Monday, January 13, 2014

Preventative Surgery: Is There Such a Thing??

Is there such a thing as preventative surgery? We usually think of surgery as something that we need to fix a problem that is currently present. That makes perfect sense! Why would we ever need to have surgery when there is no current need for it? To the average healthy person, preventative surgery seems like too much of a risk. Why fix something that doesn't hurt? Every surgeon would agree that in most cases this is correct assumption. Lets think outside the box for a minute. I will give an example to make it easier: I have been seeing a diabetic patient for several months who has a callus on the tip of his toe. His toes bend and don't straighten well. They are stuck in that position (we call those hammertoes). This is why he gets the callus. No biggie right? Shave the callus and all is well right? Say this patient has very little feeling in their foot(they have diabetic neuropathy) and cannot tell if the callus is getting irritated and they do maybe a little more than usual that day. By days end, they may end up with swelling and redness to that toe! Now that is a problem! Shave the callus this time to find a wound under it! If all is working in the patient's favor, we treat the wound and, over time it gets better. Eventually though, a callus forms over the healed skin because nothing in the patient's lifestyle has changed. Over and over this is the cycle. Callus, wound, heals. Callus, wound, heals. That is the best it gets. It heals at least. Here is the sacrifice. Every time the wound heals, scar tissue is left. Scar tissue is not as flexible or forgiving as regular skin. It forms callus more quickly because it is less resistant to friction. Some times it doesn't matter that they are in the best shoes and inserts,(and seeing the best podiatrist here at FAANT!),the skin is just too vulnerable. The worst case is that eventually, and this happens more times than you can imagine, the wound gets infected and the infection gets into the bone! That could lead to an amputation!! Who wants to risk that? Surgery in this case is a feasible option! Even if there is no wound, surgery is a viable consideration. What if we could do a surgery to straighten the toe (while they have no active wound), so that there is less pressure at the tip? We may be able to halt that vicious cycle and make visits to our office much more pleasant! Much needs to be considered health wise to make the best choice for this patient as there are risks with any surgery, especially in a patient with health problems. Is there more risk having this surgery or to continue cycling with a wound that keeps popping up, increasing the risk of infection every time it does? Next time you visit, keep an open mind about this possibility. If preventative surgery is an option for you, we will do all we can to make sure it is done under the best of circumstances!