Lack of podiatry services after operation.

[jackieandwayne]

I was diagnosed with sciatica in October 2009. At the local hospital. With physio and hardwork I got myself ove rit as much as one can by walking mainly, a hobby anyway. I was left with drop foot but managed that with step ups in my shoes. In 2015 it started to become a real problem again, or so I thought. This time it was preventing me from walking properly. I went to the GP who referred me for physio and I was given exercises to do, including pushups which really seemed to help on the left side where the sciatica was, but my right leg was getting more and more painful.

 

I was then referred to a sports psychotherapist via the GP who gave me a talking to about "analysing too much" especially when I told her my dad had died from blocked arteries and I was sure I had this. in my right leg. Then they sent me to the back pain clinic where I collapsed with pain.

 

Now something weird strarted happening to me, it felt like I had a cut or blister on my right little toe, but there was nothing there.. In the end I was trying to walk my dog in my partners size 9 trainers (I am a 6) and even this became impossible. I went back to the doctors and instead of look at my toe, she put me on amilitryptyline. It just so happened that mum was having her feet treated by her podiatrist so I asked him if he could see anything wrong with my toe. and when I put my foot on the floor he got very excited a nd told me I needed an immediate Doppler test as he could see I had hardly any circulation to the toe and that was causing the pain. It was also very serious. A few days after this the doctor invited me to have a Doppler test.

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The nurse refused to let me leave the surgery until she had seen a doctor with my results, the DR (this was a Friday afternoon) tried to get me an immediate MRI scan. The earliest was Tuesday which I duly had, I saw the vascular surgeon the next week and the week after that I had a serious blockage removed from an artery in my right leg. When I came round, although the pain was gone my toe was now covered in a huge black scab. I was in for a week, nobody even looked at the scab til the last day when the head honcho on ward rounds, and to discharge me just said to "keep soaking iti and applying scholl products, and that pink healthy skin would reappear as the toe was "viable".

 

When I got home, (with a special soft boot for my right foot as I still could not get shoes on) I rested for a fortnight as told, soaking the foot everyday. I got a blood clot in my leg. So then I had to take the superdrug to get rid of that.

 

Now every health professional I saw, including my GP as he was being fed info from the vacscular surgeon, told me to get out and walk on that leg. Which I did, I was so proud when I could do 2 miles without stopping. I went to Rotterdam and Amsterdam.

 

Mind you I had to tell the GP that my toe kept getting infected. And so he asked me to see his nurses 2 x a week and they were to report on it to him. The first nurse kept saying soak and keep walking no dressing required. After a couple of weeks of this the 2nd nurse was on duty, she used to work on a vascular ward and informed me that the toe needed to be kept permanenelty covered with Iodine patches and dressings. Now, I cannot do this myself. the sciatica on the other side prevents me from either getting down to the right toe or raising my right leg to the bed or a chair. It was also painful enough to make me scream in agony whenever they touched it. In then end they just gave me some dressings and told me to get on with it. My mum had to do her best for me three times a week and is still doing this today

 

I saw the surgeoun for sign off in November and I showed him this mess on my toe. He just said my leg was fine (Doppler and warmth) and said I needed podiatry services. Due to age and not being diabetic I don't qualify for them. However, I'm not sure what has gone on but I am now having my podiatry services. The surgeon told me to keep on walking even after he saw that ulcer.

 

Right now, fast forward to January 2017 and I had my first appt with the loveliest podiatrist you could ever wish to meet. And he is very unhappy and annoyed at they way I have been treated. He says that since the op I should have been offered podiatry services straightaway because my toe was black. Apparently there are things that could have been prescribed to help me. He says I should never have been allowed to walk until the toe had healed, everytime I take a step I break away any new skin trying to form. He is having to keep me on permanenet antibiotics, which the GP has just tripled, an urgent Xray and swab has been taken. THE GP rang me to say they could see the infection which is now in my bone, and also that there is a loose slither of bone.

 

At the same time, because I have h d to stay off the foot since January my sciatica has flared up so I can't get to the loo without help and all that jazz. I fee lthat at 54 I didn't have the year to waste that I just have, I am angry and in a lot of paIN.

I am a serious hiker amd I miss it so much and I don't believe I'll ever do it Again. I am also a PTSD sufferer and walking in the sticks with my dog on a bad day was my way of dealing with it. So now I am like an adder as well.

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Should I be complainiing to someone and who? We suspect my mobility will now be permanently affected.

 

Sorry for the long post.

 

 

Grateful for any advice or pointers.

[BazzaS]

You don't need any of the toes (except the big toe on each foot) for mobility.

The big toe is needed to help with balance : none of the others are.

So, whilst pain might be restricting your mobility, the toe itself isn't critical to walking.

 

If you have infection in the bone (osteomyelitis) : ask them what they are aiming for:

1) to cure the infection with antibiotics, or

2) to suppress the infection (but not cure it!) with antibiotics.

Is there still an ulcer? Is the bone exposed??

 

Infection in bone is hard to get rid of and requires long courses of antibiotics, more so if the bone is exposed (both as bugs can still get in from outside and it still suggests impaired blood supply)

The blood supply may be fine on a "big blood vessel" level (measurable by Doppler), but there is still some problem on a microvascular (small blood vessel) level : why else (including infection) hadn't it healed?

 

Additionally : which bone(s) is it in?. Just the toe (and which part: the end, middle or nearest 'phalanx') or the bones headed from the toes into the foot (the metatarsal bones).

 

One option (since it is "definitive") is to amputate the affected part of the toe.

If your main concerns are pain and lack of mobility, and/or infection spreading into adjacent bones you should at least discuss if this would be an option you might consider : rather than a long course of antibiotics. Ask them what the benefits to you of both operating and not operating are.

[jackieandwayne]

Thank you BazzaS. My podiatrist is coming to my home tomorrow to do some treatment, I'll ask him all of this. You see, where I had been told to walk I was trying to avoid the ulcer so I was walking weightbearing on my big toe. If that makes sense. I have a letter now an urgent apt with orthopaedics on Friday morning.

 

I am absolutely terrified of anything medical, and its not just a case of "oh I am frightened" its to do with the PTSD, and I feel my GP was wrong right at the start not to look at that toe and palm me off with anti-depressants. My stay in March in hospital for the week was so traumatic too my silly brain that a lot of its been blanked out. But I know I was in a dreadful state mentally.

 

Thank you for your time and simple explanation. Jackie

[BazzaS]

Thank you BazzaS. My podiatrist is coming to my home tomorrow to do some treatment, I'll ask him all of this. You see, where I had been told to walk I was trying to avoid the ulcer so I was walking weightbearing on my big toe. If that makes sense. I have a letter now an urgent apt with orthopaedics on Friday morning.

 

I am absolutely terrified of anything medical, and its not just a case of "oh I am frightened" its to do with the PTSD, and I feel my GP was wrong right at the start not to look at that toe and palm me off with anti-depressants. My stay in March in hospital for the week was so traumatic too my silly brain that a lot of its been blanked out. But I know I was in a dreadful state mentally.

 

Thank you for your time and simple explanation. Jackie

 

Are both your big toes OK, though?

Neither are where the infection or ulcer are, if I've understood your posts??

 

If you are really 'hospital phobic', that would be one reason to go for 'medical' (antibiotic) treatment rather than 'surgical' (an operation) treatment, although it would be a protracted course of antibiotics with no guarantee of success.

 

Although you haven't mentioned diabetes, these sorts of problems are most common in diabetics, and (even if you aren't diabetic) it might be worth asking your GP (or the podiatrist coming tomorrow) if there is a local 'diabetic foot' combined service at the hospital, who might consider your case at a 'multi-disciplinary team' meeting.

 

I'm definitely NOT saying "you have diabetes" (so I'm not trying to scare you or make you concerned!), but I am saying that if there is such a team meeting, that it tends to concentrates the relevant expertise in one place to give 'best options' planning.

 

That way, rather than it being 'orthopaedics' or 'vascular' or 'podiatry' or 'microbiology', or one of those specialties talking to only one other of those specialties......... that you get ALL of the specialties reaching a combined decision and an agreed PLAN that doesn't miss any of the inputs (avoiding the situation where e.g. you feel 'podiatry was missed out' previously......).

 

That way you don't get ANY of the specialties input and expertise missed out. This would be less important if you decided to go for the surgery option, but might be more useful if you go for the 'medical' (antibiotic) approach. Most 'out-patient only' patients don't warrant that intense an approach, but

1) If things haven't gone to plan already, over a long period, and

2) You are desperate to avoid surgery, so really want them to optimise the 'medical' treatment option,

you might get your GP or the podiatrist to push for this .....

The point to push for is "things haven't gone to plan already, and I'm keen to make sure nothing 'slips through the cracks'"

 

The microbiologist suggests antibiotics, and doses.

The orthopaedics (if they are the next team to see you) might agree to be 'in charge' overall and monitor your hospital follow-up, or if local policy is for 'medical' rather than 'surgical' cases to be under the physicians, they might defer to them.

The physicians (diabetes) team might take a 'back seat' since you don't have diabetes, or might be the 'lead team' for 'medical' rather than 'surgical' options.

The vascular team can confirm there is not any 'big blood vessel' problem (and might have podiatry hinting 'why weren't we involved earlier!')

The podiatrists can add advice on dressings and if you should be mobilising / any boots / foot cradles / foot care, together with the nurses on the other teams.

All the teams agree a duration after which things should be reassessed to see if things are working or if surgery is needed.

[jackieandwayne]

Thank you again. What a state to get into! I am not diabetic, my dad was, its the type 1 and all his 7 siblings had it, none of their children had it, some of the grandchildren developed it, no great grandchildren have it yet.

 

Well, you know what, my podiatrist is really the only person who has paid any attention to this and I think he has already yelled from the rafters. Hence the GP's getting me these appts. But I will show him this tomorrow,

 

The though of amputation of anything is horrific to me and is actually keeping me awake at night.

It is the little toe on my right foot, on top of the toe, and the podiatrist has had to do unspeakable things to it with a scalpel whilst I practically break my 77 year old mother's very frail wrist.

 

I feel like marching into my doctor and demanding to have things explained to me in future in just the way you have. I wonder if you lecture?

[BazzaS]

According to some on here, I'm just here to score points.....

 

Even some who have thanked me for help later change their mind.

I guess it just depends on if I am telling them what they want to hear.,...

 

However, I try to help by the best answer I can, to the best of my knowledge. I also try to explain / justify my answer where possible, especially if I'm contradicting someone

http://www.consumeractiongroup.co.uk/forum/showthread.php?473574-How-could-the-NHS-save-money/page2 as an example.

 

Do I lecture? Well, one poster there called me Prof BazzaS (but I don't think they meant it kindly).

 

I deliberately don't publicly say what I do / what (if any) qualifications I have. (Though, I have been "accused" of being a solicitor, a police officer, and all sorts!)

 

Why not say?

Firstly for my own privacy.

Secondly as anyone can claim almost any job / title / qualification: so how to value what is claimed?. It is unlikely many will prove it by announcing their name ....

Thirdly as my advice / opinion should be worth what the readers value it as : if it makes sense then it is worth more, if it isn't challenged or is supported by others - worth more, and if challenged or disputed : its value can be reassessed.

 

By all means run what I've posted past the podiatrist tomorrow : let us know how you get on!

[jackieandwayne]

Well you certainly helped me understand what two vascular surgeons and a GP didnlt! So I am listening to you and the podiatrist. I will post up what happens, after Friday.

[jackieandwayne]

Seen the podiatrist today, had a tiny fragment of bone removed again, bloody agony, my elderly mother now has badly bruised upper arms where I had to grip her. I am in shock. But never mind, its done, and pink and granular were both mentioned in a good way.

 

For anyone who wants to doubt your advice, my podiatrist agrees with your advice word for word.

 

Just Friday and the Blue Clinic but its not Friday yet. Confined to barracks except emergencies for another 4 weeks.

[jackieandwayne]

Got through the Blue Clinic. Now have to have MRI scan on foot but even I could see it looked a bit misshapen. The Dr who saw me rea;lised how upset I was and was very kind, and insisted he wanted to hear how this has been affecting my life. Then it was off for redressing (GP taking blood for me another major blooming issue at surgery Thurs AM) and by this point I was done for so my dear old mum just told the nurse that she would would redress the toe under her supervision, so that the nurse wouldn't have to have a bad day!

 

I phoned the clinic where my podiatrist is as he asked me to ring to let him know what had gone on. The receptionist let slip that there is a multi-disciplinary meeting on 11 May 2017 (I've not been invited so god knows whats going on now). So that's very muc h like you described in one of your posts above.

 

Had a GP telephone consultation today to get the blood test sorted. By now my GP has probably had Blue Clinic notes, and knows that it was very difficult for me. He was very nice and wants me to come and see him as he realises how depressed this is all making me, and a watch has to be kept on my mental health as well.. He has put me on the list for physio to deal with the sciatica on the other side, bearing in mind the restrictions the toe causes.

 

Well that's where we are, I feel like back to square one but hey ho gotta keep going. Thank you for all your support.

[jackieandwayne]

Hi Bazza, I just wanted to update you quickly, its been a while. I had another Blue Clinic apt, AFTER my podiatrist had extracted most of the infected bone and was happy the infection would now be gone very shortly. He actually warned me that they would still want the toe off for "financial" reasons, whilst he would prefer me to see him for a few more sessions, as he could get that last piece out, and that would solve it. He told me to stand my ground. So, off I went, got told I was up for the chop, had a bit of a **** fit, and was told to think about it, and go back in a month. In that month the podiatrist got the bone out, stopped the antibiotics, gentle tentative walking, shoes (EEEEE fitting) on for an hour a day. Went back to the Blue clinic, saw the head honcho this time, who praised the podiatrist for saving my toe! I have to go back in 6 months, but I think I'll be alright now, with a few visits to my podiatrist to make sure everything is ok.

 

Thank you ever so much for explaining all this too me when I was so distressed - everything you said turned out to be true!

[think about it]

Always great to see an update, hope you're feeling better every day.