Background: With the advent of bacterial resistance, it is important now more than ever to evaluate use of antibiotic chemoprophylaxis in foot and ankle surgery. Within this area of the body there may be less dissection, surgery time with smaller incisions and importantly smaller sizes of implanted fixation as compared to other bone and joint procedures. Our objective was to systematically evaluate the quality of evidence behind existing guidelines.Methodology: A systematic literature search was performed: MEDLINE, CINHAL, EMBASE and the Cochrane library from 1990 up to March 2018. To avoid omitting any studies on the subject, Google Scholar was also used. The inclusion criterion were studies exploring perioperative antibiotic use, postoperative infection rates in elective foot and ankle surgery and studies associated with this subject evaluating antibiotic use in clean elective foot and ankle surgery. The exclusion criterion being studies upon contaminated or dirty surgery or those which were inclusive of procedures proximal to the foot and ankle.Results: Overall 11 studies met the inclusion criteria. From the grading of evidence, 2 level one and 4 level two studies were recognised. These studies ranked relatively highly in comparison to 5 studies that were graded as level three and level four tiers of evidence. Results of SSI rates found within this systematic review ranged from 0% to 9.4% of overall postoperative infections encountered after foot and ankle surgery in the studies analysed.Conclusion: Whilst fragmented, aspects of antibiotic chemoprophylaxis are established fields in elective surgery with a growing body of evidence. Evidence for antibiotic use however, specifically within elective foot and ankle surgery, is lacking. This systematic review is a seminal paper which delivers an impression of the most influential literature within the field of foot and ankle surgery, with the aim being to entice conclusions and guide future research.

INTRODUCTION: The first comprehensive report on the interprofessional relationships between foot and ankle surgeons in the UK is presented. MATERIALS AND METHODS: A questionnaire was sent to orthopaedic surgeons with membership of the British Foot and Ankle Surgery Society (BOFAS), orthopaedic surgeons not affiliated to the specialist BOFAS and podiatrists specialising in foot surgery. The questionnaire was returned by 77 (49%) of the BOFAS orthopaedic consultant surgeons, 66 (26%) of non-foot and ankle orthopaedic consultant surgeons and 99 (73%) of the podiatric surgeons. RESULTS: While most respondents have experience of surgeons working in the other specialty in close geographical proximity, the majority do not believe that this has adversely affected their referral base. The experience of podiatrists of the outcomes of orthopaedic surgery has been more positive than orthopaedic surgeons of podiatric interventions. Podiatrists are more welcoming of future orthopaedic involvement in future foot and ankle services than in reverse. However, there are a sizeable number of surgeons in both professions who would like to see closer professional liaisons. The study has identified clear divisions between the professions but has highlighted areas where there is a desire from many clinicians to work more harmoniously together, such as in education, training and research. CONCLUSIONS: While major concerns exist over issues such as surgery by non-registered medical practitioners and the suitable spectrum of surgery for each profession, many surgeons, in both professions, are willing to provide training for juniors in both specialties and there is a wish to have closer working relationships and common educational and research opportunities than exists at present.

Background: Corrective surgery for hallux abducto valgus is one of the most performed elective procedures in foot and ankle practice. Numerous methods of surgical correction have been reported within the literature, with varying clinical and patient reported outcomes. This study reviews the patient experience and outcomes in five podiatric surgery centres using the scarf diaphyseal osteotomy.Method: Patient reported outcome measures (PROMs) were captured using the Patient Satisfaction Questionnaire 10 (PSQ‐10), part of the PASCOM‐10 podiatric surgery audit tool. PROMs were collated across five hospital sites over a 10‐year period.Results: Of 1351 patients reported during the period, 1189 had complete retrospective data. The most common patient aim of surgery was ‘no/less pain’ reported in 70% of patients. 96.8% of patients reported their original foot complaint as ‘better’ or ‘much better’ after surgery. 92.8% of patients reported their expectations had been met with 96.6% reporting they would have surgery again under the same conditions. 98.5% of patients noted that the risks, complications, and expectations had been discussed prior to surgery. The most common complication was metatarsal fracture (4.6%).Conclusion: The scarf osteotomy (with or without an Akin phalangeal osteotomy) consistently showed high patient satisfaction with low complication rates using PSQ‐10 and this information can be used as part of the pre‐operative consenting process. Patient expectations for surgery were often achieved, which may be attributed to the pre‐operative work up of the patient. Further investigation into this correlation is suggested.Level of clinical evidence: IV (retrospective review).

The description of corticosteroid injections as a treatment option for Ledderhose disease has received little attention in the literature and often only receives a passing comment in scientific papers. We present a short case series of two patients who underwent corticosteroid injection in combination with fenestration to treat painful Ledderhose disease nodules. Both patients had their lesions injected on two occasions. Significant reduction in pain and lesion volume was seen at 12 months post treatment. Our protocol combines fenestration with the use of triamcinolone acetonide (mixed with local anaesthetic) which we believe conveys further advantage over other steroid preparations or the corticosteroid infiltration alone.