Hello, I am Richard Koenig, a board certified foot and ankle surgeon. I researched and developed the Total Toe System for 4 years, then began performing the surgery for my patients in 1988. My goal is reconstruction, using implants, of the severely diseased great toe joint in a manner similar to total hip and total knee implant reconstruction. My aim is elimination of pain with restoration of function. My invention has two implants to replace both sides of the diseased great toe joint and dedicated instruments that make the surgery accurate and results reproducible.
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Degenerative Joint Disease (DJD) of the Great Toe Joint of the foot is a very painful and activity-compromising disease. We know that sufferers from degenerative joint disease of the great toe joint of the foot have symptoms of painful loss of motion, a noticeable enlargement of the joint which causes undo pressure from shoe wear, restriction of activity due to great toe joint pain and a change in their walk, which may include a limp, due to loss of motion. The causes of degenerative joint disease in the Great Toe Joint are attributed to osteoarthritis, rheumatoid, gouty, traumatic arthritis, and undetected mal-alignment of the joint probably from birth and exacerbated with time and wear. According to the 2005 study of Frost and Sullivan*, commissioned by HCUP (Healthcare Cost and Utilization Project) of NIH, there may be as many as 17 million Americans who suffer from DJD of the great toe joint. **
After performing this surgery for 20 years and influencing the development of competitive designs, my colleague’s and my surgeries are now being termed experimental and being denied access and reimbursement by major insurance companies.
Some of these companies are administrators of the Medicare program. This restriction prevents the insurance subscriber from alternative, modern medical care. It is our position that insurance companies should not be dictating advanced medical/surgical care, especially when that care is well established and in the best interest of the patient. Insurance companies insist that the “gold standard” is a 100 year old surgery.
This action by a few insurance companies establishes a very bad precedent and should not be tolerated. Their unwillingness to compromise demonstrates bad faith. We need any and all help you can offer. This is what you can do: go to greattoe.com and learn about the Great Toe joint replacement procedure, then notify your insurance company’s Chief Executive. Tell them that you disagree with their position and you want the opportunity to choose your treatments. Contact your state representatives and make them aware of your opinions. Thank you for your time and consideration.
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Effect of physiotherapy following hallux valgus surgery
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Arthrodesis to implant arthroplasty of great toe
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Effect of physiotherapy following hallux valgus surgery
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Arthrodesis to implant arthroplasty of great toe
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