Advice on my Drs Recommendation (Drs Only Please)

[NickW]

Hi again Docs!

So I had my appointment with my Podiatrist today to go over an MRI I had done last Friday. I was just hoping to get your opinion because I feel like this podiatrist may just have surgery on the brain, he seemed quite excited about it... I attached the radiologist report as well as a picture of my calcaneus with a wedge shaped drawing on it that the Dr wants to cut out due to my calcaneus being "too c-shaped" and he wants to straighten the calcaneus. From my understanding, bones once cut or broke, never get back to full strength so this scares the crud out of me, especially as I'm a runner.

I suppose I should give you all the symptoms first. I have seen 3 different doctors now and 1 physical therapist. The initial pain was in the heel and on the inside of the ankle. The first dr said I had PF and Achilles Tendonitis and just wanted to put me in an orthotic. The second dr, I can't remember exactly what he thought, but he had me do physical therapy with astym treatment which the physical therapist then found my right heel to be "locked". When he "unlocked" my heel along with doing the ASTYM treatment and also using the Stem unit the heel pain went away but I immediately developed pain in the peroneal tendons where they go through the "tunnel" just below the big ankle bone. It feels like things bind up a bit and can be pretty painful. Now the 3rd Dr thought I had a low lying muscle belly in the peroneals that was causing the binding, so he ordered an MRI to have a look. The radiologist basically reported that everything looks normal and fine except for some scarring and thickening in the anterior infrerior tibial-fibular ligament but otherwise intact (see report attached). Now after looking at this MRI this Dr wants to cut apart the calcaneus as shown and explained earlier because he thinks this may be the root cause of my problems. He also wants to cut open my ankle to cut out the "low lying peroneal muscle belly".

He did also mention that my plantar fascia is really tight. He manipulated my foot a little bit today and seemed surprised by how strong and tight everything felt on that side. He then did the other foot (my good foot) and was even more surprised to find that one was really loose compared to the other. He seemed to think this one I should have more problems with but oddly don't because of how loose everything was. My question, I guess, is it possible that things are just really tight and maybe I need to work on loosening things up? I hate to cut up my calcaneus when I have NEVER had a problem in 33 years with it (been dealing with this "PF & AT???" for a year and a halfish or so now). Is it also possible that things have weakened in the time that the heel was locked up and maybe that is the cause for the pain in the peroneals? Maybe you all can give me better ideas because I am not in any big hurry to get cut up and pieced back together and am willing to do whatever exercises or stretching I need to do in order to fix this.

Oh, and the reason for all the different docs is this has been over the last year and a half and the first dr barely looked at my foot and just seemed to hear heel pain so he prescribed custom orthotics and said PF and AT. The second dr I really liked but shortly after I found him he left the practice and so referred me to this third dr. Thanks and I appreciate any input you all can give me. Please feel free to ask questions if I did not explain anything fully enough.

 

[NickW]

I forgot to mention that I notice after stretching everything seems to feel better for a short period of time. I also forgot to mention that the pain in the peroneals is typically worst right after standing up after sitting for a long period. Seems to loosen up after being on my feet for a couple of minutes.

 

[Backfixer]

Wow, I am freaked out just thinking of the idea of this surgery. I checked your reports and quite honestly, I think you need another opinion from perhaps another discipline. I have seen many a good intentioned intervention go horribly wrong. Is it really broken, or does it need some help? Also, my experience with many foot problems include the core, and this also scares me because this is quite likely a core issue, which is tightening the back of the calves, the peroneii and the legs. Do you have upper body symptoms such as neck stiffness as well and back pain perhaps.

Have you considered a sports certified chiropractor who knows how to perform myofascial release, active release techniques or instrument assisted soft tissue. A good one will look at not only where you hurt but look at you, not just your symptoms.

Your rad report is unremarkable and the calcaneus is a normal variant. According to wolfs law, bones form based on the forces placed upon them. If you were local in NJ, I would love to help you get past this problem but unfortunately, that is impossible since you are on Oregon. The good news is that there are sports certified chiropractors in your state. Try calling the local chapter of usatf and see if they can refer you to someone or perhaps the local chiropractic sports council

 

[NickW]

Thanks for replying Doc. I used to have a lot of back pain and about 4-5 years ago I had my second (last) back surgery in which they fused the L5-S1. The first surgery to my back was to widen the holes in the L5-S1 area that the spinal cord goes through in the vertebrate because they were too narrow and pinching the spinal cord. Now only occasionally do I have tightness in my back, but I can see how this might all be related.

Oh, and I will also look around to see if I can find a good sports chiropractor.

 

[BFwillie_g]

I understand why you only want Dr's opinions Nick, but I think a Dr who wants to cut out part of your body because he 'thinks' it might be the 'root cause' of your problems, is a Dr I wouldn't be going back to in this lifetime.

 

[Longboard]

OK now that Willie has broken the Dr's only posting barrier....what the heck, my license as well as degree grants me the Dr. title anyways,....... so here goes:
For the type of symptoms and diagnosis you are dealing with I think you should avail yourself of ALL resources, whether that knowledge is coming from a licensed health care practitioner or not. You'd be surprised at the wealth of knowledge patients who have "been there" can provide.
Another thing I'd be concerned about is with your past history of nerve encroachment in your lumbar region you must be very cautious regarding ANY manipulative therapy whether being applied by a D.C., D.O., physical therapist, massage therapist, or random civilian. What works for some practitioners and patients could be doing ireversable nerve or muscle damage to others with nerve impingement related symptoms . Been there, permanent damage now.

 

[NickW]

OK now that Willie has broken the Dr's only posting barrier....what the heck, my license as well as degree grants me the Dr. title anyways,....... so here goes:
For the type of symptoms and diagnosis you are dealing with I think you should avail yourself of ALL resources, whether that knowledge is coming from a licensed health care practitioner or not. You'd be surprised at the wealth of knowledge patients who have "been there" can provide.
Another thing I'd be concerned about is with your past history of nerve encroachment in your lumbar region you must be very cautious regarding ANY manipulative therapy whether being applied by a D.C., D.O., physical therapist, massage therapist, or random civilian. What works for some practitioners and patients could be doing ireversable nerve or muscle damage to others with nerve impingement related symptoms . Been there, permanent damage now.

The reason why I put the Drs only thing on there is because I have had several posts in the past that never got answered by a doc because so many of regular posters responded that the docs assume that a doc has responded. I had just wanted to get a professionals opinion before anyone else responded and in no way did I mean to alienate you guys LB. I truly do respect your alls opinions very much.

 

[Longboard]

That's fair Nick, I can see why you would want to increase the chances of one of the Docs taking the time to respond.

 

[NickW]

Maybe I should have created two posts, one in the health forums for everyone to reply to and then this one for the docs...

 

[Longboard]

Yeah, that would maximize your information base. Might end up with more opinions than you can possibly digest, but when surgery has been proposed the more info you get the better you'll be able to make such a serious decision.

 

[NickW]

Yeah, that would maximize your information base. Might end up with more opinions than you can possibly digest, but when surgery has been proposed the more info you get the better you'll be able to make such a serious decision.

Ya the surgery is not happening, at least not at this point nor anytime in the near future. I have too much going on right now to be down for that long. I also want to get another opinion and try some other things first.

 

[Longboard]

Surgery should always be a last resort after exhausting all other options.

 

[NickW]

Surgery should always be a last resort after exhausting all other options.

Agreed

 

[BFwillie_g]

Surgery should always be a last resort after exhausting all other options.

Coming up on one year with my titanium cervical bling

 

[Longboard]

And when it is the only option we are fortunate that the technology and talent is available. Willie's case is a good example....excruciating pain from a clear-cut cause, with a terrible future outcome if left untreated or if treated with manipulation, yet with surgery he was easily cured and mowing the lawn a few days later!
Surgery is sometimes the only option, too many people are against all prescription meds and all surgery, yet many times these things are needed.

 

[NickW]

LB, my back was the same thing, very clear cut and I am obviously way better now after the last surgery.

 

[Barefoot TJ]

Coming up on one year with my titanium cervical bling

It's been a year ALREADY, Willie?! sigh.

 

[Longboard]

Time flies TJ. A year ago all I prayed for was one more ambulatory summer.
I was also seriously considering alternative surgery in Europe after hearing of Willie's successful outcome.
After instead just waiting it out I started running and lifting again last summer and am now training for a pump and run. Every case is different, Willie had a surgical success story, I had a remission of symptoms that some surgeons deemed impossible, and you experienced both plus a surgery with a poor outcome. It gets complicated I guess when we're dealing with living bodies.

 

[BFwillie_g]

It's been a year ALREADY, Willie?! sigh.

bizarre, isn't it? I mean how fast the moons go by. I have to make an appt for my 1-year check-up. I feel great, and don't expect there to be anything to report, but the area of concern is bone growth. It's possible that the bones grow too much.

 

[NickW]

Ok, so after frankendoc wanted to chop up my foot I have done a lot of reading, mostly about tight muscles and trigger points. I knew my problems probably had more to do with tight or weak muscles than with my calcaneus being slightly c-shaped or my peroneal muscle belly being to deep or me needing an orthotic. The other day I came across a video about myofascial release in the calves by using a lacrosse ball. I decided to try an experiment and I followed this videos lead, except I only did one leg and left the other leg alone. I decided to do the worst leg because, well, because it was the worst and was causing me quite a bit of pain.

I didn't have a lacrosse ball but I did have a tennis ball so I used that instead. Basically you sit down on the floor and put the ball on the floor and then rest your calf on the ball. I started in the middle of my calf down near the achilles tendon and worked up the calf and then towards the outer edges. I would slowly roll the calf over the ball in small amounts until I found a tender spot and then I would rest my other leg on top of the leg that was on the ball and just sit there for 30 seconds to a minute. I repeated this all over my calf which probably took me near a half hour just for this calf. Wow. I didn't realize it at the time because the tennis ball hurt like hell, but when I stood up after I got done I realized I had zero pain in that leg and my calf felt loose. I tried not to get my hopes up too high because I have thought I had found answers in the past, when in fact I hadn't. I went to bed a little while later and figured the real test would be if I woke up with no pain or the pain didn't come back the next as I moved around and was active. Few days later I still have ZERO pain. I have done this to my other leg to and feel much better. My legs are feeling looser than they have in a long while. Now I am contemplating getting a softball so that I can do my upper legs as well (my bubblebutt gets in the way of this and hits the floor when I try to use a tennis ball on my hamstrings). Anyhow, I just thought I would keep you all posted on my progress and I thought Doc Backfixer would like to read this (after all your suggestion was to get a second opinion and find someone who knows how to do myofascial release).