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lostmary 10-25-2005 05:36 AM

Anyone have surgery thru the bottom of the foot
:wave: Just wondering if any one has had surgery thru the bottom of the foot. I'm going to have a severe neuroma aremoved, and the Doc is going to go thru the bottom saying that it is the best way to remove it. How bad was it? How was the recovery? My doc said 3-4 wks non weight bearing. Besides crutches how else can you get around? I have horses, and know I can't take care of them for a while. Luckly, hubby will do that, (in addition to me and the house and his job, poor guy) Were you about to get out to the store, or did you have to not chance it? so many questions, I know. Any help or suggestion or experiences would be great.

Titchou 10-25-2005 07:05 AM

Re: Anyone have surgery thru the bottom of the foot
I'd rethink this if I were you. The best way is not thru the bottom of the foot. Mine was removed from the top (actually between the toes). There is no reason for a simple neuroma removal to have it done this way. I would question his expertise in this case. You might want to get a second opinion from a sports medicine doctor.

creative2 10-25-2005 07:51 AM

Re: Anyone have surgery thru the bottom of the foot
The neuroma is actually on the bottom of the foot fairly close to the skin. When the doc goes in that way, it is very easy to see the nerves, resect back far enough and bury the stump in muscle tissue, lessening the liklihood of a painful stump neuroma. Going in through the top requires the doc to spread open a lot of tissue to get at the neuroma. Thus more internal scar tissue. With a plantar incision, it is crucial to be NWB while it heals to prevent a painful scar. I've talked with people who have had neuromas removed both ways, and they reported similar recoveries - approx. 6 weeks to get back to regular activities. I've read that it is the norm in Europe to go in through the bottom, but has gone out of fashion in North America. I had a neuroma removed from the top and still have problems because my nerve pattern is not typical. If I go for more surgery, it will be through the bottom.
As Titchou said, it is always a good idea to get a 2nd opinion because there really are pros and cons to both. I just wanted to present some of the pros. I spoke with a podiatrist who has practiced in Europe, Canada and the U.S. He went with the flow, and changed his approach based on the country he was in. He's in Canada now and has switched from a plantar approach to a dorsal approach.
Another question to ask might be about the use of a tourniquet. Most foot docs use a tourniquet (around the ankle of thigh) to create a bloodless medium for operating. Vascular surgeons disagree with this because both the lack of blood supply during the surgery and surge of blood when the tourniquet is removed, can be harmful to the tissue. I've read where the tourniquet has been left on too long causing permanent nerve damage. Sorry, don't want to complicate things, but do want to share all that I have learned during my ordeal. Better to ask questions before than after, as surgery cannot be undone.
I wish you the best of luck and hope you get some permanent relief soon.

mediamom 10-25-2005 04:00 PM

Re: Anyone have surgery thru the bottom of the foot
I just had a neuroma surgery (through the top). I had a few opinions and one doc suggested going in from the bottom to aid in visualizaiton. Seemed to me it was for his convenience not for mine and the more I researched, the more frightened I was of possible scar tissue forming on the bottom of the foot (a problem that does occur). Remember, you have to walk on that foot so there is little room for error in terms of healing perfectly after surgery. When I spoke with my current doc about the bottom of the foot approach he said it should never be used for a first neuroma surgery---only if you have to go in and repair a botched job (or have a stump neuroma to fix). Also, remember the non-weight bearing piece. Definitely get a second opinion!!

lostmary 10-25-2005 04:47 PM

Re: Anyone have surgery thru the bottom of the foot
I understand what you are saying. I spoke to the doc about going in thru the top, and he said on this one he needed to go thru the bottom. I've had bone removed from the little toe(now I have a floppy toe), I had the ligment released from between the two toes,(4 & 5th), but that didn't work. The shots are no longer working either. He has been giving me shots about 2 -3 inches back from the base of the toe. It seems the neuroma is further back that most. He has told me I'll be nwb for about 4 weeks. I'm concerned about the scarring that may happen, but I'm hoping that if I stay off of it long enough that i will be ok. I spoke to another surgeon in the area, and he said that they don't come any better than my doc. He's a harvard grad, and I trust him, I just don't want any more pain.

Titchou 10-25-2005 09:23 PM

Re: Anyone have surgery thru the bottom of the foot
I'll say two things. One, even at Harvard, someone has to graduate last in the class...and they still call him "doctor."

Second, I don't know where you are but I have a standard way to find a proper surgeon or at least second opinion. If you are in a city of any size in the US, there is a pro sports team there. First choice is basketball, second is football...after that it doesn't much matter. Find out who they use for this procedure. You can do that by calling their front office or their "beat writer" at the local newspaper. That's the guy you want. They don't let bad surgeons operate on multi-million dollar assets. If you live in a town where there is a renowned sports medicine clinic (I mean one where you see stories in the paper about the Michael Jordans and Brett Farves who go there), find their foot guy. I live in a town with such a place...their foot guy did my neuroma and my cheilectomy....I'd follow him to the ends of the earth! Good luck!

lostmary 10-26-2005 05:14 AM

Re: Anyone have surgery thru the bottom of the foot
So true. Never think of coming in the last of the class. The closest team (basketball) is washington Nationals. I could give them a call and see who they recommend. Otherwise the next closest is Washington Redskins, and they are really in Maryland. I think I'll give it a try and see what they say. Doc said he has to be careful, as he wants to make sure that I will not have to have another surgery. I work with 4 drs. and they agree, that with the problems I've had the bottom of the foot is my best bet. (they are Pediatricians tho) I spoke to the orthopedic surgeon (the first one I went to) and he recommended amputating my little toe. That's why I don't go to him. ONe of the best infecticious disease drs actually recommended my pod surgeon. He has done surgery on me twice, my daughter once, and just did a simple surgery on my hubby. so far so good. I will call the paper to see what I can find. very good advice.

mediamom 10-26-2005 05:54 AM

Re: Anyone have surgery thru the bottom of the foot
I agree with Tichou's advice. But if you have any trouble with that (or in addition to), you can check out large teaching/university hospitals in your area and see the head of residency programs or chief of the podiatry department. As someone who had a bungled double bunionectomy (by an orthopod with a foot and ankle specialty), you need to be so careful when it comes to surgery. I think, in your case, especially because you've had previous foot problems that could possibly complicate the neuroma surgery, best to get a few more opinions. If they validate your current surgeon, all the better. If not, it will have been money and time well spent.

Keep us posted.

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