Jogging barefoot across Ocean Beach, Belinda stumbled and felt a slight pop in her right foot. She was worried because she had been training for a triathlon. She so she went to the ER the next day, just to make sure everything was okay. “Just a sprain,” the ER doctor told him. A week later, she sat in the foot surgeon’s office and said, “I know I’m not a doctor, but I think it’s worse than a sprain.”
I looked at his X-rays and he was right. Her foot was broken. The pain on top of her foot was coming from a subtle fracture in her foot called a Lisfranc injury. An injury to the top of the foot that does not normally heal on its own. It just wasn’t going to get better without surgery.
This story sounds far-fetched but it is terribly common. An award-winning study of foot fracture patterns from the American College of Foot and Ankle Surgeons showed that primary care physicians and emergency room physicians missed 98.4% of radiographic abnormalities they were actually visible on X-ray films indicating this type of pattern of lesions. Another groundbreaking study conducted in 2004 by the University of Utah School of Medicine showed that subtle, often misdiagnosed ankle fractures are actually 10 times more common than previously thought.
The problem is that many patients with foot pain or injury seek treatment from the doctor who treats them quickest. Often this is their primary care doctor who is willing to work with them on a busy schedule just because they are already familiar with the person. Another likely place to go is the emergency room.
This does not mean that an orthopedic surgeon is a better doctor than a primary care doctor or an emergency room doctor. All it means is that you get more of a specialized expert with a sub-specialist. If you have chest pain or a stroke, there’s no question…the nearest Emergency Department is the best place to be. But with a sprained ankle or suspected broken foot, you need to see someone who watches the broken foot bones all the time.
Even if you’ve seen a foot and ankle expert, but are really getting better, you can still seek a second opinion. There’s a reason they say a doctor is “practicing medicine.” It is an art and a science. If you are not getting better and your foot still hurts, your doctor will likely choose someone else to see you. A new set of medical eyes can help see something you’ve missed.
There is a saying in medicine that says that “the eyes see what the mind knows”. This means that someone with experience in trauma is looking for interesting, but less common patterns of injury. A podiatrist without training in reconstructive foot surgery or trauma may not recognize all of the subtle changes that would suggest a rare fracture. That is why he should always get a second opinion if he is not satisfied with the pace of his recovery.
If you get a second opinion and your doctors agree, then you can probably be sure that you’ll get better and keep seeing your original doctor. It is often worth the cost of a second opinion for your peace of mind and to fully understand what to expect with your recovery.
The other main reason you may want a second opinion is foot surgery. If you have painful bunions and are considering bunion surgery, you should definitely get a second opinion. There are over 100 different surgical procedures used to correct bunions and it is important to be informed and confident about your doctor’s surgical plan. If your surgeon tells you that you will need crutches for two months after bunion surgery, you will have major foot surgery. Perhaps another surgeon has a different approach that allows you to walk after surgery and avoid crutches.
Similarly, let’s say you’re thinking about having a bunion removed, and the podiatrist tells you that you’ll be able to walk immediately after the surgery. More aggressive surgery requiring a cast or crutches may help prevent the bunion from coming back in the future. In the long run, this might be better for you.
Either way, once you’ve had foot surgery, the rules change. You cannot undo a bad surgical result. There is no question that it is worth the time and expense to get a second expert medical opinion before any foot surgery is scheduled. Then it’s too late. By getting a second opinion, you are more likely to know what options are available and best suited to your circumstances.
Many reputable surgeons recognize the value of a second opinion. In fact, many of them will hand out a “second opinion referral list” to anyone considering surgery. This list will provide you with an easy way to choose from all the foot surgeons in the part of town where you live. You can then take the list, choose a foot surgeon, and get a second opinion.
If you ask your doctor about getting a second opinion and he seems offended or upset, this should be a red flag. When a doctor believes that he is making a good decision, he will have nothing to hide. Remember, it’s your foot and you have to walk on it many years from now. You should be like Kesha. If you have a feeling something isn’t right, get a second opinion and get the answers you need.
