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ACORN February 1994
Surgery And Its Related Fears
By: Michael
Zapf, DPM, MPH, and FACFAOM
Surgery is
always a little more stressful than seeing patients in the office. Outside circumstances
can increase the stress. Surgery on a seven-month-old baby is one such circumstance. The
entire foot fits into the palm of your hand and a one-inch incision covers almost half of
the foot. Another stress increaser is doing surgery on a colleague or their relatives. I
have performed surgery on physicians, chiropractors, their spouses and, last week, even a
doctor’s mom. Well, two weeks ago I had the ultimate in stressful surgical patients:
my mother-in-law.
Actually, I am being overly
dramatic. My mother-in-law, Lorraine, is very sweet and kind and we have a great
relationship. Using the old dreaded mother-in-law line just seemed like a good way to open
the article. We get to see Lorraine and her husband, Ed, a lot more often since they
decided to spend the winters in Palm Desert instead of Chicago. We bribe them to visit as
often as possible using their grandson, Christopher.
For a long time Lorraine has had a painful
bump on the inside of her big toe. It is caused by a bone spur (called an exostosis in
medical lingo) on the toe. The spur causes a big callus to develop on the skin where the
big toe rubs against the second toe. This callus is surprisingly large and painful and
hurts virtually every time Lorraine wears shoes.
Several years ago she had it
“fixed” by a doctor in Chicago. He made a little incision in the skin and, with
a high-speed burr, tried to shave down the bump. This sounds simple and it usually is.
Something went a bit awry with Lorraine’s procedure. Inexplicably the doctor put he
high-speed burr into the toe bone, instead of against her spur. Instead of shaving down the spur, he made a large
hole right in the bone. This not only did not solve her problem, but it caused some
degeneration of the toe joint itself.
We fixed this problem easily enough.
In the office, under local anesthesia, I removed the spur. I also used a tiny incision,
but instead of a high-speed burr, I used a little hand rasp. I have always felt that it is
risky to poke a high-speed burr into a blind hole in the foot. With the high-speed burr
technique, the surgeon cannot see what is happening under the skin. He or she just does
the surgery by feel. With a hand held rasp you have much greater control over what you are
doing. All you sacrifice is a few minutes of time for a bone spur removal. I find that
most little spurs on toes bones can be removed this way.
Some doctors use a high-speed burr to
fix more complex problems, like bunions. Under the banner “minimal incision surgery”
or “lunch time surgery” these practitioners advertise that they can repair most
foot deformities in this manner. I hear that when it works, it is a useful procedure for
the right patient. But when things go wrong with a high-speed burr, they can go very
wrong. Most foot surgeons are happier doing surgery the “old fashioned way” by
opening the tissues and actually seeing what they are doing.
Lorraine’s surgery went perfectly. I
needed only one stitch to close her incision and she recuperated at our house over the
weekend. She only needed one Tylenol for pain. I removed the stitch when we made a house
call to the desert the following weekend. She is now wearing regular shoes with much
greater comfort than she has known for years. We
will know for sure how well we did when we see her Christmas letter next winter. Keep your
fingers crossed.
Dr. Michael Zapf is a board certified podiatrist in practice in
Agoura Hills and Thousand Oaks. For more information please call his office at (818)
707-3668 or (805) 497-6979. |
