While I think that conservative treatment is a good idea for bunion treatment, prior to surgical intervention, I voted "no" because I object to the term "mandatory."
If we choose to make it mandatory, we are painting ourselves into a corner. I personally use conservative care in greater than 98% of bunion patients but occasionally, I will come across someone who absolutely refuses it and insists upon surgery. If we accept the term "mandatory," then we would have no choice but to turn them away or suffer the consequences if any problems develop.
If there had been a third choice (yes, no, advisable), I definitely would have voted for advisable. It is always easier to defend one's actions for surgery once conservative care has been rendered/exhausted.
Much discussion on this issue over the years has centered around the fact that in the past
(and possibly even now) about one third of all malpractice suits were for bunionectomies of some sort.
The main issue brought out by plaintiff attorneys regarding informed consent for the procedure would be if any discussion of, or conservative care had been tried, prior to surgery. If a defendant doctor would answer in the negative, it would make him or her look like a knife happy surgeon whose only concern was doing the procedure and getting paid.
This was the impetus for advising podiatrists to perform conservative care prior to surgery. In addition, since this type of surgery is elective and non-urgent, there is time to at least try something that fits the bill.
A point to remember regarding conservative care is that it doesn't have to start with the patient's first trip to the clinician. It includes all time spent by the patient in trying to treat the problem. Everything from new shoes, OTC insoles ,padding, changing shoe style, soaking, changing life styles and other professional treatment all count as conservative care. If this is documented in the chart, it helps support the case for conservative care.
If, as the clinician, you want to do something else (let's say injection, physical therapy,etc.) during the time you are scheduling, that is great. However, if the symptoms, physical examination, X-rays and patient needs support surgery, there is no medical reason to not proceed with surgery as needed.
Well said by Dr. Shea. I also agree with Dr. Cornfield having options as he put it.
Other than the treatment of an enlarged bursa, there are no conservative treatments that can correct a bunion deformity. Conservative treatments should certainly be offered and considered when discussing the treatment alternatives to address the symptoms associated with the deformity. A patient certainly has the right to choose the treatment that addresses his or her needs. There is no mandate, medically or legally, that prevents a qualified surgeon from correcting a deformity after a patient has received an appropriate informed consent.
Seriously, no SURGICALLY TRAINED podiatrist who has graduated in the past 30 years would recommend conservative therapy for a bunion deformity barring the obvious contraindications (patient health, compliance, being the 4th opinion, and financial status). The current theme is true. There is not a known conservative treatment plan for a bunion other then relieving the bursal irritation or accommodating the bunion with a shield or a shoe. Yes, these options should be presented to the patient but only as a mode of accommodation, not correction. This type of archaic thinking still exists with some our colleagues who have patients draw pictures of their verruca and plant in their gardens!!!!
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