Getting a second opinion before foot or ankle surgery

Why people seek a second opinion

• The operation recommended is large, or has a long recovery.
• The diagnosis or the reason for surgery is unclear.
• You haven’t tried some reasonable non-surgical options, or aren’t sure how long to try them.
• A previous operation didn’t give the result you expected, and someone has advised another.
• Two clinicians have given you different advice.
• You simply want to be sure before deciding.

Doctors expect and welcome second opinions. Seeking one does not reflect on your first surgeon.

When surgery is usually not the first step

For many conditions, research and guidelines call for non-surgical care first, and reserve surgery for people who haven’t improved:

• Bunions: surgery is considered when non-surgical measures fail and the pain interferes with daily activity.^[1,6]
• Heel pain (plantar fasciitis): surgery is generally saved for people who haven’t improved after about 12 months of aggressive non-surgical treatment.^[2]
• Achilles tendinopathy: surgery is considered after about six months of unsuccessful non-surgical treatment.^[7]
• Ankle sprains and chronic instability: rehabilitation and bracing come first, and surgery is for ankles that keep giving way despite months of rehabilitation.^[3,8]
• Early flatfoot or posterior tibial tendon problems: many people improve with support and a structured exercise program.^[9,10]
• Arthritis: activity changes, weight management, therapy, braces and injections are tried before fusion or replacement.^[11]

When prompt surgery can be the better choice

Not every problem should wait. Unstable or displaced ankle fractures generally have much better outcomes with surgery.^[4] A delayed diagnosis of a Lisfranc injury has a negative impact on the outcome, and unstable injuries are treated with fixation or fusion.^[5,12] Infections and abscesses in the diabetic foot need urgent surgical attention.^[13] A suspected Achilles tendon rupture should be evaluated promptly, rather than waiting.^[14] If your problem is urgent, don’t let the search for a second opinion delay care.

What surgery can and can’t promise

Good surgery has limits. Outcomes vary, and a realistic discussion should cover the likely improvement, the chance that the problem recurs or that you’ll need further surgery, and the recovery. For example, after bunion surgery about one in ten people is dissatisfied and some deformity can recur.^[15,16] After an Achilles rupture, surgery lowers the risk of re-rupture but carries a higher rate of complications than non-surgical treatment.^[17] An honest recommendation will also describe what happens if you wait.

How to get the most from a second opinion

1. Collect your records. Ask your first office for the notes, the imaging reports and, if possible, the images themselves on a disc or through a portal, and any operative reports from earlier surgery. Please don’t send medical information by email; bring it to the visit or ask the previous office to fax it to us.
2. Write down your story. When the problem started, what it feels like, what you’ve tried, for how long, and how it affects your life.
3. Bring your shoes, and any braces or orthotics you use.
4. Write down your questions. For example: What is the diagnosis and how sure are you? What are all my options, including doing nothing? What would you do if it were your foot? What is the realistic result and the risk of complications? How long is the recovery?
5. Ask what would change the recommendation. Sometimes a further period of non-surgical care, or a further test, can change the plan.

What a second opinion here involves

A second opinion visit includes a review of your history, records and images, a careful examination, and a discussion of your options, with the treatments described on this website in mind. We may agree with the first recommendation, suggest a different approach, or suggest waiting or further testing. The decision is always yours. See what to expect at your visit and non-surgical treatment.

When to seek care