Available online at www.sciencedirect.

com

The Foot 17 (2007) 197–204

Prevalence and type of foot surgery performed

in Australia: A clinical review
Paul J. Bennett a,b,∗
a School of Public Health, Queensland University of Technology, Kelvin Grove Campus, Brisbane, Australia
b Faculty of Health, Auckland University of Technology, Akoranga Drive, Auckland, New Zealand

Received 20 February 2007; received in revised form 8 May 2007; accepted 8 May 2007

Abstract
The aim of this study was to investigate the type and prevalence of foot surgery being conducted by fellows of the Australian College of
Podiatric Surgeons.
Methods: A clinical audit of 786 patient files was undertaken, all of whom had been operated on by 10 podiatric surgeons during a 12-month
period. A coding framework was used whereby all files audited had each foot condition classified according to the International Classification
of Diseases.
Results: A total of 1575 diagnosed conditions, which subsequently underwent surgical treatment were identified in 785 case files. The most
common conditions identified in this study were: lesser toe deformities (46.1%), hallux abducto valgus (20.8%), intermetatarsal neuroma
(Morton’s) (7.8%), hallux rigidus/limitus (6.6%) and onychocryptosis (6.7%). It would appear that, on a state for state basis, the amount of foot
surgery conducted by podiatric surgeons across Australia is relatively uniform. In terms of the type and prevalence of conditions surgically
treated by podiatrists internationally, these rates bear striking similarity to the results reported in the United Kingdom and the United States.
Conclusion: The data suggests podiatric surgeons operate ostensibly on healthy female patients in their fifth and sixth decade of life. Almost
half of the patients operated upon underwent multiple procedures, with variability in the type and frequency of procedures most likely being
attributable to individual surgeon preference.
Crown Copyright © 2007 Published by Elsevier Ltd. All rights reserved.

Keywords: Podiatric surgery; Prevalence; Demographics; Audit; Foot; Review

1. Background From a methodology perspective a clinical audit of 786

The aim of this study was to investigate the type and
prevalence of foot surgery being conducted by a cohort of
10 fellows of the Australian College of Podiatric Surgeons.
This study formed part of a larger study designed to assess
podiatric surgeon’s outcomes. This included identifying the
frequency with which fellows perform operations; the scope
and complexity of their surgical activities; and their experi-
ence of surgical complications.
∗ Correspondence address. School of Public Health, Queensland Univer-
sity of Technology, Kelvin Grove Campus, Brisbane, Australia.
Tel.: +61 7 3864 5626.
E-mail address: p.bennett@qut.edu.au.
patient files was undertaken, all of whom had been oper-
ated on by podiatric surgeons during a 12-month period.
A positivist paradigm (where the researcher retains some
distance from the participant and what is being researched)
was adopted for this component of the study and files were
audited according to standard techniques [1–3]. This research
was undertaken to specifically obtain data on the type and
prevalence of surgery performed by podiatric surgeons and
to provide information about the population of patients who
undergo foot surgery.
A ‘clinical audit’ may be conducted by either med-
ical or allied health staff with the intent of obtaining
information about condition diagnosis and clinical decision
making regarding various treatments [3]. Additionally med-
ical ‘audits’ are usually based upon the examination of

0958-2592/$ – see front matter. Crown Copyright © 2007 Published by Elsevier Ltd. All rights reserved.
doi:10.1016/j.foot.2007.05.001
198 P.J. Bennett / The Foot 17 (2007) 197–204
medical records. With these points in mind, a ‘first hand’
clinical audit, which involved the independent examination
of podiatric surgeons original medical records could be justi-
fied as an accurate method of obtaining these data and where
possible, accessing original data sources to provide optimal
richness and quality [4].
More specifically, identification of the type and frequency
of foot conditions which are surgically treated by podiatric
surgeons assists with establishing the likely type of operations
performed by podiatric surgeons to correct these problems.
There is no single data set available in Australia which pro-
vides access to such data.
2. Methods
A consensus meeting of podiatric surgeons finalised the
audit protocol and 10 fellows of the Australian College of
Podiatric Surgery were mailed an information kit outlining
the objectives of the audit. A draft of the data collection sheet
was included with this kit.
Prior to the commencement of the study written permis-
sion from each surgeon was obtained to allow access to
patient medical records held by the surgeons. Ethics approval
from the Queensland University of Technology research com-
mittee was also obtained. Emphasis was placed on the fact
participation would be voluntary and surgeon participation
could be terminated at any point in time.
3. Data collection
The unit of analysis for this component of the study
included 786 complete patient medical records, which, as
a sample, is estimated (based on information provided by the
podiatric surgeons) to capture at least 95% of all people in
Australia who had undergone surgical treatment by podiatric
surgeons in the 12-month period from July 1995 to June 1996.
Some files were not located during this audit period (i.e.
files not on the premises at the time of audit), but according
to the one participating podiatric surgeon who reported the
absence of some files, the number of files missing would
have been less than 5%, and that those files would have been
representative of the reviewed files. These files were reported
to be held in a different clinical location at the time of audit.
A standard data collection sheet was used for all tran-
scribed information regarding each subject’s name, address,
phone number, date of birth, date of operation, diagnosis of
foot condition and details of surgical procedure performed.
Where possible and when permission was granted, pho-
tocopies of the original hospital surgical summaries were
obtained for future reference and checks of accuracy.
Special care was required when extracting information
from the surgeons’ records due to some illegibility of doc-
umentation. As a safeguard, individual surgeons were asked
to check a 5% random sample of transcribed data sheets to
assess the extractions for accuracy. This was undertaken at the
outset of data transfer and helped the candidate to understand
any shorthand used or illegibility in handwriting.
4. Data coding
A coding framework was used whereby all files audited
had each foot condition classified according to the ICD 9
Classification of Diseases (Tabular List of Diseases ICD-9-
CM, 1995).
The ‘procedural’ coding systems adopted by the Com-
monwealth Health Department for the purpose of Medicare
rebates (Medicare Benefits Schedule Book, 1996) and the
Australian Podiatry Association (Podiatrist Procedural Ter-
minology, 1988) guidelines were reviewed as alternative
coding methods [5,6]. Based upon the variable and some-
times limited nature of the data contained within the
medical records, the candidate utilised the more generic
coding framework adopted by the ICD 9 [7]. It is not
a mandatory requirement that Medicare item numbers
be routinely recorded in the medical records of patients
who undergo surgery by podiatrists because podiatry ser-
vices do not currently attract a Commonwealth (Medicare)
rebate.
On each separate data sheet, individual foot conditions
were coded.
Each computer entry (patient file) was identified by a three
digit identification number to protect the subject’s identity.
Gender, date of birth and date of operation were coded in the
standard format. Once all data had been coded, all variables
were entered into the Statistical Program for Social Sciences
(SPSS, 1994) database by specialist computer data entry per-
sonnel. This data was checked for errors and missing values
by double entry.
5. Results
5.1. Descriptive statistics of study population
Seven hundred and eighty-six medical files were obtained
from 10 participating podiatric surgeons (one file was mis-
placed during the audit process, leaving a total of 785 files
for auditing). Fig. 1 displays the source of patient files as a
relative proportion of the three participating states.
Fig. 2 displays the age groups of the 785 patients who
underwent foot surgery by podiatric surgeons. Age incre-
ments are divided into groups of 10 for convenience. A
normal distribution curve is superimposed on the figure to
illustrate that the sample population demonstrates a slight
negative skew (−0.34; one sample t-test p = 0.00). Moreover,
this histogram illustrates the minor nature of this skewness.
Table 1 provides a breakdown of the study population’s
age, gender and a state by state analysis of where the surgery
was performed.
 P.J. Bennett / The Foot 17 (2007) 197–204 199

Table 1
Total study population by age, gender and state where the surgery was performed
n % Mean age (years) S.D. Range Significance
Study group 785 100 47.2 18.5 7–92
Sex
Male 156 19.9 41.9 18.4 7–78 0.000a
Female 629 80.1 48.6 18.3 8–92
State
SA 224 28.5 49.0 19.6 7–82 0.034b
Victoria 243 30.9 48.4 17.4 8–85
WA 318 40.5 45.2c 18.3 7–92
a Student t-test.
b One way ANOVA, post hoc Scheffè.
c Significant age difference between Western Australian population and other two states.

Significantly more males were operated on in Western

Australia than in either South Australia or Victoria (␹2 13.94;
d.f. 2; p = 0.000 with Pearson’s test).

5.2. Uni versus bilateral and frequency of procedures

Table 2 summarises surgeon preference for either single

Fig. 1. Represents the proportion of case files audited on a state by state
basis, for the total sample of n = 785.
or multiple foot operation/s. Also the state by state prefer-
ence for performing unilateral as opposed to bilateral foot
operations is illustrated in Table 2.
Podiatric surgeons in Victoria perform significantly more
procedures per patient than South Australian or Western
Australian podiatric surgeons. Western Australian surgeons
perform significantly fewer procedures per patient than do
podiatric surgeons in South Australia and Victoria. Podi-
atric surgeons in Victoria perform significantly more bilateral
foot operations than do their South Australian or Western
Australian colleagues.

5.3. Total number of operative procedures

A total of 1575 individual procedures were documented in

the 785 case files. Fig. 3 illustrates the number of operations
per individual patient that were performed.

5.4. Diagnosis of foot complaints

Table 3 lists the International Classification of Dis-

Fig. 2. Histogram of age groups of patients whose files were included in the eases version 9 diagnostic conditions for each foot
audit of fellows of the Australian College of Podiatric Surgeons. complaint operated on and the frequency with which

Table 2
Description of the number of patients who underwent either single or multiple operations and how many feet were operated on a state by state basis
n % SA WA Victoria χ2 d.f. Significance
Number of operations per patient
One operation 402 51.2 113 190 99 19.9 2 0.000a
Multiple operations 383 48.8 111 128 144
Feet operated on
Unilateral case 586 74.6 173 253 160 14.7 2 0.000a
Bilateral case 199 25.4 51 65 83
a One way ANOVA.
200 P.J. Bennett / The Foot 17 (2007) 197–204

5.5. Scope of surgery

A list of the types of orthopaedic and neurological opera-

tions performed for these conditions is provided in Table 4.
Table 5 lists the types of surgery conducted on the integu-
mentary system.

6. Discussion

This data is provided to establish a historical benchmark

Fig. 3. Frequency of procedures. Number of patients who underwent varying
numbers of total procedures (total n = 1575).
the condition has been surgically treated by podiatric
surgeons.
A 73.6% of all operations were conducted on acquired
toe deformities (ICD 9 class 735). The next most frequently
operated conditions were the peripheral neuropathies (ICD 9
class 335) with 9.2%, followed closely by diseases of skin
and nails (8.9%). It should be noted that the surgical treatment
of skin and nail conditions identified here does not include
those conditions treated by the use of chemical cauterisation
(phenol and alcohol techniques).
of the type and frequency of surgical procedures performed
by Australian podiatric surgeons. ICD 9 codes were used to
minimise misclassification and thereby improve the reliabil-
ity of findings. In any study where classification of health
status is required, some degree of inaccuracy in reporting or
recording information is inevitable and misclassification is a
potential concern [8]. The use of broader categorisation helps
to reduce the effects of such misclassification, but usually at
the expense of loss of detail. In this study, it would have been
more appropriate to determine to what extent the surgeons
reporting of procedures differed to that transcribed. This
would have allowed a more accurate estimate of misclassifi-
cation. Additionally, details were recorded about the patient’s
age, gender and state in which the operation was performed.

Table 3
International Classification of Diseases 9 categories of foot pathology and frequency of surgical treatment by podiatric surgeons
Dx (ICD 9) Condition
735 Acquired toe deformities 1160
735.0/727.1 Hallux valgus (acquired) and Bunion 328
735.2 Hallux limitus/rigidus 105
735.4 Hammer toe 468
735.5 Claw toes 127
735.8 Other acquired toe deformities 132

710–739 Diseases of the musculoskeletal system and connective tissue 104

726.91 Exostosis (does not include subungual exostosis) 21
726.7 Enthesopathy of ankle and tarsus (include, Charcot’s foot, tarsal coalition, posterior tibial dysfunction with/without flat foot 45
726.73 Calcaneal Spur 15
Other (includes metatarsus adductus, medial long arch reconstruction) 23

355 Mononeuritis of lower limb 146

355.6 Neuroma (Morton’s metatarsalgia) 123
Other peripheral nerve 23

703 Diseases of skin and nails 141

703.0 Onychocryptosis/gryphosis with/without sub-ungual exostosis 107
078.19 Verruca plantaris 13
709.4 Foreign body granuloma/soft tissue mass (epidermoid cyst) 9
681.10 Cellulitis and foot abscess 5
Other 7

999 Miscellaneous 24
999.1 Unclassified 23
999.9 Missing 1
Total 1575
 P.J. Bennett / The Foot 17 (2007) 197–204 201

Table 4
Lists the range of ICD 9 classification of orthopaedic and neurological procedures which were identified in patient files
ICD 9 Class of surgery Examples of procedures
77.5 Excision and repair of bunion and other toe deformities
Base wedge osteotomy
Reverdin green procedure
Dorsal chilectomy
Kellers arthroplasty
77.52 Bunionectomy with soft tissue correction and arthrodesis Fusion 1st MPJ (with internal fixation device)
77.56 Repair of hammer toe Fusion
Phalangectomy (with/without tendon “Z” plasty)
Filleting
77.57 Repair of claw toe Fusion
Phalangectomy
Capsulotomy tendon lengthening
77.58 Repair cocked-up or overlapping toes Fusion
Phalangectomy
Capsulotomy tendon lengthening
77.5 Other Excision or correction of bunionette
Interdigital heloma molle correction

Miscellaneous orthopaedic procedures

77.6 Exostosis Subungual exostectomy
Hagland’s deformity
Removal accessory ossicle
81 Enthesopathy of ankle and tarsus Charcot’s foot,
Resection of tarsal coalition
Internal fixation of fracture
Mid foot fusion
Subtalar joint triple arthrodesis
83 Calcaneal Spur Plantar fascia release
Spur excision
84 Other Sesamoidectomy
Internal screw removal
Amputation of digit/s
Removal/ biopsy bone lesion
Unclassified

4 Operations on peripheral nerves

4.07 Excision of peripheral neuroma (Morton’s) and excision of peripheral nerve (other) Neurectomy
Excision sural nerve
Tarsal tunnel release
Unclassified

Table 5
Lists the range of ICD 9 classification of procedures performed on the integumentary system which were identified in patient files
86.2 Excision or destruction of lesion or tissue of skin and subcutaneous tissue
86.23 Removal of nail, nail bed and or nail fold Modified Steindlers procedure
Winograd procedure
Sharp resection of nail bed (with/without subungual exostectomy)
86.4 Radical excision of skin lesion Wide excision of epidermoid cyst
Wide excision of verruca pedis
Wide excision of scar
86.22 Excision debridement of wound, infection or burn Excision on drainage
Unclassified
202 P.J. Bennett / The Foot 17 (2007) 197–204
6.1. Descriptive statistics
It would appear that, on a state for state basis, the amount
of foot surgery conducted by podiatric surgeons across Aus-
tralia between 1995 and 1996 is relatively uniform, with
all three states contributing to the quantum of foot surgery
conducted (Fig. 1). Of more recent time, the practice of
podiatric surgery has now extended to seven of Australia’s
eight states/territories. The age of patients who undergo
foot surgery only differs minimally between the states. In
respect to the files audited, from a sampling perspective,
both South Australia and Victoria are likely to reflect older
populations than the Western Australian. This observation
holds consistent with ABS data which identifies that over-
all both SA and Victorian populations are older than the
Western Australian population (Australian Bureau of Statis-
tics, 1997) [9]. As Australia’s population continues to age,
the need for services by podiatric surgeons will continue to
increase.
Inferences made from the statistical tests need to be
approached with caution and should be interpreted in con-
text of the actual clinical (real world) scenario, which is
being analysed. The one way ANOVA for the three states
has a p = 0.034, but with post hoc tests (to determine between
which groups the statistically significant difference exists) an
interesting situation arises.
Both the Duncan and least square difference post hoc tests
identify that the difference exists between the younger West-
ern Australian population (45.2) and both the older South
Australian (49.0) and Victorian (48.4) populations. When
the Bonferroni, Scheffé, Tukey-B and Tukey HSD test are
performed (which are more conservative post hoc tests) no
significant difference is identified between any of the popu-
lations based on age. So, one may interpret that, whilst a true
statistical difference in age may actually exist, it could be
argued that from a clinical (physiological) stand point, a mean
age difference of 4 years is inconsequential. Moreover, this
difference probably reflects the sampling characteristics of
the study (i.e. the demographic characteristics of the Western
Australian population is known to differ in age distribution
when compared with the South Australian and Victorian
population). The reasons for the presenting complaint and
physiological characteristics are likely to be very similar from
a clinical perspective.
Another important finding from this study is the identifi-
cation of the high proportion of females who underwent foot
surgery (Table 1). Approximately 80% of subjects who under-
went foot surgery were female. This observation is consistent
with other published findings [10–12].
From a cultural perspective, style of footwear differs based
on gender, and this is particularly so in the elderly. Footwear
is described in the literature as a potential risk factor for
the development of hallux abducto valgus [13]. However the
actual cause–effect relationship between the two is yet to
be conclusively established and is still a moot point among
researchers.
Knowing the typical age and gender of subjects who
undergo foot surgery (the target population for the main
study) has ramifications for health planners. Age and the pres-
ence of co-morbidity are known to be associated [14]. The
association between co-morbidity and poor health outcomes
has been established so co-morbidity would also appear an
important dimension to analyse in any study of foot surgery
outcomes [15].
6.2. Prevalence of foot pathology
A total of 1575 diagnosed conditions, which subsequently
underwent surgical treatment were identified in 785 case
files. The most common conditions identified in this study
were: lesser toe deformities (46.1%), hallux abducto valgus
(20.8%), intermetatarsal neuroma (Morton’s) (7.8%), hallux
rigidus/limitus (6.6%) and onychocryptosis (6.7%). It is note-
worthy that the outcomes of services provided by fellows
of the Australian College of Podiatric Surgeons have been
comprehensively researched, and found to be very favourable
[16].
In terms of the type and prevalence of conditions surgi-
cally treated by podiatrists (Table 1) from an international
standpoint, these rates bear striking similarity to the results
reported in audits of United Kingdom podiatric surgery;
lesser toe deformities (46.9%), first ray (24.6%), inter-
metatarsal neuroma (Morton’s) (9.7%), and onychocryptosis
(5.8%) [17]. The current study’s findings are also consistent
with reports in the United States [10,18,19].
The under reporting on onychocryptosis in this study com-
pared to US studies may, in part, be attributed to the exclusion
of patients who underwent chemical cauterisation (phenol
and alcohol techniques), which is an extremely common
podiatry procedure.
The significant under representation of rearfoot surgi-
cal pathology (6.6%) is consistent with US observations
that, podiatrists, orthopaedic surgeons, and general physi-
cians tend to care for different types of patients on the whole
[18,20].
Forty-eight percent of those patients who underwent foot
surgery by podiatric surgeons had multiple procedures per-
formed and this rate is consistent with the findings published
in the US on the frequency of multiple procedures per-
formed by podiatrists [19]. Knowledge of the number of
operations performed on an individual patient has significant
ramifications for the evaluation of an individual’s level of
post-operative disability and recuperation. It stands to reason
that, the greater the level of physiological disruption caused
by multiple procedures, the greater the potential for adverse
and/or poorer surgical outcomes. Access to, and the role of,
rehabilitation services in the post-operative management of
patients may also be a determinant of post-operative outcome
[21].
Analogous to the disability caused by multiple procedures
is whether one or both feet were operated on. Levels of mobil-
ity and functional independence are likely to be affected if
 P.J. Bennett / The Foot 17 (2007) 197–204
both feet are operated on at the same time. Cost considera-
tions may also play a role in a patient’s decision to undergo
bilateral surgery.
A three (state) by two χ2 analysis on whether the oper-
ations were performed either unilaterally or bilaterally was
conducted. Victorian podiatric surgeons appear to perform
significantly more bilateral foot operations than do South
Australian or Western Australian surgeons (χ2 14.79; d.f.
2; Pearson p = 0.000). When combined with the increased
number of procedures performed by Victorian surgeons, the
subtle differences in surgeon preferences may be appreciated.
6.3. Procedures performed by podiatric surgeons
In some, but not all instances, Medicare item rebate num-
bers (Medicare Benefits Schedule Book, 1996) were recorded
in the patients operative notes and used as the principal source
of identifying the types of procedures performed. As such,
the “type” of procedure per se is not always identified and as
such, it was not always possible to tabulate the type of individ-
ual procedure. Moreover, the range of procedures performed
by podiatric surgeons is consistent with those conducted by
the UK colleagues [17]. The range of procedures performed
ostensibly reflects contemporary surgical practice [21,22].
Moreover, caution is needed when comparing the prevalence
of surgery performed due to the small sample of surgeons in
each state. Importantly, the number of podiatric surgeons in
Australia has increased significantly over more recent time.
This growth has been reflected in both Commonwealth and
State legislative reforms which, for example, include more
states granting podiatric surgeons access to prescribing a
range of scheduled medicines such as antibiotics, narcotic
analgesics and anti-inflammatory medication.
6.4. Limitations of the audit
Clearly, limitations exist when medical records are being
used as the main source of data collection. There are gener-
ally problems with reliability and validity of data obtained
from medical records [4]. In this case, surgical records were
completed by 10 different surgeons and difference in diag-
nosis of disease status may occur. Moreover, no uniform
method of coding either chief diagnosis of foot complaint
or operative procedure performed was noted. This variability
necessitated that all original files be examined and a standard
coding protocol be used when data was retrieved.
Incompleteness of records can be an issue and this can vary
significantly from individual surgeon to surgeon. As such, the
audit process in this instance is designed to, as reliably and
accurately as possible, estimate the type and prevalence of
foot conditions which are surgically treated by podiatric sur-
geons. Moreover, audit techniques tend to have their main
application in evaluative reviews of clinical services. No evi-
dence of efficacy or even effectiveness between the various
procedures documented and surgical outcome is provided by
such approach.
203
Special care was required when extracting information
from the surgeons’ records due to some illegibility of doc-
umentation. In one study of data extracted from patient
medical records, in 23% of instances there were discrepancies
between two different extractors on identifying the presence
of underlying medical conditions [4]. As a safeguard, indi-
vidual surgeons’ were asked to comment on a random sample
of extractions for accuracy.
7. Conclusion
Clinical audits and reviews are a useful and well estab-
lished method for gaining insight to podiatric surgical
services. In the study presented here data is provided to estab-
lish a historical benchmark of the type and frequency of
surgical procedures performed by Australian podiatric sur-
geons.
It appears the majority of patients who undergo foot
surgery performed by podiatric surgeons are female, in their
fifth and sixth decade of life. Almost half experience multi-
ple foot procedures during the surgical event. The substantial
majority of procedures performed were for acquired toe
deformities, diseases of the musculoskeletal and peripheral
nerve system. Importantly, a number of complex rearfoot
surgeries were performed, indicating the extensive nature of
the developing expertise of podiatric surgery in Australia.
This study represents one of the few published research
findings which illustrates scope of activity, in what is a
dynamic and evolving aspect of podiatric care in Australia.
Of more recent time, surgical practice has now extended
to Queensland, Tasmania and New South Wales, indicating
seven of Australia’s eight states and territories now provide
the public with access to podiatric surgery services. There has
also been an increase in both total number of active fellows,
as well as trainees within the college, which now represents
in excess of 30 members.
References
[1] Perry C. A structured approach to presenting Ph.D. these: notes for
candidates and their supervisors. ANZ Doctoral Consortium. Sydney,
1995.
[2] Tollafield DR, Merriman LM. Clinical skills in treating the foot. 1st ed.
Singapore: Churchill Livingston; 1997.
[3] Bowling A. Measuring disease: a review of disease-specific quality of
life measurement scales. 2nd ed. Buckingham: Open University Press;
1997.
[4] Abramson J. Survey methods in community medicine: epidemiological
studies, programme evaluation and clinical trials. 4th ed. New York:
Churchill Livingston; 1990.
[5] Medicare Benefit Schedule Book. Canberra: Australian Government;
1996.
[6] Podiatrist Procedural Terminology: Australian Podiatry Council; 1988.
[7] International Classification of Diseases. 9th ed. National Coding Cen-
tre; 1995.
[8] Hennekens C, Buring J. Epidemiology in medicine. Boston: Little
Brown Company; 1987.
204 P.J. Bennett / The Foot 17 (2007) 197–204
[9] 1995 National Health Survey. Canberra: Australian Bureau of Statistics:
Commonwealth of Australia; 1997.
[10] Levy LA. Prevalence of chronic podiatric conditions in the US. National
Health Survey 1990. J Am Podiatr Med Assoc 1992;82(4).
[11] Hood IS, Kilmartin TE, Tollafield DR. The effect of podiatric day care
surgery on the need for national health service chiropody treatment.
Foot 1994;4:155–8.
[12] Bryant A. Patient satisfaction following the modified Austin bunionec-
tomy. Aust Podiatrist 1996;30(1):9–12.
[13] Geissele AE, Stanton RP. Surgical treatment of adolescent hallux val-
gus. J Pediatr Orthop 1990;10(5).
[14] Newschaffer CJ, Bush TL, Penberthy LT. Comorbidity measurement in
elderly female breast cancer patients with administrative and medical
records data. J Clin Epidemiol 1997;50(6).
[15] Greenfield S, Apolone G, McNeil BJ, Cleary PD. The importance of
co-existent disease in the occurrence of post operative complications
and one-year recovery in patients undergoing total hip replacement.
Comorbidity and outcomes after hip replacement. Med Care 1993;
31(2).
[16] Bennett PJ, Patterson C, Dunne MP. Health-related quality of life fol-
lowing podiatric surgery. J Am Podiatr Med Assoc 2001;91(4):164–73.
[17] Turbutt IF. Podiatric surgery audit: foot surgery survey of 46 centres in
the United Kingdom. Br J Podiatr Med Surg 1994;6(2):30–1.
[18] Glenn LL. Patient-reported medical outcomes according to physician
type and region. J Am Podiatr Med Assoc 1995;85(6).
[19] Greenberg L, Davis H. Foot problems in the US. The 1990 National
Health Interview Survey. J Am Podiatr Med Assoc 1993;83(8).
[20] Weiner JP, Steinwachs DM, Frank RG, Schwartz KJ. Elective foot
surgery: relative roles of doctors of podiatric medicine and orthopedic
surgeons. Am J Public Health 1987;77(8).
[21] McGlamry D, Banks AS, Downey MS. Comprehensive textbook of
foot surgery. 2nd ed. Baltimore: Williams and Wilkins; 1992.
[22] Mann RA, Reynolds JC. Interdigital neuroma—a critical clinical anal-
ysis. Foot Ankle 1983;3(4).