some really sharp pain on the top of my foot and went back to my Dr the next morning.

The pain was from the dressing being on too tight. After the dressing was readjusted, it was fine. I ended up stopping the pain meds 2 days post op as the constipation it caused was unbearable. Turns out, I really didn't have foot pain even after I stopped the meds. It has helped to keep the foot elevated and iced.

My podiatrist said to stay non wt bearing for 4-5 weeks. I went back to work 5 days after the surgery. I probably work 30% standing and 70% sitting. Fortunately I work as a dietitian in a nursing home and everyone is very accommodating.

I am now almost 3 weeks post op; stitches were taken out a couple days ago and still on crutches. I am happy to say that I have not had any pain or complications with this surgery yet. I am a little nervous for when I begin walking on my foot but I am eager to start!

After reading some of these stories, it seems like people are starting to weight bear earlier in recovery. Will I be at a disadvantage for waiting 4-5weeks?



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Joshua Answers:

Hi Tina.

What do you mean by 'disadvantage by waiting...'?

I think you mean, 'is it better to get back on your feet sooner than later'.

The answer is, it just all depends.

It depends on:

* how traumatic was the surgery
* how fast do you heal
* how disruptive to your body's ability to work correctly was the surgery
* how helpful was that disruption to the dynamic that caused the bone spur heel pain in the first place.

All the original factors that cause your bone spurs to develop are still present. Surgery doesn't do anything about that. But they've removed the heel spurs and severed (some of) the structural supports of the bottom of your feet and in fact, your feet. Now what?

Now we see what the results are. Will it be better overall, or worse overall?

If you heal fast, in general, MAYBE it's ok to do a small amount of load bearing, and/or light load bearing.

Having said that, if you're a runner and fit the stereotype of 'I want to get back on the road as fast as possible', then you may want to force your self to go easy on the weight bearing and heavy on the movement. Meaning, keep the foot/ankle moving, as much as possible, without weight.

In other words, don't push it, because if you push it and get more rip tear of the surgery site, that's NOT GOOD.

Movement will keep tissue moving and mobile, tissue shortening and lengthening and muscles firing etc.

Weight bearing is fine as long as that doesn't put undue tension on all the affected tissue. Starting early is fine, but rip and tear is bad, so I'd rather be safe than sorry and stay off it.

Having said that, were I to stay off it, I would be rehabbing it like crazy as much as I could. See: Reversing Achilles Tendonitis

Why 'reversing' Achilles Tendonitis? Because while you may not have Achilles Tendonitis, you have all the same factors; muscle and connective tissue tightness, a Process of Inflammation, increased nutritional needs, etc.

See: What Is Tendonitis

The problem with not having any post surgery pain is that you may have an enhanced sense of 'I'm fine', which means you will run around too much on your feet, and then BAM! you realize you just injured yourself. Avoid that at all costs. At least with pain you can get some sense of how much danger you're in.


Bone spurs form because there's too much force pulling on them. The body shapes itself to the forces placed upon it. As I said, the same factors putting undue stress on those spots is still in place. Hopefully the surgery has disrupted that to some degree.

But you may want to deal with them sooner than later.

And the plantar fasciotomy to whatever degree severed the fascial support of the arch of your foot. That's -not- ideal.

Do you know how invasive the fasciotomy was?

What are you doing for post surgery self care and/or rehab?





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Joshua Tucker, B.A., C.M.T.
The Tendonitis Expert
www.TendonitisExpert.com
















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Comments for Runner Had Heel spur resection and plantar fasciotomy 3 weeks ago

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Feb 01, 2013
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by: Anonymous

Thanks Joshua. Saw the podiatrist yesterday. He is sending me to Physical Therapy to include iontophoresis and ultra sound treatment; he also prescribed a topical medication.

I think all this is good, however; I am concerned that they will be the same as getting the shots...a short term pain reliever without addressing the underlying cause of the problem.

He says that I'm just one of those people (few) where surgery does not correct the problem. I don't know, I'm just over it! :(

I appreciate all your information and help...:)


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Joshua Comments:

No problem. I hope whatever I can add helps.

I share your concern that iontophoresis and ultrasound won't do much if anything to correct the problem (it won't).

And "I'm just one of those people (few) where surgery does not correct the problem." is an easy way for a doctor to avoid saying "I have no idea why your hurt or what to do about it, nor am I going to get off my lazy ass and look into it even a little bit."

All the same factors that were involved in your pre-surgery pain are still involved. Gotta deal with the inflammation, tightness, nutritional insufficienncy, etc. The body is amazing, but can only do so much with the tools and scenarios it's given.



Jan 25, 2013
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What is the cause of heel spur and plantar fasciitis?
by: Anonymous

So what should we be looking at as to the cause? What other things could cause this problem? I've read every site and tried to educate myself but....I am not a doctor!I just want to run! :(


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Joshua Comments:

Basically, the Pain Causing Dynamic is the process that explains the progression of tightness and pain.

Which, in a very basic explanation, causes muscles to chronically exert too much tension on their connections, and results in the nervous system behaving as if there is injury or threat of injury.

More nutrition gets used up than you take in.

Heel spurs form for a variety of reasons including all of the above. The body shapes itself to the forces placed upon it.


Not really sure if that answered your question, but as it was an broad general question, it gets a broad, general answer.



Jan 25, 2013
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Pain Again 6 Months after fasciotomy surgery....
by: Gabbie

I had a fasciotomy (january2012)after trying orthotics, stretches, ice,cortisone,... I had the pain 1-1/2 years prior to the surgery. the surgery went fine, the dr. said the band was extremely tight. I stayed off of it & did not get the site wet for 4 weeks.

Then dr, removed stitches, and told me to start walking on it. it took 2 mos. or so to heal after the surgery. It felt great....UNTILL September, when i started getting heel pain again. not only do i have constant heel pain, but also all along the right side of my foot is in pain. so the surgery really only gave me relief for about 5 mos.

went back to dr.-she wants to fit me for orthotics, again! i am not going to get fit for them but rather try over the counter ones since the ones i had pre-surgery made my feet feel worse! the dr. also said we might try an injection if it does not feel better. i have no idea what to try now. I ice, stretch & exercise it daily, as well as most days take a pain/anti inflammatory med.which i am so worried i will have to depend on them!

i dont' know if i should let this dr. try injection or what?!! HELP. I think i would not do the surgery again if i had to go back & do it over again, cause now i have pain in other areas of the foot as well as the heel. the pain before & after sugery is about the same. some times excrucialting sometimes duller.


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Joshua Comments:

Hi Gabbie.

Why would you do surgery again if the first one 'failed' and caused more problem than you had to begin with?

Did your doctor tell you WHY the band was extra tight? I'd bet not. There is a REASON the band was tight, and that reason is still fully in place and actively affecting your leg/feet after surgery.

Why exactly did the surgeon think that surgery would fix your problem, other than the belief that surgery magically fixes everything with no downsides?

Here's why I'm not a fan of Fasciotomy surgery, and the potential downsides, and how it affects the structure of the foot as opposed to fixing the CAUSE of the pain in the first place: I Had Endoscopic Bi Lateral Plantar Fasciitis Surgery Nightmare!

YOu've been icing and stretching, but I assert that you're focusing on the wrong areas. Where you feel pain isn't where the problem actually is.

Granted, depending on what happened during surgery, there's actual structural problems in the foot now, if the plantar fascia was partly or fully severed (like cutting out all the pillars or support cables of a bridge).

A Corticosteroid Injection might be fine to help for a short period of time, but they can also increase symptoms, and if there's a problem but you don't feel it and you're walking around causing irritation but not feeling it.....that's no good.


Give me a recent update, and we'll go from there.





Jan 24, 2013
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update after plantar fasciitis surgery
by: Anonymous

I am 4 weeks out from 2nd surgery. I think it is going well because I can't even tell I had surgery unless I do something to aggravate the incision site or over stretch. I have started massaging the plantar foot (where the scar is)(got a little vibrating massager for this) and I think that helps,however; the other foot (surgery 5 months ago)continues to be very tight.

No amount of stretching seems to help it; the calf muscle is tight and the foot (arch & top of foot) hurts when I stretch. Maybe it's not plantar fasciitis. It has begun giving me pains in the morning and after rest. I asked my podiatrist what happens if pf comes back he said then we start the whole treatment all over again....I will not have surgery again and I think I don't want any more shots. I think I'll just deal with the pain using ice, etc. I'm over it.


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Joshua Comments:

"Then we'll just start the whole treatment over again."

That's probably an awesome plan of attack, since it didn't work the first time. No fine tuning, no variation, no exploration for WHY it didn't work. Let's just do it all over again.

TRANSLATION = "Because that's the only tool I have in my toolbox and I have NO idea why you're hurting in the first place"


That's a great idea to massage the surgery site now that it's healed up. Keep the tissue soft and mobile instead of hard and scartissuey.




Jan 11, 2013
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Magnesium
by: Anonymous

I am already taking a Calcium supplement b.i.d. After reading your message I bought a magnesium supplement also. Hopefully this will help with the cramping.

Another concern I am having is severe knee pain because of the cam boot which I have to wear for another week. The podiatrist is out of the office for a week so-no asking him. I don't remember this problem the last time when the right foot was done. EEEGADS! Does it ever end?



Jan 08, 2013
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ouch
by: Anonymous

Yes, it was determined that although I still have pain in my right foot, it is not as bad as before the surgery. The doctor almost backed out saying, "do no harm" but then thought it best to follow through.

I am now 11 days post surgery and one suture has come out due to a BR accident but the foot looks great; still in cam boot which is causing my knee to hurt when I walk.

My right foot continues to bother me but since my activity level is low it's not that bad. I am concerned for when I start running again. From everything I've read it may be a nerve problem but I don't think the podiatrist will consider that.

I can't really tell about the left foot yet since it is very inactive in the boot. Time will tell but my fingers are crossed.

I have no other health issues, not obese, no diabetes, I run, I'm at a good weight for my age and height, etc. so....fingers crossed.

other than the boot and pain drugs which I am not using....just lots of icing for both feet. Had a very bad foot cramp in right foot last night.

Podiatrist did a venous study...no clots but hasn't addressed why I am having so many cramps...could be over use but how can I stay healthy and avoid all these side effects? I am 55 years old- not young, but not over the hill yet. Need to stay active but wish it didn't hurt.


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Joshua Comments:

The cramps are from one or both of:

A. Magnesium insufficiency/deficiency and ll that comes with that (See: Magnesiuum For Tendonitis and

B. Post-surgery on the right foot the structure is not as optimal as it was before, everything has to work harder and differently that it's designed to. Long story short, that makes things unhappy.



Jan 06, 2013
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Ouch, plantar fasciotomy, fear have to give up running
by: Cheri

I had plantar fasciotomy in July- 5 months ago- thought I was cured. Doc cut 2/3 through fascia.

Started running around 2 months ago- now have pf in left foot. Pain was severe, tried everything. Surgery was a breeze, recovery slow. Now it feels like the entire foot has a shin splint. It feels like the bones actually hurt. I am slotted to have the other foot done in 3 weeks...having second thoughts though.

Not sure if it's just over use and rest will help, if something else is going on, or if pf has returned. Foot feels tight as do calf muscles and having lots of foot and leg cramps too.

Been icing, which helps and wearing splint at night but foot is stiff and sore (achy) all the time. Don't know what to do and not sure how podiatrist will react when I tell him...?? Don't want to quit running but have to...feeling down over the whole business! :(


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Joshua COmments:

Hi Cheri.

Please give me an update as to what's happened since you submitted this. Did you have the second surgery?

What have you been doing for self care?





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