You must consider an injury or illness to be work-related if an event or exposure in the work environment either caused or contributed to the resulting condition or significantly aggravated a pre-existing injury or illness. Work-relatedness is presumed for injuries and illnesses resulting from events or exposures occurring in the work environment.
Surgery becomes necessary when conservative treatments no longer effectively address the underlying issue. Whether it’s a fracture, chronic instability, tendon tears, arthritis, or other conditions, modern techniques offer a range of surgical options to improve your foot and ankle health and restore your quality of life.
But wouldn’t it be great if we could predict to some extent our patients’ abilities to respond to the stresses of surgery?
One of the most challenging aspects of surgery is dealing with the large variety of patient responses during their postoperative recovery. This is true whether it’s a complicated rearfoot and ankle reconstruction, or something relatively simple in the forefoot.
We’re all aware that humans are highly complex, and our response to injury (trauma) is highly variable. The inflammatory and pain pathways alone, in one person can lead to irregular and unpredictable responses. Along with the physiological response, there is also the differences in patients’ psychological responses. Anxiety, for example, often leads to greater perceived pain. Similarly, the patience to put up with the inconvenience of challenges like non-weightbearing or immobilization can also be very difficult for some.
What are the Primary Decision Factors for Surgery?
Severity of Pain and Disability: Surgeons prioritize surgery when chronic pain or lack of mobility significantly interferes with essential activities like working, walking, or sleeping.
Failure of Non-Surgical Treatments: Surgery is typically considered only after conservative methods—such as physical therapy, medication, or injections—have failed to provide adequate relief over a period of 6 to 12 weeks.
Medical Necessity and Urgency: Immediate surgery is often required for acute structural issues like complex fractures, severe joint deformities, or "red-flag" symptoms like progressive nerve weakness or loss of limb function.
Patient Health and Fitness: Surgeons evaluate overall health (e.g., heart and lung function, diabetes management) to determine if a patient can safely tolerate anesthesia and recover effectively from the procedure.
Lifestyle and Recovery Goals: A patient's age and activity goals are critical. For instance, an athlete may opt for surgical repair to regain high-level stability, while a less active individual may find non-surgical bracing sufficient for the same injury.
Surgeon Experience and Expertise: A surgeon's comfort level with a specific technique and their years of experience often play a more powerful role than formal clinical guidelines alone.
Institutional Resources: The availability of specialized equipment, such as robotic-assisted tools, or the presence of a supportive multidisciplinary team at academic hospitals can make surgery a more viable or attractive option.
Clinical Evidence: While surgeons value "tried and true" methods, they also weigh newer research and success rates for specific procedures against potential long-term risks.