Rethinking orthopaedic and forefoot surgery.

This post continues the page Stop! Wrong way! in relation to orthopaedic management

Deformities of the forefoot. These include “bunions”, Morton’s “neuroma”, clawed toes and “flat foot” (whatever that is intended to mean). It is unlikely that any group of elective procedures has been performed, in total ignorance of the causative factors, more often, by more people, in more ways, than various forms of surgery to the forefoot.

Fractures being “set” as soon as possible after the injury. This damaging policy produces significant, irreversible, complications. It will be addressed in a separate post on this site at a later date.

Finger-tip injuries. These common injuries produced a plethora of surgical treatments, from skin grafts and”rotational flaps” to “cross-finger flaps”. These required not-inconsequential surgery, sometimes under general anaesthetic, were expensive and incapacitating for various periods, and unnecessary. Harvest was taken from uninjured areas of the palm and other fingers, scarring those. The best results however have been shown to be obtained by doing nothing beyond usual wound care! The body’s capacity to heal itself at that site is not unexpected, being as easily and frequently injured as the fingers are.

“Traction” for so called “slipped discs” (mostly that diagnosis was incorrect, in the event). Tens of thousands of patient-days were lost by placing these unfortunates in hospital and attaching weights by cords to their legs, literally tethering them to their bed for days or weeks. This was entirely ineffective since the friction of the legs prevented transmission of any “traction” to the discs. The management was adversely effective, since most low back pain improves more rapidly with movement (ideally in water). Deep vein thrombosis would be expected to be increased by this form of immobility. I wonder how many died of resulting pulmonary embolisms.

 Osteomyelitis. Antibiotic usage and aggressive resection of bone is often counter productive and dangerous. The loss of the limb might result from some current management policies. This is addressed in a separate post on this site.

Is there a solution to my foot problem?

 

 

 

(Name withheld) Thanks again for your emails. In March this year, I had a Weil’s Osteotomy so as to correct my hammer toe which was the one next to my big toe and not the middle toe like the toe in your photograph. Since the first operation in March, then again in April, when they removed the screw as my body rejected it – it is now October, the toe is still very stiff and it is still floating (looking awful is the least). I saw a podiatrist a few times and he has now done a wedge on the middle toe next to the hammer toe which was operated on, he told me that all my body weight is now on the toe next to the operated toe, or something to that effect. The very worst of course for me is the hard lump/callous which is now underneath my foot, like a tight knot lump there and if I don’t wear an orthotic insole for walking, I’ve had it – even when I do wear one, the throbbing recurs. I can’t take pain tablets all the time, so I am just learning to live with it. After what I went through, if there is a solution?

Response: The Weil osteotomy is discussed in the pages

The patient in the picture which you refer to had four procedures before I got to see it. The second toe (next to the great) on the left had some kind of osteotomy, and was “floating” perhaps like yours. The third toe probably looks as your second toe did pre-operatively. The hard lump is a direct result of your toe abnormality, and can be predicted to worsen progressively unless surgically corrected. There is, very definitely, a solution. I look forward to seeing you and explaining the mechanism and background of your problem.