Specialists in Foot & Ankle Surgery
Mr. Richard R. Brown
MA (Cantab) MB BS FRCS (Tr&Ortho)
Consultant Orthopaedic Surgeon
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Audit and Patient Outcomes

The Cotswold Foot and Ankle Clinic believes in carefully reviewing our standards and seeking to continually improve the care we deliver to our patients. These are some of the audits and reviews of our patient reported outcome measures.



An audit of our patients one year after forefoot procedures such as a Scarf metatarsal osteotomy or 1st MTP fusion gave the following responses:
  • I only have foot pain some of the time 89%
  • I rarely avoid walking long distance 70%
  • I rarely need to walk slowly 83%
  • I rarely have to stop and rest my foot 80%
  • I only sometimes avoid rough surfaces 78%
  • I rarely avoid standing for a long time 76%
  • I rarely feel self-conscious about my foot 78%
  • I rarely feel self-conscious about my shoes 82%
  • I never need to catch the bus or use the car instead of walking 80%
  • I only sometimes feel self-conscious about the shoes I have to wear 91%
  • I am rarely unable to do all my social or recreational activities 78%
  • During the past 4 weeks I had only mild pain foot 83%
  • During the past 4 weeks, I had foot pain in bed less than two nights 78%

Our patients’ outcomes one year after a forefoot operation were excellent according to two internationally respected scoring methods. The MOXFQ is a validated method to assess the comfort of a patient after surgery were less than 20% is excellent. Our average MOXFQ score was just 18.6 %. Another assessment is the American Orthopaedic Foot and Ankle score (AOFAS) where excellent is more than 80%. Our average AOFAS Forefoot score one year after a Scarf ostoeomy (bunion operation) was 82.3%.

January 2010

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The patients’ experience and outcomes were evaluated one year after surgery for correction of a lesser toe deformity. Patients returned to normal shoe wear quicker with an absorbable pin, average 6.7 weeks, compared to 8.5 weeks after a metal pin. They were also slightly quicker at returning to activities of daily living. Both groups had higher rates of bony union than reported in the scientific literature. 71% with an absorbable pin and 81% with a metal pin. But the precise position was less reliable with a pin that was removed. The patient reported outcome scores were better (lower MOXFQ) in the absorbable pin group.Patients after both methods were pleased with the cosmetic appearance at one year.

July 2011

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The Reliability of Forefoot ultrasound to predict Morton’s Neuroma

The NHS service has long delays for imaging of foot problems. By reviewing the NHS referral letters from the GP, appropriate patients were sent for ultrasound scanning. This study showed that Gloucestershire GPs are able to reliably able to suspect a morton’s neuroma. We introduced an innovative pathway to streamline this NHS service, which has improved clinic efficiency.

January 2009

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Forefoot surgery was always thought to be very painful. We performed an audit and re-audit to show the benefits of using a modern surgical technique and an ankle block of local anaesthetic. The patients reported 88% satisfaction with the pain control and an overall satisfaction of 76%. Each patient was able to mobilise in a sloped shoe the same day as surgery and 89% reported a good experience with the physiotherapy. Overall the patients preferred the day case option.

January 2009

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A successful mid-foot or hind-foot fusion operation does NOT cause a reduction of the patient’s BMI. The BMI does not reduce after surgery even in obese patients. The small change in BMI after fusion surgery is not significantly affected by sex nor quality of pain relief.

September 2008

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A popliteal block is a method of numbing the lower leg for between 8 and 24hrs after ankle surgery. Since 2007 Mr Brown has been using popliteal blocks with a General Anaesthetic and top up patent controlled analgesia pumps. This study compared the old practice before the introduction of this advancement. It showed that patients having popliteal blocks used less opioid analgesia and thus avoided the unpleasant side effects. They also were able to mobilise sooner than those having alternative anaesthetic procedures.

July 2008

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Minimally invasive techniques are used where proven. A degenerate ankle can be fused thru small key hole incisions using an arthroscope. Arthroscopic ankle fusions performed by Mr Brown from 2007 until 2011 had a 92% fusion rate. The average time to bony union was 7.4 months, slightly quicker than by the open technique. The length of hospital stay has been reduced to 2 days.

July 2012

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