When having a bunion op may be the wrong step

Keen golfer Pamela Hewitt had hoped that bunion surgery would end the decades of pain she had endured. Instead, the surgery on both feet left her in more agony than before.

‘The pain and bunion had come back in both cases,’ says Pamela, 78, who lives with husband Ivor, 80, in Purley, Surrey.

‘After the second operation in 2010, on my right foot, not only did the bunion recur within two years but I also developed hammer toes, where the toes become bent. And I was in constant pain.’

After more than eight years of agony, last year Pamela decided to have corrective surgery on her feet and was stunned to be told that the previous two operations had not been done correctly.

‘The surgeon said that my feet were a mess,’ says Pamela.

In both cases, the original operations had been performed privately by podiatric surgeons — podiatrists, not doctors, trained in foot surgery.

To be a consultant foot and ankle surgeon you will usually have between 15 and 20 years’ experience, working with foot and ankle problems and have dealt with a high volume of cases.

After a four-year degree course, a consultant podiatric surgeon undertakes a post-graduate degree and four more years of training to perform minor foot surgery, such as the removal of ingrowing toenails and bunion treatment.

They are the only non-medically qualified professionals in the UK allowed to carry out surgery.

Most bunions that cause pain will eventually need surgery. This usually involves trimming the protruding bone — the toe bone will then be straightened and fixed in place with metal screws. This may be complicated by, for example, arthritis in the toe. Some experts say such complex surgery shouldn’t be left to someone who, though highly trained, isn’t a doctor.

Kumar Kunasingam, a consultant orthopaedic surgeon at Croydon University Hospital, who performed revision surgery on Pamela last year at the Ramsay Hospital, Catherham, says he is seeing more revision cases as a result of podiatric surgeons and non-specialist orthopaedic surgeons doing this surgery.

Complications such as tendon damage, pain or a recurring bunion occur in fewer than one in ten bunion operations, according to nHS Inform, but there is no breakdown of how many of these were performed by a podiatric surgeon and how many

BUT Liz north of the College of Podiatry, the leading professional body for the UK’s 13,000 podiatrists, says consultant podiatric surgeons are highly trained, completing a minimum of 11 years training to reach consultant level.

She doesn’t accept there’s lack of clarity about podiatrists’ training.

‘nHS primary care trusts make it very clear in their patient information leaflets that podiatric surgeons, although qualified to do surgery, are not medical doctors.’

Suzanne Taylor, dean of podiatric surgery at the College of Podiatry and a consultant podiatric surgeon at Sussex nHS Trust, adds that until consultant level, podiatric surgeons are constantly supervised.

‘And there’s no evidence we have a higher rate of complications than orthopaedic surgeons,’ she says.

Since Pamela’s two revision operations last year, she’s been able to return to golfing every week ‘and I’m now wearing sandals’.

‘Bunion surgery is definitely worth having: just be careful who you choose to do it,’ she says.