Preparing for a foot operationThe London Podiatric Centre

1. What do I need to dobefore I come in for myoperation?

� check your appointment letterto make sure you know whattime to arrive and where to go

� you will receive a form whichmust be signed and returnedbefore the date of your surgery.This confirms that you haveread and understood all theinformation you have beengiven regarding your operation.Surgery cannot proceed unlessthis form has been returned to us

� bathe or shower one hourbefore arrival. Please wearclean hosiery and do not wearsandals

� cut your toenails and cleanunder the nails well the daybefore surgery

� remove all nail polish fromhands and feet

� remove jewellery

� wear loose clothing as a largedressing and a surgical shoewill be applied after theoperation

� bring with you a clean pair ofshorts and a t-shirt that havenot been worn outside

You are coming into ourCentre for an operation onyour foot or feet.

This booklet has beendesigned to provide you withsome information about youroperation, your care whilstwith us, and what to expectwhen you arrive in theCentre.

We would ask you to takethe time to read it. Morespecific information aboutyour treatment will be givento you by members of thepodiatric surgery team youmeet.

Most foot surgery can be doneas a “day case operation” whichmeans that you are able to gohome the same day. You willneed a fit and responsible adultto stay with you for at least threedays after your operation. Theamount of help patients needafter surgery varies a great deal.We would urge you to makesure you fully understand theimpact of your proposed surgeryby discussing this with one ofthe podiatric surgical team.

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� you may bring along apersonal stereo player withheadphones or a book to read

� bring any regular medicationwith you

� do not put any cream on yourfeet

� bring asthma inhalers to takeinto surgery if you wear them

� bring glasses or hearing aids ifyou use them and inform thesurgeon if you wear dentures

� do not smoke or drink alcoholfor at least 48 hours beforeand after your surgery

� please make sure you arrangetransport to and from the day-surgery unit.

� once home, it is important foryou to have a fit andresponsible adult staying withyou for at least three days afteryour operation

� you should arrange therecommended period of restfor after your operation asadvised by your podiatricsurgeon

� if you are under 16 years ofage you must have a parent orlegal guardian accompany youto all your appointments

About podiatric surgery

� if you will need to take yourregular pre-prescribed medicationduring your time in thedepartment, or may have need ofan inhaler or angina spray orepipen; please remember to bringthese with you

� if you have been advised toarrange any tablets / medicines byyour podiatric surgeon rememberto obtain these prior to youroperation. If you have been askedto obtain these from your owndoctor please arrange this well inadvance

� take any prescribed medicines asnormal unless you have been tolddifferently and remember to bringall medication with you that youmay need whilst in hospital

� read any additionalinformation you may be givenregarding your admission forsurgery.

2. Do I have a choice withregard to my anaestheticfor foot surgery?Foot surgery can be undertakenusing a number of types ofanaesthetic,

These are:

� Local anaesthetic� Local anaesthetic + sedation� Spinal anaesthetic� General anaesthetic

Only local anaesthetic is availableat The London Podiatry Centre.Patients who require sedation orgeneral anaesthesia are generallytreated at one of the majorhospitals where Mr McCullochconsults.

Not all of these types ofanaesthetic may be suitable foryou. You should discuss yourpreferences with one of thesurgical team during your visits tothe department.

Local anaesthetic

Local anaesthetic means you canbe awake during your operationthough your foot will be numb

and the operation will be screenedaway from you. You will be able tolisten to music or read whilst youroperation is done.

Many patients choose to have theirfoot operation using a localanaesthetic. Sometimes it isnecessary to give you additionallocal anaesthetic during yoursurgery (about four cases per 100).

Local anaesthetic with sedation

Sedation normally requires ananaesthetist to be present toadminister a sedative through asmall needle placed in a vein in theback of the hand. Sedation usuallyhas the benefit of reducing anxietyduring the operation. You will notbe able to eat or drink forapproximately 6-8 hours prior toyour surgery.

General anaesthetic

With a general anaesthetic you areput to sleep though you will stillrequire a local anaesthetic (this isusually given once you are asleep).Some patients can feel sick whenthey wake-up. You will not be ableto eat or drink for approximatelysix to eight hours prior to yoursurgery.

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3. So can I eat and drink asusual before my operation?If your surgery is going to beundertaken using a local anaestheticonly, then you are able to eat anddrink as normal. If your surgery isplanned under general anaestheticor using sedation then you shouldnot eat or drink for six hours prior toyour operation. This will bediscussed with you prior to yoursurgery. If you have any questionsabout this, please speak to one ofthe podiatric surgical team.

4. What will happen on theday of my operation?� you will be asked to come in to

the hospital / day-surgery unit onthe day of your operation

� when you arrive you will bewelcomed by one of the team whowill escort you to the admissionarea where you may be asked tochange into a theatre gown

� your consent form will bechecked by one of the podiatricsurgery team and the proposedoperation re-explained. This is anopportunity for you to askfurther questions

� you may be asked more questionsabout your health and have yourblood pressure checked

About podiatric surgery

� the operation site will beclearly marked by drawing onyour foot/leg

� if you are going to be providedwith crutches after yoursurgery, you will be shownhow to use these either beforeor after your operation

� if you are having a localanaesthetic this will be givenbefore you are taken totheatre. If you are havinggeneral anaesthetic, theanaesthetist will come and seeyou before your operation.

� your local anaesthetic will bechecked for effectiveness byone of the team before you aretaken into theatre

� when the team is ready, youwill be taken into the operatingtheatre for your surgery

� your foot will be cleaned withsurgical scrub and sterile sheetswill be placed around the area

� your local anaesthetic will bere-checked to make sure thearea of your foot is fully numb

� a tourniquet (like a bloodpressure cuff around yourankle) may be used during youroperation. This may beuncomfortable for a short

� you will be discharged homewith your escort (who must be aresponsible adult). A copy ofyour discharge form will beprovided.

6. Will I be in a cast aftersurgery or have to usecrutches?This will depend on the type ofoperation you have had. You willbe told beforehand if crutches or acast are required following youroperation. You will be shown howto safely use crutches if these arenecessary.

7. What happens if I have aproblem after myoperation?You will be provided with an advicesheet to take home after youroperation detailing yourpostoperative instructions, anduseful information

8. What will I wear on myfoot after my operation?Where required we providepatients with a specialpostoperative shoe which isdesigned to accommodate thebandages over the foot.

while until your ankle tissuesadjust, but most people find itquite acceptable after aboutfive minutes

� after your operation your footwill be bandaged up carefullyand you will be transferredback to a recovery area.

5. What will happen after Ihave my operation?� you will be transferred from

theatre to a recovery area

� one of the team will make surethat you are comfortable andcheck your dressing

� it is usual for you to bemonitored for about 15-30minutes after your operation,this varies depending on whatoperation(s) you have haddone and the type ofanaesthetic. You may beoffered a drink and somethingto eat

� a special post-operative shoeor boot (or sometimes a cast)will be applied to the foot

� one of the team will check youare pain-free, read throughand explain your postoperativeinstructions, including anycontact numbers to use in caseof a problem

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9. Contact numbers to use incase of a problemIf there is any bleeding or pain,please contact the Centre on thethree numbers provided. Call eachof the three numbers until youhave had a reply. If you have nothad a reply within the hour, thenplease contact your GP or accidentand emergency.

10. Will I need to take timeoff work after my surgery?You are advised to rest aftersurgery. The amount of timerequired varies according to thetype of operation and your owncircumstances. Please refer to thespecific operation informationleaflet provided by your podiatricsurgeon or ask one of the clinicstaff.

11. Will I have to back tohospital / clinic after mysurgery?The arrangements for follow-upafter podiatric surgery will vary butusually takes place at The LondonPodiatry Centre. You will beinformed of what to expect beforeyour operation. In most cases youwill be reviewed by one thepodiatric surgery team followingyour operation.

About podiatric surgery

11. Who is who?Your treatment / surgery will beundertaken or supervised by apodiatric surgeon who is a Fellowof the Faculty of Surgery (Collegeof Podiatrists). Podiatric surgeonsare not registered medicalpractitioners (medical doctors), butare non-medical specialists in thesurgical and non-surgicalmanagement of problems of thefoot and associated structures.

Titles:

The podiatric surgical team mayconsist of several differentprofessionals all dedicated to thesuccess of your surgery, this includes:

Podiatrist:

Is a clinician who has studied forthree years to obtain a degree inpodiatric medicine and registrationwith the Health ProfessionsCouncil. Podiatrists areindependent clinicians, qualified todiagnose and treat foot problems.

Podiatrists may specialise inparticular areas of work e.g. thecare of the diabetic patient orsports medicine. With theexception of nail surgery,podiatrists undertake thetreatment of foot problems by

Podiatric Surgeon:

A podiatric surgeon hassuccessfully gained both theirFellowship and a certificate ofcompletion of training. A podiatricsurgeon is a non-medicallyqualified specialist in the treatmentof foot problems by both surgicaland non-surgical methods.

Consultant Podiatric Surgeon:

After some years of practice withina health service department ofpodiatric surgery, a podiatricsurgeon may be appointed as aconsultant, i.e. the lead clinicianappointed by an NHS Trust toprovide a podiatric surgery service.

Trainees

The London Podiatry Centre is atraining centre for the nextgeneration of healthcare staffincluding podiatric surgeons.

An essential part of staff training isworking with patients. Yourcooperation would be appreciatedbut you are under no obligation tohave a trainee involved in your careand you can discuss with thepodiatric surgeon.

non-invasive methods (untilrecently podiatrists were known aschiropodists).

Trainee in Podiatric Surgery:

Is a podiatrist who has studied fora further two or three years tocomplete the initial sections of theFaculty of Surgery exams (orobtained an MSc degree) in thetheory of podiatric surgery and isundertaking a formal surgicaltraining programme under thesupervision of a ConsultantPodiatric Surgeon who is anaccredited Tutor of the Faculty ofSurgery.

Specialist Registrar (SpR) inPodiatric Surgery:

Is a past trainee in podiatric surgerywho has successfully completedand gained their Podiatric SurgicalFellowship (qualification in thepractice of podiatric surgery) and isworking as part of a continuedtraining programme towards thecompletion of their three year postFellowship specialist trainingperiod.

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About podiatric surgery

Things to consider before having a foot operationPatients seldom have problems following podiatric surgeryand most are pleased with their result. Unfortunately alltreatments/operations carry risks. You need to carefullyconsider the severity of your problem against the likelyrisk/benefit from any proposed surgery (for more informationon understanding risks, see the BestTreatments website(http://www.besttreatments.co.uk/btuk/howtouse/7432.html)

This information booklet is not intended to worry you. It ishoped that by providing as much information as possible, allyour pre-surgery questions are answered. If you have additionalquestions do not hesitate to ask a member of the team.

For convenience this section is laid out in alphabetical order.

Activity

You will be required to rest afteryour operation. How much restand how much you are allowed toundertake will be discussed withyou before and after your surgery.

Postoperative recovery times varybetween patients. For an indicationof this please refer to the specificoperation information leafletprovided by your podiatric surgeonor ask one of the clinic staff.

Alcohol consumption

You are advised to avoid alcoholafter your foot surgery, whilst onmedication. Alcohol may interactwith one or more of yourmedicines in addition to increasingthe risk of falls postoperatively.

Altered walking pattern

Foot surgery may affect the wayyou walk. Following foot surgery,patients naturally favour the otherfoot. This is usually temporary, untilthe foot settles and you become

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accustomed to walking normallyagain. Sometimes we provide afoot splint to help with symptoms.

Avascular necrosis

This is where part of the bone losesits blood supply. This may occurafter an operation or even fromsimple trauma. The bone may‘weaken’ and change shape.

Usually the blood supply will returnto the bone with time. Sometimesthe bone is damaged resulting inproblems such as secondaryarthritis. This is a very rareoccurrence.

Being awake during theoperation

If you have elected to have youroperation under local anaestheticyou will be awake during youroperation. Your foot / leg will betested before you enter theatre toensure you are pain free. We checkthis again once you are in theatre.

In the rare event you feel anydiscomfort you simply need tonotify the nurse and we will beable to deal with this immediately.

This is a rare event and most

patients are able to chat to one ofthe nursing team or listen to theirmusic whilst the operation isbeing performed.

Bleeding

There will be some bleedingpostoperatively but the majorityof this is controlled during theoperation. Infrequently, a smallcollection of blood in the deepertissues may form. This occurs lessthan 1 per cent of the time andcan be dealt with and generallysettles without problems.

Changing your mind

Whilst we will have done our verybest to diagnose your footcomplaint and formulate anappropriate treatment plan foryou, you do not have to followthis treatment plan against yourwishes. Patients have the right tochange their mind at any timeabout their treatment.

Please be assured that should youchange your mind about yourproposed treatment staff will dotheir utmost to find an alternativetreatment plan that suits youbetter.

Death

This is extremely rare and mostunlikely to happen, but as with allsurgical procedures it remains aremote possibility, for example asa result of an anaphylactic shock(severe allergic reaction) to aninjection. The podiatric surgeryteam is trained, and thedepartment equipped, to dealwith such an emergency.

Delayed healing

Although you will be given anestimate as to how long therecovery process will take; delaysin healing of the soft tissue orbone can occur. Generally, thesoft tissue will heal although bonesometimes does not heal properly(see non union). You shouldremember that the informationyou have been given is a guideand you should allow for thiswhen planning your recovery.

Deterioration of symptoms

The vast majority of patientsundergoing foot surgery have lessdiscomfort following theiroperation. Occasionally however,some patients have noimprovement of symptoms and

About podiatric surgery

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Chronic regional painsyndrome (reflex sympatheticdystrophy - RSD)

This is a rare condition, whichmay occur even after evenminor injury. It is not alwaysassociated with surgery. Thecondition is very uncommonand can occur after any type ofoperation. Persistent / chronicpain develops as well asswelling / colour changes andchanges to bones of theaffected limb. Treatmentrequires early diagnosis andreferral to a pain specialist.Complete resolution of RSDmay not always be possible.This is not a predictable eventbut fortunately uncommon (3in 2500 – 0.01 per cent).

Crutches

Some operations will require youto use crutches post-operatively.You will be made aware of thisbefore your surgery. If you thinkyou will have difficulty in usingcrutches please let one of the teamknow, so that alternative walkingaids can be arranged.

more rarely, some patients havemore discomfort. It is for thisreason that foot surgery forcosmetic reasons is notrecommended. It is alwayspossible to have a straighter toeor foot, which hurts more.

Driving

You should not drive afteryour foot surgery, until advisedby the Podiatric Surgeon orone of the team, as you maydamage the operation siteand to do so may invalidateyour insurance and be anoffence under the Road Traffic Act.

Failure of the operation

The important point to note isthat despite the very best effortsof the team we cannot guaranteeoutcomes. This is true of anypatient undergoing any surgery. Insome operations (eg bunionsurgery) full correction may not beachieved although symptoms areusually improved. Most patentsare pleased with the result of theirsurgery.

Fixation problems

Any metalwork (pins / screw /plate / implant) used, is normallyleft in place. In about 10 per centof cases, a patient’s metalworkneeds to be removed (if it worksloose or cause irritation to thesurrounding tissues). Once thebone is healed, the metalwork isnot required, however unless itcauses a problem we leave it inplace.

General anaesthetic

General anaesthetic means youwill be ‘asleep’ during youroperation. There is a slightly higherrisk of medical complications forpatients receiving generalanaesthetic compared to localanaesthetic. Some patients mayfeel nauseous ‘sick’ when theywake up from the generalanaesthetic.

Infection

Infection rates are estimated atless than 2 per cent of allsurgeries. If infection does developit is generally superficial, usuallytreated with antibiotics andresolves very easily. However,although uncommon, infectioncan get deeper into the bone

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About podiatric surgery

previous history of keloids doesnot mean you will not developone. It is recognised that certainethnic backgrounds maypredispose to (increase the chanceof developing) this type of scare.g. Afro-Caribbean. In patientswho have a history of ‘keloids’ weneed to weigh-up very carefullythe real risk of ‘keloid’ developingafter surgery. There are somethings we can try to minimise therisk but they are not 100%effective. These measures include:

� use of corticosteroid injectionsprior to surgery

� careful incision planning

� use of zinc creamspostoperatively.

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which is a much more seriouscomplication.

This may require a period ofhospitalisation, possibly furthersurgery and a longer course ofantibiotics. In rare instances, theinfected bone may need removingwhich could affect your footpermanently. Any infection hasthe potential to be fatal and footsurgery is no exception.Fortunately, this is extremely rare.

Joint stiffness

Surgery near joints e.g.bunion surgery can lead tosome joint stiffness. Theimmobilisation followingsurgery and healing of thedeep tissues near to the jointmay be the underlying cause.We will usually give you somegentle exercises to minimisethis risk.

Keloids

Keloids are large unsightly scarswhich are raised up and mayextend beyond the margins of theoriginal wound. This is a rare typeof scar. Patients may have ahistory of poor scar formation /keloids, although having had no

Local anaesthetic

Local anaesthetics are medicineswhich, when injected near nerves,stop pain. Most of us haveexperienced a local anaesthetic atthe dentist. Foot surgery is readilyperformed under local anaestheticand involves injections placedeither around the ankle or aroundthe knee. After the injection hashad time to work, which can takeseveral minutes, you will notnormally be able to feel pain in thearea affected. A small number ofpatients do require additional localanaesthetic during surgery. In rarecircumstances some patients donot respond to local anaestheticinjections and we cannot proceedwith surgery (less than one caseper 100). In these situationssurgery may have to bepostponed. Whilst localanaesthetic drugs are consideredvery safe there are some potentialside-effects such as:

� allergic reaction to theanaesthetic (less than oneperson per 10,000)

� toxic reaction to the drug (lessthan one person per 2000across all injections)

� irritation or damage to thenerves at the injections sites

� bruising around the injectionsite (one person in 20).

Loss of sensation

It is possible for you to losesome sensation around or awayfrom the surgical site aftersurgery. Great care is taken toavoid damage to nerves and itis rare for a major nerve to bedamaged. If nerve damagedoes occur it is more often thetiny nerves to the skin, whichmay leave an area of skin withreduced or altered sensation.

This loss of sensation cansometimes recover with timebut this is not always the case.

Loss of tissue / part of foot /limb

This would be a very rarecomplication for the vast majorityof patients having foot surgery.

However it is possible for injury toblood vessels and/or seriousinfection to lead to loss of tissuewhich can involve some or all ofthe foot. The risk of this for

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Numbers of operationsperformed

In most cases your consultant orpodiatric surgeon, whose careyou are under will haveperformed a large number of thesame operation for which youhave been scheduled. In somecircumstances however theconsultant may have onlyperformed a very small number ofsuch operations. This might be forexample if your operation is notsomething that is commonlyrequired to be performed. Alsosometimes the combinations ofdifferent operations necessary tofix your foot may not becommonly required.

On-call availability

The London Podiatry Centreprovides an out of hoursemergency service for patientswho have undergone surgery.

You can call the Centre for adviceduring normal working hours andthe departmental number is atthe end of this booklet.

About podiatric surgery

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healthy patients would be muchless than 1 per cent.

Metatarsalgia

This refers to discomfort under theball of the foot (metatarsal heads).

Surgery to the foot may alter thepressure under the forefoot andincrease discomfort here.

Sometimes this is treated withshoe inserts and rarely by furthersurgery.

Non-union

This term refers to the situationwhere bone fails to fuse (join)together as planned. Thepercentage risk varies greatlydepending on the bone or joint inquestion e.g. Bunion surgery risk isless than 1 per cent and majorjoint fusion such as talo-navicularjoint (big joint near ankle) risk ishigher around 10 – 20 per cent. Ifthis situation occurs we may:

� allow more time for the bonesto knit together

� re-operate on the bone / jointusing a graft of bone fromanother part of your foot / body

� do nothing if there are nosymptoms as a result.

Pain medication

You may be advised to takemedicines after your operation tohelp control postoperative pain.

Postoperative pain

Most people find they have mild tomoderate pain after their surgery.

The level of pain varies betweenindividuals according to painthreshold and what medicationspatients are able to take. You willbe provided with instructions onwhat to do should you have anyproblems immediately after yoursurgery.

Recurrence of the originalproblem

It is possible for a problem to recurpostoperatively for a number ofoperations. For example a bunioncorrected and looking perfect attwo weeks postoperatively maydeteriorate overtime. Recurrencevaries greatly for individualoperations.

Oral contraceptivemedication

Certain (oestrogen containing)oral contraceptive medicationsare associated with a slightincreased risk of thrombosis.

You may wish to discuss theimplications of this with one ofthe podiatric surgical team oryour own GP.

Stopping oral contraceptivesmeans you are at risk ofpregnancy unless alternativecontraceptive measures aretaken. Continuing with sometypes of oral contraceptivesmay mean you are at anincreased risk of a blood clot.

Pain

It is difficult to predict how muchpain you will suffer after theoperation as this is variablebetween patients. Generally, thefirst night is the worse night butadvances with local anaestheticsand pain medication means thatthis can be managed if notavoided.

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About podiatric surgery

proposed treatment at any stage.

Please notify one of our staff ifyou feel you would like a secondopinion. Seeking a secondopinion does not mean we willnot treat you if you decide youwish to continue to receive carefrom within our department.

Secondary arthritis

Some operations, generallyjoint fusions, lead to anincreased risk of arthritisdeveloping in adjacent joints.

This is termed “secondaryarthritis”. Fusion operationsare generally performed todeal with pain from arthriticjoints beyond salvage orbecause of instability in thefoot. This can place morestress on adjacent jointsincreasing the risk ofsecondary arthritis in thesejoints.

Shoe difficulty

Although every effort is made togive as good a result as possible,you may still have difficulty withshoes and, in rare cases, have lessshoe choice after the operation.

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Rest

You are strongly advised torest after your surgery. Restingwith your foot elevated withan ice pack over the ankle willgreatly reduce pain andswelling.

Scars

All surgery will create scars. Greatcare is taken to minimise the scaryou will have by carefully placingthe incision and taking great careduring your operation. Somepeople will have a discomfort,nerve entrapment or thickeningof the scar. These are uncommon,generally short term and, if theyoccur, they are often related topostoperative infection or to apredisposition to problem scars(see also Keloids). The vastmajority of patients have minimalcosmetic defect from their scars.If you have any concerns pleasespeak with one of the team forfurther advice.

Second opinion

We are very happy to arrange foryou to have a second opinionregarding your diagnosis or

Smoking

Smoking has the following adverseeffects in relation to surgery:

� delays wound healing

� is associated with failure ofbones to fuse (‘knit together’).Risk increase 2.7 times morecompared with a non-smoker

� is associated with increased riskof thrombosis.

Swelling

Swelling is always present aftersurgery as it is part of the normalhealing process. Swelling may beminimised by following thepostoperative instructions issued toyou by the team. Some patientsexperience prolonged swelling ofthe foot after surgery (5-10 percent). Smaller operations usuallygive rise to minimal swellingwhereas larger operations may beassociated with greater swelling forlonger duration. In a few cases,swelling may be present long termbut this is usually painless althoughcan affect shoe fit.

Success / failure rates

Many patients wish to knowthe overall success rates ofindividual operations.

Sometimes we are able toprovide this information basedon our own audit data.

Sometimes however, where itis a more unusual operation,statistics may be based onthose from the literature. Alloperations carry risks andpatients must accept this factbefore electing to proceedwith surgery.

Thrombosis

Thrombosis has been the subjectof much discussion recently inrelation to flying. A thrombosis isa clot which most often forms inveins of the lower legs e.g. ’DeepVein Thrombosis’. Risk factors forthrombosis are:

� previous history of thrombosis

� individual predisposition

� smoking

� certain drugs (e.g. some typesof oral contraceptives)

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About podiatric surgery

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� damage to vessels and tissue(e.g. surgery)

� immobilisation (includingrecent air travel i.e. within inprevious two weeks).

The post surgery thrombosis riskhas been calculated at 0.5 percent, however the more riskfactors you possess the greaterthe chance of a clot forming. Inpatients with a history of clots,medicines to help reduce the riskof the further clots following yoursurgery will be arranged. In othercircumstances you should reducewhat risk factors you can by:

� stop smoking at least fourweeks prior to you operationand until you are recovered

� avoid medicines whichpredispose to clots e.g. oralcontraceptives (in discussionwith your GP, who will adviseyou of alternative measures ofcontraception)

� follow the exercise regime asrecommended by yourpodiatric surgeon or the team.

Trainees

The London Podiatry Centre isa training centre for the nextgeneration of healthcare staffincluding podiatric surgeons.An essential part of stafftraining is working withpatients. Your cooperationwould be appreciated but youare under no obligation tohave a trainee involved in yourcare and you can discuss withthe podiatric surgeon.

Uneventful recovery

The vast majority of patients whoundergo foot surgery under thecare of a Podiatric surgeon havean uneventful experience and arepleased with the result of theirsurgery. This booklet is designedto make sure that patients arefully aware of the potential forcomplications despite their lowfrequency. Some patients may feelmore anxious being provided withthis information but it is hopedthat the number is low.

It is hoped that thisbooklet has answered allof your questions aboutyour proposed operation.If you feel there isanything else you need toknow, please do nothesitate to contact thepodiatric surgery team.

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This information booklet has been adapted from national produced information ofthe Faculty of Podiatric Surgery, College of Podiatrists, UK to reflect local practice.

Date: January 2009Review Date: January 2011

Please contact The London Podiatry Centre if youneed any further information or advice

3 Courthill RoadLewishamLondon SE13 6DNTelephone: 020 8297 9631

www.londonpodiatry.com