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My Big Dilemma

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Old 04-23-2009, 03:30 PM   #1
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My Big Dilemma

Just wanted to get some advice from my fellow foot friends. You "regulars" know my history but I'll recap: PTTD surgery 05, Peroneal surgery 06, Arthroscopy with debridement 08. Diagnosed with Anterior Tarsal Tunnel 6 months ago. For this I take Lyrica daily and Talwin as needed, which is usually just at night.

My "good" foot has been gradually getting worse and now hurts at least to some degree every day. My dilemma is: Do I fix my good-now-bad foot before it gets worse? (I waited tooooo long to fix the first foot) or do I let my surgeon do a nerve release to free up the entrapped nerve on the first foot? I am not convinced that the nerve issue is my only problem. I have had signs of early arthritis in the joint with several subchondral cysts noted in my last MRI. I am afraid the first foot will eventually need fusion as I have not been pain-free since the first surgery.

I don't know if the first foot can handle the stress of having the second foot fixed. But if I don't do the second foot it will surely progress to the point of not having a choice.

I just simply don't know what to do. So right now I'm doing on pills and putting off the inevitable. I sleep in my boot every night as the neutral position is the only one that doesn't cause pain but lately it's a choice of which foot needs it more.

argggghhhhh..........I don't know what to do.


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Old 04-23-2009, 05:35 PM   #2
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Re: My Big Dilemma

i dont know about the surgery you had or are planning to have. i know that once arthritis sets in, the surgery becomes harder to do to have a positive outcome. ask your dr. and i wish you good luck.

Old 04-23-2009, 06:05 PM   #3
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Re: My Big Dilemma

emmie: as you know I just had pttd surgery on my second foot at 7 months post op from the other foot. As far as the first post op foot being ready...I actually feel like having this second surgery has given my first foot more rest than if I hadn't had the second surgery. I have a job where I am on my feet and I am a very busy person besides. So by having this other foot done now....I am forced to rest the first foot too. Yes....all of my weight is on that foot when I am up and about but that is not too much these days. BUT I had this second surgery because I was in severe I am not sure if I would have had the second surgery this soon if I could have waited it out.

And as you know, I have also had tarsal tunnel release surgery for nerve entrapment on one of my feet (the one I had the pttd surgery on first). Right now I am pretty sure that the nerve entrapment is back in that foot but I am waiting for more healing time from the pttd procedure to think about that.

You are always the one who gives the great advice and the encouragement here.....wish I could be of more help. There will never be a "right" time for another surgery as you already know.....take your time.....what has your doc said about this?

Old 04-23-2009, 06:11 PM   #4
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Re: My Big Dilemma

Hi Emmie, sorry you're still hanging around here.

Well, it's a dilemma. The nerve release surgery presumably has a relatively short recovery, but then you'll still have the arthritis and possibly need a fusion in there someday anyway. The PTTD surgery on your other foot may indeed head off problems there permanently, but then you'll have a very difficult recovery with both feet in bad shape.

PTTD repair is better done sooner than later, because the tendon might tear more. Nerve release is better done sooner than later, because the nerve might become even more sensitized. Bone fusion for late stage arthritis may as well be put off as long as the patient can tolerate things.

If it were me, I'd probably try to get the good foot repaired, because it sounds like that procedure has better odds of long-term success at that point, but I tend to have a prejudice for dealing with new problems first and ignoring the old ones. Also, I'm naturally suspicious of surgery involving the nervous system. Surgeons understand bones, muscles, tendons, forces and balances. Nerves? There's way too much we are only beginning to learn.

Try making a list of the possible outcomes each way, and the probability of each one. If you can't do that, get more information.

Try to set yourself some kind of timetable to make a decision one way or the other.

Old 04-23-2009, 07:03 PM   #5
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Re: My Big Dilemma

Although my foot problems are different from yours, it is possible to get around with both feet out of commission, it is really hard, but possible. I had very severe bunions on both feet, I waited way too long to fix them, and so I had a lapidus bunionectomy on the right foot, and the left one was hurting also, and couldn't take the stress of being the only usable foot so I ended up using a wheelchair alot, scooting around on a rolling stool, and crawling up and down the stairs. Two years after the right foot, I had a lapidus bunionectomy on the left foot (the right was pretty much recovered, and able to support my weight). Now I can see the light at the end of the tunnel.
I have no more bunions and the nightmare of the last number of years will soon be over. If your good foot is getting bad, it may be better to have surgery on it. There never seems to be a good time for foot surgery. Does your surgeon think now is the time to fix your "good" foot?

Old 04-23-2009, 09:30 PM   #6
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Re: My Big Dilemma

Thanks to all of you for the advice. You all have had some great suggestions. I haven't had "the talk" with my surgeon yet. He jokingly said that he is ignoring my second foot until I tell him he can't anymore. Truth is, I've been ignoring it myself. But it's getting to the point where I can't much longer. Although I can still do a single heel raise so it's not as progressed as the first one. I haven't had an MRI on it yet, but I recognize the pain and it is pronating more and more.

I never really thought about the fact that my first foot will get a rest along with the second foot. I do have a wheelchair so I wouldn't have to "crutch it". It sounds like the consensus of you "experts" is to take care of the second foot before it progresses. I can't help but think I will have a more positive outcome than I have had with the first one. I had a lot of extenuating circumstances leading to my ongoing problems with that foot that I shouldn't have with the second one.

Also, I just don't feel good about the nerve release surgery. I know it may entrap again just like Hurts has done. My surgeon was upfront about that possibility. Since I know it's not all of my pain I just don't know how worth it it will be. I also don't know if I have permanent nerve damage already. What if I put that foot through yet another trauma only to have the exact same pain? That would really suck. The nerve conduction test showed no conduction through that nerve. We are assuming it's entrapped in scar tissue. If it's nerve damage, the surgery would not help.

guess it's time to have that discussion with my doctor.

I like Jane's idea of setting a deadline for a decision. I think I'll do that. No, I WILL do that!

thanks guys.


Old 04-24-2009, 09:27 AM   #7
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Re: My Big Dilemma

Emmie, you poor thing!! I just saw this post, but I really don't have more to add than what's already been said.

I just wanted to give my support to you. I think you know in your heart you'll end up having surgery anyway, and like Hurts said, this way you can rest both feet at once. But gosh, I don't envy you this decision!

Let us know how it goes.

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