Welcome to the Podiatry Arena forums

You are currently viewing our podiatry forum as a guest which gives you limited access to view all podiatry discussions and access our other features. By joining our free global community of Podiatrists and other interested foot health care professionals you will have access to post podiatry topics (answer and ask questions), communicate privately with other members, upload content, view attachments, receive a weekly email update of new discussions, access other special features. Registered users do not get displayed the advertisements in posted messages. Registration is fast, simple and absolutely free so please, join our global Podiatry community today!

  1. Everything that you are ever going to want to know about running shoes: Running Shoes Boot Camp Online, for taking it to the next level? See here for more.
    Dismiss Notice
  2. Have you considered the Critical Thinking and Skeptical Boot Camp, for taking it to the next level? See here for more.
    Dismiss Notice
  3. Have you considered the Clinical Biomechanics Boot Camp Online, for taking it to the next level? See here for more.
    Dismiss Notice
Dismiss Notice
Have you considered the Clinical Biomechanics Boot Camp Online, for taking it to the next level? See here for more.
Dismiss Notice
Have you liked us on Facebook to get our updates? Please do. Click here for our Facebook page.
Dismiss Notice
Do you get the weekly newsletter that Podiatry Arena sends out to update everybody? If not, click here to organise this.


Discussion in 'General Issues and Discussion Forum' started by Rick K., Jul 29, 2013.

  1. Rick K.

    Rick K. Active Member

    Members do not see these Ads. Sign Up.
    Had a patient show up with a large hypertrophic scar over the distal tarsal tunnel and porta pedis. She previously had an apparent fasciotomy(by her history) and probable tarsal tunnel release, but do not have other physicians' records. She then had a second procedure to try a scar revision and then went to another physician and had another scar revision with no improvement in which she claims that she was nonweightbearing for 6 weeks with PT referral for mobilization. Last physician injected site with steroid and that helped for 2 days. And then discharged her and said he could do nothing more to help her.

    The scar is no classic keloid as it is noninvasive to the surrounding skin, but does have multiple nucleated keratotic spots. There is a dense fibrosis that extends essentially down to the calcaneus. It was very difficult to infiltrate any steroid into this fibrotic band.

    I referred patient back to primary care physician for possible referral for possible flap coverage, but the likelihood of that happening approaches zero since she is a Medicaid patient.

    Any words of wisdom or options? I am exceedingly reluctant to be the final blame holder in our litigious society, especially after 3 previous failures by competent physicians. If it had been try number 2, not 4, then I might have resected it and tried to place a Graftjacket under it to reduce adhesions. This worked nicely in a redo of a fasciectomy previously.
  2. Lab Guy

    Lab Guy Well-Known Member

    My advice is to validate what your intuition is telling you. You can even aggravate her symptoms so I would stand on the banks where it is safe from the high risk of being dragged into the quicksand. Its no fun going to the office seeing patients that you did surgery on that have complications. It is draining and distracts you from giving 100% to your other patients.

  3. Rick:

    My advice? Don't do surgery on her unless you really have a wish to be the name at the top of her list on the malpractice lawsuit that has an excellent probability of occurring.

    As you do more and more surgery, you will eventually discover that you must pick and choose your surgery patients carefully if you also want to have a happier life with fewer complications. Maybe you can send the patient to a teaching hospital where there will be plenty of surgical residents anxious to take on a difficult pathology such as you describe.

    Just because you do not do surgery on the patient, does not also mean that you cannot empathize with her unfortunate circumstance and try to refer her to someone who is willing and possibly better able to treat her surgically.

Share This Page