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WARNING ABOUT BIZARRE SURGERY

Posted by Dr. David S. Wander on 12/07/02 at 10:56 (102075)

It has recently come to my attention, that there are several doctors across our country performing a BIZARRE surgery in conjunction with ESWT. These doctors are performing a procedure where multiple holes are drilled in the calcaneus (heel bone) to 'decompress' the pressure within the calcaneus. These doctors are also performing ESWT during the same session. They are calling this procedure a 'calcaneal fenestration' procedure.

Many years ago there were a handful of articles describing a calcaneal decompression surgery, also performed by drilling holes in the calcaneus to relieve the 'internal pressure'. This ultimately resulted in MANY cases of multiple calcaneal fractures due to the weakening of the bone by drilling holes. This is NOT A STANDARD ACCEPTED PROCEDURE AND HAS NO LITERATURE TO VERIFY IT'S SAFETY OR EFFECTIVENESS. For some reason, a group of doctors has recently rekindled this unproven procedure, and are performing this procedure after performing ESWT.

The beauty of ESWT is that it is non-invasive and has few if any side effects. Performing an absurd, unproven surgery with some extremely serious potential side effects, in conjunction with ESWT is as bizarre as taking a sleeping pill with high caffeine coffee!

If any patients on this forum have been in contact with a doctor that suggests this 'new' fenestration surgical procedure in conjunction with ESWT.............RUN OUT THE DOOR.

Re: WARNING ABOUT BIZARRE SURGERY

Dr. Z on 12/07/02 at 11:38 (102076)

I also read about this procedure on another forum. Are we sure that it is the exact type of decompression procedure that was performed years ago.
I know Dr. Smith wrote an article in the Journal APMA where he did this drilling and then used a screw fixation. IS this the same procedure.

The doctor who talked about this procedure in his e-mail didn't sound like he though he was doing anything wrong. I would like to know more and learn more about this procedure combination. It does sound crazy but we need to keep an open mind until we know all the facts. Would you believe the first time I saws this procedure was in the operating room at one of our own podiatry schools. I agree that pateints at this point in time until more information is obtain is avoid this kind of procedure.

Re: WARNING ABOUT BIZARRE SURGERY

Pauline on 12/07/02 at 12:21 (102087)

Dr. Wander, you know the doctors using ESWT, and you know which ones are performing this bizarre surgery. Besides warning posters here what action do you plan, as a professional group, to take againt these practitioners?

You sit on the Quack Medicine Board so I would expect at the very least
some action be taken by you and your colleagues. Personally, I'd start with a large newspsper ad where they practice. It's not enough to warn posters. Since you know this is being done I hold you and your colleagues responsible to stop the injury being caused, to unknowing patients, at the hands of these Quacks.

Take them down Dr. Wander.

Re: WARNING ABOUT BIZARRE SURGERY

Ed Davis, DPM on 12/07/02 at 12:58 (102098)

Dr. Z:

No -- two different procedures. I don't have the original paper but an Egyptian orthopedic surgeon, back in the mid-1980's, hypothesized that heel pain is caused by vascular congestion of the calcaneus. His treatment involved placing multiple drill holes in the calcaneus in order to achieve 'decompression.' That procedure migrated to the US where some used k-wires, usually percutaneously, to place multiple holes in the calcaneus -- occasionally that led to fractures. The procedure rapidly fell out of use. David was shocked to see someone still using it.

Steve Smith, DPM hypothesized, also starting back in the mid-1980's that much heel pain, especially intractable heel pain was due to undiagnosed stress fractures of the calcaneus. He delivered a lecture entitled, 'Stress Perturbations of the Os Calcis.' He was very convincing and gave an excellent lecture. The treatment, then, based on his hypothesis, was to increase use of casting. If casting did not work, then a bone scan was to be performed, followed by placement of fixation across the calcaneus, generally using a cancellous bone screw from the tuberosity coursing upwards and distally into the body of the calcaneus.
Ed

Re: WARNING ABOUT BIZARRE SURGERY

Ed Davis, DPM on 12/07/02 at 13:00 (102099)

David:
Do you have any reason to believe that there are any significant numbers of docs beyond the poster we both noted on the forum doing the procedure?
Ed

Re: WARNING ABOUT BIZARRE SURGERY

Dr. Z on 12/07/02 at 15:14 (102111)

I have no reason to believe that there is a large group of doctors using this procedure period with ESWT.

Re: Re Lets get the facts first

Dr. Z on 12/07/02 at 15:20 (102112)

Steve Smith DPM published his artilce in or around 1992. What i am saying is we need to get all of the facts of this fenestration plus eswt procedure . I have no idea what this doctor is doing. I am always open to
to an idea that makes sense and can't cause severe harm

I still remember the podiatric/orthopedic world calling miminial incision heel spur surgery a blind procedure and probaby though it was bizarre.
This was in the late 1970's . It turned out to be one of the best heel spur surgical procedure available. So lets gather the fact and listen and maybe learn.

Re: WARNING ABOUT BIZARRE SURGERY

Dr. Z on 12/07/02 at 15:21 (102113)

I didn't think that the ESWT companies would be allowing the use of their machine in any other way that wasn't described by the FDA for chronic pf.

Re: Re Lets get the facts first

Dr. David S. Wander on 12/07/02 at 17:14 (102123)

David,

Fenestration surgery involves multiple drillings of the calcaneus and is not a standard accepted procedure. There is no reason to perform any adjunct surgical procedure, prior to even seeing if ESWT works for the patient. You will not convince me that any surgical procedure should be performed with ESWT, especially a procedure with no scientific merit. Can you think of ONE reason why you should add a surgical procedure to ESWT?

Stating that minimal incision heel spur surgery 'turned out to be one of the best heel spur surgical procedures available', is certainly your opinion and not shared by all podiatrists. The original critique of this surgery was the 'blind' characteristic of not visualizing the tissues/bone. This procedure was then performed via the assistance of flouroscopy, therefore the instrumentation and 'heel spur' were visualized, eliminating the 'blind' surgery and the procedure gained more mainstream acceptance. This is not a valid comparison with this new 'fenestration' procedure, which is simply a rekindling of the old calcaneal decompression osteotomy that didn't work years ago and won't work now. Most importantly, with the advent of ESWT I do not see any reason for this unproven surgery to resurface.

Re: WARNING ABOUT BIZARRE SURGERY

Dr. David S. Wander on 12/07/02 at 17:17 (102124)

Pauline,

This is not as simple as it sounds. Taking ads out in papers is costly and can ultimately result in expensive litigation. Unfortunately, educating the patient population and protecting these patients from quacks is not easy and certainly is time consuming. Poor medical practice usually runs itself into the ground, and unfortunately there will be patients that have suffered for no logical reason. Since there is a large population that reads this site, I thought that I would certainly post my feelings about this procedure.

Re: WARNING ABOUT BIZARRE SURGERY

Dr. David S. Wander on 12/07/02 at 17:19 (102125)

Ed,

I think there is a very small group of doctors performing this procedure, and given the responses on the website that you and I read, I think that this procedure will be very short lived. All the podiatrists that responded, basically responded with horror and anger that this was being performed. Hopefully, this will be the last we hear about it.

Re: WARNING ABOUT BIZARRE SURGERY

nancy s. on 12/07/02 at 17:34 (102128)

dr. wander, thank you very much for posting about this rather than simply reading about the procedure yourself and tossing it off as a no-good. you've warned a great many people today.

nancy
.

Re: Re Lets get the facts first

Dr. Z on 12/07/02 at 17:40 (102129)

Let's just see what this is all about is what I am saying. What I meant by miminial incision heel spur surgery is that in the beginning when only a few including myself were doing this procedure and helping alot of pateints, others were calling out that this was a dangerous and blind procedure . Blind , bizarre , ridiculous, stupid etc.

I have to admit this is a very strange procedure to add to ESWT but I would like to hear the reasoning behind the drilling . I just have learn from others attaching miminial incision foot surgery to keep an open mind especially when my own observations were just the opposite.

There are now textbooks, articles, journals that show that miminial incision heel spur surgery is efffective . These are all mainstrain podiatric and orthopedic journals and literature. Alot of these journal never mnetions a fluroscope.

Re: WARNING ABOUT BIZARRE SURGERY

Dr. Z on 12/07/02 at 17:43 (102130)

David,

Maybe I haven't read the same web postings. Was this on coding.com.? Was this the questions about proper billings. ? I would like to read the postering you are talking about.

Re: WARNING ABOUT BIZARRE SURGERY

Pauline on 12/07/02 at 18:58 (102144)

Bottom line is that poor medical practice hurts patients. You know the doctor or doctors performing this procedure. Certainly open censure
at your professional meetings as well as in your Podiatry online publications would be appropriate and cost nothing. You can also decry this practice publically.

I won't let you or your colleagues wash your hands on this, ignoring it hoping it will just go away. You can put pressure on these physicians professionally with little to no cost and without litigation.

What I hear in your reply is a lack of motivation, poor excuses and a profesional courtesy being extended to one of your own knowing fully they are out there harming patients.

There isn't a rug big enough to hide this wrong doing as far as I'm concerned. Their patients are the victims and deserve more than a mere posting on this web site.

Your warning posted on heelspurs should be the beginning to stopping these doctors and their practice, not the end of it.

Do what is right, police your own and at the very least call them on it. Yelling fire then turning your back on its victims doesn't save lives.

Re: WARNING ABOUT BIZARRE SURGERY

Pauline on 12/07/02 at 19:14 (102145)

Dr. Ed,
What I hear you saying is 'Let's close this can of worms as soon as possible' I say point out these charlatans to the public so their income and reputation takes a beating.

It's high time your profession begin to seperate the chaff from its wheat.
Sorry to say it's long overdue.

Re: WARNING ABOUT BIZARRE SURGERY

Ed Davis, DPM on 12/07/02 at 19:17 (102147)

David and Pauline:
It sounds like that poster had already run into the podiatry board in California. They would have the responsibility for any action.
Ed

Re: WARNING ABOUT BIZARRE SURGERY

Ed Davis, DPM on 12/07/02 at 19:19 (102148)

Dr. Z:
It was on Barry Block's forum, I believe Dec 5.
Ed

Re: WARNING ABOUT BIZARRE SURGERY

Ed Davis, DPM on 12/07/02 at 19:25 (102150)

Pauline:

Based on the post, it appears that that individual already faces action from the California Board of Medical Quality Assurance. I am not suggesting that we close the case, only that it be placed in proper perspective -- we know of one individual who openly stated he was doing this procedure and that is it. Maybe one 'worm' but far from a 'can of worms.'
Ed

Re: We Need the Facts Not emotions

Dr. Z on 12/07/02 at 20:32 (102160)

You can contact the ESWT equipment company that is allowing their machines to do this procedure if you feel that this is wrong. By the way we still don't know all the facts and that is what is more concerning. I still remember the bad mouthing that went on in the late 1970's about miminial incision heel spur surgery and now look where it is.

IF I felt that a procedure was wrong I would do something, but I would have to know all of the facts for example.

Why is this doctor doing this procedure. I have seen some form of this procedure years ago and it WORKED. Can there be complications with this procedure yes. Was the pateint told all of the complications. WE NEED FACTS NOT STUPID EMOTIONS .

Re: WARNING ABOUT BIZARRE SURGERY

pala on 12/07/02 at 20:50 (102165)

can the rest of us go to this forum? if its about feet.....

Re: WARNING ABOUT BIZARRE SURGERY

Dr. Z on 12/07/02 at 20:50 (102166)

Here is the post. The Blue Shield MD has the duty to report this doctor if he feels that something is wrong. I just hope this MD knows feet and knows the facts
Query*: ESWT & Fenestration, Fraud
From: Kirk Allen, DPM

I recently performed extracorporeal shockwave therapy along with
fenestration procedure for heel spur syndrome. I billed an osteotomy
procedure code with a '-52' modifier, in addition to the ESWT code.
The Blue Cross MD review called me to tell me that not only going to
recommend non-payment, but that this was fraud.
Needless to say I have not been paid for either procedure on
this, as well as similar procedures performed on three other
patients. What do you recommend? Thank you.

Kirk Allen, DPM
Monterey, CA

Re: We Need the Facts Not emotions

pala on 12/07/02 at 20:54 (102167)

i can't figure out why an operation of any kind is performed with eswt. wouldn't the logical thing to do is see if the eswt worked before doing anything invasive?

Re: WARNING ABOUT BIZARRE SURGERY

pala on 12/07/02 at 21:04 (102170)

i would like to thank dr wander for bringing this to our attention. i think he got jumped on a bit here for not taking it further. but really, how many docs would have brought it up at all. pauline i agree with you in theory but why put one doc on the defensive. now keep in mind that i have no love or general respect for medical professionals and even less so for unnecessary cutting (or drilling) of feet. but our docs here seem to me to get some credit for what they do here. which is engage in open discussion and debate and help us for free. well, maybe this is a backhanded compliment to the docs here, but it is the best i can do in my bitter and depressed mood. seems to me like the docs are trying to get to the truth and bring the truth to us here on this issue.

Re: WARNING ABOUT BIZARRE SURGERY

Pauline on 12/07/02 at 21:45 (102175)

Pala,
Dr. Wander sits on the Quacker Medicine Board so he is very familiar with various forms of deceptive medical treatments that cause injury to lots of patients.

He is a leader in his profession, a man who holds some authority and a professional. I hold not only him but his colleagues everywhere who know about this doctor and who do nothing to expose the truth about his practice of medicine responsible for the fate of the patients he harmed by
this treatment.

All to often in most of the areas of medicine, the members are left to police their own, yet on many occassions we see them bury their heads
in sand rather than face one of their own colleagues with diciplinary and legal action. I think that's wrong.

Those who hold the highest offices are given more responsibility and in my opinion therefore more is expected of them.

A post by one of the doctors finally indicated that the Calif. Medical Board was looking into this case. At the very least this should be expected, not just a mere warning post on a Plantar Fasciitis
web site.

Knowing that some definate action is being taken and the case is being investigated is important to this reader.

That part of this story was posted after my response to Dr. Wander.
We now know additional action is being taken.

Re: WARNING ABOUT BIZARRE SURGERY

Dr. Z on 12/07/02 at 22:10 (102176)

Where did you ever get the idea that Dr. Wander sits on the State Board of Medical Examiners.? Whatever happen to due process, gathering of facts an investigation. None of the doctors including myself know the facts or the reasons that this treatment was done.
Dr. Wander is a fine doctor but you are mistake that he is a member of the State Board of Medical Examiners. Where do you come up this ?

Re: WARNING ABOUT BIZARRE SURGERY

Pauline on 12/07/02 at 22:32 (102179)

I'm not saying he sits on the State Board of Medical Examiners, I said he is on the Board for Quackwatch.

Podiatric Medical Advisors

(Titles are listed for identification only)
Our advisors help us evaluate web sites, answer health-related questions, review books, help prepare articles, and engage in other projects that foster the spread of accurate information on the Internet. Our projects can take anywhere from a few minutes per month to several hours per week. If you have expert knowledge and would like to volunteer, please join our advisory board. We are interested in setting up smaller versions of our site in other languages. If you operate a site and would like to translate and post some of our articles, please mention this in your application.

United States (3)
Clinton Clark, DPM, FACFAS
Honolulu, Hawaii
Peter Marshall Harvey, DPM
Wichita Falls, Texas

David S. Wander, DPM, FACFAS
Philadelphia, Pennsylvania

Advisory Board Index (PIPE)(PIPE)(PIPE) Quackwatch Advisor Application
Quackwatch Home Page

Re: WARNING ABOUT BIZARRE SURGERY

Pauline on 12/07/02 at 22:38 (102180)

Now will you apologize for thinking I make things up?

Re: WARNING ABOUT BIZARRE SURGERY

Dr. Z on 12/08/02 at 00:15 (102185)

Yes . I am sorry. I think I was on that board at one time. One day I started reporting too many podiatrist so they removed me.

Re: PAULINE-you are unbelievable

Dr. David S. Wander on 12/08/02 at 08:45 (102206)

Pauline, it takes a lot to anger me but you've done a great job. I made an attempt to warn patients regarding this matter that came to my attention 24 hours prior to my posting. For you to have the audacity to say I have no motivation and poor excuses if beyond belief. In the past 24 hours I've posted on this website warning patients, wrote to the original website with the original posting, wrote to the doctor performing the procedure and contacted approximately 3 other sources. Just like the rest of the doctors on this site, I VOLUNTEER my time and I gain nothing monetarily from this site. For you to accuse me of having a lack of motivation, poor excuses and protecting a 'colleague' is a personal attack on my integrity.

I thought I did the proper thing regarding posting on this site as soon as I heard about the procedure and I contacted the doctor and other sites. But I guess my efforts aren't good enough for you, and apparently no matter what I do, you won't appreciate it.

I have no idea how many doctors are performing this procedure or how many they have performed, and I have no way of determining that information. Enough of the 'right' people have been alerted about this and the wheels are in motion. These things don't happen overnight, but I think I've accomplished quite a bit since I only heard about this on Friday, 12/6/02.

I'd strongly advise you to think twice prior to attacking my integrity. I was one of the guys on 'your side', attempting to help patients on this website during the little free time I have.

Re: PAULINE-you are unbelievable

Pauline on 12/08/02 at 10:40 (102223)

Dr. Wander,
Sorry to have angered you. Had you put in your original post all the additional actions you had taken which you are only now describing it would have been easy to see you left no leaf unturned nor were you satisfied with simply a post on heelspurs.

You didn't do that. How was anyone to know you had indeed taken additional action?

Not to anger you more or any doctor on this board, but as a Volunteer myself I know what it means to be a VOLUNTEER. We go into it knowing there is no money, no glamor and no guarantees of kudos or even a pat on the back or even that our work will be appreciated.

We do it because we want to, because we feel a need to give back to our communities and because we care about and love people.

Most of the time volunteers gain more than they give and unless someone mentions they are a volunteer we don't even know it. That's what is so neat about being a volunteer. Your part of a large underground group of caring people that needs no recognition for helping others. We come from all income groups and professions, we're all ages and we all try our best to make this world a better place.

Re: YOU GO! Dr. Wander!!!!!!!

Sheila S on 12/08/02 at 10:47 (102224)

I have kept silent on this whole thing while reading every idiotic reply from Pauline. Dr. Wander, you are quite correct. I was rather shocked at Pauline's audacity on a topic she knows nothing about, a procedure she knows nothing about and, particularly, a doctor (you) whom she knows nothing about. You will note that she is the ONLY one who spoke like that, which should indicate that NONE of us agree with her. I hope you realize that. The rest of us feel this way I think:

Your obligation as a professional was to warn everyone of something being fishy and suggest thorough investigation before undergoing the procedure. And, subsequently, on your own, eventually learn more about it. This you did, and are obviously doing.

It's pretty obvious that, with the limited knowledge of what and how things were actually done (as indicated by Dr. Z) in this bizarre procedure, you could do no more - ethically, morally, judgementally - than what you have done.

JUST the very fact that you warned on this site, tells me without a doubt that if you gathered, at a later date, verifiable, and accurate, information - you would not hesitate to take appropriate steps to have the matter properly investigated.

Forget Pauline, she is way off base and way out of line.

Her type of attitude - judgement with no brains - is what sues McDonald's when they spill coffee in their own lap; or because their kids are fat. And the reason your malpractice insurance premiums are so exhorbitant. There is one in every crowd.

Forget it, if you can. No one else agrees with her.

Sheila with a big pat on the back for Dr. Wander

Re: Sheila

wendyn on 12/08/02 at 11:25 (102235)

While I agree with you that Pauline was out of line with her comments to the Doctor, you should know that your post is heavy on the personal insults, and goes beyond what's normally considered okay on this board.

It's fine for you to support Dr Wander, but attacking Pauline like that will only get you into trouble with Scott (and it doesn't help support your point).

Re: My apologies to Pauline and everyone else

Sheila S on 12/08/02 at 11:30 (102239)

I apologize to everyone for my statements regarding Pauline. Perhaps, I felt Pauline deserved to be on the receiving end of the hurt she inflicted on a helpful and respected physician. I don't even know Dr. Wander. But you are correct, I should have kept them to myself.

Won't happen again.

S

Re: Pauline

Julie on 12/08/02 at 14:33 (102260)

Pauline, I want to observe that the love you say you bear towards your fellow humans is not always apparent in the way you address yourselves to them. It was not apparent in your post to Dr Wander, which I think was uncalled for, and undeserved, by anything he said, or didn't say.

Re: Pauline

pala on 12/08/02 at 18:08 (102281)

dr. wander, please know that i and others really appreciate you here. dr ed once got attacked online here but it all blew over and fortunately his great mind and great help is still with us. i hope you will stay here as well and not be run off. pauline, no one understands anger towards med. profession more than me. and no one sympathizes more. but dr wander did do right here and has helped a lot of us for free. while i think it is important to talk firmly to med. professionals if they are out of line in any way, rather than treat them like gods, it is also very important not to dump anger on one who does not deserve it. i think all of us here understand that pain, frustration and anger get the better of us sometimes. i hope we can drop this now and move one without anybody getting their feathers rumpled permanently. humans make mistakes. sheila, we want to hear your opinions as well. we try not to attack here. we fail sometimes. but then we just get up and try again. and this great board carries on.

Re: Pauline

Pauline on 12/09/02 at 08:52 (102331)

Julie,
Observations can be very misleading--case in point the Catholic Priest Scandal.

Re: Dr. Wander -- a psychic?

Ed Davis, DPM on 12/09/02 at 14:39 (102377)

Pauline:
How could Dr. Wander possibly know who the doctors are who perform the 'bizarre' surgery? He has no more access to what goes on in operating rooms across the country than anyone else.
Ed

Re: Education is the best "weapon" against poor practice.

Ed Davis, DPM on 12/09/02 at 14:44 (102378)

Dr. Wander did the best thing anyone can do-- come online and educate the public. He was the first person to step forward and deserves applause from doing so from all including Pauline.

Physician discipline is a whole other topic. I can can provide some hair raising stories about that subject.
Ed

Re: Pauline

Julie on 12/09/02 at 16:43 (102393)

Pauline, what on earth are you talking about? What has the Catholic Priest Scandal have anything to do with Dr Wander's efforts to keep us informed, and your completely uncalled-for stamping on him?

Re: WARNING ABOUT BIZARRE SURGERY

dave r on 12/10/02 at 07:52 (102512)

I just found a web site that explains the procedure. Wow. Check it out!
Thanks Dr. Wander for warning us against this...Here is the link
http://www.totalfootandankle.com/procedures.cfm

Re: Pauline

Dr. David S. Wander on 12/10/02 at 08:05 (102521)

Julie,

I agree with you, I have no idea what Pauline is talking about with her analogy to the priest scancal.

Re: Education is the best "weapon" against poor practice.

Dr. David S. Wander on 12/10/02 at 08:07 (102523)

Ed,

Thanks for your support and kind words.

Re: WARNING ABOUT BIZARRE SURGERY

Ed davis, DPM on 12/11/02 at 16:27 (102744)

Dave:
Interesting find. How did you find this site? Another controversial topic on this site is 'heel neuroma.' They refer to the 'drilling' procedure as 'new.'
Ed

Re: WARNING ABOUT BIZARRE SURGERY

Ed davis, DPM on 12/11/02 at 16:32 (102746)

Pauline:
The 'board' you speak of is not an official entity. A psychiatrist started the 'quackwatch' web site and invites professionals to act as advisors or 'board' members. That organization or web site is purely informational and has no disciplinary capacity. I am a bit uncomfortable with some of the author's views. He is anti-chiropractic, anti-wholistic medicine.
Ed

Re: WARNING ABOUT BIZARRE SURGERY

A MANOLI, MD on 12/11/02 at 21:33 (102778)

i saw these postings late, but would like to comment. taking off any bone, or drilling the undersurface of the calcaneus is hazardous. we collected a few cases some years ago where scrapping the bottom, or even just removing a heel spur, weakened the bone enough so that a calcaneal fracture occurred when the patient started to walk on the heel. i've seen at least 3 more cases since.

reference:

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1478582&dopt=Abstract

am2

Re: WARNING ABOUT BIZARRE SURGERY

dave r on 12/12/02 at 07:39 (102795)

Dr Ed, i am always looking on the internet for information on feet and foot surgery procedures.

Re: WARNING ABOUT BIZARRE SURGERY

Ed Davis, DPM on 12/13/02 at 21:00 (103010)

Heel spur surgery not only creates a stress point on the calcaneus but removes an important supporting structure, the plantar fascia. I feel it is usually necessary to cast post operatively for those reasons. Some EPF 'ads' mention an early return to regular shoegear -- that can be risky.
Ed

Re: WARNING ABOUT BIZARRE SURGERY

Dr. Z on 12/07/02 at 11:38 (102076)

I also read about this procedure on another forum. Are we sure that it is the exact type of decompression procedure that was performed years ago.
I know Dr. Smith wrote an article in the Journal APMA where he did this drilling and then used a screw fixation. IS this the same procedure.

The doctor who talked about this procedure in his e-mail didn't sound like he though he was doing anything wrong. I would like to know more and learn more about this procedure combination. It does sound crazy but we need to keep an open mind until we know all the facts. Would you believe the first time I saws this procedure was in the operating room at one of our own podiatry schools. I agree that pateints at this point in time until more information is obtain is avoid this kind of procedure.

Re: WARNING ABOUT BIZARRE SURGERY

Pauline on 12/07/02 at 12:21 (102087)

Dr. Wander, you know the doctors using ESWT, and you know which ones are performing this bizarre surgery. Besides warning posters here what action do you plan, as a professional group, to take againt these practitioners?

You sit on the Quack Medicine Board so I would expect at the very least
some action be taken by you and your colleagues. Personally, I'd start with a large newspsper ad where they practice. It's not enough to warn posters. Since you know this is being done I hold you and your colleagues responsible to stop the injury being caused, to unknowing patients, at the hands of these Quacks.

Take them down Dr. Wander.

Re: WARNING ABOUT BIZARRE SURGERY

Ed Davis, DPM on 12/07/02 at 12:58 (102098)

Dr. Z:

No -- two different procedures. I don't have the original paper but an Egyptian orthopedic surgeon, back in the mid-1980's, hypothesized that heel pain is caused by vascular congestion of the calcaneus. His treatment involved placing multiple drill holes in the calcaneus in order to achieve 'decompression.' That procedure migrated to the US where some used k-wires, usually percutaneously, to place multiple holes in the calcaneus -- occasionally that led to fractures. The procedure rapidly fell out of use. David was shocked to see someone still using it.

Steve Smith, DPM hypothesized, also starting back in the mid-1980's that much heel pain, especially intractable heel pain was due to undiagnosed stress fractures of the calcaneus. He delivered a lecture entitled, 'Stress Perturbations of the Os Calcis.' He was very convincing and gave an excellent lecture. The treatment, then, based on his hypothesis, was to increase use of casting. If casting did not work, then a bone scan was to be performed, followed by placement of fixation across the calcaneus, generally using a cancellous bone screw from the tuberosity coursing upwards and distally into the body of the calcaneus.
Ed

Re: WARNING ABOUT BIZARRE SURGERY

Ed Davis, DPM on 12/07/02 at 13:00 (102099)

David:
Do you have any reason to believe that there are any significant numbers of docs beyond the poster we both noted on the forum doing the procedure?
Ed

Re: WARNING ABOUT BIZARRE SURGERY

Dr. Z on 12/07/02 at 15:14 (102111)

I have no reason to believe that there is a large group of doctors using this procedure period with ESWT.

Re: Re Lets get the facts first

Dr. Z on 12/07/02 at 15:20 (102112)

Steve Smith DPM published his artilce in or around 1992. What i am saying is we need to get all of the facts of this fenestration plus eswt procedure . I have no idea what this doctor is doing. I am always open to
to an idea that makes sense and can't cause severe harm

I still remember the podiatric/orthopedic world calling miminial incision heel spur surgery a blind procedure and probaby though it was bizarre.
This was in the late 1970's . It turned out to be one of the best heel spur surgical procedure available. So lets gather the fact and listen and maybe learn.

Re: WARNING ABOUT BIZARRE SURGERY

Dr. Z on 12/07/02 at 15:21 (102113)

I didn't think that the ESWT companies would be allowing the use of their machine in any other way that wasn't described by the FDA for chronic pf.

Re: Re Lets get the facts first

Dr. David S. Wander on 12/07/02 at 17:14 (102123)

David,

Fenestration surgery involves multiple drillings of the calcaneus and is not a standard accepted procedure. There is no reason to perform any adjunct surgical procedure, prior to even seeing if ESWT works for the patient. You will not convince me that any surgical procedure should be performed with ESWT, especially a procedure with no scientific merit. Can you think of ONE reason why you should add a surgical procedure to ESWT?

Stating that minimal incision heel spur surgery 'turned out to be one of the best heel spur surgical procedures available', is certainly your opinion and not shared by all podiatrists. The original critique of this surgery was the 'blind' characteristic of not visualizing the tissues/bone. This procedure was then performed via the assistance of flouroscopy, therefore the instrumentation and 'heel spur' were visualized, eliminating the 'blind' surgery and the procedure gained more mainstream acceptance. This is not a valid comparison with this new 'fenestration' procedure, which is simply a rekindling of the old calcaneal decompression osteotomy that didn't work years ago and won't work now. Most importantly, with the advent of ESWT I do not see any reason for this unproven surgery to resurface.

Re: WARNING ABOUT BIZARRE SURGERY

Dr. David S. Wander on 12/07/02 at 17:17 (102124)

Pauline,

This is not as simple as it sounds. Taking ads out in papers is costly and can ultimately result in expensive litigation. Unfortunately, educating the patient population and protecting these patients from quacks is not easy and certainly is time consuming. Poor medical practice usually runs itself into the ground, and unfortunately there will be patients that have suffered for no logical reason. Since there is a large population that reads this site, I thought that I would certainly post my feelings about this procedure.

Re: WARNING ABOUT BIZARRE SURGERY

Dr. David S. Wander on 12/07/02 at 17:19 (102125)

Ed,

I think there is a very small group of doctors performing this procedure, and given the responses on the website that you and I read, I think that this procedure will be very short lived. All the podiatrists that responded, basically responded with horror and anger that this was being performed. Hopefully, this will be the last we hear about it.

Re: WARNING ABOUT BIZARRE SURGERY

nancy s. on 12/07/02 at 17:34 (102128)

dr. wander, thank you very much for posting about this rather than simply reading about the procedure yourself and tossing it off as a no-good. you've warned a great many people today.

nancy
.

Re: Re Lets get the facts first

Dr. Z on 12/07/02 at 17:40 (102129)

Let's just see what this is all about is what I am saying. What I meant by miminial incision heel spur surgery is that in the beginning when only a few including myself were doing this procedure and helping alot of pateints, others were calling out that this was a dangerous and blind procedure . Blind , bizarre , ridiculous, stupid etc.

I have to admit this is a very strange procedure to add to ESWT but I would like to hear the reasoning behind the drilling . I just have learn from others attaching miminial incision foot surgery to keep an open mind especially when my own observations were just the opposite.

There are now textbooks, articles, journals that show that miminial incision heel spur surgery is efffective . These are all mainstrain podiatric and orthopedic journals and literature. Alot of these journal never mnetions a fluroscope.

Re: WARNING ABOUT BIZARRE SURGERY

Dr. Z on 12/07/02 at 17:43 (102130)

David,

Maybe I haven't read the same web postings. Was this on coding.com.? Was this the questions about proper billings. ? I would like to read the postering you are talking about.

Re: WARNING ABOUT BIZARRE SURGERY

Pauline on 12/07/02 at 18:58 (102144)

Bottom line is that poor medical practice hurts patients. You know the doctor or doctors performing this procedure. Certainly open censure
at your professional meetings as well as in your Podiatry online publications would be appropriate and cost nothing. You can also decry this practice publically.

I won't let you or your colleagues wash your hands on this, ignoring it hoping it will just go away. You can put pressure on these physicians professionally with little to no cost and without litigation.

What I hear in your reply is a lack of motivation, poor excuses and a profesional courtesy being extended to one of your own knowing fully they are out there harming patients.

There isn't a rug big enough to hide this wrong doing as far as I'm concerned. Their patients are the victims and deserve more than a mere posting on this web site.

Your warning posted on heelspurs should be the beginning to stopping these doctors and their practice, not the end of it.

Do what is right, police your own and at the very least call them on it. Yelling fire then turning your back on its victims doesn't save lives.

Re: WARNING ABOUT BIZARRE SURGERY

Pauline on 12/07/02 at 19:14 (102145)

Dr. Ed,
What I hear you saying is 'Let's close this can of worms as soon as possible' I say point out these charlatans to the public so their income and reputation takes a beating.

It's high time your profession begin to seperate the chaff from its wheat.
Sorry to say it's long overdue.

Re: WARNING ABOUT BIZARRE SURGERY

Ed Davis, DPM on 12/07/02 at 19:17 (102147)

David and Pauline:
It sounds like that poster had already run into the podiatry board in California. They would have the responsibility for any action.
Ed

Re: WARNING ABOUT BIZARRE SURGERY

Ed Davis, DPM on 12/07/02 at 19:19 (102148)

Dr. Z:
It was on Barry Block's forum, I believe Dec 5.
Ed

Re: WARNING ABOUT BIZARRE SURGERY

Ed Davis, DPM on 12/07/02 at 19:25 (102150)

Pauline:

Based on the post, it appears that that individual already faces action from the California Board of Medical Quality Assurance. I am not suggesting that we close the case, only that it be placed in proper perspective -- we know of one individual who openly stated he was doing this procedure and that is it. Maybe one 'worm' but far from a 'can of worms.'
Ed

Re: We Need the Facts Not emotions

Dr. Z on 12/07/02 at 20:32 (102160)

You can contact the ESWT equipment company that is allowing their machines to do this procedure if you feel that this is wrong. By the way we still don't know all the facts and that is what is more concerning. I still remember the bad mouthing that went on in the late 1970's about miminial incision heel spur surgery and now look where it is.

IF I felt that a procedure was wrong I would do something, but I would have to know all of the facts for example.

Why is this doctor doing this procedure. I have seen some form of this procedure years ago and it WORKED. Can there be complications with this procedure yes. Was the pateint told all of the complications. WE NEED FACTS NOT STUPID EMOTIONS .

Re: WARNING ABOUT BIZARRE SURGERY

pala on 12/07/02 at 20:50 (102165)

can the rest of us go to this forum? if its about feet.....

Re: WARNING ABOUT BIZARRE SURGERY

Dr. Z on 12/07/02 at 20:50 (102166)

Here is the post. The Blue Shield MD has the duty to report this doctor if he feels that something is wrong. I just hope this MD knows feet and knows the facts
Query*: ESWT & Fenestration, Fraud
From: Kirk Allen, DPM

I recently performed extracorporeal shockwave therapy along with
fenestration procedure for heel spur syndrome. I billed an osteotomy
procedure code with a '-52' modifier, in addition to the ESWT code.
The Blue Cross MD review called me to tell me that not only going to
recommend non-payment, but that this was fraud.
Needless to say I have not been paid for either procedure on
this, as well as similar procedures performed on three other
patients. What do you recommend? Thank you.

Kirk Allen, DPM
Monterey, CA

Re: We Need the Facts Not emotions

pala on 12/07/02 at 20:54 (102167)

i can't figure out why an operation of any kind is performed with eswt. wouldn't the logical thing to do is see if the eswt worked before doing anything invasive?

Re: WARNING ABOUT BIZARRE SURGERY

pala on 12/07/02 at 21:04 (102170)

i would like to thank dr wander for bringing this to our attention. i think he got jumped on a bit here for not taking it further. but really, how many docs would have brought it up at all. pauline i agree with you in theory but why put one doc on the defensive. now keep in mind that i have no love or general respect for medical professionals and even less so for unnecessary cutting (or drilling) of feet. but our docs here seem to me to get some credit for what they do here. which is engage in open discussion and debate and help us for free. well, maybe this is a backhanded compliment to the docs here, but it is the best i can do in my bitter and depressed mood. seems to me like the docs are trying to get to the truth and bring the truth to us here on this issue.

Re: WARNING ABOUT BIZARRE SURGERY

Pauline on 12/07/02 at 21:45 (102175)

Pala,
Dr. Wander sits on the Quacker Medicine Board so he is very familiar with various forms of deceptive medical treatments that cause injury to lots of patients.

He is a leader in his profession, a man who holds some authority and a professional. I hold not only him but his colleagues everywhere who know about this doctor and who do nothing to expose the truth about his practice of medicine responsible for the fate of the patients he harmed by
this treatment.

All to often in most of the areas of medicine, the members are left to police their own, yet on many occassions we see them bury their heads
in sand rather than face one of their own colleagues with diciplinary and legal action. I think that's wrong.

Those who hold the highest offices are given more responsibility and in my opinion therefore more is expected of them.

A post by one of the doctors finally indicated that the Calif. Medical Board was looking into this case. At the very least this should be expected, not just a mere warning post on a Plantar Fasciitis
web site.

Knowing that some definate action is being taken and the case is being investigated is important to this reader.

That part of this story was posted after my response to Dr. Wander.
We now know additional action is being taken.

Re: WARNING ABOUT BIZARRE SURGERY

Dr. Z on 12/07/02 at 22:10 (102176)

Where did you ever get the idea that Dr. Wander sits on the State Board of Medical Examiners.? Whatever happen to due process, gathering of facts an investigation. None of the doctors including myself know the facts or the reasons that this treatment was done.
Dr. Wander is a fine doctor but you are mistake that he is a member of the State Board of Medical Examiners. Where do you come up this ?

Re: WARNING ABOUT BIZARRE SURGERY

Pauline on 12/07/02 at 22:32 (102179)

I'm not saying he sits on the State Board of Medical Examiners, I said he is on the Board for Quackwatch.

Podiatric Medical Advisors

(Titles are listed for identification only)
Our advisors help us evaluate web sites, answer health-related questions, review books, help prepare articles, and engage in other projects that foster the spread of accurate information on the Internet. Our projects can take anywhere from a few minutes per month to several hours per week. If you have expert knowledge and would like to volunteer, please join our advisory board. We are interested in setting up smaller versions of our site in other languages. If you operate a site and would like to translate and post some of our articles, please mention this in your application.

United States (3)
Clinton Clark, DPM, FACFAS
Honolulu, Hawaii
Peter Marshall Harvey, DPM
Wichita Falls, Texas

David S. Wander, DPM, FACFAS
Philadelphia, Pennsylvania

Advisory Board Index (PIPE)(PIPE)(PIPE) Quackwatch Advisor Application
Quackwatch Home Page

Re: WARNING ABOUT BIZARRE SURGERY

Pauline on 12/07/02 at 22:38 (102180)

Now will you apologize for thinking I make things up?

Re: WARNING ABOUT BIZARRE SURGERY

Dr. Z on 12/08/02 at 00:15 (102185)

Yes . I am sorry. I think I was on that board at one time. One day I started reporting too many podiatrist so they removed me.

Re: PAULINE-you are unbelievable

Dr. David S. Wander on 12/08/02 at 08:45 (102206)

Pauline, it takes a lot to anger me but you've done a great job. I made an attempt to warn patients regarding this matter that came to my attention 24 hours prior to my posting. For you to have the audacity to say I have no motivation and poor excuses if beyond belief. In the past 24 hours I've posted on this website warning patients, wrote to the original website with the original posting, wrote to the doctor performing the procedure and contacted approximately 3 other sources. Just like the rest of the doctors on this site, I VOLUNTEER my time and I gain nothing monetarily from this site. For you to accuse me of having a lack of motivation, poor excuses and protecting a 'colleague' is a personal attack on my integrity.

I thought I did the proper thing regarding posting on this site as soon as I heard about the procedure and I contacted the doctor and other sites. But I guess my efforts aren't good enough for you, and apparently no matter what I do, you won't appreciate it.

I have no idea how many doctors are performing this procedure or how many they have performed, and I have no way of determining that information. Enough of the 'right' people have been alerted about this and the wheels are in motion. These things don't happen overnight, but I think I've accomplished quite a bit since I only heard about this on Friday, 12/6/02.

I'd strongly advise you to think twice prior to attacking my integrity. I was one of the guys on 'your side', attempting to help patients on this website during the little free time I have.

Re: PAULINE-you are unbelievable

Pauline on 12/08/02 at 10:40 (102223)

Dr. Wander,
Sorry to have angered you. Had you put in your original post all the additional actions you had taken which you are only now describing it would have been easy to see you left no leaf unturned nor were you satisfied with simply a post on heelspurs.

You didn't do that. How was anyone to know you had indeed taken additional action?

Not to anger you more or any doctor on this board, but as a Volunteer myself I know what it means to be a VOLUNTEER. We go into it knowing there is no money, no glamor and no guarantees of kudos or even a pat on the back or even that our work will be appreciated.

We do it because we want to, because we feel a need to give back to our communities and because we care about and love people.

Most of the time volunteers gain more than they give and unless someone mentions they are a volunteer we don't even know it. That's what is so neat about being a volunteer. Your part of a large underground group of caring people that needs no recognition for helping others. We come from all income groups and professions, we're all ages and we all try our best to make this world a better place.

Re: YOU GO! Dr. Wander!!!!!!!

Sheila S on 12/08/02 at 10:47 (102224)

I have kept silent on this whole thing while reading every idiotic reply from Pauline. Dr. Wander, you are quite correct. I was rather shocked at Pauline's audacity on a topic she knows nothing about, a procedure she knows nothing about and, particularly, a doctor (you) whom she knows nothing about. You will note that she is the ONLY one who spoke like that, which should indicate that NONE of us agree with her. I hope you realize that. The rest of us feel this way I think:

Your obligation as a professional was to warn everyone of something being fishy and suggest thorough investigation before undergoing the procedure. And, subsequently, on your own, eventually learn more about it. This you did, and are obviously doing.

It's pretty obvious that, with the limited knowledge of what and how things were actually done (as indicated by Dr. Z) in this bizarre procedure, you could do no more - ethically, morally, judgementally - than what you have done.

JUST the very fact that you warned on this site, tells me without a doubt that if you gathered, at a later date, verifiable, and accurate, information - you would not hesitate to take appropriate steps to have the matter properly investigated.

Forget Pauline, she is way off base and way out of line.

Her type of attitude - judgement with no brains - is what sues McDonald's when they spill coffee in their own lap; or because their kids are fat. And the reason your malpractice insurance premiums are so exhorbitant. There is one in every crowd.

Forget it, if you can. No one else agrees with her.

Sheila with a big pat on the back for Dr. Wander

Re: Sheila

wendyn on 12/08/02 at 11:25 (102235)

While I agree with you that Pauline was out of line with her comments to the Doctor, you should know that your post is heavy on the personal insults, and goes beyond what's normally considered okay on this board.

It's fine for you to support Dr Wander, but attacking Pauline like that will only get you into trouble with Scott (and it doesn't help support your point).

Re: My apologies to Pauline and everyone else

Sheila S on 12/08/02 at 11:30 (102239)

I apologize to everyone for my statements regarding Pauline. Perhaps, I felt Pauline deserved to be on the receiving end of the hurt she inflicted on a helpful and respected physician. I don't even know Dr. Wander. But you are correct, I should have kept them to myself.

Won't happen again.

S

Re: Pauline

Julie on 12/08/02 at 14:33 (102260)

Pauline, I want to observe that the love you say you bear towards your fellow humans is not always apparent in the way you address yourselves to them. It was not apparent in your post to Dr Wander, which I think was uncalled for, and undeserved, by anything he said, or didn't say.

Re: Pauline

pala on 12/08/02 at 18:08 (102281)

dr. wander, please know that i and others really appreciate you here. dr ed once got attacked online here but it all blew over and fortunately his great mind and great help is still with us. i hope you will stay here as well and not be run off. pauline, no one understands anger towards med. profession more than me. and no one sympathizes more. but dr wander did do right here and has helped a lot of us for free. while i think it is important to talk firmly to med. professionals if they are out of line in any way, rather than treat them like gods, it is also very important not to dump anger on one who does not deserve it. i think all of us here understand that pain, frustration and anger get the better of us sometimes. i hope we can drop this now and move one without anybody getting their feathers rumpled permanently. humans make mistakes. sheila, we want to hear your opinions as well. we try not to attack here. we fail sometimes. but then we just get up and try again. and this great board carries on.

Re: Pauline

Pauline on 12/09/02 at 08:52 (102331)

Julie,
Observations can be very misleading--case in point the Catholic Priest Scandal.

Re: Dr. Wander -- a psychic?

Ed Davis, DPM on 12/09/02 at 14:39 (102377)

Pauline:
How could Dr. Wander possibly know who the doctors are who perform the 'bizarre' surgery? He has no more access to what goes on in operating rooms across the country than anyone else.
Ed

Re: Education is the best "weapon" against poor practice.

Ed Davis, DPM on 12/09/02 at 14:44 (102378)

Dr. Wander did the best thing anyone can do-- come online and educate the public. He was the first person to step forward and deserves applause from doing so from all including Pauline.

Physician discipline is a whole other topic. I can can provide some hair raising stories about that subject.
Ed

Re: Pauline

Julie on 12/09/02 at 16:43 (102393)

Pauline, what on earth are you talking about? What has the Catholic Priest Scandal have anything to do with Dr Wander's efforts to keep us informed, and your completely uncalled-for stamping on him?

Re: WARNING ABOUT BIZARRE SURGERY

dave r on 12/10/02 at 07:52 (102512)

I just found a web site that explains the procedure. Wow. Check it out!
Thanks Dr. Wander for warning us against this...Here is the link
http://www.totalfootandankle.com/procedures.cfm

Re: Pauline

Dr. David S. Wander on 12/10/02 at 08:05 (102521)

Julie,

I agree with you, I have no idea what Pauline is talking about with her analogy to the priest scancal.

Re: Education is the best "weapon" against poor practice.

Dr. David S. Wander on 12/10/02 at 08:07 (102523)

Ed,

Thanks for your support and kind words.

Re: WARNING ABOUT BIZARRE SURGERY

Ed davis, DPM on 12/11/02 at 16:27 (102744)

Dave:
Interesting find. How did you find this site? Another controversial topic on this site is 'heel neuroma.' They refer to the 'drilling' procedure as 'new.'
Ed

Re: WARNING ABOUT BIZARRE SURGERY

Ed davis, DPM on 12/11/02 at 16:32 (102746)

Pauline:
The 'board' you speak of is not an official entity. A psychiatrist started the 'quackwatch' web site and invites professionals to act as advisors or 'board' members. That organization or web site is purely informational and has no disciplinary capacity. I am a bit uncomfortable with some of the author's views. He is anti-chiropractic, anti-wholistic medicine.
Ed

Re: WARNING ABOUT BIZARRE SURGERY

A MANOLI, MD on 12/11/02 at 21:33 (102778)

i saw these postings late, but would like to comment. taking off any bone, or drilling the undersurface of the calcaneus is hazardous. we collected a few cases some years ago where scrapping the bottom, or even just removing a heel spur, weakened the bone enough so that a calcaneal fracture occurred when the patient started to walk on the heel. i've seen at least 3 more cases since.

reference:

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1478582&dopt=Abstract

am2

Re: WARNING ABOUT BIZARRE SURGERY

dave r on 12/12/02 at 07:39 (102795)

Dr Ed, i am always looking on the internet for information on feet and foot surgery procedures.

Re: WARNING ABOUT BIZARRE SURGERY

Ed Davis, DPM on 12/13/02 at 21:00 (103010)

Heel spur surgery not only creates a stress point on the calcaneus but removes an important supporting structure, the plantar fascia. I feel it is usually necessary to cast post operatively for those reasons. Some EPF 'ads' mention an early return to regular shoegear -- that can be risky.
Ed