Plantar fasciitis= surgery

[IFjane]

so IFjane, what IS the surgery?

Mimi - it's arthroscopic - heavy sedation but not general anesthesia. A tiny incision is made on each side of the heel, one for the scope, and one for all the other stuff The surgeon clips a tiny hole in the tendon to let the bone spur (cause of all the pain) poke through. I still have my bone spurs but they have nothing to rub against and there is no pain.

Recovery is crutches for a couple days to a week, then a walking-type cast for 4 weeks. I had to take it easy for about 6 weeks but after that was back to normal and had no residual pain once the inflammation in the tendon healed.

[KnottedYet]

We used to treat bone spurs with iontophoresis using acetic acid. One of the podiatrists had us doing it. I must say, it's the only time I've ever seen ionto to be really effective at *resolving* a symptom, rather than just burying it.

(the acid helps the body resorb the spur, and the PT exercises and footwear modifications take the strain off the foot which caused the pf and spur in the first place. Remember, pf is never spontaneous: it is always a symptom of something else awry in the kinetic chain. Gotta fix the original problem, or the pf will come back; acetic acid or no.)

Spurs are never resorbed completely, the periosteum has been pulled away from the bone and the body has responded by building new bone to fill in the gap created. But if you can resorb it enough to take the pain out of the equation, you can generally cope with the remaining spur. (and if that doesn't suffice, surgery is a welcome relief)

[Tri Girl]

The surgery he described is a bit different than the one you had, IFjane. He said I don't have a bone spur, but that the PF is too short and needs to be lengthened. He said they'd cut the entire width of the PF, then set it, cast it, and it would grow back together longer than before. He said I'd have a cast for 4 weeks, then I'd have to use the giant boot for a few weeks. He also said I couldn't run for about 3 months afterward.
I didn't ask many more details because I wasn't really considering surgery at that moment. I'm all about exploring EVERY other option before I go under the knife (but I think it may come down to surgery in the end).
I ran 6 today because I have a race this weekend that I needed to make sure I could do. During the run no pain at all. The rest of the day; pain on and off. He showed me a different foot taping technique that held my arch much more securely than before. Between the tape, the orthotics, and the motion control shoes: I think I did OK.

[KnottedYet]

WAIT! WAIT!! WAIT!!!!!

The pf isn't actually abnormally tight!!!! It's just under abnormal amounts of tension!

Doing surgery to lengthen it is like saying "hmm, my back is sore when I slouch. My spinal ligaments are tight when I slouch. Therefore I must cut and lengthen my spinal ligaments so I can continue to slouch in comfort."

I shudder at z-plasty of the iliotibial band. Z-plasty of the pf is a new one on me!! Oh, please, no!

(PT... go see a PT recommended by a podiatrist... get second and third opinions... find out what is causing the abnormal tension and take care of *that* before you go cutting the structure that is under tension)

Edit to add: sorry if I seem to have overreacted. I have a horror of z-plasties. Unless you have cerebral palsy and need a z-plasty of the achilles tendon. I'm ok with that.

[Tri Girl]

No, Knot, I appreciate your concern!!! I'm not real gung ho on the surgery, so it's why I appreciate any advice from anyone here. It's why I posted in the first place, because I know a lot of you are in the medical field and can share experiences/wisdom, etc. You ladies are indeed my second opinion, and I will certainly explore more. I like your overreaction... kinda motherly instinct and all.

[KnottedYet]

Oh, yeah, motherly instinct just went into total overdrive there!

To push an analogy to its utter limits: if your back were sore when you slouched I'd want to check if the chair you usually sat in gave you inadequate support (better chair = better footwear) or if your core muscles were too weak to support your back in good posture (core strength = lower extremity strength, especially hip external rotators and ironically enough core strength) or if you had overdeveloped your spinal flexors from a bunch of sit-ups and they were overwhelming your extensors and core (extensor/flexor imbalance = hip or ankle imbalance) or if you had a disc out of whack that forced you into a slouch (disc derangement = foot joint derangement) or if you just had bad posture habits (posture education = posture education, same stuff, really!) and so forth.

Edit to add: +1 on everything Wahine just said.

I'm a bit militant about PT before surgery. I freely admit my bias, and accept all consequences there of.

[Wahine]

It's good to call around to different clinics and ask if they do video analysis of running. If you can find a clinic that does that, you'll likely find a PT that is into the whole running thing. It's also good to ask a sports med doc or podiatrist. There is also a sports specialty certification here in the States but I can't remember what the designation is (the letters behind the name). Do you know Knott? I could google it but I'm a bit lazy tonight.

[Wahine]

TG - I happen to agree with Knott on this. It doesn't make sense, especially if you are an overpornator. The foot exercises Knott suggested are great. I'd also second the Chakos and emphasize again the need to see someone to assess your running mechanics, including low back and hip flexibility and strength. If the foot stuff isn't working, chances are that you have a muscle imbalance around the hips and pelvis that is contributing to you putting too much pressure on the inner part of the foot. A quick test is to do a half squat and look at how your knee lines up with your foot. Is the center of your knee cap directly over your second toe or are you knees tending to buckle in. If you're buckiling in... you really need to have all that hip and back stuff checked out. There are soooooooo many mechanical facotrs invovled including abdomenal strength that I could never point them all out. Please go see a PT with running expertise, better yet one that does video analysis of gait.

[Tri Girl]

Thanks, Wahine!
How do I go about finding a PT who specializes in sports (or one who could analyze my gait and know all about running)? I've never been to the doc for anything serious, so I don't know how to go about finding a GOOD PT. Do I find a good podiatrist first (ask the running doc I'm seeing for a good podiatrist?), then go ask them for a good PT?
Sorry if that's a dumb question.