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.

For clinical, psychological and social reasons the diagnosis of Duchenne muscular dystrophy should be established as early as possible. In a survey of 83 families with 93 affected boys, the diagnosis was missed in every case referred to an orthopaedic surgeon (37 patients). In the whole group there was a mean delay of 2.0 years (0 to 6 years) during which time inappropriate treatment, difficulties in communication with parents, much parental anxiety and further pregnancies occurred. A serum creatine kinase estimation is a simple outpatient test which should be carried out on any boy with clumsy or abnormal gait, with flat feet or with an unexplained equinus deformity.

Equinus deformity of the ankle is one of the serious orthopaedic problems associated with Duchenne muscular dystrophy. Sixty-nine patients (age range 4 to 17 years) were treated, 43 conservatively and 26 operatively. They were followed up at six-monthly intervals for a minimum of two years and a maximum of six years. The patients were divided into three groups: independently mobile, mobile in calipers, and wheelchair-bound. It was found that conservative treatment could at best only minimise progression of the deformity. The indications for surgery, the operative procedure and the postoperative management are described; all varied according to the stage of the disease. The postoperative follow-up suggests that, though the deformity recurs, the patients have several years of benefit from the procedure.