Testimonials as patient feedback in bunions

The subject matter is bunions. The aim to find out how patients feel and how successful surgical treatment is.
Testimonials as part of feedback are helpful as long as they are truthful and not contrived. Each of these comes from genuine patients. In some cases I have used names but these are not their own. In other cases I have not stated the gender of the patient concerned.

While The College of Podiatry produces quality evidence on all foot surgery through it’s database PASCOM-10  we don’t always know what patients think. I have published a book covering material beyond these articles now available on Amazon. This publication covers a huge amount of information in one place and extends the idea of the testimonial. When following three patients over six months the gravity of their feedback brings alive the daily tribulations. 

Making decisions based on facts: Bunion surgery – when is the best age?

I am always dubious about making fast decisions when treating the big toe for bunions (Hallux valgus). For that matter, I prefer my patients to observe caution. It is important to lay out all the facts. More discussion can be found by using the useful link on my site regarding age based decisions.

Keen golfer struggled with foot pain caused by her arthritic bunion

One of my testimonials came back from patient B who was a keen golfer. B struggled with foot pain caused by an arthritic hallux valgus.  In this case the bunion was accompanied by cartilage damage and ordinary surgery was insufficient. [Rigid toe joint fact sheet No.3 2018] 

The use of false toe joint implants have been used for some years as a plastic hinge joint.  Following joint replacement surgery the toe is not unduly shortened but is more likely to be stiffer with a slight amount of movement but no pain. The push down power against the floor reduces to under 50%. Foot specialists will select the best treatment for foot problems. There is no such thing that one treatment fits all! 

B’s feedback revealed a full return to golf which was  the reason for surgery being considered where conservative care fails.

Testimonial feedback shows that not all surgery is simple!

A patient had surgery ten years earlier. She had been provided with a bump (hard bone) removal by another surgeon from a different centre. We call this an exostectomyThis type of surgery is quick and easy to do but long term may not always be the best. Of course there is a case for some patients to avoid complicated surgery. My patient, who was far from old, was concerned that she was in worse pain after the surgery. Far from recovering quickly her June 2004 operation was anything but successful.

What was the cause?

It was more than likely that while her surgeon executed her surgery ably, her testimonial suggested that the pre-surgical assessment failed to evaluate the full extent of her joint damage. This could well have been the real cause of her foot pain. This means she could have an inflamed joint lining (synovitis),  loose particles of bone or even split cartilage. Sometimes these type of problems are hard to assess before surgery and today we need to be prepared to reassess the state of the joint at surgery. So often we do not ask enough questions!

Jo and a 15-year old bunion pain

A patient who shows appreciation is both exciting and motivating for any clinicians.

Jo suffered from a bunion for 15 years and realised how important her feet were. The consultations were unhurried. We had plenty of time for questions and I provided comprehensive fact sheets on all the pros and cons. Well done Mr T for heading such a great team. Read the whole testimonial in Footlocker. I wish all my surgeries had gone as well.

A testimonial when surgery does not go right

Maybe around 4% fall below the ideal aims of success. Data is published by the College of Podiatry PASCOM-10.com annually so this is not just a guess. Over the last 7 years, over 30,000 bunion surgeries have been performed where 93% believed their expectations had been met. There is a common problem that arises with the best surgery. Read my latest Bunion joint fact sheet No.1 2018

Pain and stiffness

Julia feedback revealed that she was keen on tennis. Her surgeon selected an osteotomy as this would provide the best movement after her treatment and she had fully healed. This is where the bone is cut (broken) to improve the shape of the toe. Although an osteotomy is perhaps the gold standard because more movement is retained, sometimes the joint stiffens and can then become painful.

Loss of joint quality is not uncommon and can progress as we age. Much of the indication about when to seek treatment and to decide what treatment is best will depend upon how much the toe joint hurts during daily activity. Too much pain and jamming means the toe may have a problem. An injection of steroid might be recommended first before surgery. 

Julia had this type of damage before surgery so she had around a 70% of success of improving even though there was loss of joint quality but this is not a guarantee. If the extent of deformity is the big concern, injections are of less use. Furthermore, injections may only help temporarily. When pain on movement arises after surgery, it might be back to the drawing board and a second procedure required.

How long should you leave it before speaking out?

This may vary between patients and their expectations but in general we prefer to do little more for our patients other than support and monitor them. Physiotherapy is important in many cases. I would suggest as a rule of thumb taking 4-6 months. I know some surgeons prefer a year but this must come down to individual preferences.

Julia actually went on to have a replacement joint and her pain settled immediately.

‘What having this operation means to me? ‘

In the next examples patients talk about hip pain being made better. Others happier that their feet looked a better shape.

No longer enduring pain in my hip because I can walk correctly. I am able to wear shoes without having to take one off as soon as the opportunity arises. To relieve the pain in my toe. I am able to go on long walks again, 8 to 10 miles, without having to stop every 20 minutes and also to relieve the pain. I am no longer woken up at night if my husband accidentally touches my toe and sends a sharp pain from my toe up my leg. I no longer have to visit my chiropodist every month. I no longer cry with the pain. I have my life back.
C.R female November 2013

“I had surgery performed for a bunion removed. I would just like to say thank you very much. My foot looks so much better, I have no pain and bunion has gone. It takes a long time to get better, but it was all worth it. Also, I can still wear ‘high heel shoes’. Thank you”
S.A.N female patient 53 years of age

“…I’m so pleased with the progress I’m making since having two-foot operation in the last 12 months…at least the appearance of them has greatly improved and I’m not so self-conscious when wearing open sandals anymore…you’ve always been very reassuring, patiently explaining all the procedures and possibilities to me…managing to make me feel completely at ease…!”
SB Female 2007

And finally, the result we all want…

“Just wanted to say thanks for my new feet!! I’ll look forward to showing them off in the summer. Thank you”
AL Female 2007

All cases and photos provided permission 

Thanks for reading ‘Testimonials as Patient feedback on bunions’ written by David Tollafield

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 Published by Busypencilcase Reflective Communications Est. 2015

Originally published 2018 and re-launched July 2020