Introduction Foot surgery has an increased risk of postoperative infection when compared with surgery of other anatomical regions. A pre-surgical foot bath in a bactericidal solution is thought to reduce the incidence of postoperative wound infection. We compared the incidence of post-operative wound infection in two groups, one undergoing a pre-surgical footbath and one group that did not.

Method We prospectively assessed 83 patients undergoing forefoot surgery under the care of two surgical teams. Forty-one patients underwent a pre-surgical foot bath in povidone iodine solution. Forty-two patients did not have a pre-surgical foot bath. All patients had microbiological swabs taken on admission and following surgical preparation and draping. These were cultured for bacterial growth. All patients were reviewed at 2 and 6 weeks after surgery and were monitored for signs of infection. The results for each group were analysed and compared.

Results There were seven post-operative infections in the pre-surgical foot bath group. This compared with only two infections for the group who did not undergo pre-surgical bathing. Correlation of infection with complexity of surgery, medical co-morbidities, operative time, method of closure and use of metalwork was examined.

Conclusions These results suggest that pre-surgical bathing in a bactericidal solution is not effective in preventing post-operative infection.

With an alarming 10% increase in disability payments for backpain annually, the importance of early management of backpain within the first 6 weeks is paramount. The problems of a long and often agonising waiting time for a hospital consultation has been overcome by setting up of the Alexandra Hospital Backpain Assessment Clinic (ABPAC) with initial and immediate consultation by a trained clinical physiotherapist.

From the period March 1995 to March 1999 a total of 1881 patients werw reviewed by the ABPAC and an analysis of these cases is presented. 640/1881 (34%) patients were assessed, advised and discharged. 535/1881 (28%) patients were assessed, given supervised physiotherapy, advised and discharged. 169/1881 (16%) patients were assessed, investigated and discharged. In all 292/1881 (16%) patients needed actual review by consultant, out of which only 48 (2.5%) needed surgery. Only 63/1881 patients needed an MRI scan. There were only 2 patients who were found to have serious pathology in the form of spinal metastasis and only 5 were inappropriate because non-spinal pathology was picked up at initial assessment. There were no “missed” diagnosis.

Thus the clinic with its emphasis on examination and advice rather than “treatment” does not allow for repeated series of consultations nor the development of “regulars” who become dependent on the hospital for treatment, saving the NHS serious money and consultant time. This study proves that such a clinic apart from being safe, is also well accepted by patients and referring G.Ps alike. An outline of its working and the management algorithms is presented.