Broken sesamoid - treatment under NHS
Discussion
A question for the PH docs.
Mrs CVP has been diagnosed with two injuries to her foot
1. Stress fracture of one of the metatarsals and
2. Broken sesamoid bone (think the medial one)
My question is what would the appropriate treatment be under the NHS?
A slightly strange question but we are currently we are based in the USA and our agreement with our company upon coming here is that we would only pay the same costs as we would pay under the NHS. BUPA & the company pay any additional costs. So far this has worked well but there are now questions about who would cover the cost of the proposed treatment options being considered.
So far
1. To treat the stress fracture a cam boot was prescribed. This has worked well and that has healed
2. The broken sesamoid is not getting any better. We have tried PRP therapy and an orthotic to take the weight off that joint and now surgery to remove the broken piece of the sesamoid is being discussed as an option. It's pretty urgent as there is a lot of pain and walking is not easy.
Bottom line can the PH docs tell me what they would do in the UK to treat these two conditions.
Thanks
Chris
Mrs CVP has been diagnosed with two injuries to her foot
1. Stress fracture of one of the metatarsals and
2. Broken sesamoid bone (think the medial one)
My question is what would the appropriate treatment be under the NHS?
A slightly strange question but we are currently we are based in the USA and our agreement with our company upon coming here is that we would only pay the same costs as we would pay under the NHS. BUPA & the company pay any additional costs. So far this has worked well but there are now questions about who would cover the cost of the proposed treatment options being considered.
So far
1. To treat the stress fracture a cam boot was prescribed. This has worked well and that has healed
2. The broken sesamoid is not getting any better. We have tried PRP therapy and an orthotic to take the weight off that joint and now surgery to remove the broken piece of the sesamoid is being discussed as an option. It's pretty urgent as there is a lot of pain and walking is not easy.
Bottom line can the PH docs tell me what they would do in the UK to treat these two conditions.
Thanks
Chris
I work in the NHS as a podiatrist.
And I'm not sure of the answer.
As far as I am aware surgical excision of the sesamoid would be indicated if it fails to resolve after a reasonable amount of time. Trouble with that part of your foot is unless you are off your feet for a few weeks it never gets chance to heal fully. Also if you've cracked a sesamoid it will no lunger run in the (sort of) groove under the met head and will also be pulling things at funny angles.
Podiatrists in the USA hold a degree in medicine but specialise in feet. I don't see why they wouldn't be considered wholly appropriate to treat this surgically using your health insurance.
In the UK you would get foot surgery for this complaint by an orthopaedic or podiatric surgeon and it would be free as per any other similar procedure.
I don't think that helps much?
And I'm not sure of the answer.
As far as I am aware surgical excision of the sesamoid would be indicated if it fails to resolve after a reasonable amount of time. Trouble with that part of your foot is unless you are off your feet for a few weeks it never gets chance to heal fully. Also if you've cracked a sesamoid it will no lunger run in the (sort of) groove under the met head and will also be pulling things at funny angles.
Podiatrists in the USA hold a degree in medicine but specialise in feet. I don't see why they wouldn't be considered wholly appropriate to treat this surgically using your health insurance.
In the UK you would get foot surgery for this complaint by an orthopaedic or podiatric surgeon and it would be free as per any other similar procedure.
I don't think that helps much?
Dave , that is helpful thanks.
I have to say i trust the orthopod treating Mrs CVP completely. Highly recommended and having been with her aat her last appointment I found him very professional and explained things to us like we had brains, which we appreciated.
We're just getting push back from certain people on paying the expenses we have incurred and I'm trying to find out what would normally happen in the UK.
The initial push back is the cost of the cam boot that was prescribed to treat the stress fracture. We are being told, by a non medically qualified person in HR, that this may not be the treatment in the UK and so we might not be able to reclaim that cost. Doing my own research I think it would be the treatment for a stress fracture. The information I'm trying to get at is what would a UK doc likely do for that injury so I can query the decision if appropriate.
The good news is that the boot did fix that injury so even if we have to bear the cost then so be it. The broken sesamoid on the other hand is not getting any better and it seems surgery is an option we need to consider so it's handy to know this treatment would be indicated in the too.
If you could let me have your opinion on the stress fracture treatment options, I'll post you a virtual turkey from over this side of the pond
Cheers
Chris
I have to say i trust the orthopod treating Mrs CVP completely. Highly recommended and having been with her aat her last appointment I found him very professional and explained things to us like we had brains, which we appreciated.
We're just getting push back from certain people on paying the expenses we have incurred and I'm trying to find out what would normally happen in the UK.
The initial push back is the cost of the cam boot that was prescribed to treat the stress fracture. We are being told, by a non medically qualified person in HR, that this may not be the treatment in the UK and so we might not be able to reclaim that cost. Doing my own research I think it would be the treatment for a stress fracture. The information I'm trying to get at is what would a UK doc likely do for that injury so I can query the decision if appropriate.
The good news is that the boot did fix that injury so even if we have to bear the cost then so be it. The broken sesamoid on the other hand is not getting any better and it seems surgery is an option we need to consider so it's handy to know this treatment would be indicated in the too.
If you could let me have your opinion on the stress fracture treatment options, I'll post you a virtual turkey from over this side of the pond
Cheers
Chris
Chris.
Immobilisation using a cam boot (or similar) is definately something the NHS would offer.
The trouble you've got is finding out what would be offered by the PCT you used to live in. They are all different. One might use a plaster cast (£50). Another might use a aircast walker (£few hundred). There a quite a few variations of this in between.
If you get real resitance from your insurance bods then you could try contacting your old GP who would/might/should/won't write you a short letter stating this care plan was appropriate and would have been prescribed in your case. This will likely cost you but will probably be less than the cost of the boot.
Good luck.
Immobilisation using a cam boot (or similar) is definately something the NHS would offer.
The trouble you've got is finding out what would be offered by the PCT you used to live in. They are all different. One might use a plaster cast (£50). Another might use a aircast walker (£few hundred). There a quite a few variations of this in between.
If you get real resitance from your insurance bods then you could try contacting your old GP who would/might/should/won't write you a short letter stating this care plan was appropriate and would have been prescribed in your case. This will likely cost you but will probably be less than the cost of the boot.
Good luck.
- prices quoted are a wild guess btw.
Dave, many thanks for the expertise & comments. I thought some kind of immobilisation for the stres fracture would be the recommended treatment. I will contact what was our local surgery to see if they will write us the letter to say what they would do.
It's one of the things I love about PH is the wealth of expertise we have as a community and that folks are kind enough to offer that expertise readily to others.
Cheers
Chris
It's one of the things I love about PH is the wealth of expertise we have as a community and that folks are kind enough to offer that expertise readily to others.
Cheers
Chris
Firstly, the treatment program you have been offered is entirely reasonable. It is exactly what would be offered to you in the UK. The NHS would provide this for you at point of contact for no fee. You would not have even needed your BUPA cover.
In the USA you may have a deductible to worry about but by the sound of it your company have agreed to pick this up for you.
I cannot see how a report from a UK based GP is going to help you tbh, by the sounds of it your company is trying to wriggle out of their agreement with you. If they are trying to tell you that USA healthcare is providing you with treatment not available in the UK then its cobblers, we do have aircast cam walkers in the UK - they come in at about 90 quid, but this is not a cost that would be borne by a patient.
With regard the injury how long ago did it occur? the majority of sesamoid injurys settle with non surgical care, but if all else has failed surgery can be helpful.
by the way Dave, US pods do not have a medical degree, they share the first few semesters with medics, but then only deal with foot pathology and are only qualified in podiatry.
In the USA you may have a deductible to worry about but by the sound of it your company have agreed to pick this up for you.
I cannot see how a report from a UK based GP is going to help you tbh, by the sounds of it your company is trying to wriggle out of their agreement with you. If they are trying to tell you that USA healthcare is providing you with treatment not available in the UK then its cobblers, we do have aircast cam walkers in the UK - they come in at about 90 quid, but this is not a cost that would be borne by a patient.
With regard the injury how long ago did it occur? the majority of sesamoid injurys settle with non surgical care, but if all else has failed surgery can be helpful.
by the way Dave, US pods do not have a medical degree, they share the first few semesters with medics, but then only deal with foot pathology and are only qualified in podiatry.
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