To explore the relationship in terms of time scale between pre-operative expectations and postoperative outcomes and satisfaction after Hallux valgus surgery. A patient derived questionnaire was developed and 30 patients aged 19 to 67 were included undergoing primary hallux valgus correction with a first metatarsal osteotomy and distal soft tissue release. Patients were asked pre-operatively to quantify their expected time scale for improvement in pain, ability to walk unaided, ability to drive, routine foot wear and foot feeling normal at 6 weeks, 3 and 6 months following surgery, and to indicate their confidence in achieving this result. Patients recorded postoperative outcomes achieved at number of weeks. Ordinal logistic regression multivariate modelling was used to examine predictors of postoperative satisfaction.Purpose
Methods
More than half of patients with neck of femur (NOF) fractures report their pain as severe to very severe in the first 24hrs. Opioids remain the most commonly used analgesia and are effective for static pain but not dynamic pain. Opioids provide suboptimal analgesia when patients are in a dynamic transition state and their side-effects are a source of morbidity in these patients. The Fascia Iliaca Compartment Block (FICB) involves infiltration of the fascia iliaca compartment with a large volume of low concentrated local anaesthetic to reduce pain by affecting the femoral and lateral cutaneous nerve of the thigh. The London Quality Standards for Fractured neck of femur services (2013) stated that the FICB should be routinely offered to patients. We performed an audit of patient outcomes following the introduction of the FICB across three centres. We performed a two-cycle audit across two hospitals in 2014/15. The first cycle audited compliance with the NICE guidance in the management and documentation of pain and AMTS (Abbreviated Mental Test Scores) in patients. The second cycle was conducted following the integration of the FICB into the multidisciplinary NOF fracture protocol across three hospital sites. Data was collected on numeric pain scores, pre and post-op AMTS and opioid requirements. There were 40 patients audited with 20 in the first cycle prior to the introduction of the FICB and 20 following this. In the second cycle, there was a statistically significant improvement (p<0.001) in the difference between the pre and post-op AMTS. The preliminary findings in this audit support the use of the FICB adjunct to analgesia in the pre-operative management of NOF fracture patients. The FICB is a safe procedure and the organisational learning of this procedure through a multidisciplinary approach can significantly improve the outcomes of NOF fracture patients.
First metatarsophalangeal joint (MTPJ) arthrodesis plays a significant role in the management of symptomatic hallux rigidus. Several open and very few percutaneous techniques have been described in the literature. The authors present a new minimally invasive technique along with patient reported outcome, radiological parameters and a discussion on this novel technique. A total of fifteen cases of first MPTJ arthrodesis were included in this prospective continuous series from September 2011 to June 2012. Mean age was 56 years and the indication for surgery was hallux rigidus in 13 of 15 cases. All patients underwent the same minimally invasive procedure by the same primary surgeon (AHS), 13 of 15 as day cases. Clinical outcome and patient satisfaction were assessed by the Manchester-Oxford Foot Questionnaire (MOXFQ) preoperatively and at most recent follow up. Radiographic and clinical evaluation of fusion was also assessed. No patients were lost to follow up and all scores were collected by an independent surgical practitioner to avoid bias. Mean follow up was six months (range 1 to 9 months). The MOXFQ score for cases where fusion was achieved (n=14) improved from a mean 40/64 preoperatively to a mean 15/64 at last follow up ( This minimally invasive technique for first MTPJ arthrodesis is simple and can achieve results similar or better than open techniques in experienced hands. Further cases are needed to expand this series and evaluate for further complications.
Single-photon emission computed tomography is a new imaging modality combining high detail CT with highly sensitive triple phase nuclear bone scanning to help clinicians in diagnosis and management of various conditions. Little has been published about its particular usefulness in foot and ankle pathology. We conducted a prospective study to evaluate the role of SPECT for the same. Fifty patients were seen in a tertiary referral foot and ankle clinic presenting with a variety of foot and ankle conditions. SPECT-CT was requested when a definitive clinical diagnosis could not be reached after thorough clinical examination and plain radiography. Pathology shown by SPECT-CT was taken as the final diagnosis and interventional surgical management carried out accordingly. Patients were subsequently seen in the follow up clinic to evaluate the outcome of their treatment.Aim
Material and Methods
Forefoot surgery causes postoperative pain which requires strong painkillers. Regional blocks are now increasingly used in order to control postoperative pain especially in the first twenty four hours when the pain is at its worst. We conducted a study to see whether timing of ankle block i.e. before or after application of tourniquet shows any difference in efficacy in postoperative analgesia in first twenty four hours. A prospective study was conducted between September and March 2011 involving 50 patients. Group A had ankle block after and Group B had block before application of tourniquet. Both group had twenty five patients each. Patients were given assessment forms to chart their pain on Visual Analogue Scale (VAS) at 4hrs and twenty four hours after surgery. Both groups demonstrated good postoperative pain control. Average pain score at four and twenty fours after surgery was 2.5 and 5 in Group A and 3.5 and 6.1 in Group B respectively. Pain control, both at four and twenty four hours surgery was better in Group A but this was not statistically significant. Ankle block should be routinely used in forefoot surgery to control postoperative pain. Ankle block before or after the application of tourniquet had comparable pain relief with no statistical difference.
Metatarsal fractures are extremely common injuries accounting for 10% of all fractures seen in our accident and emergency departments (3). The vast majority can be treated conservatively. There is no standardised treatment, but it is commahplace to immobilise the foot and ankle joint in a below-knee back-slab, full cast or functional brace for a period of up to 6 weeks, weight-bearing the patient as pain allows. This practice is time-consuming and expensive, not to mention debilitating, and carries a morbidity risk to the patient. We describe a simple, effective and cheap treatment method for metatarsal fracture management using the functional forefoot-offloading shoe (FOS). This is clinically proven to offload pressure on the metatarsals and is commonly used in both elective forefoot surgery and in diabetic patients. Between January and September 2009, we identified 57 patients attending our fracture clinic with new metatarsal fractures. 28 met our inclusion criteria. All patients reported a significant improvement in their pain At Injury – mean 8.21 out of 10 (range 4-10) After FOS fitting - mean 2.92 out of 10 (range 0-6) The forefoot-offloading shoe is an excellent alternative to plaster casting or functional boot immobilisation, offering high patient satisfaction, an excellent outcome and a considerable cost-saving to the hospital trust.
There is a general assumption amongst many patients – and some Surgeons- that 1. Metatarsophalangeal Joint Arthrodesis “in neutral plantigrade position” will postoperatively restrict the choice of shoes and heels in particular. To our knowledge no studies have been carried out to assess this further. A review of a single Surgeon's series of 25 patients and Radiographs following neutral 1.MTPJ Arthrodesis after 14 – 38 months follow up to assess the type of shoe and height of heel comfortably worn.Background
Methods
