Author: nancy
Last saved by: Andrew J. Schneider
Company: Weaver's Podiatry Clinic

933 N Topeka				1515 S. Clifton Ste. 103			613 N. Main St.
Wichita, KS 67214			Wichita, KS 67218				El Dorado, KS 67042
316-269-3338	office			316-687-3338 office				316-320-3338 office
316-264-5516	fax									316-322-8192 fax
CENTRAL KANSAS PODIATRY ASSOCIATES
SURGERY INFORMATION
(Information About Your Podiatric Surgery)

ALTERNATIVE METHODS OF TREATMENT MAY INCLUDE 
											Patient’s Initials
	
   1.	Surgical program as explained in this consultation          	 ___________
	2	Wide shoes or change in shoe gear				 ___________
	3.	Periodic care								 ________  __		  
          4.	Antibiotics								 ___________
	5.	Padding and strapping					            ___________                                                                                                     	6.    Prescription orthotic shoe inserts					 ___________
	7.	Change in occupation						 ___________
	8.	Injections								 ___________
	9.	Physical therapy							 ___________
	10.	No treatment at all							 ___________
	11.	________________________________________                	 ___________

 POSSIBLE COMPLICATIONS:
	1.	Infection and/or inflammation of operated areas		            ___________
	2.	Delayed/non-healing of incisions and/or operated bones	 ___________
	3.	Excessive bleeding							 ___________
	4.	Excessive swelling							 ___________
	5.	Allergic reaction to suture or other implanted materials	            ___________
	6.	Peripheral neurovascular complications (i.e., phlebitis)	            ___________
	7.	Adverse reaction to anesthesia					 ___________
	8.	Loss of toe or foot							 ___________
	9.	Failure of procedure or reoccurrence of condition		 ___________
	10.	Worsening of condition/disability					 ___________
	11.	Flail toe/stiff toe/shorter toe/elevated toe				 ___________
	12.	Transfer lesion/callous						 ___________
	13.	Damage to nerves or vascular structures		            ___________
	14.	Significant or chronic pain						___________
	15.	Reflex sympathy dystrophy(painful nerve condition of the foot) ___________
	16.   _______________________________________________   ___________

_______________________________  _______________________
Patient Signature				Date

_______________________________  _______________________
Witness	     				Date