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Foot and Ankle

The foot and ankle surgical clinics are for patients who have conditions that require the last resort surgical treatment.  It means they have failed conservative treatment such as physiotherapy, podiatry, medications and even injections which can be done by the x-ray department.  To refer somebody without  conservative treatment to the foot and ankle surgical service stops other people who require surgery getting an appointment and delays management for the patient.  In essence surgery is the last resort, it is for significant symptoms that have not responded to conservative treatment and usually interfere with the activities of daily living and the ability to work.  

 

Role of foot and ankle orthopaedic surgeons

  • Surgeons provide expertise in diagnosis and management of simple and complex conditions and can offer an expert opinion and advice on conservative options as well as X-ray guided injections and surgery.
  • Initial opinions and non-surgical treatments such as insoles, appliances and physiotherapy are available from podiatrists, orthotists and physiotherapists.
  • Patients who have surgery should expect several months of rehabilitation depending on the type of surgery.
  • Surgery is not the first-line treatment for many conditions but those with hind-foot pain and large joint pathology who have significant pain and disability are often best managed by a foot and ankle surgeon.

 

Imaging - please request for all referrals to foot surgeons

Always ask for weight-bearing views please

  • For ankle pathology– AP ankle and lateral ankle and foot
  • For Foot pathology – AP, lateral & oblique foot

 

Information about X-ray views are for information only, there are protocols in place within radiography department to ensure appropriate views are performed

 

Considerations prior to referral for surgical intervention

  • Conservative measures have failed – See NICE Osteoarthritis guidelines
    • Orthoses / specialist footwear
      • Initially try over-the-counter products
      • Usually podiatry input is needed before this is deemed to have failed
    • Physiotherapy
      • If input from a general physiotherapist fails consider referral to the specialist foot physiotherapy clinic
    • Analgesia
    • Weight loss
  • X-ray within 6 months
  • Patient is fit for surgery
  • Patient wishes to undergo surgery or wishes to get an expert opinion
  • Patient has such marked symptoms as to cause significant functional & social impairment*

*Significant functional impairment is defined as a loss or absence of an individual’s capacity to meet personal, social or occupational demands. Please provide examples of the impairment the individual is experiencing.

Podiatry or physiotherapy are appropriate for many, but not all foot conditions. 

The Cornwall & IoS Diabetic foot check and referral pathway can be found here