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The Power of Heelspurs.com - Scott R. please read

Posted by Darlene on 4/11/05 at 20:26 (173006)

Heelspurs.com has become probably the most active foot message board on the Internet.
In reading the messages, it is clear that many, many people have received bad treatments from both podiatrists and orthopaedic surgeons. In my case, the pod who did my surgery gave me a verbal 90% success rate (a number which seems to be thrown around with abandon). After it failed, he wrote inthe Operative Report under prognosis: 'Guarded, due to length of pathology.' My new pod said that there was no way it could have worked given the length of time I had my Morton's neuroma. It is clear that the first pod knew this as well, but still went ahead with the surgery. His '90% success rate' convinced me to naively go ahead with the surgery. When I asked the first pod about alcohol injections, he said 'I've got some here.' It clearly would not have helped me, but no analysis was done as to the best approach in my particular case. National averages are not relevant - we rely on the pod to look at our individual case and apply their years of learning, experience, research etc.
That brings me to my point. I noticed that there is a 'Rate the Doctor' area on the website. This could become a very powerful tool for patients. To be effective, we need to name the doctor and explain exactly what happened. The 'doctor' section should be a required field and the poster should have the option of anonymity. This would show both the good and the bad. I imagine that a lot of GP's and doctors who do re-do surgery see a lot of the bad, but how is a patient to know?
Are there any legal implications?
What does everybody think?

Darlene

Re: The Power of Heelspurs.com - Scott R. please read

Liboralis on 4/11/05 at 21:44 (173008)

That section is good but how doyou keep some docs from having friends or themself post that they were great. i see afew names on there with multiple a-1 scores and the wording sounds almost the same

Re: The Power of Heelspurs.com - Scott R. please read

Scott R on 4/11/05 at 22:10 (173011)

Doctors have the right to protect themselves from libel. If a patient warns others away from a doctor, the doctor has the right to identify and sue that person for harming his business. If the allegations are found to be false, then the doctor can win in court. If a web site allows visitors to speak bad about a doctor but does not provide the courts with a way to idenitify the authors, then the web site is liable for participating in the potential crime. I've thought of ways to deal with this, but it gets a little complicated and would require too much of my time.

Re: The Power of Heelspurs.com - Scott R. please read

elliott on 4/12/05 at 08:45 (173026)

Scott R, I thought I finally had it straight that only Scottr attracts your attention, not Scott R. Yet you responded promptly to Scott R. So now I have to ponder whether it's

a) still scottr but coincidentally you were perusing the boards

b) still scottr but you were contacted by a third party that you were being paged

c) really Scott R and my memory is foggy

d) either element of the set {Scottr, Scott R} now works

I have a headache. :-)

Re: The Power of Heelspurs.com - Scott R. please read

Scott R on 4/12/05 at 09:54 (173029)

i just happened to look at the board. this causes so much confusion, i'll just make it both

Re: The Power of Heelspurs.com - Scott R. please read

Darlene on 4/12/05 at 15:45 (173063)

Scott:

What if we simply recount our personal experience with the doctor? I would be happy to help set this up. If I could save just one person from going through this nightmare, the effort would be worth it.

Darlene

Re: The Power of Heelspurs.com - Scott R. please read

Scott R on 4/12/05 at 16:30 (173066)

Recounting your personal experience is fine, but i would have to get a copy of your driver's license (minus the SSN) and contact the doctor to give him fair warning of any negative comments about him that are published on my web site, a chance to post a response to the negative comments, and the name and physical address of the person making the negative comments in case he decides to take legal action for the libel that may cause harm to his business.

Re: The Power of Heelspurs.com - Scott R. please read

Darlene on 4/12/05 at 17:30 (173077)

Wow!!!

Is there no way around that?

Any lost business to him means saved feet out there.

Re: The Power of Heelspurs.com - Scott R. please read

Scott R on 4/12/05 at 17:35 (173079)

Don't you think doctors should have a chance to defend their reputation? If someone dedicated a web site to telling others that you and your family are incompetent at your work in an effort to decrease your employment opportunities, wouldn't you feel like you had the right to find out who wrote the bad things and take them to court?

Re: The Power of Heelspurs.com - Scott R. please read

Darlene on 4/13/05 at 20:56 (173145)

Scott:

I see your point.

That section of the board is such a good idea, it would be great if it could be utilized in some ways. How about using it as a record for good doctor reports? For example, I remember Denise reporting excellent results from a TTS surgery done by Dr. Deland in NYC. It would be handy to have access to such info. all in one place on the Board.

Regarding surgeries or treatments with other outcomes, would it work to just report the name of the doc, the procedure and the individuals personal outcome? That way the doc is not being attacked.

BTW, if I were a surgeon and did not get consistently good results, I would focus on earning a living in a different non-surgical way. For example, a local pod here just focuses on orthotics and that's it.

Darlene

Re: The Power of Heelspurs.com - Scott R. please read

Scott R on 4/13/05 at 22:23 (173147)

It already has 700 good doctor reports from patients....and growing

Re: There is a web page, sort of

BrianG on 4/14/05 at 08:02 (173160)

Hi Darlene,

This doesn't answer your question for this forum, but there is a web site available, for checking the worst, of the worst, doctors, dentists, pods, etc. It's is: http://www.quackwatch.com
I imagine they look at posting names, the same way that Scott does. A doctors name won't get posted unles legal action has been taken against him.

I don't see why Scott should have a problem posting the same information about Pods, who have been disciplined, that is found at Quackwatch. That info can also be gotten at any State's web page. I realize it doesn't list all the bad doctors, only the one's that got caught!

Regards,
BrianG

Re: There is a web page, sort of

John H on 4/14/05 at 09:52 (173172)

Brian or Brain as I once called you I agree with Scott. Why take a chance. Even if you break no law some rascal can sue you and you have to defend yourself. If I am scottr I do not tempt fate or some lawyer on the hunt.

Re: The Power of Heelspurs.com - Scott R. please read

John H on 4/14/05 at 10:03 (173173)

Patients can often report on a Doctor based on emotions rather than results. Some Doctors (Dr. House on TV) is a very brilliant Doctor but very easy to hate. We can say a Doctor did not help us or we became worse but perhaps we would have become worse with any Doctor. Personally I tend to take with a grain of salt individuals reports on Doctors although I do not discount it altogether. One can check any reports of disciplanary action against a Doctor and where he is authorized or not authorized to perform surgery. I often ask Doctors I personally know if they were going to have a procedure on themselves who would they use. I often look closely at their medical education and how often they may have performed a given procedure. In the final analysis you can never be sure as any Doctor can have a bad day. Better to have surgery on Monday or Tuesday than on Friday. Hospitals really have a wide varriance in surgical outcomes and that is something to really really consider when having surgery. This information is avialiable.

Re: The Power of Heelspurs.com - Scott R. please read

elliott on 4/14/05 at 10:54 (173182)

John H, the body is complex and it certainly is true that every surgical procedure has a failure rate, and if you're one of the failures, your opinion of that doc will be lower even if it wasn't his fault and even if his failure rate is far lower than the average. At the same time, from the stories on these boards I do get a certain sense that there are a lot of POD COWBOYS out there, doing surgeries they have no business doing, all the while claiming phenomenal results, especially to their patients pre-surgery. And yes, I think this problem is far more common with pods as a class than with orthos as a class.

I have met a few surgical podiatrists I consider equal to very good orthos. But, with all due respect to pods here and elsewhere, many pods spend much of their day on things like corns, orthotics and bunion surgery (not that the latter is routine either). I value pods who concentrate on such things too, as I may need their services and they may do these things better than others. But many of them are out of their league, performing often bizarre surgeries with disastrous results. Pods as a class also seem to jump from one new treatment modality to the next (each with the mandatory 90% success rate). Looking for new, better treatments can be a good thing (I'd say orthos as a class are less likely to accept new modalities, especially non-surgical ones). But all too often, with a new treatment, even an otherwise informed patient may have no choice but to put their total trust in what sometimes turns out to be a pod cowboy who is using inappropriate treatment or treatment inappropriately.

Re: The Power of Heelspurs.com - Scott R. please read

Darlene on 4/14/05 at 20:02 (173225)

I would definitely include the podiatrist who did my first surgery in the Pod Cowboy category. Having had Morton's neuroma for over 20 years, my sample size of pod office visits is approaching statistically significant levels. In the past 12 months alone, I have seen 25 docs. Why in the world would this pod perform a surgery with a hindsight written prognosis of 'Guarded' while giving me the patient, the magic 90% number?

I had one pod tell me that one cortisone shot would definitely 'cure' the neuroma (100% success rate - sounded good to me). The shot in fact made it much worse for a few weeks and was quite painfully administered.

I have a bagful of custom orthotics from 10 different pods which do not work - almost all of them are 3/4 length orthotics and the only adjustments made were putting in or taking out met pads. I have since learned from my pedorthist that there are many different kinds of adjustments which could be done to fine tune the device.

I was told by another pod cowboy that alcohol injections were the answer to my 20 year old, very large neuroma (as per diagnostic ultrasound and MRI). I have since learned that alcohol injections would not likely work for me by my current pod (who is not a cowboy) and also from Dr. Z's comments on this website.

Another pod told me that he does surgery for neuromas by 'fishing' them out.

This is just a sampling of my personal experience over the past 20 years.

I do agree that foot disorders can be very difficult to diagnose and treat, and perhaps I have just had a string of bad luck with pods, but sadly it seems that I'm not the only one.

Re: There is a web page, sort of

Darlene on 4/14/05 at 20:09 (173226)

Brian:

Thanks for posting this website - very interesting and very scary.

Darlene

Re: The Power of Heelspurs.com - Scott R. please read

John H on 4/15/05 at 11:25 (173254)

Having visited a lot of Podiatrist and M.D. Orthopedic surgeons it is my experience that Podiatrist are much quicker to offer surgery as a solution. I think statistically the Podiatrist offer surgery for PF much more often than M.D.'s. At least two M.D.'s I know will not do a PF release under any circumstance. The very first POD i ever visited wanted to do a PF release on both beet and replace the second joint in the great toe on both feet with an artificial joint all at the same time. He told me I would be running in 3 months. My research led me to find out the artificial joint in the toe would not last long under stress and the dangers of a PF release. He also told me I had no cartlidge in the great toes. Wrong! I did and an orthopedic surgeon perfomed a Cheilectomy and my toe is fine. I also ran into an MD who suggested realeasing the entire fascia. Did not listen to him either. One really needs to stay informed and do your own research before engaging in some surgical procedure.

Re: The Power of Heelspurs.com - Scott R. please read

Darlene on 4/15/05 at 11:47 (173256)

John H:

Thank goodness you didn't listen to the first Pod. That's wild - bilateral PF release with joint replacement and running in 3 months!

How could people like that live with themselves? I wish I would have been as smart, but I was very naive and trusting. I'm smarter now, but still in pain from Pod #1.

Darlene

Re: The Power of Heelspurs.com - Scott R. please read

Dr. Zuckerman on 4/15/05 at 13:03 (173261)

It is possible that the doctor believed that they are doing correctly with their patients and just don't have enough experience to understand what they are doing.

Re: The Power of Heelspurs.com - Scott R. please read

Darlene on 4/15/05 at 17:21 (173271)

But Dr. Z., how would one account for the fact that the doc gave me a 90% success rate verbally, and a 'guarded' in the report?

Notice I specifically excluded you from the POD COWBOY category.

Re: The Power of Heelspurs.com - Scott R. please read

Dr. Z on 4/15/05 at 19:27 (173275)

Good point. I still hope my horse Silver still love me when she finds out I am not a real cowboy. Seriously. If your Pod had come out of the operating room and told you that things were just different AFTER he did the surgery and the explanation was true that were be completely different story.
Peoples/doctor make poor judgements, and this is 100% a poor judgement the real question is was this more then just a poor judgement. ?????

Re: The Power of Heelspurs.com - Scott R. please read

Darlene on 4/15/05 at 22:23 (173284)

Dr. Z:

You bring up a very interesting ethical point. The neuroma surgery performed was the Koby Surgical ligament release performed 'blindly'. A minimal incision was done between the 3rd and 4th toes and the Koby instrumentation was used to locate and then sever the ligament. Therefore the pod would have no more information after the surgery than before. After the surgery he said 'you and I are going to be so happy you did this.'

The fact that you do not perform this type of surgery adds further credence to your non pod cowboy status - something to be proud of.

Re: The Power of Heelspurs.com - Scott R. please read

Dr. Z on 4/16/05 at 13:28 (173302)

Hi
I have investigated and I did purchase the instruments to do the Koby procedure. I even wrote to the head of our podiatry department to get permission or clearance to do this procedure at the hospital. This was about one year ago.
I still am waiting for the patient that it might benefit. Most of my patients benefit from conserative treatment or the lesion is so big that we do surgical exision.

Re: The Power of Heelspurs.com - Scott R. please read

john h on 4/16/05 at 14:35 (173305)

I have had Doctors quote me success rates and success rates for many common surgeries are readily available. Remember that is not necessarily your Doctors success rate or the one you will have. It is just a success rate for a general procedure reported by thousands of Doctors. If the success rate for open heart surgery with a tripple bypass is 80% and you die during surgery the success rate will probably still be 80%. It is widely reported that 90% of PF patients are cured within one year using conservative treatment but to look on this board you would think that 90% of the patients get worse. Our board is skewed with the 10% that do not get better.

Re: The Power of Heelspurs.com - Scott R. please read

Darlene on 4/16/05 at 22:28 (173314)

Dr. Z:

Thank you for answering. See - you definitely are not a pod cowboy. I think careful patient selection is crucial for the Koby method.

My pod had just been trained in this procedure (January 04) and he said he had already done 10 procedures. I wonder if that included the cadaveurs.

BTW, I also spoke with the Koby people before I committed to the surgery and asked if length of time of pathology and/or size of neuroma had an impact on outcome and they said no.

Live and learn.

Re: The Power of Heelspurs.com - Scott R. please read

Darlene on 4/16/05 at 22:43 (173315)

Dr. Z:

Thank you for answering. See - you definitely are not a pod cowboy :-). I think careful patient selection is crucial for the Koby method.

My pod had just been trained in this procedure (January 04) and he said he had already done 10 procedures. I wonder if that included the cadaveurs.

BTW, I also spoke with the Koby people before I committed to the surgery and asked if length of time of pathology and/or size of neuroma had an impact on outcome and they said no.

Live and learn.

Re: The Power of Heelspurs.com - Scott R. please read

elliott on 4/16/05 at 22:56 (173316)

john h, just as this board is not representative of patients at large, it also is a clearinghouse of information so that certain misconceptions and exaggerated claims can be put in check. For example, based on the experience of regular visitors to this board who have posted in advance that they are going to get ESWT and then get it oft-times with less than spectacular results, I just don't believe that the 94% or whatever success rates are being realized with the public at large. You read the literature and web sites and you get the impression that MIND works 90% of the time for neuromas. From this thread, I get the impression that the patient has to be chosen rather carefully or else it might fail at much higher a rate, something one might not have realized or discovered if not for this board. And many docs seem not to screen their patients properly.

Re: The Power of Heelspurs.com - Scott R. please read

elliott on 4/16/05 at 23:12 (173317)

Dr. Z or other doc:

Somes docs always do a neurectomy with some resulting sensory loss since they consider the failure rate too high with other procedures. Some just release the ligament. Some always do MIND with the Koby instruments. Now there's cryosurgery. Some of these procedures claim phenomenally high success rates.

Neuroma is a common problem. Can't the ortho and pod societies develop a surgery protocol for neuroma, e.g.,

1) classify patient by type of neuroma (based on size, type and location of pain)

2) decide whether ultrasound or other test is necessary to aid in selecting next step

3) choose most appropriate type of surgery based on 1) and 2)

[]

Re: The Power of Heelspurs.com - Scott R. please read

Dr. Z on 4/16/05 at 23:16 (173318)

Darlene

That is strange. It is my opinion that the size of the neuroma would play a major factor. Decompression isn't going to reduce the size of neuroma or reverse the nerve damage. Decompression should be able to heal the neuroma it is a neuritis. Cutting of the ligament is a very old procedure . I first saw the procedure in the early 1970's.

Re: ESWT success rates

Scott R on 4/17/05 at 08:40 (173325)

I just had a thought. Maybe the studies have a higher success rate because the patient doesn't have to pay for it (especially FDA studies) or doesn't have to pay as much (european studies). But when it comes time to use it in regular practice, the patient often has to either do a lot of insurance leg work or fork over big bucks. This means the typical U.S. ESWT patient is going to be in worse shape than the 'oh, i guess i'll do it' patients that were in the studies. Therefore the studies that do not operate under the same 'the patient has to pay for it' environment are invalid.

Re: ESWT success rates

elliott on 4/17/05 at 09:54 (173327)

Scottr, what you say likely is part of it (not sure if you mean to also include gratitude for the free treatment as swaying the results). The mean duration of symptoms in the FDA study was 2 years. As you say, those having to pay out of pocket may tend to wait longer. And then, of course, there's the group that already had PF for a long time before ESWT became readily available. Both groups likely will have tried far more than the 3 conservative treatments required of the trials. So as a class these groups would be far hardier to treat. There are more reasons too: the FDA study had a far more pristine population--one that excluded those with bilateral symptoms, previous PF surgeries, diabetes, etc.

Re: The Power of Heelspurs.com - Scott R. please read

Darlene on 4/17/05 at 19:25 (173348)

Dr. Z:

What you are saying sounds very logical to me. In fact, if it is just neuritis, a cortisone shot may be just as effective. The pod who did my surgery said that he had 100% success rate until me (sample size of 10, 11 including me). When talking with Koby, I specifically asked about factors like size and length of pathology, as well as asking about whether or not there would be any pain with lateral compression after the procedure, and I was told there would be no neuroma pain at all after. It sounded too good to be true, and that should have been my first clue. However, when the doc (who should be representing the best interests of his patient) presents an equaly rosy picture, one does not think to further question the procedure.

Elliott:

If all docs followed your protocol suggestion, a lot of suffering could be avoided. Thank you for expressing it so succinctly.