Aa
frustrated with insurance at a loss
Hi, I'm having a problem trying to follow up with a doctor after having ORIF surgery to the right ankle. I broke my ankle in December 2013, which required surgery immediately. At the time I did have insurance but I ended up losing my job because I didn't heal quick enough. I ended up losing the insurance I had and now have medicaid. Now my issue is I have tried following up with the original orthopedic surgeon but was turned away at the window because they don't participate in medicaid. I then tried following up with an orthopedic that did participate in medicaid but he basically said go talk to the original surgeon. I would really like my ankle to heal correctly. I'm still limping and have days that I'm in more pain than others. Does anyone have any advice in what to do?
Hello again.
Oh my. Okay, I think JD1963 may have a bit more insight on multiple castings post surgery. I am an athletic trainer so my input here is more on the rehabilitative side of things, so I will start with that.
You most likely have plateaued with your motion because you have not increased your exercises as you have been feeling better. You are still on a basic level of exercises. Advancing rehab during the recovery process is very important. That is where PT visits come into play.
I will briefly touch on the PT/doctor issues with Medicaid and then recommend some additional exercises. Last year, I took a year off from my profession and volunteered in St. Louis, MO and worked with the low income and uninsured population. Medicaid issues are very frustrating; however, there are doctors out there that want to help this population, you just have to find them. I found in a city setting, it is much easier to find doctors that participate with Medicaid...in the surrounding areas, it becomes much harder and in rural areas it is the most difficult. If you are not in the city and close to a city setting, I would suggest you start looking there for doctors and physical therapists that take Medicaid in the city, you should find much more success that way. If you do not have that option, try a Google search like 'physical therapist accepts Medicaid close to 'insert city and state'. You should be able to yield some results that way. You can try the same thing for an orthopedic. Once you find a PT that will accept Medicaid, make sure they can still accept your script (depending on the date, it may be a problem. I am unsure of this, but better to ask on the phone then find out when you get to your appointment).
Alright, let's get to the exercises. With an ORIF surgery, you can lose a little bit of range of motion if you are overly flexible to start with, but should regain enough to be able to do your daily activities and do them pain free.
The first thing you need to do in rehab is to gain your range of motion back, then strength. For the towel exercises you mentioned, I am going to say you do towel stretches and exercises where you scrunch the towel. Is this correct? If so, continue that.
Look up online these following excises and add if you are not already doing them:
Ankle pumps (3 sets of 20 reps to start)
Ankle alphabet (1 set of entire alphabet to start)
Heel raises sitting on chair (don't put weight on you legs or add resistance, just do the motion - 3 sets of 10 reps to start)
4 way ankle strengthening (you will see lots of pictures with resistance bands - you don't need a band if you don't have one - just use the towel for now)
Try to walk without a limp if you have one. Focus on walking correctly when you have the chance. Try to retrain yourself to waling properly. This will take slow walking and focus if you have been limping for some time, but it is important to walk correctly.
Start with adding those exercises. This is a start and some ideas. You can try a search online to look up more excises if you need. Biking is also good for the motion in the ankle.
The shooting pain sounds like a nerve issue...like when you press in that area, you are pushing on a nerve which is shooting the pain up you leg. I am unsure why that is occurring though.
I would continue to look for an ortho. I think an x-ray and a re-evaluation is very much needed in your case. I hope that increasing rehab exercises will help you though until you can make that appointment.
Let me know if I can be of any more assistance.
Oh my. Okay, I think JD1963 may have a bit more insight on multiple castings post surgery. I am an athletic trainer so my input here is more on the rehabilitative side of things, so I will start with that.
You most likely have plateaued with your motion because you have not increased your exercises as you have been feeling better. You are still on a basic level of exercises. Advancing rehab during the recovery process is very important. That is where PT visits come into play.
I will briefly touch on the PT/doctor issues with Medicaid and then recommend some additional exercises. Last year, I took a year off from my profession and volunteered in St. Louis, MO and worked with the low income and uninsured population. Medicaid issues are very frustrating; however, there are doctors out there that want to help this population, you just have to find them. I found in a city setting, it is much easier to find doctors that participate with Medicaid...in the surrounding areas, it becomes much harder and in rural areas it is the most difficult. If you are not in the city and close to a city setting, I would suggest you start looking there for doctors and physical therapists that take Medicaid in the city, you should find much more success that way. If you do not have that option, try a Google search like 'physical therapist accepts Medicaid close to 'insert city and state'. You should be able to yield some results that way. You can try the same thing for an orthopedic. Once you find a PT that will accept Medicaid, make sure they can still accept your script (depending on the date, it may be a problem. I am unsure of this, but better to ask on the phone then find out when you get to your appointment).
Alright, let's get to the exercises. With an ORIF surgery, you can lose a little bit of range of motion if you are overly flexible to start with, but should regain enough to be able to do your daily activities and do them pain free.
The first thing you need to do in rehab is to gain your range of motion back, then strength. For the towel exercises you mentioned, I am going to say you do towel stretches and exercises where you scrunch the towel. Is this correct? If so, continue that.
Look up online these following excises and add if you are not already doing them:
Ankle pumps (3 sets of 20 reps to start)
Ankle alphabet (1 set of entire alphabet to start)
Heel raises sitting on chair (don't put weight on you legs or add resistance, just do the motion - 3 sets of 10 reps to start)
4 way ankle strengthening (you will see lots of pictures with resistance bands - you don't need a band if you don't have one - just use the towel for now)
Try to walk without a limp if you have one. Focus on walking correctly when you have the chance. Try to retrain yourself to waling properly. This will take slow walking and focus if you have been limping for some time, but it is important to walk correctly.
Start with adding those exercises. This is a start and some ideas. You can try a search online to look up more excises if you need. Biking is also good for the motion in the ankle.
The shooting pain sounds like a nerve issue...like when you press in that area, you are pushing on a nerve which is shooting the pain up you leg. I am unsure why that is occurring though.
I would continue to look for an ortho. I think an x-ray and a re-evaluation is very much needed in your case. I hope that increasing rehab exercises will help you though until you can make that appointment.
Let me know if I can be of any more assistance.
I was really getting extremely discouraged with what to do and your advice and kind words mean so very much!
I have a prescription for PT. I just have to find someone that will take it. I am doing home exercise with a towel and basic occupational therapy (I have a 4 year old) but it still seems like the pain is fairly consistent everywhere but where the actual screws were placed (inside right ankle), unless he squeezes the area. The top of my foot, sides, heal, other side of ankle, shin, calve, knee and shooting pain up the back of leg to butt area. I also have the strangest hair line on the top of my foot that was never there before. He has said that I have nerve and ligament damage but I've asked for an ultrasound in the past and he has said it will heal eventually.
My range of motion is significantly less than the other foot, but I have ballerina feet and very flexible. I'm not sure if they'll ever be the same. I really would just love if it didn't twitch like a fish out of water when I drive and any wrong move I'm in pain and limping for the rest of the day.
Some more background information. I was recasted five times after the surgery. I was supposed to start the walking boot after the fourth cast but was way too weak and in too much pain he didn't recommend the boot yet. I went through the walking boot and lost the crutches and cane, like he asked. I followed up with regular appointments until February. I've definitely had improvement but I would like more. Just feels like improvement has plateaued.
As for the job.....that's a huge story all by itself...I slipped and fell in my own driveway so no it wasn't their fault...it was my dream career and had just finished my masters degree in December.....2013 was not a good year.
I have a prescription for PT. I just have to find someone that will take it. I am doing home exercise with a towel and basic occupational therapy (I have a 4 year old) but it still seems like the pain is fairly consistent everywhere but where the actual screws were placed (inside right ankle), unless he squeezes the area. The top of my foot, sides, heal, other side of ankle, shin, calve, knee and shooting pain up the back of leg to butt area. I also have the strangest hair line on the top of my foot that was never there before. He has said that I have nerve and ligament damage but I've asked for an ultrasound in the past and he has said it will heal eventually.
My range of motion is significantly less than the other foot, but I have ballerina feet and very flexible. I'm not sure if they'll ever be the same. I really would just love if it didn't twitch like a fish out of water when I drive and any wrong move I'm in pain and limping for the rest of the day.
Some more background information. I was recasted five times after the surgery. I was supposed to start the walking boot after the fourth cast but was way too weak and in too much pain he didn't recommend the boot yet. I went through the walking boot and lost the crutches and cane, like he asked. I followed up with regular appointments until February. I've definitely had improvement but I would like more. Just feels like improvement has plateaued.
As for the job.....that's a huge story all by itself...I slipped and fell in my own driveway so no it wasn't their fault...it was my dream career and had just finished my masters degree in December.....2013 was not a good year.
Hello and Welcome to the MedHelp Orthopedic Community!
Nae1 has given you excellent advice, I just wanted to piggyback on her if I could.
I am disgusted with the whole insurance business and your past employer! I was wondering if your injury occurred on the job?
If you are still limping/ experiencing pain after 4+ months, you need a follow-up ASAP!
I (Orthopedic Surgical First Assistant) have assisted on hundreds of these procedures. You should be practically 95% by now!
Please keep us updated on your progress.
Best of Luck! JD1963
Nae1 has given you excellent advice, I just wanted to piggyback on her if I could.
I am disgusted with the whole insurance business and your past employer! I was wondering if your injury occurred on the job?
If you are still limping/ experiencing pain after 4+ months, you need a follow-up ASAP!
I (Orthopedic Surgical First Assistant) have assisted on hundreds of these procedures. You should be practically 95% by now!
Please keep us updated on your progress.
Best of Luck! JD1963
Hi.
Sorry to hear about your insurance issues. Sadly, it is a fact that a lot of doctors do not accept Medicaid and it becomes more frustrating in a situation like yours.
However, I have a couple questions for you before I give my suggestion:
1. At your last follow up with your doctor (if you had one), how did he/she say your progress with healing was going? Was it said you were doing well?
2. Did you go through any physical therapy after surgery or given any exercises to do at home?
3. How is the range of motion in your ankle? Take a look at both ankles: point your toes up, then down, then to the inside and outside. Does there seem to be a difference with any of those movements?
The one thing I would say is to keep calling around to orthopedics that do take Medicaid in your area and see if they would accept you as a patient. Hopefully someone will be able to take your case.
Hope to hear from you soon.
Sorry to hear about your insurance issues. Sadly, it is a fact that a lot of doctors do not accept Medicaid and it becomes more frustrating in a situation like yours.
However, I have a couple questions for you before I give my suggestion:
1. At your last follow up with your doctor (if you had one), how did he/she say your progress with healing was going? Was it said you were doing well?
2. Did you go through any physical therapy after surgery or given any exercises to do at home?
3. How is the range of motion in your ankle? Take a look at both ankles: point your toes up, then down, then to the inside and outside. Does there seem to be a difference with any of those movements?
The one thing I would say is to keep calling around to orthopedics that do take Medicaid in your area and see if they would accept you as a patient. Hopefully someone will be able to take your case.
Hope to hear from you soon.
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