Surgical query
 

Has anyone had experience w/ surgical correction of shortened tendons/muscles together with foot/toe deformities due to PN? I have some genuine ?'s re: the procedures themselves and success rates particularly as PN progresses. This looks more and more to be the option open to correct or at least reduce some of my problems but I want to be certain before I commit particularly since both feet and all toes need a fix.

Also, any recommendations for skilled surgeons would be greatly appreciated. Thanks in advance.

Alkymst

Umm, are we talking Achilles here or...
 

something else? I do know that the achilles is connected to...and all that?

Here are some sites I've pulled in that quarter, but IF other stuff is needed gimme some key words?

http://www.nismat.org:80/ptcor/eccentric_achilles/

http://podiatry.curtin.edu.au/encycl...treatment.html

http://www.aafp.org/afp/20050901/811.html

http://www.achillestendon.com/Footwear.html

If need be, I've a distant in-law of sorts who's a podiatric surgeon in FL I could always beg and ask....

My last round of PT after given the GO after knee fracture lay up..I started walking in my Crocs...WHOEEE! I do NOT recommend that. AT ALL! It was the front of the ankles-the tendons and muscles that went into serious overdrive in terms of contraction pain upon use. Thera-bands on a regular basis and some versions of the exercises above helped...but it took about 7-12 days before I was not one yelping camper.

Do marble exercises for toe-tone too. I can't DO the toe-towell things my toes are too short! Of use? or do you need more?

BTW-OUCH and DOUBLE OUCH! That is a hurt almost as bad as the concrete-deep-fat fried nerves burning! It does not let up...ever. :hug: -j

Please
 

Who has told you this would be helpful,and they forgot Dancers.
What tests have you been given to make you think you need this.
Could you please tell us if you would.

Thanks dahlek for those posts Sue

thanks
 

Dahlek,
Thanks for your reply and the links - I'll check them out and I'll trade you a bunch that I've collected on the same topic.

Alkymst

Thank you
 

ShineySue,
thank you for responding - I must admit to my complete and relative ignorance about Dancers.
thus far 2 physical therapists, 2 neurologists, and 3 podiatrists have independently arrived at the same conclusion - it will take me awhile to gather data - what were you thinking that might have been overlooked?

Alkymst

Dahlek
 

Thanks again for the links - I read them this morning and they were very informative. I'm happy to say that I've been following a multiple exercise regimen that combines most of the ones described in the links together w/ more specific ones designed for me and my back issues. I've been doing these now for >3years (not all because of PN, lumbar problems 1st) and have had several "refresher" courses w/ the physical therapist. Unfortunately, I'm not making progress, rather finding it difficult to maintain status quo as things slowly degenerate (no pun intended) :Bang-Head:.
Some of the links I'll trade you follow - hope you won't have a need to use them but if so maybe they can be of some small use to you - they have been very helpful to me. I have others too.

http://www.seafordfootcare.com/problems_hammer.html

http://health.yahoo.com/ency/healthwise/hw143427

http://www.sma.org.sg/smj/4702/4702te1.pdf

http://www.dynomed.com/encyclopedia/.../Claw_Toe.html

http://www.wheelessonline.com/ortho/claw_toes (this orthopaedic textbook was really very helpful for me)

http://www.podiatrynetwork.com/r_hammertoes.cfm

Thanks again for the links and many pain free moments to you :)

Alkymst

Ok let me get this clear?
 

Is this the 'flexible' type or 'fixed' type of toe issue?

I looked for specifics and they don't seem to be in super-abundance on the distinctions and when the situation becomes one for surgical necessity.

One of these sites has a chart for hand 'manipulation' stretching gently at first [VERY gently I'm assuming] that seems promising...

If you can at all, try the toe/marble/pick-up thing. After 7 weeks off both feet [mostly] I had a zero toe strength...All I could do was smush the marbles inbetween my toes and the work out was getting the toes spread and flexible enuf to let them go...after two weeks it was amazing how a little practice helped my toe, foot, ankle and leg strength.

I would start off gently tho, 10 marbles one set of pick them up and get them in a dish x3 and work your way to do more 'sets'. Do NOT try to do a lot all at once...the pay-backs are worse than the initial problem!

http://orthoinfo.aaos.org/booklet/vi...pcategory=Foot

http://www.med.umich.edu/1libr/sma/sma_brkntoes_rex.htm

Hope this helps start to get you 'flexing'! - j

Oops
 

Dahlek,
sorry for the confusion, what were once somewhat flexible are becoming more and more rigid now - the toes still bend but w/ a lot of effort and discomfort. I've tried the marbles and towels for a long time, as in months and made no progress w/ either - my toes curl so much that I can't retrieve anything. I also take each toe and all of them together and bend them backwards as far as possible to stretch the tendons - same effect as doing toes stretches or hamstrings on the edge of a stair - tried those too.
the complication here is that the big toe has been sreiously pulled out of alignment, .i.e back and to the left or right depending on the foot, because of the tendon shortening - net result I can no longer straighten my toes or feet at all. this is why I feel like :Bang-Head:

Thanks
 

Dahlek,
I read the 2 links for the toe and foot exercises - very nice and well illustrated - makes repeating them much simpler. Of the many exercises that I've tried and I fail at many because I can no longer straighten my toes or either foot.

However, ones that seem to help but are also the most painful are to pull all the toes as far down as I can - this really strectches my shin and follow that by bending the toes backwards as far as I can. For most people I'm told this should stretch the plantar fascia but mine is so tight now it has no affect. Actually the joints in my toes hurt much more from this. The toes themselves still have a little mobility but they are becoming rigid.

I was hoping to get some ideas about soft tissue vs bone surgery and the pros and cons of each before my only option was the more involved bone surgery. Thanks again for the links - they've all been very good ones.

Alkymst

Alkymst and dahlek
 

Sorry Alkymst sorry for coming off so crabby,but Sjogren's Syndrone is
in a flare up,and 2 more new Drs.
First of all thanks to both of you for the wealth of information. When well
meaning Mom's start far to young children into dance lessons,all kinds
of nasty's happen to feet and toes. Many professionals dancers have
to retire at the ripe old age of hmm 28.
Have you tried the Dorsal Night Splints,I use them and the hand ones when
i can get them on without screaming. I can't pick up marbles,although i use
to. I try to do stretching exercises everyday but my toes are starting to
look like A's pictures and my Aunt Nellies toes. They just don't bend far
enough down or back. And i use to save a lot of time picking things up
up with those toes. My Aunt ended up having to have metal splints put
in 3 of hers,she couldn't get one foot in a shoe.I asked if it hurt she said
NO,but she's a tough 91 yr. old, also she's back out in the garden again.

It seems like you got a lot of yes's and have been doing your research,
and thinking things through A. I can't even get up and down on a
scale without falling on my but. Ahh for the good old days and all
that. Please post and keep us up on what you might do.And thanks
again to you both. :hug: :hug: Crabby Sue

There's no need
 

to explain anything to me Sue, I understand, my lab partner has Sjogren's Syndrome and I watch his struggles every day. I try to help him in anyway that I can - just listening seems to be of some use although I do help him "interpret" his labs and reports - sometimes a different perspective can help with the situation.

I had no idea about the issues w/ dancers - I'm culturally impaired you see but I can see how the many hours of pratice during formative years can lead a child to ruin as an adolescent and an adult. You sound as though you speak from the voice of 1st hand wisdom - if so I'm sorry that you have to deal w/ that too.

I will add another link to the ones posted already - hopefully not one anyone else will ever really need but something that was informative to me. The info is really for intrinsic muscle atrophy and deformities from diabetic neuropathy but I can relate in any case. Now just to find a Dr who can do a similar study for me.

http://care.diabetesjournals.org/cgi/reprint/25/8/1444

Thanks again for your reply - I'm sorry you were having a series of bad days and I hope you will get some meaningful relief soon. :hug: and many good thoughts to you

Alkymst

Drat!
 

Sue
I forgot to answer your ? about the night splint. It was first suggested and described to me by an extremely knowledgeable physical therapist. One of the 3 podiatrists I mentioned in an earlier post prescribed one for me which I used on each foot for quite a while. I can't really say it improved either foot but it probably slowed the progression somewhat.

The major positive effect was that I could now launch my wife's kittypuss without hurting my foot - great for me but not viewed as a significant benefit by the other half of the family - the cat's vote doesn't count.

Sorry I missed this before and thanks for the suggestion - a really good one. The splint is sort of the court of last resort I'm told.

alkymst

Ha
 

Poor kittypuss right in the air huh!! Well thanks again for the imformation.
I'm glad your lab parter has your help. Sjoren's is odd it sneaks up on you
and goes away,untill next time. But you get to visit new Drs. who seem
more confused then you Ha!! Take care and leave your wife's cat alone.
I would like to see you do that with my son's 38 lb. Kitty. And thanks
for the laugh. :) Sue

I have had my Achilles Tendon lengthened
 

Dear Alkymst;

I was convinced by the same doctor that did my first Tarsel Tunnel surgery that I needed to have my Achilles tendon lengthened. Up to that point I had lived almost 50 yrs. with my Achilles being too short but I went ahead with the recommendation. BIG MISTAKE. I had both done at the same time (no big deal, right?) so I had those horrible podiatric boots up to the knees on day and night for 5 weeks and now I find out that physical therapy could have done the same thing for me. Yea or Nay it doesn't matter since the Tarsel Tunnel surgery was a waste and only made my PN much worse and forced 2 addl. surgeries to clean up scar tissue and open the tarsel tunnel again.

I have no idea if this helps in your situation but I wish you much luck.

Nancy

Thank you
 

Nancy and yes your comments do help a lot. I apologize for not replying sooner but I had a neuro app't this AM which would shed a lot of light on my next move or lack thereof. His opinion is that since I still have some flexibility in my toes he wants me to continue PT, indefinitely if necessary, to see if things improve, even on a glacial or cosmic time scale.

He won't recommend any sort of surgical intervention until and unless my toes become completely rigid - I respect his opinion enough not to press for going under the knife so I'll hold off and certainly rethink this given your experience - thank you for sharing and I'm sorry it was such a costly experience for you.

Alkymst

My only concern, and my neuro doc, tells me the same thing....cutting does damage. You can't avoid doing even microdamage, so consider every surgery and consult your neuro..some things go out of alignment even after surgery, as the nerves are 'dead' or not functioning. Surgeons like to cut...they are good at it and it increases self esteem and revenue, and often times, it helps the patient....Neurologists see every little trauma and see millions of synapses severed....Some birds are made to fly, some birds are made to swim...just consider the perspective of the individual proposing or opposing the procedure.

I suppose you have tried orthotics and braces already. It sounds like you are up on stuff. Most orthotics need replacement every 2 years, at least for feet.

I have had a few poor docs who did nothing, when they should have, and a few excellent ones who told me when NOT to do something was the better option.

The same rule, risk versus benefit ratio!

Thanks cyclelops
 

for very sage advice. Long story short yes I have worn orthotics now for nearly 22 years, not the same pair, for lumbar problems long before manifestation of the on-going PN issues. They have been refit and recasted several times to account for the on-going changes in my plantar surfaces and toes. I've also done night splints on each foot for some months which probably slowed the progression but I have not tried a formal,rigid brace if that's what you mean.

Believe me I'm not jumping at the opportunity to go under the knife, rather just looking for some blessed relief from a 24/7/365 problem which everyone here shares in some manner.

Thanks again for your advice.

alkymst

38# and still growing?
 

Sue, yes I would defer to your son's 38# kittypuss and it brings a smile to my face although it sounds like it could be 38# of ***** kicking death and destruction! Is it a Maine Coon?

Vicki (my wife) took a roll of pictures some years ago of me holding, with geat difficulty, a 44# kittypuss named "The Big Kahuna" that belonged to the author of a children's book who came to our town for a book signing. Her story and the cat were written up in the local paper so I went to see the cat. As we arrived the author asked if we had a cat, we do - the same furball we have now - and she asked if we, read that me, would mind watching her furry lump while see signed books for a bit.

Bozo that I am I agreed and was caretaker of Kahuna for ~30-35minutes. Everyone I tell this too thinks I'm yanking their chain until I show them the pictures and then that quiets the conversation.

Thanks for the smile. :)

Alkymst

I know for a fact, have scars to prove it ...
 

that a cat of ANY size, when angry, is not one to 'cuddle with'? My long gone 18 pounder [that's after the diet...he chewed/gnawed the furniture in protest] had wonderful eyes....they changed color according to mood -could always tell when I was in the Danger proximity....meaning close the door! But this guy KNEW how to open plain old round doorknobs. My apartment downstairs neighbor thot I had a 'puppy'. Beast would fall asleep on these big-wide window sills and FALL off FLOMP...the lady loved the beast, and I would bring him down to 'visit' her on his leash [yes, I leash-trained him...took lots of time and patience, used to take him for 'walks' in area parks..had to usually carry him back-ugh].
I would think a cat 2X's the size of my big guy would be either the size of a standard poodle or well, pretty fat? Am I wrong here?

As for surgery, I'd had plantar treatments for over a year on a wart I couldn't see...the doc did NOT want to create more scar tissue and other issues for me later. My podiatrist now does NOT want to do any ingrown nail removal stuff on my feet now due to the neuropathy..even tho I've escaped any infections and all to date...[It was all done chemically, salacylic acid every two weeks for a year...almost akin to the stabbing pains of acute PN's- no scars tho - tied a long-term treatment record w/a guy from the FBI?]

With neuropathy, any surgeries or other invasions in key areas are risk rated 50-100% higher due to possible complications. Your circulation and vascular aspects are compromised as with those who have diabetic neuropathies...you are less likely to heal normally due to those complications, I would think. As for micro damage due to surgeries...it depends...but the stuff is micro surgery or should be! With that, IF and only IF there were no tolerable alternatives, I would surely look for the BEST micro-surgeon to do whatever needs doing.. AND a surgeon who does nothing but THAT aspect you want addressed. Otherwise I would approach it all with pounds of caution...

GEESH! Orthotics for that long? OUCH! - j

Dahlek
 

You're up late - hope it's by choice and not due to pain. To your ? about the cat, the big Kahuna I presume - if I can figure out how to scan the pictures and post them I will - you have to see this thing to believe it. He was the size of a medium sized dog but he really couldn't lay down like a normal cat - his legs splayed out beneath him so I suspect he really wasn't very comfortable.

I'll show Vicki your post about your cat on a leash. She tried w/ her furball a few times and on each occassion he just swelled up like a furry tick, moaned and groaned angrily, and threatened imminent eruption. If she tried to move it, it would literally be dragged for a real short distance - probably not good since we didn't want cat abuse charges. We've found that just holding the leash now elicits the same response so we've abondoned this as a viable exercise.

I can share your experiences w/ plantar warts although not for the length of your treatment. Many years ago I had multiple ones chemically burned off of both feet using nitric acid rather than salicylic - always remember the conical shaped depressions ~1/16-1/8" deep on my feet after the treatment and debriding the dead skin - took multiple visits over a few months but it worked well and I've not been bothered by them since.

You're dead on about the surgery and I'm not anxious to do so, just anxious to get some relief. I am fortunate re: vascular issues in that I have no compromised circulation in my legs or feet. Just had the 2nd Doppler study and ABI's for both feet done ~ 5 months ago - my PCP and cardiologist are excellent about working w/ me for these types of concerns. Long story short - thankfully no issues for me, normal waveforms from femoral through feet including dorsal pedal and posterior tibial. ABI's were normal bilaterally too. At the same time my PCP ordered a 3 phase bone scan which ruled out RSD.

From the neuro's view yesterday he won't recommend surgery until all else has been shown to fail unequivocally. Highlite of the visit was his determination that I am a curmudgeon which tickled Vicki no end. However, I pointed out that she could be a curmudgeonette by default.

Your advice to search out the best microsurgeon is dead on too. I'm doing so now but hoping that the search results won't be necessary. I've worn orthotics now for so long that to go without them is more uncomfortable for me. Thanks again for your kind thoughts - many good ones back to you!

Alkymst

Hi. When I first had this pain I went to a foot/ankle doc and though my emg did not show tarsel tunnel he still felt like it may be. I wore the air boot which was first given to me by the ortho when though it may be a fracture but could also help with tts. I had 2 shots of cortisone in that area which made it worse. Since none of my tests at that time showed pn and at start was so isolated I wanted to do surgery as well but then started having other symptoms and had more tests which showed pn. I too just wanted relief and even now would like to have surgery to just be fixed but forget though things seem like they can't get worse there always is if you know what I mean. Before this there is a website and I don't know if its more a sales thing as I am very skeptical of everything but called the dillion institue and its more on issues like tts. Good luck in what you decide and I understand the frustration and fear.

Many thanks!!
 

Daniella,
Many, many thanks for your comments and I'm so sorry about your situation and frustration. I know the website well - the A. Lee Dellon Institute in Baltimore - went there ~ 2years ago for an evaluation since preliminary e-mail correspondence w/ Dellon himself suggested that I might have some entrapment contribution to my situation and that they could help.

I was seen by one of Dellon's partners who gave me a most thorough physical evaluation and concluded there was only ~20% chance that surgery would give me any benefit. He suggested some other non-surgical possibilities and told me to pursue them before I opted for surgery - I have done so since. I give this fellow credit that he didn't push surgery as the only solution. In fact, later on a very skilled physical therapist I've seen multiple times during the last 3 years told me that I had little evidence for tarsal tunnel syndrome which was subsequently confirmed unequivocally by my neurologist at UPenn. I know people have long debated the "value vs hype" of Dellon's work and I seem to remember there were posts on this site some time ago that addressed this issue.

At my neuro app't yesterday he discussed at length other issues that could contribute to my deformed toes and feet besides PN and he wants to pursue all of them before any surgery - as you said - it can always be worse and surgery is not always the answer.

Thanks again for your kind words - I hope you will find some meaningful relief yourself.

Alkymst