09/13/2026
I copied and pasted my podiatrist letter to my rheumatologist. Hopefully, it will help to give a better understanding of what’s going on with my left foot now😕😕
Charles Griffith, DO
Re: Rheumatology Clearance and Timing Recommendations for Staged Surgical Management
Patient: Star L Newell
7/29/1981
We are evaluating our mutual patient, for management of a painful nonunion at a prior foot fusion site. Given her rheumatologic history and current treatment regimen, we would appreciate your recommendations regarding perioperative management and timing of a planned staged surgical approach.
Our initial concern is the possibility of an underlying bone infection contributing to the nonunion. Therefore, the first stage of treatment is planned as follows: "Removal of orthopedic hardware, bone biopsy with application of antibiotic spacer, left foot, planned as a staged procedure."
The goal of this initial procedure is to obtain cultures to determine whether infection is present. If infection is identified, treatment will proceed accordingly with referral to ID for extended course of antibiotics prior to revision. If the bone biopsy and cultures are negative and there is no evidence of active infection, we anticipate proceeding with a second-stage procedure involving revision of the fusion site.
We would appreciate your guidance regarding:
• Any perioperative recommendations for management of the patient's rheumatologic medications, including biologics, DMARDs, corticosteroids, or other immunosuppressive therapies.
• Whether there are any rheumatologic concerns that would affect wound healing, infection risk, or surgical recovery.
• Your recommendations regarding timing of the initial procedure in relation to the patient's medication schedule.
• Assuming the biopsy and cultures are negative for infection, when you would feel it is appropriate from a rheumatologic standpoint to proceed with revision of the arthrodesis surgery.
Thank you for your assistance in coordinating this patient's care. Please feel free to contact our office at ********** if additional information is needed.
Sincerely,
Preston Jensen, DPM
