Posted by Ed Davis, DPM on 8/13/04 14:58
John:
It has been a few months since I have done a full release since the success rate with ESWT has been so high. Those who have not had complete success with ESWT have, at least, brought their level of discomfort down to the point that they will not consider surgery.
By the way, we, a long time ago discussed the possibility of surgically lengthening the fascia instead of cutting it and I stated that that was not possible. I have been thinking about this for a long time and am reconsidering that it MAY be possible. The residents I am teaching have some cadavers they are working on and I am going to test a novel approach that may allow the fascia to lengthen. If this works, yet another alternative may exist....stay tuned...
Keep in mind that the fascia is a strut that supports the foot so even lengthening it, while sounding like a good idea, has the potential to have complications in that we are shifting workload from fascia to other structures so adaptation time is needed. It boggles my mind to see that the are those getting EPFs but no casts or supportive devices to allow the foot to adapt to the loss of the fascia. EPF's are a rare procedure in the Northwest as many of us feel it is not superior (possibly inferior) to classical open or minimal incision techniques. It may carry a higher reimbursement rate.....let me say no more.... that is a whole other story.
Ed
Ed
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