Minor Surgery anyone?

Martin Harvey FPodM PGC IP BSc

One of the most frequent questions I am asked about minor surgery training for podiatrists is “why?” It is a fair question and one deserving a considered answer. In reflecting on that answer, it may be relevant to take a closer look at ourselves as a profession.

It is a fact that that we are a highly diverse profession in terms of both our individual roles as well as our individual scopes of practice. Role – wise some of us work exclusively in the NHS, others work exclusively in private independent practice, yet others in a mixture of both. That diversity is also displayed in what we do in our clinical lives. In the most recent registrant demographics report available (HCPC 2021); of 12,390 HCPC registered Podiatrists some 51% work full time. Additionally, while some 10,500 of us have access to local anaesthetics (POM-A) just short of 6,500 have access to the specified range of antibiotics and other medicines that POM-S annotations allows. Those of us who can independently prescribe any appropriate prescription-only medicine number just over 500 and there are 88 registered Podiatric Surgeons.

The pictures (left) go some way to suggesting the answer to the question; why learn about minor surgery? We are a profession of varied individuals, arguably perhaps more so than most other registered Health Professions (we certainly have the highest average age – 48 years). Some colleagues will have routine care practices, some will perhaps incorporate basic nail surgery, yet others will concentrate on biomechanics, yet others – such as myself – will include a fair amount of medicines utilisation in our practices as independent prescribers and a few dedicated individuals will follow the long road to becoming an annotated podiatric surgeon. A short minor surgery course will certainly not make you into an annotated podiatric surgeon, so do not revise Kellers excisional arthroplasty and buy a sagittal saw! However, an understanding of minor surgery can add a very interesting dimension to the practice of any podiatrist with both POM-A and POM-S or POM-A and IP, not to mention having the potential to increase your income! and will undoubtedly appeal to some of our very varied workforce.

So, what kind of conditions lend themselves to minor surgery? In fact, a surprisingly large variety; corns that require more than a simple enucleation, acrochordons, cutaneous horns, dermatofibromas, refractory verruca, pyogenic granuloma, epidermoid cysts etc, and the modality utilised on the foregoing may be sharp steel or electrosurgery or cryosurgery.

Additionally, and specifically for us as podiatrists, the wide variety of nail surgical procedures that go well beyond PNA and phenolisation and often necessitate good suturing skills. How is your mattress suturing technique and what type of suture would you utilise? Do you know the difference between a Winograd or a Zadek procedure (or a Frost or a Vandenbos?) How effective is your field block anaesthetic technique? Do you know ALL the anaesthetics we can utilise together with doses, applications and cautions? What type of procedures CAN you do in a podiatry clinic? what procedures need other types of premises? where does CQC regulation fit in? when is it needed?

So, is minor surgery of interest? – You can always find out more by contacting IOCP and arranging to listen in to one of our webinars on “is minor surgery right for me?”. The course is led by Dr Soon Lim, a GP trainer who is president of the Association of Surgeons in Primary Care and it involves online learning modules performed at your own pace, online lectures and a practical day workshop.

HCPC (2021) Diversity Data Report: chiropodists/podiatrists. https://www.hcpc-uk.org/globalassets/resources/reports/hcpc-diversity-data-report (accessed 10.11.2022)

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