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Foot & Ankle Problems Message Board


Foot & Ankle Problems Board Index


the surgeon I was capitated to see through out insurance first suggested a full joint replacment with the bunion surgery, due to a badly damaged ball joint; at th pre-op appt he changed his mind to a bunion surgery only. My bunion was quite severe. The day of the surgery- the nurse stated he was in a hurry to catch the 10am bus to the NCAA basketball playoffs- Following the surgery, it was apparent he performed minimal work on my foot. My big toe is not only just as slanted as before, but it pushes even further into the middle and third toe. The swelling is immense, the pain is so bothersome, I cannot wear any shoes beside flip flops or extra wide, no laced sneakers. The scars on my foot look like he cut my foot open with a dull butter knife. At my 14 week follow up he also said the screws have become loose in my foot. He suggested physical therapy. Not sure how this can help with the loose screws. The therapy is prescribed for 3 times a week for 6 weeks; I cannot take off the time from work to fit in the therapy, nor can I afford it. My insurance company denied my request for a second opinion from another surgeon.
What can I do? Please help, I am desperate.
I would say any doctor who suggests physical therapy for loose screws might have a few loose himself.

It sounds like you know what you need to do, which is talk to another surgeon. Do you have a primary care doctor who can maybe help you do that? There are ways to override denials and apply for exceptions.

Meanwhile, whenever you don't have to be standing or walking, elevate your foot. It might help reduce the swelling.
I'm sorry for your situation but I did not understand "capitated." I looked it up to be sure I was thinking the right definition and I can't make it fit in your sentence. What do you mean?

As for the second opinion, I was under the impression that was a requirement. Can you talk with your HR people about it?
[QUOTE=Titchou;4010092]I'm sorry for your situation but I did not understand "capitated." I looked it up to be sure I was thinking the right definition and I can't make it fit in your sentence. What do you mean?

As for the second opinion, I was under the impression that was a requirement. Can you talk with your HR people about it?[/QUOTE]

In U.S. health services, capitation refers to a fixed "per capita" amount that is paid to a hospital, clinic or doctor for each person served. The primary care doc has allocated specialists that are 'linked' with their practice. Although other docs may be in the network, under my policy, you must see the 'capitated' doctor first.
My primary care doc said this was the ONLY surgeon approved for me to see. I've been told, second opinions used to be a requirement for surgeries before and/or after, but that law changed about 7 years ago. Not sure really. My 'HR" person isn't worth anything really- the insurance / referral person at my primary's office is actual very good and trying..but getting no where. Reading many of the posts, it seems I should try to fit in the PT, buy my insurance doesn't pay for it completey & it will be about $120/ week...I simply cannot afford it. any sites you know of that give PT info online? thanks for your reply.
[QUOTE=janewhite1;4010090]I would say any doctor who suggests physical therapy for loose screws might have a few loose himself.

It sounds like you know what you need to do, which is talk to another surgeon. Do you have a primary care doctor who can maybe help you do that? There are ways to override denials and apply for exceptions.

Meanwhile, whenever you don't have to be standing or walking, elevate your foot. It might help reduce the swelling.[/QUOTE]

thanks for your reply, i kind of thought the same thing. I don't have any range of motion in the great toe, so perhaps it could help for that- but what do we do about the loose screws? yes, my primary care doc is trying.. at least i think they are.. i have submitted an appeal, but it may take a while.. a long while. not sure what to do in the meantime.
I would try pt at least one week so that you can say you made an effort. You can claim that the pain is too bad to continue. If you refuse to go to pt weather you can afford it or not, it might come back to haunt you. I would have the physical therapist take a look at it and he may suggest not doing any therapy.
Also, I would go to a different surgeon after you stop therapy and get a second opinion. If the first surgeon screwed you up, then I would get the opinion of a second surgeon and give it to your hr person and push the issue. If you don't take a pro active approach, they will wait you out until you give up. There is nothing wrong with you trying to get the best care possible and to get another opinion to verify you are or aren't getting the proper care. This will cost you a few dollars but if you don't address it now, it may cost you more in the long run. If this surgury you just had gives you trouble and keeps you from working, the lose of income and possibly you job will cost you a lot down the road.
The bones in the foot are not forgiving and can cause you long term problems if not taken care of. You can develop arthritis or other bone problems. If you wait for your insurance to care about you, then pull up a chair and sit down because you will be waiting for a long time. Keep track of every thing you do. Keep times and dates and what the surgeon and pt person says. Also keep up with what your hr has to say. Keep up with what you can and can't do and what you have to stop doing because of the surgery. Keep very detailed and accurate records. Ask your surgeon a lot of questions and document his answers. All this might help you down the road. You might want to get a copy of your medical records before you make anybody nervous. Take care of yourself because it is your respnsibility and because nobody else will.
I am so sorry to hear of your predicament. From your first post, it sounded like your bunion/joint issue was of moderately severe to severe degree (from what your surgeon was planning to do) But you ended up with a simple bunionectomy only. I completely agree with half step, you need to get a copy of your medical records from this unprofessional doctor and record everything single details of your attempts and difficulties.
I don't understand how going to PT will help with your loose screw. I am not a podiatrist or an orthopedic surgeon although I have a medical background, I don't think the loose screw is going to screw itself back down and proper with PT, in fact, PT may just aggravate your symptoms?!
From your description of your toes continue to bend to one side (original position unchanged), additional procedure is usually required ie akin osteotomy to better align your toes after the bunion osteotomy. This sounded like malpractice but unfortunately you need evidence to go that route. ie statements from the staff in the OR, second opinion (therefore must have medical record from first). I sympathize with your financial difficulties and that you are trying to get the insurance to pay, but your feet may not be able to wait that long for you to go through that channel. Remember: Your feet are priceless! Even if you have to get a loan to get the ball rolling, it may be in your best interest. May be a second opinion can help straigthen out your nightmare sooner.
I just had a Scarf osteotomy bilateral. My surgeon informed me that Akin may be necessary to straighten the big toes, but he will make the final decision during surgery. At the end, he didn't do Akin as he thought that the bend was very mild (after he did the Scarf, he assessed how the big toe looked) and more of a cosmetic issue and not worth the risk of the additional procedure. So I am currently in bed with my feet always elevated to keep the swelling down.
I wish you the best of luck and able to sort this out at the earliest possible time.





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