Scroll down for a list of conditions and treatments


The foot and ankle are two of the most complex musculoskeletal regions in our body. A multitude of conditions can affect their function and hold back patients from enjoying an active lifestyle. As a medical professional specializing purely in the treatment of foot and ankle conditions my goal is to provide patients with the best available solutions that stem from cutting-edge research. 


Helping you understand these conditions is the first stage of the treatment that I will provide. 


My personal contribution to research allows for a patient-centered and evidence-based practice for the benefit of my patients. This is exemplified below in the treatments provided and our own research contribution in each field:

Latest Treatments

The very latest developments and techniques at the service of our patients

Ankle

Ankle conditions that range from sports injuries or tendon problems to fractures

Foot

Treatments for bunions, flat feet, arthritis or toe deformities

Latest Treatments

Ankle Arthroscopy

Ankle Arthroscopy

 

Description:

Arthroscopy, or otherwise known as “keyhole” surgery, is a specialised procedure performed using a small camera and designated instruments that are inserted into the ankle joint through small “holes” (of 5 mm). This minimally invasive technique has evolved in the last few years and currently most of the surgeries that had classically required of long skin cuts and incisions to expose the whole ankle joint can be performed with tiny cuts. The benefits are many and include a faster recovery, day case instead of inpatient surgery, fewer complications, and almost invisible scars.

 

Our research:

One of my publications was featured in the most influential journal in orthopaedic surgery (Journal Bone & Joint Surgery – America). A complete review of current concepts entitled “Ankle Arthroscopy – an update” has become an article of reference, describing the state of the art in all aspects related to this technique. Link to article



Minimally invasive surgery (MIS) or minor incision surgery of the foot and ankle

Minimally invasive surgery (MIS) or minor incision surgery of the foot and ankle

 

Description:

MIS uses the smallest possible incision or skin holes (generally of 5 millimeters or less) in order to perform surgery. With the use of special instruments, precise bone cuts and fixation can be achieved without the need for large scars. It is different from arthroscopy or “keyhole” surgery in the sense that MIS uses X-rays instead of a camera to visualize the actions of surgery. This is because MIS is used for procedures that are performed in bones whereas arthroscopy is performed in joints where there is space to insert a camera. Both procedures share some of the benefits as opposed to open surgery, which include faster recovery and better cosmetic results.

 

Our research:

As a relatively new technique, MIS is expanding, and more surgeons are learning about and performing these techniques. I am a regular faculty member in courses that focus on teaching MIS techniques to surgeons from all over the world. Course flyer



Fracture healing stimulator

Fracture healing stimulator

 

Description:

Some fractures may not heal according to the expected timeline or may fail to heal properly. In such cases, an operation can be considered or we can provide you with a home-based non-invasive novel treatment that is safe and effective to promote bone healing. It is based on a technology supported by the National Institute for Clinical Excellence (NICE) that uses low intensity pulsed ultrasound (LIPUS).

 

Our research:

My experience in treating fractures with LIPUS has proven very helpful for our patients, helping them to heal fractures quicker with the advantage of being risk and pain free. Ask our team if you want to know more and bring the treatment home.



Viscosupplement injections

Viscosupplement injections

 

Description:

Normal healthy joints are bathed in synovial fluid, which is formed of molecules like hyaluronic acid. This natural component provides lubrication and the adequate cushioning to allow for good joint gliding and function.

 

Our approach:

Joints in the foot and ankle affected by osteoarthritis lose their cartilage lining becoming painful. An injection with high-level supplements of this natural joint component will provide protective effects on the cartilage and relieve pain with a simple intervention in clinic.



Bone substitutes

Bone substitutes

 

Description:

Bone grafting is a common procedure in orthopaedic surgery in which bone voids are filled with the patient’s own bone harvested from other areas (involving an additional operation). Bone voids or defects are encountered in approximately 10% of trauma and orthopaedic surgeries. Recent developments have introduced synthetic and biocompatible materials that fill the void without the need for an additional operation to take the graft from the patient).

 

Our research:

One of the hypothesis investigated during my PhD revolved around the novel application of bone graft substitutes in the foot to assess their benefits during surgery.



Shockwave Therapy

Shockwave Therapy

 

Description:

Extracorporeal Shockwave therapy (ESWT) or Shockwave therapy for short is a non-invasive treatment that improves pain caused by a number of conditions, like Achilles tendonitis or plantar fasciitis. The device that produces specific sound waves is applied on the skin and stimulates a healing response in damaged tissue. 

 

Our approach:

Shockwave therapy has an extremely safe profile as described in the guidance by The National Institute for Care and Health Excellence (NICE), and it has proven to be an effective alternative to surgery.



Stem Cells

Stem Cells

 

Description:

Stem cell therapy is a revolutionary advancement in medicine. Some cells in our body, generally extracted from the bone marrow via a needle, have the capacity to regenerate into healthy tissues after these being damaged. In the field of orthopaedics Stem Cells are mainly used in cases of cartilage damage or Osteochondral lesions as an adjunct to help improve the body’s natural healing response. These techniques include the so-called AMIC (Autologous Matrix-Induced Chondrogenesis) to recreate damaged cartilage and MAST (Matrix-Associated Stem Cell Transplantation).

 

Our research:

An international study that I co-authored surveyed thousands of surgeons and provided valuable insights on the treatment of ankle osteochondral lesions including the use of stems cells. Other studies on the benefits of stem cells are currently underway. Link to article



Ankle

Ankle sprains

Ankle sprains

 

Description:

 Sprains are common injuries affecting the ligaments and muscles. Ligaments hold the bones forming the ankle joint together and can be damaged after a twisting injury. Patients experience acute pain or weakness and the ankle appears swollen, bruised and tender.

 

Treatment:

Most ankle sprains will heal with rest and anti-inflammatory medication followed by physiotherapy. Only those severe cases that fail to heal may require keyhole surgery. 

 

Our research:

As one of the commonest ankle injuries, it has attracted significant attention as one of my research topics, leading to new insights in the treatment of sprains, on how to prevent them and how to repair them surgically. Link to studies.

Ankle instability

Ankle instability

 

Description:

May occur in rare cases where torn ligaments fail to heal and the ankle “gives way” regularly.

 

Treatment: 

An intense course of physiotherapy and ankle training are the base of treatment. Severe cases may require keyhole surgery (arthroscopy) and ligament reconstruction.

 

Our research:

The bulk of my research studies is based on this condition and it revolves around a novel technique that repairs the ligaments with keyhole surgery. Link to published surgical technique

Ankle fractures

Ankle fractures

 

Description:

Ankle fractures occur when the bones in the ankle joint sustain a break as a consequence of an injury. Pain, swelling, bruising, tenderness and difficulty to bear weight are all common after ankle fractures.

 

Treatment: 

The severity of the fracture as seen on an X-ray will determine the type of treatment that can range from a few weeks of leg support in a boot or surgery to fix the broken bones.

 

Our research:

I was awarded a grant to attend an American Academy of Orthopaedic Surgeons (AAOS) course in Baltimore, USA to discuss the management of difficult fractures amongst experts “Daily Dilemmas in Trauma: Your topics, expert solutions”. Staying up to date and engaging in continued debate with peers is a key part of our profession in this day and age. Link to AAOS Courses


Ankle osteoarthritis

Ankle osteoarthritis

 

Description:

 The protective cartilage lining covering the end of your joint suffers wear and tear, causing pain, swelling and stiffness. Possible causes of osteoarthritis include joint injury, overuse, genetics or ageing. Any joint in the body and in the foot can be affected by osteoarthritis.

 

Treatment: 

The mainstay of treatment for osteoarthritis is a combination of non-surgical measures, including painkillers, physiotherapy and injections that tackle inflammation and help preserve the cartilage and lubricate the joint. End-stage arthritis may benefit from keyhole or joint replacement surgery.

 

Our research:

During one of my international visitations I had the opportunity to learn from two of the most renowned surgeons in the field of ankle osteoarthritis, Dr Knupp and Dr Hintermann in Switzerland. Joint preserving (osteotomies) as well as total ankle replacements are some of the available treatments for ankle osteoarthritis.

Osteochondral lesions

Osteochondral lesions

 

Description:

A layer of cartilage covers the bones where they meet in the joints, acting as a cushion to allow smooth movement. Osteochondral lesions occur when an area of this cartilage lining is damaged. They can cause pain, clicking, locking, grinding and giving way in the ankle joint.

 

Treatment: 

Mild lesions will likely heal with physiotherapy. More severe lesions may necessitate keyhole surgery.

 

Our research:

The treatment of osteochondral lesions has been the topic of a review chapter edited by an international foot and ankle society that I was commissioned to author. Link to review chapter

Footballer’s ankle (anterior impingement)

Footballer’s ankle (anterior impingement)

 

Description:

This occurs when bone spurs at the front of the ankle pinch the soft tissue resulting in pain and decreased movement. It is most common in athletes who repeatedly perform kicking such as footballers. 

 

Treatment: 

 An initial course of physiotherapy aiming to reduce the effects of pinching. If the pain persists, keyhole surgery to remove the bone spur may be required. 

 

Our research:

In a recent study that I authored an anatomical ligament was discovered which helped provide insight on some of the structures causing impingement syndromes in the ankle. Link to study

Posterior impingement

Posterior impingement

 

Description:

An overgrowth or swelling of ligaments at the back of the ankle can restrict the movement as they get pinched by the bones of the shin and heel. It can also be caused by an additional small bone called "os trigonum". This is most common in athletes who require their foot pointing down in forced positions such as dancers.

 

Treatment: 

Specific physiotherapy that intends to stretch the ligaments at the back of the ankle is the first line of treatment. If pain persists, keyhole surgery to smoothen the ligaments and bones may be required. 

 

My contribution:

What is now a famous scientific paper that we published back in 2012, served as a reference to provide a detailed description of the ankle ligaments involved in posterior impingement syndromes. This study has become a scientific success for foot and ankle surgeons worldwide, being the most downloaded article in the history of the Journal. Link to article

Achilles tendinopathy or tendinitis

Achilles tendinopathy or tendinitis

 

Description:

The Achilles is a broad tendon located at the back of the ankle just above the heel bone and being the strongest tendon in the body also means that it is prone to overuse injuries. The tendon then suffers from tendinopathy and it is painful even during low demand activities like walking.

 

Treatment: 

In a majority of cases non-surgical treatment is enough to treat the inflammation related to overuse injuries, ranging from physiotherapy and modification of activities to anti-inflammatory drugs.

 

Our research:

A study that I presented at a European sports orthopaedics meeting sheds some light onto the still relatively unknown causes of overuse injuries or tendinopathy in the Achilles. With this contribution, advances were made towards finding the best possible treatment for such injuries. Link to the study. 

Achilles tendon rupture

Achilles tendon rupture

 

Description:

The Achilles tendon can snap and this injury is seen frequently in sportsmen/women. Following a sharp pain at the back of the ankle the leg becomes weak and tiptoeing is difficult.

 

Treatment: 

If misdiagnosed or left untreated, the ruptured Achilles is unable to activate the muscles and a limping gait develops with weakness in the leg and limitation for sports and daily activities. Early treatment with a cast and a special boot can provide excellent results and return to sports. Some cases that are diagnosed late may require surgery.

 

Our research:

 Along with my fellowship directors we published a review article on the topic of the challenging Achilles ruptures that are initially missed or undiagnosed. The article remains a reference in the treatment of chronic Achilles rutpures. Link to study.

Peroneal tendon problems

Peroneal tendon problems

 

Description:

There are two peroneal tendons that run along the side of the ankle and foot. They can cause a number of conditions including tendinitis (pain and swelling), tears or dislocation (constantly moving in and out of their path)

 

Treatment: 

Depending on the condition patients will benefit from a period of physiotherapy, podiatric insoles or surgery when all other measures fail to improve symptoms.

 

Our research:

A study that I authored on peroneal tendons keyhole surgery provides a step-by-step description for surgeons in order to accurately perform this novel surgery. Link to published technique.

Subtalar joint conditions

Subtalar joint conditions

 

Description:

The subtalar joint is located directly below the ankle joint and provides the side-to-side movement to the foot. Disorders of this joint normally cause pain and/or difficulty when walking on uneven surfaces.

 

Treatment: 

Depending on the type of problem patients may benefit from biomechanical analysis to address any misalignment with insoles and physiotherapy. Arthroscopy of this joint is an innovative treatment that facilitates surgical strategies including subtalar fusion surgery.