Question
Initially, I had a hyprocure implant to try to take pressure off of the ptt. Initially, the implant seemed to be ok, but after about 8 weeks, I began to have increasing pain.  The doctor re xrayed my foot and found that the implant had backed out a bit. I ended up with removal of the hyprocure and a modified kinder.  Now, by the area of the implant removal, I have a thickened scar.  I find that everytime, I touch the scar to do scar massage, my pinky toe and the one next to it has a pins and needle sensation.  The pt feels that the sensory nerve got caught up in the scar tissue and breaking down the scar tissue should release the nerve.  The doctor wants to give me a cortisone shot.  The PT doesn't feel that a cortisone shot will help if nerve is trapped in the scar tissue.  I kind of think that the pt may be right because the pins and needles happens only when the scar is touched.  How can I tell who is correct?

I am 12 weeks modified kinder.  I was NWB in a cast for 3 weeks and in a walking boot for approximately 3 weeks.  I am in physical therapy and am waiting for my new orthotics.  I have been back at work full time for about 8 weeks, the first 3 weeks in a cam walker.  While working, I have to wear a brace (element DeRoyal) to make it though the day.  When I am at home and able to take it slow, I wear my Brooks Ariel sneakers.  By the afternoon at work, even with the brace, my foot starts to throb.  By the evening, I start to get sharp pains in the area of the posterior tibial tendon and my arch and every step I take feels as if someone is sticking something sharp in my tendon/navicular area.  The doctor just says, remember you had several micro tears and the tendon has to heal.  Could these symptoms and my need for the brace to make it through a day at work be considered to be normal for 12 weeks post op?  How can you tell if the damage was completely repaired? How can I be sure that no new damage has been done post op?  I am getting very frustrated by my slow recovery and reliance on the brace 12 weeks after my surgery. Any input would be appreciated.  

Answer
This Chicago Podiatrist will answer this question
IN ANY SURGERY--
If a nerve is trapped by a suture-then you need to go in and free it- No guarantee that the symptoms will resolve,but it should improve.
If a nerve is trapped by scar tissue-then it may improve with a cortisone injection and sometimes physical therapy-with ultrasound(a heating modality that helps with scars). Also make sure that the therapist is also doing ultrasound in the area of the posterior tibial tendon insert (has healing effects also)-with your Podiatrist's approval.
If you are overweight or in a standing job all day then it can definitely take longer to heal. Good news is that you don't wake up with these symptoms, and that it takes time for them to bother you. If the symptoms of pain continue to decrease then hang in there another month.
Talk to your Podiatrist like you just talked top me.  Also have the physical therapy reevaluated.
I cannot comment on the efficacy or completeness of any surgery or treatment without the patient present.

Hope this helps!
Good Luck My Friend!


Dr George Tsatsos & Svetlana Zats
Podiatrist Chicago 60618 & Elmhurst 60126 Podiatrists
Board Certified in Foot and Ankle Surgery & Orthopedics
New South Loop Location-Chicago 60661
AnkleNFoot.com

Not Med Advise-Info for All
SEE YOUR DOCTOR IF YOU HAVE PAIN OR ARE CONCERNED