Saturday, February 22, 2014

Thinking About Foot Surgery? Ten Things You Need To Think About BEFORE You Have Foot Surgery.

Ten Things You Need To Think About
BEFORE 
You Have Foot Surgery.


1. You need to exhaust conservative treatment before you decide to have foot surgery.
Assuming that you are having foot pain, before you have foot surgery you should try three months of this regimen: no barefoot walking, no walking around the house in just socks, no flip-flops, and no flimsy bedroom slippers. You should be wearing RX Crocs in the house as a bedroom slipper and you should try New Balance 928 or 1540 with custom-molded orthotics. If you cannot get a custom-molded insert, try over-the-counter inserts such as Powerstep or Superfeet. 

Even if you have surgery and you get a perfect result, if you are not doing these things and wearing proper shoes after the surgery - you are setting yourself up for more foot problems and a higher risk of the problem coming back. Yes, bunions can reoccur - even after a successful surgery.


2. The goal of foot surgery is to take an abnormal painful foot and turn it into an abnormal non-painful foot. 
A common misconception of foot surgery is that, after the surgery, you are going to have a normal foot that is cosmetically pleasing. Of course, that is the desired outcome but in reality - the goal of foot surgery is to have a non-painful and cosmetically pleasing foot that functions well in proper shoegear and orthotics. 

I've been running an unoffical patient survey for years. I ask patients who had foot surgery years ago if they were pleased with the outcome and, if they could go back in time, would they do it again. Eighty percent of patients say they are not happy with the outcomes and that it was more painful and took longer to heal then they originally thought and that they would not do it again. About twenty percent of patients are happy with the results and say they would do it again.


3. The only time you should consider elective foot surgery (meaning it is not an emergency situation) is if conservative treatment has failed and you have hit a point where you are having so much pain that you can't do your normal daily activities.
Years ago, an elderly gentleman came into the office for a second opinion on whether or not he should have bunion surgery. 
As he was taking off his shoes I asked, "Does your bunion hurt?" When he said that the bunion didn't hurt, I said, "Then don't have surgery." He started laughing and said, "Aren't you going to wait for me to take off my shoes?" I told him that he was eighty-two years old and if his bunions didn't hurt, he doesn't need surgery. 

My experience has been that if you do a bunion surgery on an older but active patient and have them elevate and rest their foot for six weeks - that person might like resting too much and might not want to get up and get going after they are healed. If you are active and your bunions don't hurt - let's keep you active and enjoying life. 


4. If any doctor guarentees the outcome of your surgery - RUN!
In medicine, there are exceptions to every rule and there are no guarentees - especially with surgery. When you sign a pre-op consent for any surgical procedure, you are signing that you understand that a possible outcome of the procedure is everything from infection, chronic pain, failure of the implant, disability and possibly death (to name a few). 


5. Be proactive and get a second opinion. 
If you line up ten different doctors, you are going to get ten different opinions. It's frustrating but true. 

As a patient, you have to be proactive. Do your research, ask questions and get a second and even third opinion. A good doctor is not offended or intimidated by a patient getting a second opinion. If your doctor is offended by you getting a second opinion then that is his or her problem. Your decision to have surgery and choose the surgeon is not about their pride - it's about you making the best decision possible and gathering information is an important part of the decision making process. 


6. Foot surgery is more subtle and complex than you think - the foot heals slower, hurts more and swells more because while you are trying to heal it, you are walking on it. 
Because the foot is weight-bearing, recovering from a foot injury or surgery can be frustrating. If you break your nose, it's going to heal much faster than your foot because you are not walking around on your nose. 

Hammertoe surgery sounds easy but is one of the more subtle and complex surgeries. It's actually quite easy to do the surgery. What's hard is getting good results. I have a practice full of ladies who had this surgery twenty-plus years ago and are very uphappy with the results. Their toes are not cosmetically pleasing and often still have painful corns and ulcerations.  


7. After foot surgery, you can have swelling and low grade pain for up to one year. 
This may not be the case but you should expect that there is a good chance that this will occur. The best way to prevent this from happening is to be compliant with the post-op plan that your surgeon will reveiw with you. If you are non-compliant and do too much walking and do not enough rest and elevate your foot after the surgery - you dramatically increase the chance of having more pain and swelling. 


8. If you think you can have foot surgery and you will be able to wear ballet slippers and flip-flops and walk barefoot - you are kidding yourself. 
Of course, you can have the foot surgery and continue to wear poor shoegear but there is a high probability of eventually developing more foot issues and possibly getting a re-occuarnce of the original foot problem. 

Think of it like this, if you went through all the time, money and pain of getting a foot surgery - why wouldn't you protect that investment with proper shoes and orthotics? 

Not doing so is the equivalent of getting skin cancer and, after getting all the cancerous lesions surgically excised, deciding that you don't need to wear sunscreen. 

Protect your investment!


9. If you are not compliant with your surgeon's post-operative plan, you are going to sabotage the success of your surgical outcome.
The next time someone tells you their 'nightmare' bunion story - ask them if they did what their surgeon advised them to do. Did they stay in their surgical shoe or CAM Walker for the allotted time? Did they rest, elevate and ice their foot? Did they take the time off from work that was recommended so that the foot would have time to heal? The fair amount of 'nightmare bunion' stories come from patient non-compliance. Did you know that if you have hammertoe surgery and do too much activity or are non-compliant that you can get a complication called 'sausage toe'? Having a toe that looks like a fat, ugly, red sausage is one of the dreaded complications of hammertoe surgery. It's difficult to treat and patients get very upset. The typical response is they want their hammertoe back! 

If you have done your homework and found a good surgeon then you have a responsibility to follow post-op protocol so you can get the best possible result. I can't stress this enough - rest and elevate your foot. Stay in the surgical shoe or CAM walker as directed by your surgeon. Take off time from work if you are able. 

Overall, if you are compliant - you will get much better results, have less pain and have a more cosmetically pleasing foot. 


10. Make sure whoever is doing your surgery is Board Certified. 
If I had to have foot surgery, I know exactly who I'm going to! 

And you can bet that that Podiatrist is Board Certified. 

When I completed my residency, I took the first part of a two part  National Surgical Board exam and passed, which made me Board Qualified. Once you are Board Qualified, you have seven years to do 'x' amount of surgeries and put together case reports on each of these. Once you submit the required number of cases, then you do  the second part of the exam where you are grilled by other Board Certified Surgeons who test you face to face on the cases that you have submitted. It is a grueling process. 

Three years after I became Board Qualified, I faced an ethical question. I wasn't doing enough surgeries. If I wanted to become Board Certified then I had to start doing way more surgeries so that I could get the numbers I needed to be eligible to apply for the second part of the exams. The problem was - how was I supposed to get the numbers that was required unless I started doing surgery on people who I did not think needed surgery?

I came to the conclusion that I would no longer do surgical procedures. I still do simple procedures in the office but I would no longer do the more complex surgeries. Currently, if I have a patient who needs surgery, I will refer them to a Board Certified Surgeon. 

Make that Eleven...

11. Check the state board to see if your surgeon is being sued for malpractice. All surgeons eventually get sued but if your surgeon has a high number of malpractice cases - that is a red flag.  
Your state board of Podiatry has a websight where you can look up any malpractice cases that are filed against your surgeon. Every surgeon is going to eventually get sued for malpractice - that's just a fact of life for surgeons. But, if your surgeon has an excessive number of malpractice cases - get a second opinion from another surgeon. Ask your Primary Care Physician or other Specialists who he or she would recommend - other doctors are an invaluable source of information. 


If I have to leave you with one final thought - do not rush into foot surgery. The only time you should consider foot surgery is if you have reached a point where you have tried everything and nothing works and the pain is so bad that you are unable to do your normal daily activites. 

For more information, check out my two articles in this blog, which you can find by using the 'search' box):

"My foot hurts - top ten things to alleviate foot pain today."

"Shoe recommendations for patients recovering from Lisfranc's fractures"




*****



On a non-Podiatry note, check out my new novel 'Gunning For Angels', which is available as an ebook on Kindle. 

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Thank you so much for your support!

:)


6 comments:

Elizabeth said...

Thanks for the wonderfully informative post -- I sent it to a friend who's considering foot surgery but has no clue what she's getting into.

On a side note, I no longer receive your emails. I try to resubscribe, but am told I'm already a subscriber. Did you make a recent change to your blog? Is there any way around this?

Anonymous said...

I'm 9.5 weeks out from a bunionectomy and my recovery is going MUCH better than the surgery I had on the other foot ten years ago from another doctor. Some lessons I learned. From the first surgery that I took with me into the second experience with a NEW doctor. Are really aligned with your recommendations as well... My family doctor referred me to a board certified surgeon who is conservative in his approach. My new podiatrist/surgeon helped me develop strategies for managing an uncomfortable bunion, such as guiding me through shoe choices (yes I brought a big bag of shoes to his office and he helped me figure out which ones I should wear and which ones to get rid AND why), pain management techniques such a Rest, ice, ibuprofen,, and custom inserts. He recommended that I manage the bunion for as long as possible. But once I got to a point where doing all the right things had ceased to help me manage the pain he recommended surgery. I questioned him pretty rigorously about how often he did these types of surgeries and checked with my regular physician to get her advice as well. I questioned his rehab philosophy to make sure that physical therapy was part of the plan. I weighed the consequences of waiting, which were further damage to the joint and the fact that I wasn't getting any younger And my fitness level was being impacted by the pain. In the end I decided to have surgery and followed his directions to the letter including the physical therapist's rehab plan which started two weeks after my surgery. I'm really satisfied with the results. Yes, I still have some swelling and some pain, but it's gets better the more I do my exercises. Not the bone on bone stinging, aching pain that made it painful to put weight on my foot before the surgery. I wish I'd run across you blog before I had the first surgery. But I'm surviving bunion surgery quite nicely, so it is possible!

Lisa Crew said...

I regret the Morton's Neuroma surgery I had three years ago. I have a different kind of pain and no feelings in my middle toe.

I wish I'd taken more time before deciding on surgery and found your excellent blog three years ago.

Doctor of Podiatry Discusses and Recommends Shoes. said...

Hi Anonymous,
Hearing that you had a good experience with your bunions surgery makes me very happy. Sounds like you were proactive, personally responsible with your post-op care and had a good surgeon.
Kudos to you and your doc!
Cathy
:)

Doctor of Podiatry Discusses and Recommends Shoes. said...

Hi Lisa,
Thanks for reading the blog!
I'm sorry to hear that you had a bad experience with your Morton's Neuroma surgery. Now that you've had the surgery, just remember that wearing a shoe with a thick, rigid sole is crucial for continued healing and decreasing the chance of a re-occuarnace of a 'stump neuroma'.
Hope all is well and thank you for reading,
Cathy
:)

Andri Septen said...

it is likely to crack. This normally occurs in healthy and fit individuals who subject their body to excess physical activities. This kind of fracture is normally experienced by sportspersons and military recruits who engage in physical activities for long periods of time. They develop a stress fracture that leads to foot pain. The second situation is where people have extremely weak bones. This commonly affects women with osteoporosis.99