Background There is limited evidence in the literature to describe an analgesic protocol that takes into consideration the extent of foot and ankle surgery. The aim of this study was to develop a guide for acute postoperative pain management for podiatric surgery in Australia, and to identify opportunities to improve the current list of scheduled medicines available to podiatric surgeons. Methods A Delphi method involving 3 survey rounds was employed for this study. Twelve expert panellists in the field of podiatric surgery and anaesthesiology were invited to participate, and 10 panellists remained by the end of the study. Round 1 involved 15 open-ended questions. These answers formed the basis of the 55 statements that were developed for the following 2 survey rounds, where panellists rated the appropriateness of each statement on a 9-point Likert scale. The third survey round was an opportunity for panellists to revise their answers to each statement in light of the majority response. Results For mild acute postoperative pain, non-opioid oral analgesics were recommended as an appropriate management option. For moderate and severe acute postoperative pain, both non-opioid and opioid products were found to be appropriate by the majority. It was agreed that oral opioids be reserved for breakthrough pain at all severity levels. All other statements in the Delphi study pertaining to drug hypersensitivities or allergies, stratification of pain management, opioid prescription concerns, and access to pain medications were accepted as appropriate by the majority of panellists. Conclusion The agreed approach to acute postoperative pain management for podiatric surgeons in Australia was with a stepwise approach, utilising multimodal therapy, and reserving oral opioids for breakthrough pain. Additionally, there was consensus for podiatric surgeons in Australia to have wider access to alternative analgesics and anti-emetics that have similar or improved efficacies with better safety profiles.

Background Morton’s neuroma is a common cause of forefoot pain and can be difficult to treat. Ethanol ablation (ETA) and Radiofrequency ablation (RFA) are increasingly used for treatment of chronic Morton's neuroma. However, there is limited evidence on the effectiveness of these guided ablation therapies in relation to broad-ranging patient recorded outcome measures (PROMs), and prospective studies directly comparing the two interventions are lacking. In this pragmatic clinical trial, we aimed to compare the efficacy of Ethanol ablation (ETA) and Radiofrequency ablation (RFA) on patient recorded outcome measures (PROMs) in pain, function, and ability in patients with Morton's neuroma. Methods Participants with chronic Morton's neuroma were randomly assigned to either ETA or RFA. Outcome measures were the Visual Analogue Scale (VAS), the eight-domain Foot Health Status Questionnaire (FHSQ) and the Foot and Ankle Ability Measure (FAAM). These were assessed at baseline, three, and six months after treatment. Results Sixty-three participants were allocated to either RFA (n=35) or ETA (n=28). A slight decrease in pain ascertained through VAS scores was observed in both intervention groups over six months relative to baseline. FAAM scores moderately improved in both groups over six months, with ETA showing a marginally greater mean change compared to RFA (3.8 points; p=0.004). FHSQ scores improved from baseline to six months in both groups, across all domains except vigour, which decreased in both interventions over three months and then stabilised in the ETA group at six months. Between-group differences of minor clinical importance favouring the ETA group were reported in improvement from baseline to six months of foot pain (3.7 points on 100 point scale; p<0.005), foot function (3.3 points; p=0.017), general health (2.5 points; p=0.013), and physical activity (11.0 points; p<0.001). Conclusion In the treatment of chronic Morton’s neuroma, ETA and RFA appear to confer comparable six-month improvements in pain, foot health, function, and ability. Multi-dimensional scales such as the FHSQ and the FAAM potentially elicit substantial treatment-related improvements that are not evident from VAS. Accordingly, incorporation of diverse PROMs into clinical assessments may enhance therapeutic decision-making and research in this context. Trial registration Australian New Zealand Trials Registry (ANZCTR) ACTRN12622000912785 (retrospectively registered on 27/06/2022