As a patient, you have the right to be informed and ask questions of your healthcare provider. Below are 5 things patients should question when undergoing tests or treatments for foot and ankle conditions. Before moving forward with any treatment, consult with a foot and ankle orthopaedic surgeon in your area.
1. Performing surgery for a bunion or hammertoes without symptoms
Foot surgery for cosmetic reasons is not supported by medical research. Symptoms such as pain and limitations of activity are the most common reasons to pursue bunion or hammertoe surgery. Patients having surgery for bunions and hammertoes are at risk for a wide range of complications such as nerve damage, infection, bone healing problems and toe stiffness.
2. Using shoe inserts for symmetric flat feet or high arches in patients without symptoms
Symmetric flat feet or high arches are common conditions, and generally they are asymptomatic. The development of the arch is not related to external supports, and no evidence exists that any support is needed in asymptomatic patients.
3. Undergoing surgery for plantar fasciitis before trying six months of non-operative care
With six months of consistent, non-operative treatment, plantar fasciitis will resolve up to 97% of the time. Surgery has a much lower rate of success and has the added possibility of post-operative complications.
4. Having an X-ray evaluation of the foot and ankle without standing (weightbearing) in the absence of injury
The functional position of the foot and ankle is one of weightbearing (putting weight on the foot and ankle). When compared to non-weightbearing X-rays, deformities of the forefoot, midfoot, and hindfoot have been shown to increase on weightbearing X-rays. In addition, narrowing of the ankle joint space on standing X-rays is associated with symptoms of arthritis. Therefore, weightbearing X-rays, when possible, give the most accurate assessment of the functional bony anatomy of the foot and ankle.
5. Using alcohol injections for Morton’s neuromas
Alcohol can permanently damage the nerve, but without effective pain relief. At five year follow-up, alcohol injection for Morton’s neuroma has both a high recurrence rate and a high rate of complications, including bruising, scar formation, dysesthesia, severe pain and infection.
This list was created in conjunction with Choosing Wisely, an initiative of the ABIM Foundation.