How to Decide Between Surgical and Non-surgical Treatment

With ankle and foot problems, there are three general treatment options.

1. Live with it, do nothing. Most people never choose this option. This is only a good option if the risk of doing something strongly outweighs the benefit of treatment.
2. Non-surgical treatment. This includes options like physical therapy, bracing, casts, injections, and medicines.  Many foot and ankle conditions improve with these but, few are cured. Instead, these treatments help you accommodate for the problem. But sometimes the problems that develop from finding ways around the problem are worse than the problem itself. Bunions, for example, get worse, develop arthritis, and cause painful deformities to the second toes. Loose ankle ligaments cause the peroneal tendons to tear sometimes beyond repair.
3. Surgical treatment. Orthopedic surgeries are designed to return function to a dysfunctional organ or system. Some surgical decisions are easy, others are more challenging. Whatever the injury, the decision to proceed with surgery should never be taken lightly.

If a patient and doctor decide that surgery is an option, it is essential for the doctor or surgeon to speak with the patient about the procedure. These are a few essential questions to ask your doctor before deciding whether or not to have surgery.

1. What will I gain from surgery that I can’t from non-surgical treatment? If surgery can offer a cure that non-surgical treatment will not, this is an important point to make.  For example, physical therapy often resolves pain from ankle instability, but it’s just a matter of time until the ankle rolls again.
2. What are the most common complications?  To both a patient and a doctor, nothing can be more upsetting than a post-operative complication.  Even worse is the post surgical guilt that can accompany it:  Why did I have this surgery? What could I have done differently? Why do these things always happen to me? General Eisenhower said, “Plans are meaningless, planning is everything.” You can’t prepare for everything, but knowing about the major things that could go wrong and how to prevent them makes the decision easier.
3. What are the risks and the benefits? If the risks are high and the benefits are low, the answer is obvious.  For example, cosmetic foot surgery to wear the latest 5″ high heel shoe is not a good risk/benefit ratio. But, a woman with a closet full of shoes she can’t wear because of pain or a deformity is very reasonable.

A caring and thoughtful surgeon needs to explain the good, the bad, and the ugly of every surgery. But, with enough information and counsel, you will be able to determine which treatment option is best.