Podiatric Surgery provides an alternative to Orthopaedic Surgery and is performed using local anaesthetic and is undertaken on a daycase basis (with the patient going home on the day of the operation).

Acceptance

• Patients with foot pathologies that need a surgical opinion
• Patients that are able to have surgery under local anaesthetic

Exclusions

• Patients under 16
• Patients who have not had any basic podiatry or conservative care for their problem – see above.
• Primary nail and nail fold conditions (decommissioned)
• Diabetic foot ulcers (diabetic foot pathway)
• Skin coverage problems (plastic surgery)
• Vascular disease (general/vascular surgery)
• Medical skin diseases (dermatology)
• Diagnosis and medical management of inflammatory arthritis (rheumatology)
• Pain management (pain clinic)
• Trauma (orthopaedics)
• Malignant tumours (MDT).

The following patients may be excluded from day case surgery listing:

• Patients whose foot pain results from inappropriate footwear
• Patients who have not yet tried conservative management without success
• Patients without a responsible adult available to be with them for the first 24-48 hours after discharge
• Patients without General Practitioner (GP) out-of-hours back-up available locally.
• Patients above ASA grade 3
• Patients without access to telephone at home, or unable to arrange appropriate time to recuperate after surgery
• Patients with a BMI greater than 35 (due to the difficulty of ensuring effective load protection to the foot as a day case
• Patients with significant haemophilia, sickle cell disease or thalassaemia
• Patients on renal dialysis
• Patients with a history of malignant hyperpyrexia
• Patients with MRSA (will be deferred until clear)
• Patients with poorly controlled asthma (frequent hospital admissions within the last 3 months
• Patients with poorly controlled hypertension (diastolic over 105) or unstable angina
• Patients with a history of Ml in the last six-months

Referrals can be made using a standard referral letter.