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Wednesday, March 3, 2021

Timing of Hallux Rigidus Surgery: Now or Can We Wait and Get more Information

Dear Dr. Blake,

You can imagine my surprise when a podiatrist here in Davis, California just told me that the bunion bothering me is Hallux Rigidus
Apparently my daughter whom you have seen inherited this condition from me. Since you took such super good care of her I really hope you can see me too. The first available appointment with your reception is April 16. I plan to be in NM visiting my grandkids March 18-April 15, and since those visits include tons of hiking I would greatly appreciate it if you can somehow see me before I go.The x-rays today showed NO cartilage left, and the doctor suggested fusion surgery and orthotics. Apparently I should have been using orthotics for years now, but the podiatrist I saw for the bunion in 2015 told me simply to wear shoes with a slight heel lift and I’d be fine. Hmm...I went to today’s appointment because the toe area often hurts and clicks as I walk. I still play tennis 5 days a week and am generally very active, so I dearly hope you can help me!


Dr. Blake's comment: 

Thanks for your email and compliments. For sure I should be able to see you. Call and make sure you are on the wait list. Surgery can always be done, so if you can put it off indefinitely, that would be nice. Right now surgery and your symptoms make no sense. Rich
If you can make it, tell them I can see you 11:30 on 3/5 Friday

Addendum: The patient was able to schedule at that time. Rich 

Dr. Blake's further comments: I am not a surgeon although trained as one. Just not my interest, so I gave it up to be home more when my kids were small, but also to focus on sports medicine and biomechanics my true loves in podiatry. In situations like this, meaning problems that may need surgery at some point, I love to be able to work with a surgeon so the patient understands the whole process. The assessments I routinely use in this scenario are:
  • Assess when the health of the patient needs immediate surgery (like in alot of fractures we see in sports medicine)
  • Assess if the risks of surgery are less than the patient's problem (said another way----the patients disability now has to be worth the disability short and long term from the surgery)
If we use this rationale, yes, the patient may need surgery, but their activity level now is too high to warrant that surgery. They should know about the surgery, but what if there is a complication and the patient can not play tennis again? 
Some of this reminds me of how doctors get in trouble giving too many pain pills. Some of it is because they do not want the patient to have pain. Some of it is that they do not want to be looked at as a bad doctor. This is why I search for ways daily at getting my patients in the 0-2 pain level out of 10 consistently. If they can not accomplish this, we can talk about surgery and definitely get some opinions. Just because the xrays or MRI indicate a problem, does not mean we have to address that problem with surgery. Rich 

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Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.