Interview with a foot and ankle surgeon

As a Trust we see a huge amount of feet and ankle related conditions and injuries. In 2021 the Office for National Statistics census noted Rotherham’s population as 265,800 – that’s on average 531,600 feet! ‘Heeling’ all of those feet is a big job, but we’ve got a fantastic team to do it.

Hi Nikhil, thanks for speaking to me today. We wanted to get this started by asking you about your background – and really, our main question is – why feet?

I’ve been training, for about 18 years qualified and as a consultant for 3 and a half years. 

The reason I chose to go into a foot and ankle specialty is because it’s very diverse. Every day is very different and I enjoy the variability within the specialty. Not every operation is the same – there are so many different parts in the foot and ankle, which are all very intricate and relate to each other in various ways. You have to have an innate understanding as to how one has a knock on effect on the other. 

It sounds difficult but very rewarding.

It is. There’s a real buzz about getting people walking again, because walking is such a fundamental part of people’s lives. To not be able to walk or have pain whilst walking, can ruin a person’s quality of life. So for us to be able to help people to be able to do those things again is great.

The surgical aspect is very technical. We’re working with small bits of equipment, small implants, so you’ve got to be delicate with your hands, precise and deliberate with all of your movements. 

For me, all of these things tied together make it a very rewarding vocation. You’ve got to be thinking and planning for your patients all of the time which I enjoy. I also really enjoy the multi-disciplinary team working aspects. 

Are there recent developments in foot and ankle surgery technology that you think have contributed to the increased capacity and collaborative approach within the team’s specialist service?

We’ve just appointed a new foot and ankle consultant here, Miss Lauren Thomson, because our service is booming in the Trust. We’re seeing a lot more patients under the speciality of foot and ankle with various complexities and had to increase our capacity as we’re seeing more patients than we were 5 or 10 years ago. 

We’ve set up a pathway in the region (a foot and ankle pathway for GPs and Allied Health Professionals) to make referrals easier. It gives an idea of the types of surgeries we can complete as a Trust and which conditions we can help treat. 

For example, just now, I’ve just come from our first ever Infinity total ankle replacement. Lauren (the newly appointed consultant) and I completed this as a joint case together. Whilst this wasn’t the Trust’s first total ankle replacement it was both the Trust’s, and my first one with this technology and this implant which is exciting. Thankfully it went really well! 

Technology is improving which is giving us and our patients so many more options. Because we have such highly-skilled consultants in this speciality within the Trust, we can take a collaborative approach to our cases. This means we combine our various skills across a mix of areas and strengths for the best outcome for the patient. 

This variety means we cover a lot of bases of the types of elective surgery we can offer as a Trust. Elective means that those surgeries can be planned in advance. We very rarely have to transfer patients to other hospitals or Trusts for foot and ankle surgery as we can complete treatment in house.

On top of the elective surgery, we have a very dynamic trauma set-up too.

Oh I was going to ask about that, I bet you’ve seen your fair share of fractured ankles! 

Yes, absolutely. At the moment we’ve got 4 or 5 on our waiting list for reconstructive surgery. This afternoon I’ve got a complex 4 hour case for someone who has significant injured their their tibia (shin) bone. 

Our understanding of foot and ankle has come along a lot, not just amongst ourselves as foot and ankle specialists, but our peers in other specialities. 

I’m a keen teacher – not just to surgeons or doctors, but anyone who is interested and willing to learn. We’ve got a teaching session coming up for physiotherapists about the different types of surgery we perform, and why we do those surgeries. We work closely with other specialties like physiotherapists, as we often share patient care together.

I suppose events like the teaching session could help to strengthen that rapport you have with various teams?

100%. When I first joined the Trust, something I was keen to invest time into was strengthening those relationships with different people and teams. One of the solutions we implemented was our complex multi-disciplinary team meeting which occurs once a month. 

The orthotists, podiatrists, orthopaedic consultants and physiotherapists all get together to discuss 4 complex cases. We all assess each patient together which means that everyone can put forth their thoughts on patient care. Because we do it this way, it means we’re not having to wait for referrals between specialties. It also means that our patients benefit from a joined-up approach to care because so many different specialities have assessed their needs and are looking for the best outcome for them. It’s really efficient and really strengthens our team working. 

Within the foot and ankle unit ourselves we have radiology meetings to assess elective cases we have approaching, so we review x-rays and discuss our plans so that we’re all on the same page. 

As a Trust we’re really well equipped and our multidisciplinary departments are brilliant. The orthotics department, run by Helen is a great department. She does wonders!

Is there any advice you’d offer to us to help keep our feet and ankles in top condition?

At the end of the day, accidents are accidents. A lot of the time it’s a case of people keeping fit and exercising, then they might end up with an Achilles tendon rupture. Then they have to have time off work which can be distressing especially for those who are self-employed or work on their feet a lot, as it would potentially stop them going to work to earn a living. That can be devastating for people. 

If I did have any advice it would be for those over the age of 35 to watch the level of activity they’re doing – I’m not saying don’t keep fit, we all know how important it is, but just be careful with high propulsion activities (like running) that could put your Achilles at risk. 

You can’t negate every potential accident! That’s why we’re here to help.