Dear Dr. Zapf,
To begin with: I am a man (age: 36) living in
Holland and just discovered your web site. My story is the following: I bruised
my left foot very badly about 4,5 months ago due to a heavy fall in my own home.
First I went to the First Aid (they did nothing because my foot was swollen),
after 2 weeks my own doctor examined my foot (the bunion was already visible)
but didn't do anything, after almost 2 months I finally got
"permission" for an X-Ray (nothing broken, no furthermore comment),
after 2,5 months I went to a second doctor (my complaints were growing : pain in
my left hip, muscles hurting, stiffness in my left leg that feels like missing a
shock absorber) who finally for the first time diagnosed a Hallux Valgus. I'll
had to go to an orthopedist (waiting list: 6 weeks) who "prescribed"
me (within 5 minutes) standard (!) orthopedic soles under my shoes (which I'm
still waiting for). In the mean time I developed also a beginning of a callus.
I'll have a few burning questions for you because I'm getting a bit desperate: -
Are there similar podiatric clinics in Europe like yours ?, I cannot find them
in Holland and I don't trust a surgeon who operates a foot once a month or so.-
Is it possible (as a Dutch citizen) to undergo an operation in your clinic? (my
health insurance will never pay for this of course, but money doesn't matter to
me, I want to do everything to get my ambulant capacities back). Hope to hear
from you soon :),
Sincerely, R van der W. (once a walker by heart...........)
Dear R.
In America we have a health plans like yours: they are called HMOs.
Fortunately, I do not deal with many HMOs. Most all of my patients (or their
insurance company) get to pay for their services as they are needed. This is
known as Fee For Service and it was once the dominant form of health care in The
States. Anyway, back to your bunion.
A few years ago I had the happy occasion to go to a foot surgery seminar
in Bordeaux, France. I met foot surgeons and orthopedic surgeons, from
many European countries. I was amazed (not to mention surprised and disappointed)
at the methods and techniques they used to fix a bunion. Long hospital stays
were the rule and not the exception. In America no one stays in the hospital for
a bunion surgery. It is all done as an "out-patient" procedure which
means that the patients check into the surgery center an hour before the surgery
and leave the building about an hour or tow after the surgery is completed. A
surgery center, by the way, is a building with just a pre-operative waiting
area, several operating rooms, a post-operative recovery area and a waiting room
for relatives. In areas that do not have a Surgery Center (and there are getting
to be very few of those) you can do the procedure at the hospital -- also as an
"out-patient" without an overnight stay. The European doctors all used
general anesthesia. Virtually no podiatrist in the States uses general
anesthesia for bunions. Instead an I.V. (intravenous) line is placed in the arm
and light sedation is used. While under sedation (also called twilight sleep)
local anesthesia is injected into the foot and the procedure is performed.
Interestingly in America orthopedic surgeons also perform bunion surgeries. They
usually use general anesthesia. The anesthesiologists at the Surgery Center say
the reason orthopedists use a general anesthesia is that they (the orthopedists)
were not trained to do local anesthetic blocks and do not have confidence in their
ability to achieve sufficient anesthesia of the foot to perform the surgery. In
my area of Los Angeles most bunion surgeries are performed by podiatrists. I am
sure there are areas of in The States where the majority are performed by
orthopedists.
The surgery techniques used by the European foot surgeons were ones that we,
in The States, discarded many years ago. At lest we, the podiatrists. With the
old techniques, the foot was not left in a stable position after surgery and patients
were required to wear a cast and use crutches for up to six weeks. Somehow this
did not seem to bother the European foot surgeons but my patients wouldn't stand
for it (no pun intended). With the techniques practiced by U S podiatrists you
can walk the same day in a protective surgical shoe and are back in athletic
shoes in a few weeks. This is a pretty standard procedure across the U.S.
At a couple of meetings I have met podiatrists from England and Australia.
Some of them claim to use nearly the same techniques we do, but it is outside
the regular health care system used in their respective countries (again the
basic system is a socialized medicine). I wouldn't know how to have you get in
touch with them - maybe put in "podiatrist' "bunion' and
"England" in a search engine.
As far as surgery in the United States, I have done bunion surgeries on
patients from Mexico, Bermuda and The Philippines. They all paid a cash price
for the surgery that includes my fee, the surgery center charge and the fee for
the anesthesiologist. I estimate that a cash price would be about US$
4,000 to 5,000. This fee would include all x-rays and medications, but not
physical therapy if needed (and it usually is not needed). Harder than paying
the fee is the time you need to spend in the U.S. I recommend arriving a couple
of days in advance. After the surgery I would need to see you on day three
(wound inspection), day 12 (suture removal), day 21 (first x-rays) and, if you
are still in the U.S., day 42 for a final checkout and x-rays before resuming
normal activities. If needed you could leave after the 3rd week if you had
someone in Holland who could follow you medically and x-ray your foot at the 7th
week.
This all presupposes that you have a standard bunion. If you are actually
serious about coming to the state, please take a standing digital photo of your
foot and e-mail it to me. I can get a good idea about the size of your bunion
from the photograph.
I hope this helps. Good luck.
Dr. Michael Zapf
