The bunion 'surgeons' who are maiming their patients



01:36 GMT, 3 July 2012

At 41, teacher Beth Day, a fit aerobics and Pilates enthusiast, would not have expected to be spending much of her day shuffling about in slippers.

But she has to make sure she has a pair in her bag wherever she goes in case the pain of wearing shoes becomes unbearable.

Beth’s feet have been permanently damaged after an operation to correct a bunion, a toe deformity, went wrong.

'I am often in much more pain than before I had the operation, and am very restricted in terms of footwear,' said Beth Day

'I am often in much more pain than before I had the operation, and am very restricted in terms of footwear,' said Beth Day

The procedure was meant to involve nothing more than shaving the bony growth from the side of her foot, but the surgeon accidentally broke her toe.

The operation, which also caused nerve damage in her foot, was carried out in 2007 when she was 36.

She spent the following three years in agony before she received corrective orthopaedic surgery last year, but has still been left with arthritis, pain and deformity.

Although she can get into extra-wide shoes, she is often struck by excruciating arthritic pain on cold days and has to put on her slippers.

‘I am often in much more pain than before I had the operation, and am very restricted in terms of footwear,’ she says.

Beth, who lives with her children Charlie, eight, Lily, five, and husband Mike, a design and technology teacher, in Epsom, Surrey, adds: ‘You need your feet to live a full and active life and exercise properly.

'There is osteoporosis in my family and I need to be fit to make sure I don’t get it.’

Her original operation was performed by one of a new breed of healthcare practitioners, called a podiatric surgeon.

‘I was unaware of the difference between a podiatric and an orthopaedic surgeon in terms of training and background,’ she says.

Podiatrists are specialists who treat in-growing toenails, corns, calluses and verrucas, and advise on foot problems.

Beth's original operation was performed by one of a new breed of healthcare practitioners, called a podiatric surgeon

Beth's original operation was performed by one of a new breed of healthcare practitioners, called a podiatric surgeon

Surgical podiatry was developed as an additional specialism two decades ago.

It was intended to take over some of the more straightforward NHS surgical procedures such as bunion removal, treatment for hammer toes and nerve problems.

To perform such surgery, practitioners are allowed to administer local but not general anaesthetics to qualify as a podiatric surgeon.

The qualification involves a one-year postgraduate course in surgery after a chiropody or podiatry degree.

Surgical podiatrists are less highly trained, so do not command the high fees of orthopaedic surgeons.

They are in competition with consultant foot and ankle orthopaedic surgeons, who have extensive training of around 16 years.

Following complaints from orthopaedic surgeons, the practitioners were told in 2010 by the Department of Health they cannot use the title ‘podiatric surgeon’ because surgeons have to be medically trained.

However, they are continuing to do so because of a loophole in the law.

There are thought to be about 80 so-called podiatric surgeons in the country, but they are not required by the Health Professions Council, which regulates them, to state whether they have an additional surgical qualification or where it is from, so there is no way for the public to check a practitioner’s qualifications.

The concern is there is a considerable variation in standards among podiatrists performing surgery.

Patients are generally referred to podiatrists for NHS treatment through GPs who are often as unaware as their patients about the level of skill on offer.

Orthopaedic surgeons claim they regularly have to repair disasters caused by podiatric surgeons.

‘There are two groups of podiatric surgeons, one of them is willing to work alongside orthopaedic surgeons in hospitals, and the other is not,’ says Anthony Sakellariou, spokesman for the British Orthopaedic Foot and Ankle Society.

‘All the problems I have seen come from this second group.

‘I would say all of us get at least one referral a month involving a patient who has had a problem following treatment from podiatric surgeons.

'The problems often include accidentally broken bones, nerve damage and even bone cancers which podiatric surgeons have not recognised or have misdiagnosed.

'No one seems to be taking this seriously.’

Indeed, Beth Day’s case may be just the tip of the iceberg.

Bill Crampin, 66, an architect, has just received a ‘substantial six-figure settlement’ after botched podiatric surgery on his foot forced him to give up his career because he could no longer walk properly.

‘It was an operation I didn’t even need and it led to more surgery to try to put it right,’ he says.

‘I thought this man was a doctor. I think it is appalling that these people can call themselves surgeons when they are not medically qualified.’

Earlier this year, a former leading cosmetic surgeon was in hospital to have a toe amputated after a similar operation by a podiatric surgeon went wrong.

He is negotiating a settlement worth hundreds of thousands of pounds and did not want to be named.

‘My husband’s career has been destroyed,’ his wife said.

Huw Foxall, 67, a keen runner from Ealing, West London, suffered severe gangrene which went unnoticed because his foot was put in a plaster boot following an operation by a podiatric surgeon to correct hammer toes.

He had to have his big toe amputated.

‘The cast was taken off and the foot was a truly awful sight, it was black and blue,’ he said.

‘The chap in the plaster room who took it off said he’d never seen anything like it except when people had been mangled in an industrial accident.’

Mr Foxall received 50,000 damages. He said he wouldn’t have agreed to the operation if he had known the surgeon wasn’t a doctor.

David Whitby, 60, a telecommunications expert from Tewkesbury, Glos, says he lost seven years of his life after a podiatric surgeon left him unable to walk, drive or work, following an operation to treat pain after he twisted his ankle.

He was told he needed major surgery to remove a piece of floating bone and to reattach a ligament.

The procedure was put right by an orthopaedic surgeon at the Royal National Orthopaedic Hospital in Stanmore, Middlesex, and Mr Whitby received 100,000 damages.

However, his complaint against the surgical podiatrist involved went nowhere.

He contacted the Health Professions Council, which decided that although his care had been substandard, it was not so serious the practitioner involved should be prevented from working.

‘I was treated in the private sector and completely fooled by the title consultant podiatric surgeon. It means nothing,’ he says.

Beth Day also complained to the Health Professions Council after her 2007 operation.

David Whitby is setting up a group to campaign for either more regulation or more training of podiatric surgeons.

‘It seems that because no one is dying, there is no interest in doing anything,’ he says.

The Health Professions Council said it had 78 complaints in the year April 2010 to 2011 — six practitioners were struck off; one voluntarily left the register following a complaint and three more were suspended.

Only one of the disciplinary hearings was the result of poor clinical practice.

The others related to other issues including financial fraud and assault.

The Society of Chiropodists and Podiatrists insists the complaints about podiatrists are being orchestrated by orthopaedic surgeons anxious to protect their territory.

Spokesman Ron Finlay said: ‘A small number of cases go wrong, whether conducted by podiatric surgeons or orthopaedic surgeons.

'It is not the case that podiatric surgeons are any less competent than orthopaedic surgeons when it comes to foot surgery.’