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Abstract: Background: The incidence of venous thromboembolism (VTE) is unknown in elective foot and ankle surgery. The National Institute for Health and Clinical Excellence (NICE) recently published guidelines on reducing the risk of venous thromboembolism in surgical patients. This includes patients undergoing elective foot and ankle surgery. Method: In March 2010 we surveyed the current practice in VTE prophylaxis in elective foot and ankle surgery amongst members of the British Orthopaedic Foot and Ankle Society (BOFAS). Results: The response rate was 84 (53%). The total number of elective foot and ankle operations performed by the surveyed group was 33,500 per annum. The estimated incidence of DVT, PE and fatal PE was 0.6%, 0.1% and 0.02%. In our study the number of patients needed to treat to prevent a single fatal PE is 10,000 although this figure is open to important bias. Conclusion: We question the applicability of the NICE guidelines to patients undergoing elective foot and ankle surgery. We consider that this data justifies the prospective study of the incidence of VTE in patients undergoing elective foot and ankle surgery, without the use of chemical thromboprophylaxis. [Copyright &y& Elsevier]

Metatarsophalangeal (MTP) replacement arthroplasty has been an accepted form of treatment for hallux rigidus. Failure of such arthroplasties has led to complications including silicone synovitis, granulomatous bone destruction, loss of first metatarsal length and eventual transfer metatarsalgia. These failed arthroplasties pose a challenge in revision surgery.We present our early results of six patients (7 ft) who had failed primary MTP joint arthroplasties, treated with impaction bone grafting, and a customised ceramic on ceramic MTP joint (MOJE) replacement. The mean follow up was 16.8 months. Patients were examined clinically and radiographically. The American Orthopaedic Foot and Ankle Society (AOFAS) score improved from 26 points (range 10–59) to a mean of 67 points (range 59–87). All patients reported relief from transfer metatarsalgia, improvement in their activity status and satisfaction with the final outcome of treatment. We conclude that ceramic implant revision, with impaction bone grafting into areas of granulomatous destruction, appears to be a viable, versatile, and safe alternative in the treatment of failed arthroplasty of the first MTP joint. [Copyright &y& Elsevier]

Abstract: Background: The angle of the Weil osteotomy is usually referenced relative to the floor irrespective of the plantar angulation of the metatarsal. This study aims to analyse the long term results following the Weil osteotomy and identify the cause of poor outcome. Methods: This study presents a retrospective review of 61 patients (86feet), with mean follow-up of 31 months. Each patient underwent clinical, pedobarographic and radiological examination. The radiographs obtained included ‘Metatarsal Skyline Views’ (MSV), to assess the plantar declination of the metatarsal heads following the osteotomy. The functional scoring was performed using AOFAS and Foot Function Index. Results: Fifty-five patients (80 feet) showed good to excellent results clinically. Six patients had persistent metatarsalgia. All these 6 patients had callosities beneath metatarsal heads. Pedobarography showed peak pressures in the same distribution as callosities and the MSV showed increased plantar declination of the metatarsal heads. This correlation was found to be significant (p <0.05). Conclusion: The Weil osteotomy is a safe and effective treatment for metatarsalgia. An MSV radiograph is helpful to identify the plantar prominence of metatarsal which can be associated with poor clinical outcomes. [Copyright &y& Elsevier]