Nice Stories

[p100]

There is a lot of negativity here so I want to post a nice story.

A 30 something male pt came in with pain at medial heel with positive Tinel's sign radiating up lower leg, plantar heel pain, and pes cavus.

I diagnosed him with tarsal tunnel syndrome and plantar fasciitis. Gave him ankle brace, medrol dose pack, discussed stretching, icing, and Powersteps.

He returned 2 weeks later and thanked me and wanted to give me money. He says no other doctors make a diagnosis and treat this quickly.

This is one reason podiatry is nice. We often see quick results and happy patients.


Please post your nice podiatry stories if this isn't in violation of HIPAA.

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[air bud]

Let me get in before @Pronation can post this....

I had a patient come to me recently after a history of multiple failed matrixectomies. She said she was unable to wear sandals with confidence because of how her toe looked. Fake nails wouldn't properly adhere. I performed a TTR on her and now she is able to wear sandals with confidence. She recently met a tech billionaire and is engaged. She stated it was all due to me and the TTR I performed. She gave me some preferred stock but it went to zero when SVB went under.

 

[Pronation]

Damn!

 

[HardRoadPaved]

I had a patient come in for a second opinion for surgery. I told them what I could offer. They chose me because I was triple board certified with CAQ in surgery and did an intensive fellowship where I retracted in a few hundred cases. I was happy myself when I saw the EOB allowed $397 for her bunionectomy where I did a 3-D correction of her problem.

 

[air bud]

This is why we can't have nice things.

 

[air bud]

I also had a patient that had a history of PVD, Dialysis and A1c of 14.6. I performed multiple OR debridements including a rotational flap. It still wasnt healing. Once we achieved less than 50 percent improvement within 4 weeks we began amniotic membrane grafting. Fortunately this is a new graft on the market and the q code reimbursed 500 dollars per unit. I have a new boat. She ended up getting a BKA and came in recently thanking me because she was finally able to get the handicap sticker she had been trying to get for years. Also gave me a carton of pall malls.

 

[air bud]

I recently had a 75 year old male present to my office. He runs marathons and is in the top 1 percent of his age bracket. He came to me after stumbling while running and he sprained his 1st MPJ. I made bilateral better balance braces for him. He has now returned to running and has no further history of falls and credits me with helping him return to activity. I was able to get a bottle of William larue Weller off a Facebook bourbon group for 1800 bucks to complete my Weller vertical. I will show the patient a picture of it next time since I won't open it instead just display it on my shelf at home.

 

[heybrother]

I was recently hired by a Saudi prince to perform bunion surgery on his daughter. He flew my Treace rep and I first class on a beautiful private jet to the Middle East. I performed a perfect Princess Lapiplasty on her right foot. Everyone was so happy. My owner told me what a great job I'd done and said he'd look at our collections to see if I'd be on the bonus tier next quarter. I proceeded to try and correct the opposite foot but the frontal plane rotation was just a little off. I escaped the country, but my Treace rep did not. His fingers arrived in the mail the other day and I'm being subpoenaed by the Saudi Ministry of Health over concerns that I unbundled the the procedure and a that spot weld screw is not a real thing.

 

[air bud]

Somebody post something nice and real before the mods shut this down...

 

[heybrother]

Somebody post something nice and real before the mods shut this down...

Today I was the 5th opinion for a teenage girl. She has calcaneal apophysitis. No one else had ever come up with a diagnosis and another doctor was about to make her non-weight-bearing for 3 months in a cast. My timely intervention has presumably saved her life or at least her summer assuming she gets better. I have generously agreed to accept the fee schedule for her insurance.

 

[air bud]

I recently had a patient come into my office. He was about 450 lb and couldn't reach his toes. He was not diabetic. He had 4 other podiatrists refuse to perform nail care without charging him cash. I performed nail Care and billed his insurance. He thanked me profusely.

 

[GreenHousePub]

I had a patient who was paralyzed and had severe mental issues. She ended up with a huge calcaneal wound and calcaneal osteomyelitis. Her family was really concerned and was desperate to not lose her leg. I worked with vascular and proposed doing a calcanectomy, abx bead placement and wound vac'ing the area.

Did surprisingly well, and healed within like 6 weeks. Patient and family was very grateful. Follow up 2 years later still healed.

 

[HardRoadPaved]

Today I was the 5th opinion for a teenage girl. She has calcaneal apophysitis. No one else had ever come up with a diagnosis and another doctor was about to make her non-weight-bearing for 3 months in a cast. My timely intervention has presumably saved her life or at least her summer assuming she gets better. I have generously agreed to accept the fee schedule for her insurance.

The best is when you look like a hero for Islens dz when everyone wants to CAM boot them thinking its a fx

 

[Poddy2Hotty]

Also gave me a carton of pall malls.

dyyyyyyyyingggg 😂

 

[Poddy2Hotty]

I had an 68 y/o DM2 patient come in for plantar fasciitis pain wearing 5 year old "podiatrist approved" Skechers. Hooked him up with a PRP injection and then casted him for custom inserts. Saw he had onychomycosis so biopsied the nail to check for possible additional bacterial infection. Had him come back in a week and found out he had a polymicrobial MRSA infection in his nails. Gave him 4 weeks of Doxycycline to cure the infection and set him up for weekly laser treatments for his onychomycosis for 3 months. Also sold him some UV lights to help kill the bacteria in his shoes. The patient wasn't able to afford to eat as much food due to medical bills, but he ended up losing 50lbs which lowered his HbA1c! I love a win-win situation.

 

[air bud]

I had a patient come in recently for a really poorly done bunion by another podiatrist. She asked me for a nail trim. Of course I did it and she was really happy, thanking me profusely for getting her in and out so fast because she was seeing Ortho after for a bunion revision.

 

[Weirdy]

Alright take it easy guys.
For every 2 troll posts there better be at least 1 legitimate story or we will be closing the thread.

Will let the reader discern what is facetious or not as some of you have had such crafty responses I had to pause for a second.

 

[air bud]

I had a lady come in yesterday for a DFU. She had a bunion and hammertoes done by Ortho with a revision. She is frustrated with the ulcer. I have gotten it to nearly heal with some debridement and a boot. Going to get her into some diabetic shoes but have talked about surgery. She is excited for this to hopefully be over. We then talked about her pet tortoise and I am probably going to adopt it from her and she is really excited for it to go to a good home.

 

[DYK343]

You guys are awful.
I love it.

 

[wakaflocka88]

Had a nice 70s lady come in with a chronic sub 2nd ulcer, tiny. Healthy overall. Contracted hammertoes, mallet great toe. Zero fat pad. Prominent met heads. Equinus.

Very active, has vacations lined up every week this summer.

Offered her great toe IPJ fusion, floating osteotomies 2-5, strayer, IPJ arthroplasties 2-5. 1 week post op and told me she’s already advertised my services to her friends.

Within 2 weeks after surgery, wound is nearly healed and has been full WB in post op shoe since day 1 with minimal pain. She’s a trooper and very grateful.

 

[Boba Foot]

I had a poorly controlled diabetic with gas to her anterior inferior ankle this past fall. She had been seeing a wound care doc whom had been painting a plantar foot wound with gentian violet (lol) every week and sending her on her way. In residency, this patient probably would've been sent straight to vascular for BKA. Went ahead and took a shot at saving it and she ended up just losing two partial rays. Put her on a vac for a long time. Now at about month 7-8, she's finally almost fully healed up. Every time she comes into the office she says "I love you papi" and gives me a bag full of clementines and granola bars. I can't tell if that's her way of saying thank you, or if she's trying to subtly hint I need to eat better and lose a few pounds.

 

[air bud]

I had a lady come in with a significant pes planus foot. Thin, healthy 55, well to do. PT pain, navicular pain with subfibular pain. She had seen multiple orthopedic surgeons all who recommended surgery. I made her a custom articulating AFO. I haven't seen her back so I assume she is very happy.

 

[HardRoadPaved]

I had a gentleman that was treated with Formula 3 for unkempt toenails by a TFP. The nails never got better and he was mad he spent so much money. I pointed to the 'money back guarantee' on the label and he was elated to get his $50 back.

 

[Shiyuan]

Had a patient see a VA podiatrist locally for one full year for his sub first met ulceration. All the doctor did for offloading was trim about 2 mm thickness off his DM insoles corresponding to the ulcer. So, I did a PL tenotomy and healed in two months. The patient was super thrilled. Suffice to say, he asked why the other doctor did not do this and I just smiled.

 

[heybrother]

Had a patient see a VA podiatrist locally for one full year for his sub first met ulceration. All the doctor did for offloading was trim about 2 mm thickness off his DM insoles corresponding to the ulcer. So, I did a PL tenotomy and healed in two months. The patient was super thrilled. Suffice to say, he asked why the other doctor did not do this and I just smiled.

I would like more details.

Waka or someone on here awhile back told me I should be doing more PL work. After the recent diabetic ulcer thread, I went and read every article I could find online about peroneus longus surgical management for sub-1st metatarsal ulcers. There is not a lot out there. A few decent Podiatry Today articles (don't tell Feli!). There's an article where PL transfer was the last of a 4 procedure intervention (last step though). Roukis has an article on doing a peronus longus recession in the tendon/muscle belly.

Sub-1st metatarsal ulcerations have been a source of frustration for me. While I see cavus/CMT/etc patients with true rigidity and plantarflexion of the 1st ray the majority of people I would see would be relatively rectus/planus with good mobility through the medial column and nothing to suggest that osteotomy/fusion through the 1st ray should work. I've started "testing" these patients for peronus overdrive as they describe in the articles and it is fascinationg to see the plantarflexion of the 1st ray when peroneus longus is isolated. PL intervention seems fascinating. Curious to hear from more people who are doing them. Thanks!

 

[wakaflocka88]

I would like more details.

Waka or someone on here awhile back told me I should be doing more PL work. After the recent diabetic ulcer thread, I went and read every article I could find online about peroneus longus surgical management for sub-1st metatarsal ulcers. There is not a lot out there. A few decent Podiatry Today articles (don't tell Feli!). There's an article where PL transfer was the last of a 4 procedure intervention (last step though). Roukis has an article on doing a peronus longus recession in the tendon/muscle belly.

Sub-1st metatarsal ulcerations have been a source of frustration for me. While I see cavus/CMT/etc patients with true rigidity and plantarflexion of the 1st ray the majority of people I would see would be relatively rectus/planus with good mobility through the medial column and nothing to suggest that osteotomy/fusion through the 1st ray should work. I've started "testing" these patients for peronus overdrive as they describe in the articles and it is fascinationg to see the plantarflexion of the 1st ray when peroneus longus is isolated. PL intervention seems fascinating. Curious to hear from more people who are doing them. Thanks!

My n=1 for a PL tenotomy at the level of the fibula for one patient so far with a sub 1st met ulcer, not a cavus foot, just prominent met heads. So far it has worked, patient was semi sensate.

I also have n=1 for both a PL tenotomy plus a floating osteotomy of the first met in a non sensate patient and will see how it holds up long term. I thought about adding a Strayer too but ended up not. If he ends up having transfer ulcers I’ll do the strayer plus floating osteotomy of 2-5 in the future

 

[PeaJay]

PL intervention seems fascinating.

Did a few in residency. Always worked well.

Along the same vein, I like intra muscular TA lengthening for flexible forefoot varus and sub 5 breakdown

 

[air bud]

Did a few in residency. Always worked well.

Along the same vein, I like intra muscular TA lengthening for flexible forefoot varus and sub 5 breakdown

Have never heard of that. Interesting.

 

[Shiyuan]

I would like more details.

Waka or someone on here awhile back told me I should be doing more PL work. After the recent diabetic ulcer thread, I went and read every article I could find online about peroneus longus surgical management for sub-1st metatarsal ulcers. There is not a lot out there. A few decent Podiatry Today articles (don't tell Feli!). There's an article where PL transfer was the last of a 4 procedure intervention (last step though). Roukis has an article on doing a peronus longus recession in the tendon/muscle belly.

Sub-1st metatarsal ulcerations have been a source of frustration for me. While I see cavus/CMT/etc patients with true rigidity and plantarflexion of the 1st ray the majority of people I would see would be relatively rectus/planus with good mobility through the medial column and nothing to suggest that osteotomy/fusion through the 1st ray should work. I've started "testing" these patients for peronus overdrive as they describe in the articles and it is fascinationg to see the plantarflexion of the 1st ray when peroneus longus is isolated. PL intervention seems fascinating. Curious to hear from more people who are doing them. Thanks!

Works like a charm. No need to anastamose to the PB IMO. Just cut the PL, sew it up, watch the magic.

However.... one type of patient this can fail on is 1st MPJ fusions. If that’s the case, do a sesamoidectomy.

 

[PeaJay]

Have never heard of that. Interesting.

I think one of the east coast wound heavy programs has a JFAS article on a “z” lengthening of a TA for sub 5 ulcer. For the recession, Just make a 2 cm incision just off tibial crest at musculo tendon junction and cut it like a strayer.

 

[HardRoadPaved]

I think one of the east coast wound heavy programs has a JFAS article on a “z” lengthening of a TA for sub 5 ulcer. For the recession, Just make a 2 cm incision just off tibial crest at musculo tendon junction and cut it like a strayer.

Do u use an 18g needle?

 

[Boba Foot]

Works like a charm. No need to anastamose to the PB IMO. Just cut the PL, sew it up, watch the magic.

However.... one type of patient this can fail on is 1st MPJ fusions. If that’s the case, do a sesamoidectomy.

You don’t get any residual deformity after just cutting the PL?

 

[Shiyuan]

You don’t get any residual deformity after just cutting the PL?

Maybe some, but not enough to cause re-ulceration... at least for the peeps i’ve done it on so far 🤷🏻‍♂️

 

[Sweatshirt]

I graduate residency in 1 month and will never have to put another cartiva in ever again

 

[Shiyuan]

I graduate residency in 1 month and will never have to put another cartiva in ever again

Gotta love those worthless gummy bears!

 

[Pronation]

I graduate residency in 1 month and will never have to put another cartiva in ever again

Are people actually still putting this crap in?

 

[Adam Smasher]

People have a really short memory about the Cartiva, but go back in time to ~2016, it was the hottest new thing in forefoot surgery. There was a prospective RCT published in FAI that won the Roger Mann Award for excellence in research which showed that the Cartiva was the silver bullet for hallux rigidus or something like that. At the time, I was in residency and my director and attendings were all over it because it was the next next big thing. And we all saw how that panned out. Really an amazing hero-to-zero story.

 

[Sweatshirt]

Are people actually still putting this crap in?

Yeah, we have 1 guy in the area who still does them. Only a few though. He's the last one in the city

 

[GreenHousePub]

I graduate residency in 1 month and will never have to put another cartiva in ever again

You guys are still using them? After everyone stopped like 5 years ago?

 

[Sweatshirt]

You guys are still using them? After everyone stopped like 5 years ago?

Not "you guys". One random podiatrist in the city who does surgery about 2 times a month