Introduction: Hallux valgus is a common presentation at the elective orthopaedic clinics. Patients complain of pain and deformity of the big toe. Treatment is aimed at improving the cosmesis and alleviating pain in the fore foot.

This study assesses the pre and post-operative pedal pressures during stance phase of dynamic gait cycle to identify objective biomechanical factors which influence the final outcome.

Materials and Methods: This is a prospective study, approved by the local research and ethics committee, in which 17 feet were assessed with moderate to severe hallux valgus. Distal-L and Scarf osteotomies were performed for moderate and severe deformities, respectively.

Pedobarography was performed before and 8 months after surgery, on an average. Sole was divided into eight segments i.e. heel, midfoot, lateral forefoot, central forefoot, medial forefoot, II–V toes, hallux and total sole area. Variables compared were contact area, peak pressure, mean pressure and contact time. Manchester-Oxford foot questionnaire (MOXFQ) was used to assess the clinical disability. The inter-metatarsal and metatarso-phalengeal angles were measured radiographically. Both clinical and radiological assessments were performed pre and post-operatively.

Results: 11 had distal-L and 6 had Scarf osteotomies. There were significant improvements in all the three domains of the subjective MOXFQ questionnaire i.e. walking/standing (p 0.013), pain (p 0.001) and social limitation (p 0.002).

The inter-metatarsal angle reduced from 15 to 7 (p 0.001) and the metatarso-phalengeal angle reduced from 32 to 9 (p 0.001).

There was significant reduction in heel contact area (p 0.002), the medial forefoot (p 0.030) and II – V toes (p 0.048) contact time.

Conclusion: Both distal-L and Scarf osteotomies resulted in significant improvements in clinical and radiographic outcome. Although there was reduction in heel contact area and medial forefoot contact time, there were no significant changes in pedal pressures at 8 months postoperatively.

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.

Our aim was to determine if a tourniquet placed on the ankle has any advantage in forefoot surgery over the position on the midcalf. We randomised 30 patients who were undergoing forefoot surgery under under local anaesthesia into two groups. One had a tourniquet on the ankle and the other on the mid calf. All calf and ankle tourniquets were inflated to 100 mm Hg above the systolic pressure, just before the surgical procedure.

The blood pressure, pulse and level of pain were recorded at intervals of five minutes during the operation. The surgeon evaluated the quality of the anaesthesia, the bloodless field, and the site of the tourniquet.

The patients tolerated the tourniquet on the ankle much more. Both the tourniquet positions gave good operative fields, however the use of the ankle tourniquet was less painful at 5,10,20 and 30 minutes after the operation had started (p< 0.01). Physiological parameters were better in the ankle group.

We conclude that the ankle tourniquet gives a good bloodless field and provides improved pain tolerance for forefoot surgery carried out under local anaesthesia.