Common questions & brief summary

Foot Pain Consultant Birmingham - Podiatric surgical services at Spire Little Aston Hospital

Please use this website to find out more information about foot problems and treatment or contact us to see if we can help

What do I treat?

The breadth of foot management is wide but I concentrate on common problems. Local and general anaesthetic is used where appropriate for all treatments. I specialise in pain controlled management and work also with a consultant in pain management.

  • Bunion pain and surgery to correct deformity
  • Arthritis of the foot joints (midfoot and forefoot) with pain controlled imaging guided injections
  • Neuroma pain
  • Metatarsalgia
  • Painful heel including using extra corporeal shockwave therapy
  • Hammer and deformed toes
  • Ingrowing toe nails
  • Corns (intractable)
  • Ganglia, bursae and exostosis (lumps and bumps)
  • Second opinions and advice.

What is the difference between local and general anaesthetics?

‘Anaesthesia and pain management is as important as the skill of foot surgery’

The choice between staying awake and remaining at a level of consciousness is the main difference for a local anaesthetic, often called a regional block in the foot. A general anaesthetic is where a patient would have no conscious state at all.

At Spire Little Aston I work closely with anaesthetists to ensure the best method is used for foot surgery. All our local anaesthetic patients can have some sedative relaxation. This is sometimes known as ‘twighlight anaesthesia’. The main benefit is lack of awareness of needles for phobic patients whilst being ‘numbed’.

Patients can ask about their preferred method and discuss this with my anaesthetist to help make the best choice.

Modern anaesthetics are much more refined these days so that fewer unwanted reactions arise. Most patients can return home safely after their foot surgery on the same day.

More information about anaesthesia can be directed at the Royal College of Anaesthetists’ website patient and relatives section. www.rcoa.ac.uk

When should bunions be treated?

As a rule we do not treat bunions unless there are definite concerns. There are some golden rules or indications that might be worth considering. Professional advice from someone who deals with this problem is important as some internet information may not be backed by professional expertise. Be very careful of false promises such as minimal incision surgery, or ‘lunchtime surgery’ often popularised by small incisions and performed with quick return to walking. Please look at Clinical Fact sheets on my website under Educational Information; Nos. 7,16,50,52,106

  • Where recurrent skin breakdown arises (ulcers, chilblains, corns)
  • A high chance of worsening in older age
  • Where secondary problems are likely e.g. dislocation of smaller toes
  • The foot is so broad that footwear is difficult
  • After foot growth has finished ideally
  • Where soft tissue problems such ganglia arise
  • Nerve pain compression often know as neurogenic bunion pain
  • Some medical conditions such as rheumatoid arthritis
  • Chronic Infections including osteomyelitis

All surgeries carry risks and these must be fully understood and explained to you before consenting for surgery. Treatment fact sheets

Be very careful of false promises such as minimal incision surgery, or ‘lunchtime surgery’ often popularised by small incisions and performed with quick return to walking. Refer to NICE guidelines an official site on surgeries for toes which are approved. www.nice.org.uk

Fellows of the College of Podiatry (FCPodS) are qualified and regulated by the HCPC to perform foot surgery in the UK

Why is the private sector so expensive?

Unlike the NHS, all hospital services have to cover their outgoings without subsidy. This allows you more choice when you have treatment and also ensures we have staff to provide your treatment swiftly. Something that might take six weeks to arrange in the NHS can often be carried out in the same week at our hospital. The cost of healthcare in the UK has risen as people who perform higher risk treatment must meet ever increasing standards. Obviously this is correct and you will find under ‘quality assurance’ the type of activities we must include. This has pushed the cost of healthcare delivery up. I believe it is important to spend time with patients and this is included within the cost of delivery high quality consultations.

Why use podiatric surgery in the private sector?

Treatment and diagnostics can usually be carried out for your convenience by different departments in one location without the traffic of a large general hospital. Our rooms are of a high quality with en suite for day surgery or admission if required, quality food and nursing support. Spire has a high satisfaction record at Little Aston. Only experienced consultants perform surgical treatment and have to meet high standards of practise. Please refer to ‘Quality assurance’.

Do your charges cover other services?

My charges only cover my time and treatment carried out by me. Other services such as  blood pressure, urine tests, height and weight attract separate charges. Physiotherapy, x-rays, blood tests and ECG are charged separately. Where an inclusive cost is pre-arranged many tests needed for your surgical episode are part of the package. It is always important to make sure you know any costs in advance.

My child is under 16 years of age; can he have treatment at your hospital?

Spire Hospital do not allow any surgery on children under 16 years of age. This will include nail surgery for ingrowing toe nails. Assessment for ‘gait’ and walking problems are carried out by me and all advice on orthotics (arch supports).

Do you guarantee success from treatment?

This is not possible as too many factors can affect the outcome. If you feel that the risks are too great you should not consider surgery for non urgent conditions

What happens if my insurance runs out?

It is always best to ensure you know the limits of your insurance policy. Do discuss this with me if it is likely to run into a shortfall. I do offer a ‘package’ which will depend on how much you have spent with me on previous treatment to date. I can discuss this once you are a registered patient.

What tests might I need?

x-rays account for over 60% of patient investigations, urine sample tests 98% and ultrasound 22%. Many other investigations might be used for specific conditions. Blood pressure is taken before surgery treatment on all patients to ensure that your heart is sound. Local blood flow tests with doppler in clinic is used to make sure circulation is acceptable. Podiatric surgeons cannot provide you with a lesser service than any medical consultant.

How do I know what I am paying for as I am on a limited budget?

You will always be told what is covered first. We undertake no treatment or investigations without your consent. It is my intention to always protect patients against escalating fees balanced against the risk of performing surgery.

Can I pay for my consultation only and use the NHS?

Yes the option is available to do as you prefer using the consultation as an opinion without pressure to follow on with treatment. You can be referred into the NHS by going back to your own GP. All consultations will conclude with a letter to your GP automatically as part of our code of practise.

I cannot offer you NHS treatment without prior GP arrangement. I will not provide mixed treatment however between NHS ‘contracted care’ and ‘private care’. These episodes must be considered separately. An episode of care may comprise several contact appointments, or events. An episode commences with consultation, diagnosis and treatment with a final clinical contact ending with discharge. A new episode starts again usually with a new condition but it can involve assessment of an existing condition.

I am very anxious about having surgery and do not want to be awake?

I work with an anaesthetist to ensure appropriate anaesthetic is provided. Please refer to ‘About’ section in the drop down bar on the home page and then ‘Working closely with other conusltants’

Part of our service and our role is to ensure you do not have undue anxiety during your treatment. My anaesthetist always discusses your care before treatment to put your mind at rest.

I am covered under my medical insurance?

Most medical insurers will cover podiatric consultants at this level of treatment i.e surgery but will not support podiatrists except for limited treatment. Appliances or orthoses are rarely covered by the scheme. Please bear in mind that you must check with your insurer always before treatment to ensure that it is authorised and that you understand if any ‘shortfall’ is likely.

Will I have to have surgery for my foot problem?

No I will always consider conservative treatment first and discuss with you reasonable options. I never push patients to have treatment that they do not need. I am here to advise and support decisions.It is always worthwhile asking for a consultation to clarify which treatment options work and are safe.

Will my treatment be different to an orthopaedic surgeon?

No your treatment is not expected to be different as we hope a good outcome is expected in both cases. Podiatric specialists are able to use all their basic training as a podiatrist as well as advanced training in foot surgery. Podiatric surgeons will not suggest surgery without a medical consultation if your medical health is not stable. There are conditions that I would suggest you see an orthopaedic surgeon for if this is in your best interest. At Spire Little Aston Hospital I work closely with orthopaedic colleagues.

Should I see an orthopaedic surgeon?

No it is not necessary to see an orthopaedic surgeon as not all orthopaedic practitioners specialise in feet. Only those members of the British Orthopaedic Foot and ankle Society carry out regular foot surgery. Podiatric surgeons treat feet exclusively in both the NHS and in private practice. A podiatric specialist will have trained to assess, diagnose and treat feet for 13 years before becoming a consultant. Orthopaedic surgeons specialise in foot surgery toward the end of their long training.

Are you medically qualified?

Our formal education includes studying medical sciences and we are able to treat surgical problems. We do not call ourselves medical doctors. A podiatric surgeon is to feet very much like a dentist is to teeth; I am an independent clinician in my field. Please download there patient information leaflet under Quality AssuranceGood practice. These leaflets discuss standards that podiatric surgeons adhere to and provide more information about training.

What is the difference between a podiatrist and podiatric surgeon?

A podiatrist will be able to help with some foot problems as some treatment will be limited to conservative treatment. Not all podiatrists are able to access all relevant investigation tests. A podiatric surgeon takes a further 9-10 years to qualify as a consultant. Only consultant podiatric surgeons are allowed to operate on human feet in the private sector. Podiatrists may undertake minor procedures for skin and nail conditions under local anaesthetic.

Chiropody

Chiropody is an old name that has been around since 18th century. Surgical chiropodist does not mean a surgeon or someone who can operate but predates the British Medical Auxiliary Act 1938. Surgeon chiropodists advised past monarchs including Queen Victoria.
Podiatry was a term used officially by the Podiatry Association in 1975 (now merged with the Society of Podiatrists & Chiropodists in 1997). Since 1975 podiatry has mirrored the American sister profession. Podiatrists used the term Podiatric Surgeon when the first undergraduate degrees in podiatry came into being in the late nineteen eighties to avoid confusion with podiatrists. www.feetforlife.org

Special note: BOFAS the orthopaedic sub specialty for foot and ankle surgery erroneously refers to surgical podiatry in many cases. This is not a term officially supported by the podiatry profession or the Directorate of Podiatric Surgery, College of Podiatry.www.bofas.org.uk