Plantar Fasciitis (Heel Spurs): Why I Decided to Have Surgery on One Foot

by Tina Blue                                  
August 18, 2002

          Over the past ten years I have had three major bouts of severe plantar fasciitis.  The first two times I successfully treated my plantar fasciitis conservatively, as I detailed in my article "Plantar Fasciitis: How I Cured My Heel Spurs Without Surgery."

          But last summer I took a temporary factory job that required standing on a concrete floor for eight hours a day.  This caused my plantar fasciitis to recur, with a vengeance.  At the end of the summer, when school started up again at KU, where I have taught freshman-sophomore English since 1972, I was dismayed to learn that my classes were scattered all over campus.  I spent the whole day during that semester walking significant distances at top speed.

          This meant, of course, that my feet did not get any time off for healing.  On top of that, my apartment is a 20-minute walk up and down a very steep hill.  Furthermore, my car was wrecked last year in a freak accident (while parked), and as a poorly paid adjunct faculty member, I could not afford to have it fixed.  That means that to get anywhere, I usually must walk.

          Of course, one of the most important factors in treating
plantar fasciitis
is to stay off your feet as much as possible.  Since that wasn't an option for me, my plantar fasciitis became more and more aggravated, especially in my left foot.

          Part of the reason it got so bad is that I was so busy that I didn't really register what was happening until it was too late.  You know how it is.  We're so busy these days that we forget to remember that we are in pain.  (Remember that old Carly Simon song "I Haven't Got Time for the Pain"?)

          By the time I focused on taking care of myself, both feet had gotten to the point where after a normal day's walking, I would have to use a cane to hobble painfully around the apartment all evening.

          I returned to the methods detailed in my earlier article and saw some improvement in my right foot, though I was still having to do way too much walking, so it remained painful.

          But my left foot was so bad by then that even when I was sitting or lying down, it felt as though a hot nail were being driven into my heel. 

          My doctor referred me to a podiatrist, with the option of surgery if he recommended it.

          The podiatrist started off by taking X-rays of my feet and fitting me with good quality orthotic inserts.  I continued wearing my Futuro elastic ankle braces* also.  The braces, combined with the orthotic inserts, gave me such excellent support that within a week, my right foot was already about 50% better.

          But my left foot was another matter.  It was already so far gone that it showed no improvement at all.  I refused to consider a cortisone shot, because as I explained in my other article, they are excruciatingly painful and, besides, I got no significant relief from the one I did have many years earlier.

          Since this was my third bout in ten years with crippling
plantar fasciitis
, I decided to go for surgery on my left foot.  The right foot was already doing so much better with the orthotics, though, that I figured I could probably avoid surgery on it.  Still, if my right foot isn't completely healed by, say, December, I will have surgery on it, too.

Endoscopic Plantar Fasciotomy

          One of the reasons I decided to go ahead with surgery on my left foot is that there is a relatively new surgical procedure,  endoscopic plantar fasciotomy, that is far less invasive and that allows one to walk immediately after surgery.  Not only is there less trauma and more rapid healing, but the procedure itself takes only about 15 minutes.

          I am not a fan of drastic or invasive medical treatments, so the fact that I could have this procedure rather than the other made me more willing to consider the surgical option.  The idea of being able to walk right away also appealed to me, because I really cannot afford to be grounded by surgery.

          We wasted no time.  Having decided on Thursday, July 11, to do the operation, we scheduled it for the very next day at 2:30 in the afternoon.  I expected that the procedure would be done under a local anesthetic, as it usually is.  I'd had surgery 18 months earlier for trigger thumb, and had needed only a local anesthetic.  In fact, when I'd had a C-section in 1981, I had a spinal block rather than general anesthetic. 

          Partly it's because I always prefer the less drastic intervention, but partly it's because I have never completely trusted the idea of general anesthetic.

          But the most important reason why I always prefer to remain fully conscious during surgery is that I am insatiably curious.  I always want to know exactly what's going on.  Besides, I wanted to be able to watch the surgery on that cool video monitor and then report in detail on the procedure for those of you who might be interested.

          Unfortunately, I have rather poor circulation, and sometimes a local anesthetic simply will not take effect on me within a reasonable time frame.  Oh, it always works
, but often not until long after it needs to be working.

          I didn't realize that the local was not taking effect.  I had already been lightly sedated, so I was a bit spacey.  I recall saying, "Ow! Sharp!" at one point when I felt my ankle being pricked.  In fact, I think that might have happened twice.  Of course, it was the doctor testing whether the local anesthetic had taken effect. 

          The next thing I knew I was coming to in the recovery room, with the doctor trying to talk to me.   I don't remember what he said, except for his final remark, "I'll come back and talk to you when you're more awake."

          The nurses tell me he did come back to talk to me, but I have no memory at all of any such conversation.

          At one point I asked to use the bathroom.  The nurse offered a wheelchair, but they'd already put a surgical boot on my foot, and I was sure I could walk across the hall.  She walked with me, to make sure I didn't fall down, but my legs kept buckling under me--the after-effects of the general anesthesia. 

          On the way back from the bathroom, she insisted that I ride in a wheelchair.

          When we got back to my bed, she put my right shoe on and offered to tie it for me.  "No, no, I can handle it," I assured her.

          "You are determined to everything yourself, aren't you" she scolded me gently.

          By this time my friend had arrived to drive me home.  The nurse took him aside to talk to him, and I felt certain she was tattling on me, telling him to keep an eye on me.  I was right.  She'd warned him to watch me and not leave me alone for a second, because I was determined to do everything myself--the exact same words she'd directed at me.

          The doctor had recommended that I fill my prescription for pain medication before the surgery, so I would have it available if the pain flared up suddenly.  I filled the prescription--but I never used it.  I never had any pain at all!

          In the first place, that recalcitrant local anesthetic that wouldn't work at 2:30 p.m. kicked in full force right around 4:00 p.m.--after I was already home.  By 9:00 that evening the numbness from the anesthetic was just starting to wear off.

          I figured I would start feeling pain pretty soon after it wore off, but that never happened.  Now, four weeks later, I still have not had to use any pain pills.  I simply never had any pain from the operation.

          The surgery was on a Friday afternoon.  I was walking around--even up and down several flights of stairs--all weekend.  On Monday, the surgical dressing came off and I was able to wear my regular shoe instead of the surgical boot on my left foot.

          I was told I wouldn't need crutches.  It's true--I didn't.  But I did use my trusty cane sometimes, especially right after the surgery.  I could have done fine without the cane, but I just felt more secure with it.  For a while I did feel some stiffness and pressure in my foot (though not pain), and I just felt that it was better not to put all of my considerable weight on it for a while.

          A few days ago, just 3 ½ weeks after surgery, I went to the sprawling Kansas City Zoo with some friends.  We walked for
3 ½ hours
, without a break! The next day, both my feet ached a bit (remember, I still have plantar fasciitis in my right foot), but I rubbed some "Sports Creme" into them, and by the day after that, they felt fine.

          Before surgery, I had reached a point where I couldn't walk at all without crippling pain in my left foot.  I was trapped at home, because I couldn't even walk the four blocks to the grocery store! 

          But now I walk wherever I want to.  My left foot feels fine.  With the orthotics, my right foot is doing much better, too, though it still gives me some trouble.  I will wait until December to decide whether to have surgery on the right foot.

          But if your podiatrist is experienced at performing
endoscopic plantar fasciotomy
, and if your insurance will cover it, I would suggest that you consider that option if more conservative measures have not brought you enough relief.  I still say give the conservative measures a fair trial first. But it's so nice to know that if they don't work, there is an option that produces such good results without significant trauma.

Now, if you will excuse me--I'm going out for a little walk.


*To read my report on how I am doing 16 months after my surgery, click here.
* I describe the Futuro ankle braces in my earlier article.
*Read about Greg Bailey's epf surgery at "A Reader's Experience with Endoscopic Plantar Fasciotomy."  He promises to keep us informed about how his recovery goes.  I will post his descriptions as he sends them to me.
*To read about another reader's experience with "heel orthotripsy," which uses shock waves to treat plantar fasciitis non-invasively, click here.

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