Lack of podiatry services after operation.

[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.

[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.

[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!