What is Podiatric Surgery?
Podiatric surgery is a specialist field in the podiatry profession. Podiatric surgeons have been working in Australia since 1975. Countries including Australia, New Zealand, the United States and the United Kingdom have accredited podiatric surgeons. Podiatric surgery is defined as "the surgical treatment of conditions affecting the foot, ankle and related lower extremity structures by accredited and qualified specialist podiatrists". Foot and ankle surgery may be performed as day case surgery, or overnight stay if necessary. Surgery is performed under local or general anaesthesia.
What is a Podiatric Surgeon?
Podiatric Surgeons are podiatrists who have completed extensive, post-graduate medical and surgical training, which enables them to perform reconstructive surgery of the foot and ankle. An average Podiatric Surgeon spend 10 years of exposure to foot and ankle related diseases and would have treated 20 thousand patients before attaining the title of 'surgeon'. Naturally this enables a podiatric surgeon to have a special and greater medical, biomechanical and functional understanding of foot.
Before attaining a podiatric surgical fellowship qualification, an average podiatrist completes the following programs and requirements:
- A Podiatry Degree
- Minimum two years of clinical practice
- Master's degree in Podiatry
- A 3 stage surgical fellowship training (6 years)
- International residency training both in UK and USA
- An extensive practical and oral examination phase on both forefoot and rearfoot related surgery
- Minimum 2500 logged cases of podiatric and orthopaedic surgery in which a huge portion is performed or assisted surgery under supervision.
- A thorough understanding of medical and pharmaceutical complications
- Understanding of local and international disease trends.
- A thorough understanding of biomechanics of posture and gait
- A good understanding of exercise and sport related disorders
- Ability to work in a multidisciplinary hospital environment
- A sound understanding of systemic disorders, and emergency room protocol.
- Ability to work with high risk foot especially in the field of Diabetes.
- Advance life support – provider licence
- Publication of research papers in peer review journals
- Expected to carry out minimum of 45 presentations to peers and other medical professionals.
- A good character
The qualifications of podiatric surgeons are recognised by Australian State and Federal Governments. Podiatric surgeons are included within both the Health Insurance Act and the National Health Act.
Around the world, podiatric surgery has a long history of leadership and innovation. Podiatric surgeons are unique, having dedicated their energy over many years in research, investigation and mastery of medical and surgical therapeutics of the foot and ankle. For most disorders there is more than one form of treatment and management of foot and ankle problems may involve surgery, medicines, casts or splints and allied therapies. A podiatric surgeon will discuss the merits of conservative and surgical treatment options for each individual patient and help one to select the best treatment plan to enable an active and functional life.
What do Podiatric Surgeons treat?
Podiatric surgeons are concerned with the diagnosis and treatment of disorders of the foot and ankle. Podiatric surgeons are uniquely qualified to care for bone, joint, ligament, muscle and tendon pathology of the foot and ankle, including:
- Structural deformities,including bunions, hammertoes, painful flat foot and high arched foot deformity
- Bone spurs
- Heel pain
- Nerve entrapments
- Tendon and soft tissue problems
- Degeneration and arthrosis of the joints of the foot and ankle
- Skin and nail conditions, including warts, ingrown toe nails and corns
- Congenital deformities
Chronic trauma-related injuries, including fractures and dislocations and posttraumatic arthrosis
In most podiatric/orthopaedic injuries pain is only one aspect of the disease process. Restriction in footwear, in ability to walk and function properly, and degenerative joint damage are all part of the reasons why one seeks help. Conservative treatment of many foot and ankle problems often produces temporary relief of pain. If pain persists, and difficulties in day to day living increase, surgery is the more definitive answer to a persistent problem and the best way to prevent more serious conditions. On the other hand, surgery is not always the best approach for all patients. Your podiatric surgeon can tell if you are an appropriate surgical candidate or not.
What are the Benefits and Risks with Podiatric Surgery?
Podiatric surgery is a proven and effective aspect of foot health care. Podiatric surgery is performed on a day case basis usually under local anaesthetic. The benefits of a local anaesthetic include not experiencing the side effects of a general anaesthetic especially nausea and vomiting.
Early post-operative ambulation and discharge home reduce the potential for hospital-acquired infections. You will be able to walk out of the centre and go home immediately after the surgery.
The risk of developing a blood clot is very high after any operation that disables you to walk. Therefore quicker we can get you walking the quicker you start healing and less likely to develop deadly blood clots! The calf muscles within the back of the legs act as excellent pumps, they deliver fresh new blood to the operation site and remove swelling, this helps in a speedy recovery from surgery. No operation can be deemed to be without risk and it's important that you are aware of this, however small, before consenting to foot surgery.
We can avoid complications via a system of screening and investigations. This includes a detailed medical and surgical history including questions about various body systems. If any of these raises health problems, further investigations or medical opinion may be sought. It may be decided to avoid surgery or defer it until the problem is treated or under control.
Podiatric Surgery Complications include:
- Prolonged swelling
- Haematoma - accumulation of blood at the operation site
- Thick / sensitive scar
- Loosening / movement is screws and pins used to stabilise joints
- Irritation of screws and pins
- Reactions to the local anaesthetic or prescribed pain killers
- Infections (deep and superficial)
- Temporary / permanent loss of sensation
- Delayed healing of soft tissues or bones
- Circulatory impairment and tissue loss
*RARELY* thrombosis of the deep veins which can be life threatening
How do I prepare for foot surgery?
Always ask your surgeon for complete pre-operative preparation instructions. Typically, these may include:
- Complete any pre-operative tests or lab work prescribed by your practitioner
- Arrange to have someone drive you home from the hospital
- Call the appropriate surgery centre to verify your appointment time
- Please ensure that your foot is clean and the toenails are trimmed when you present for surgery. A general podiatric visit can be useful to remove the dead skin from around the foot and make sure your nails are appropriately short. As your foot will be bandaged for some time this will make your foot much more comfortable post operatively
What do I need to do the day of surgery?
- If you currently take any medications, take them the day of your surgery with just a sip of water
- Refrain from taking diabetic pills or insulin on the morning of surgery
- Do not wear any jewellery, body piercings, makeup, nail polish, hairpins or contacts
- Leave valuables and money at home
- Wear loose-fitting, comfortable clothing
- Tell us if you are wearing braces or false teeth
What do I take to hospital?
- X rays
- Regular medication
- Forms i.e. consent forms, pathology results
What happens when you arrive at the centre?
- You will be met in reception and will have to fill out administrative forms
- You will then meet with the nursing and anaesthetic team
- You will meet your surgeon
- Your foot will be prepared for surgery
What Is Worn on the Foot Following Surgery?
- Immediately after surgery, the entire foot will be carefully wrapped in a bulky dressing or cast as protection for the first few days
- Keeping the foot elevated during this time will help minimize swelling. Some swelling and stiffness can be expected following surgery, for as long as eight to twelve weeks
- Crutches may be needed for walking or standing as the foot heals
- Each surgical procedure requires a different type of foot immobilization such as a bandage, splint, surgical shoe, cast, or open sandal
- Good postoperative results require proper foot support to prevent future problems. Early use of leg and foot muscles hastens recovery
- After sufficient healing time, most patients can resume wearing their usual footwear
What should I do the night before foot surgery?
- Do not eat or drink anything after midnight
Will I see my surgeon prior to surgery?
Yes you will met him prior to your operation to go through last minute checks and to mark your limb.
How can I manage at home during recovery from foot surgery?
- After the first 48 hours of foot elevation, you can usually gradually return to most activities wearing your post operative shoes
- The dressing placed at the time of surgery is left intact until your first postoperative visit
- The surgical dressing cannot get wet. Therefore, baths are encouraged
- We will provide you contact details of companies which provide "over-the-foot" protective bag if necessary
What happens after surgery?
It is not unusual to experience numbness, tingling, and burning sensations in your foot or ankle. You should elevate your foot above your heart for 48 hours after the procedure, in order to relieve pain and these sensations. If this does not resolve the problem, your cast or surgical dressing may be too tight, and you may need to call your surgeon. Avoid prolonged sitting or standing, and refrain from putting weight on the operative site unless given permission by your surgeon.
Your surgeon will give you pain medication, which may cause nausea or constipation. Eat lightly on the day of surgery. Have lots of fluids.
Keep your bandages clean and dry.
Follow-up X-rays may be required to ensure the foot is healing properly. These are usually done 3-6 weeks after surgery.
Additionally, patients are typically required to wear a post-operative shoe.
Your surgeon will be providing you full post-operative instructions.
How long is the recovery period after foot surgery?
This is very much dependent of the type of surgery. Majority of soft tissue operations recover in 2-4 weeks. Any bone related surgery typically requires between 6 and 12 weeks. There are more complex procedures where mid foot and/or rearfoot bone work is involved, and these can take up to 12-36 weeks and beyond.
Any recovery from surgery depends on 3 things:
- Surgical care; what we do to your feet before, during and after surgery is very important part of your healing process. This is an area where we endeavour to show utmost attention to detail and provide the best care
- Systemic factors, i.e. your health, age, medications you take
- Environmental factors, i.e. your compliance with the instructions, dressings and appointments
We will work together to balance the top three factors so you heal faster.
Swelling is the "enemy" after surgery and precautions must be taken to minimise it.
A slow, gradual return to activities is encouraged.
How frequently should I schedule follow up appointments following surgery?
It is very important for us to be in close contact with you following your surgery. Apart from regular phone calls, we will discuss the frequency of your visits on your first week back from your surgery. Commonly we will see you on the first week, third week, sixth week and twelfth week post operatively. After this, appointments will be made depending on your particular surgery.
What do I do if my dressing gets wet or bandages falls of?
Although there is no need to be alarmed about getting it damp or having few lose pieces of bandage, we need to now the state of your dressing and the wound. We will instruct you on further care, or will get you to see us ASAP.
How do I obtain a work certificate?
Please call the rooms at any time ad we will provide you the necessary documentations.
When can I ravel by plane?
You can travel at any time but there are increased risk of DVT (blood clots) during the first three months after surgery.
When can I drive?
Every individual is different but you should be able to drive when you can fully mobilise your feet and have no hindrance/pain when accessing car's breaks. This might be within the first 2 weeks of your post operative phase.
How much does surgery cost?
It is very difficult to give a cost of a surgical procedure prior to the surgeon reviewing your foot as all feet and different and each procedure is tailored specifically to your foot. The surgeon will give a written quote for your procedure after your consultation.
As a guide, however, an uncomplicated basic bunion procedure costs approximately $1800. This cost is billed directly by the surgeon.
You will also have an anaesthetic cost and this is billed by the anaesthetist on a per half hour basis. This cost is not claimable through your private health fund or Medicare.
The day surgery facility bills your health fund directly and there may be a gap that you will need to pay on the day of surgery. If you are not in a private health fund then the cost of the day surgery facility will have to be fully paid on the day of surgery. Please call the particular surgery directly to confirm these costs. These details will be provided to you at your pre surgical consult.
Rebates: There is no Medicare rebate for podiatric surgery at present. Private health insurance rebates vary substantially between funds. Most private health funds provide a very minimal rebate for surgery but you should check with your health fund prior to surgery. You will have a written quote with MBS codes and podiatry item numbers that will help the fund determine what your rebate may be.
Are there other resources that I can go to for more information on the procedure?
Please visit the following links or go to 'further links' on this web site. We are happy to answer any of your questions on our chat section. Feel free to ask us. Patients can go to the following resources for more information:
- Australasian College of Podiatric Surgeons www.acps.edu.au
- American College of Foot and Ankle Surgeons www.acfas.org
- Podiatry Online www.footdoc.com
Podiatric Surgeon or Orthopaedic Surgeon?
Both Podiatric and Orthopaedic surgeons perform foot surgery. The question often arises as to who is more qualified. The reality is that it depends on the surgeon. There are exceptional Podiatric foot surgeons and exceptional Orthopaedic foot surgeons. Conversely, there are mediocre surgeons in each profession.
Podiatric Surgeons are not medical doctors; however they are doctors of their field and their training allows them to do surgery of the foot and ankle in Australia and UK. Orthopaedic surgeons are medical specialists and they are allowed to do surgery on every part of human anatomy.
From day one of their training, Podiatric surgeons know they will be treating foot and ankle conditions, thus early on they receive in-depth education on foot and ankle conditions as well as broad education in general medical conditions. They further deepen their knowledge in general medicine and podiatric medicine for three years at a Master's degree level. The six year fellowship program allows Podiatric Surgical Registrar to detect any medical conditions affecting the lower extremities as well as deal with surgical patients who have medical conditions. Unlike other specialties, Podiatric surgeons receive significant training in biomechanics during their education. They also spend considerable amount in USA and UK for up to date skills and information.
Board certified Podiatric Surgeons are the surgical specialists of the Podiatric profession. Australasian College of Podiatric Surgeons (ACPS) is the body that regulates their area of expertise. All ACPS members are dedicated to surgical excellence in the treatment of foot and ankle disorders.
Why should I seek a second opinion regarding treatment for this procedure?
As medicine becomes more complex less personal, patients can feel overwhelmed. We feel it is important for you to feel comfortable with your surgeon. The opportunity to consult a recognised authority about a particular diagnosis and treatment can bring peace of mind at an emotionally difficult time. A second opinion may be beneficial when:
- You are uncertain about having surgery
- You still have questions or concerns about your current treatment
- You have multiple medical problems
You have choices to make about treatment.