This work aims to quantitatively assess the current opinions of foot and ankle surgery provision by podiatric surgeons within the UK. Three groups were targeted by postal questionnaire; Orthopaedic surgeons with membership to BOFAS, Orthopaedic surgeons not affiliated to the specialist foot and ankle society and surgical Podiatrists. In addition we aim to identify areas of conflict and suggestions for future integration.

A postal questionnaire was sent to all Fellows of the Faculty of Podiatric Surgery, College of Podiatrists (136), members of the British Orthopaedic Foot and Ankle Society, (156), and a randomly selected number of Fellows of the British Orthopaedic Association, who are not members of BOFAS (250).

We have received replies from 99 (73%) of the Podiatric Surgical group, 77 (49%) of the Orthopaedic Foot and Ankle surgeons and 66 (26%) from non-Foot and Ankle Orthopaedic Surgeons.

Respondents were asked to detail their present practice and issues that they considered to restrict closer working between Orthopaedic Surgeons and Podiatric surgeons. Additionally, each surgeon was given a range of surgical procedures and asked to identify the most appropriate surgical profession to undertake the procedure.

The good response rate amongst Foot and Ankle Practitioners (both Podiatric and Orthopaedic) reflects the interest in these issues compared to Orthopaedic Surgeons from other sub-specialties. Poor understanding of Podiatric surgical training, impact on private practice and medical protectionism were areas identified by podiatric respondents. Conflicts over job-title, concerns over training, role boundaries and responsibilities were identified by Orthopaedic respondents as being significant restrictors to further integration.

The paper will present the full results of the survey and discuss the suitability and feasibility of closer working practices between Orthopaedic and Podiatric surgeons.

In a survey of 6000 children between 9 and 10 years of age, 122 were found to have unilateral or bilateral hallux valgus. These children were randomly assigned to no treatment or to the use of a foot orthosis. About three years later 93 again had radiography. The metatarsophalangeal joint angle had increased in both groups but more so in the treated group. During the study, hallux valgus developed in the unaffected feet of children with unilateral deformity, despite the use of the orthosis.

A survey of 6000 schoolchildren discovered 36 cases of unilateral and 60 cases of bilateral hallux valgus, defined as a metatarsophalangeal angle of more than 14.5 degrees, measured on standing radiographs. Metatarsus primus varus was found not only in the early stages of hallux valgus but in the unaffected feet of children with unilateral hallux valgus. Adduction of the first metatarsal is not due to differential growth of the cortices of the first metatarsal nor is it a consequence of malalignment of the metatarsocuneiform joint. The intermetatarsal angle did not correlate with the angle of metatarsus adductus nor with the intercuneiform angle.