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Please see foot & ankle anatomy for more information about the big toe anatomy.
The big toe joint (1st metatarsal and hallux) is big for a reason, it takes almost half of the weight transmitted through the toes when walking and standing. It is also commonly referred to as the first ray, referring to the 1st metatarsal, the sesamoid bones and the proximal and distal hallux.
Abnormalities of the first ray can prevent the big toe joint from working properly, such as 1st MTP joint arthritis (hallux rigidus) or bunions (hallux valgus).
Due to the first ray abnormal biomechanics and/or pain, the normal physiological load across the first ray is shifted across to the second toe and then the other lesser toes. This is called transfer metatarsalgia. Not surprisingly the second and other lesser toes are not designed to bear the extra load, and as a result, several complications can occur.
Illustration of how load is transferred from the big toe to the lesser toes in transfer metatarsalgia
Transfer metatarsalgia is essentially forefoot pain caused by dysfunction in another forefoot area. While the commonest presentation is 2nd MTP joint pain secondary to 1st MTP joint pathology, it is not exclusively the case.
Surgery to one part of the foot may alter the biomechanics sufficiently to cause a shift in load across the forefoot. This can result in painful symptoms and transfer metatarsalgia. This is an uncommon complication of most types of forefoot surgery.
The following are the commonest causes of transfer metatarsalgia:
Clinical picture of a patient with a painful bunion who is off loading the big toe and as a result, develops transfer metatarsalgia
Calf tightness results in increased forces going through the front of the foot “forefoot overload“.
This can cause or exacerbate problems in the forefoot. Please read about calf tightness for further information.
When considering treatment for a problem at the front of the foot, it is important to also treat the calf tightness to ensure a good outcome.
Patients with transfer metatarsalgia can develop problems in adjacent bones, joints and soft tissues such as:
Investigations help confirm the underlying cause of the transfer metatarsalgia, grade the severity of the condition and where applicable, aid in pre operative planning.
Plain radiographs are a quick and effective way of confirming first ray pathology such as big toe (1st MTP) joint arthritis and bunion deformity in a foot. In the early stages of the condition, the deformity can be quite subtle. Most people however present when there is an obvious clinical and radiological deformity, often with additional complications such as lesser toe deformity.
Plain radiographs (x-rays) provide the following information:
Ultrasound is used to confirm swelling (synovitis) in the 2nd MTP joint, and to see if there is anything else that may be causing the symptoms of transfer metatarsalgia for example, Morton’s neuroma or intermetatarsal bursitis.
MRI is useful especially when x-rays appear normal. It provides excellent high definition static images.
MRI is particularly useful in assessing:
An MRI of the foot demonstrating inflammation (synovitis) in the 2nd MTP joint
If the underlying diagnosis is not clear an MRI can be a useful investigation.
Left untreated, the symptoms of transfer metatarsalgia can get worse.
The untreated abnormal biomechanics and subsequent overload of other parts of the forefoot can exacerbate or result in several different complications involving adjacent bones, joints and soft tissues such as:
Radiograph (x-ray) of the foot in a patient with a severe bunion deformity and arthritis in the midfoot
Radiograph (x-ray) of the foot, of a patient with a bunion deformity and 2nd MTP joint arthritis
Clinical picture of a foot in a patient with a bunion (hallux valgus) deformity with associated crossover toe deformity
A – AP, B – oblique and C – lateral radiographs (x-rays) of the foot demonstrating dislocation and crossover deformity of the 2nd toe
Serial radiographs (x-rays) of the foot demonstrating a 2nd metatarsal stress fracture in a patient with a hallux valgus deformity A – at initial presentation B – 6 weeks C – 3 months (healed)
Transfer metatarsalgia is treated by resolving the underlying pathology.
See relevant condition pages regarding the following for further information:
Calf tightness is tightness in the gastrocnemius and soleus muscles. These muscles form the bulk of the calf.
You may wish to read about the anatomy of the calf muscles here.
Calf tightness can lead to a number of problems in the lower leg and foot. As the gastrocnemius and soleus are large and powerful muscles, contraction of these muscles creates considerable force across the foot and ankle. Abnormally tight calf muscles can either cause or exacerbate a foot and ankle problem.
Calf tightness can be associated with the following conditions:
Calf tightness can be caused by or be associated with the following:
The most common symptom felt in the calf in patients with calf tightness is muscle spasm and cramping pain.
It is not uncommon, however, for patients to have tightness in the calf muscle and actually have no or little pain and discomfort in the calf itself. Instead, these patients often complain of pain resulting from problems caused or exacerbated by the calf tightness as described above such as plantar fasciitis and Achilles tendon problems.
Tightness in the calf, increases the forces going across the forefoot (ball of the foot). When the forces are greater than normally encountered in the foot, a diagnosis of increased forefoot loading is made.
Increased forefoot loading exacerbates any problem a patient may have in the forefoot such as:
For information regarding symptoms in conditions associated with calf tightness please read the relevant condition page below:
Not all calf cramps are caused by calf tightness, the following may also be underlying causes and will be investigated as part of the initial work up:
There currently does not exist any readily available and reliable investigation to measure calf tightness.
The best way of assessing calf tightness is by clinical examination.
Your surgeon will look for the following:
Clinical picture demonstrating the Silfverskiold test
Clinical picture demonstrating diffuse plantar callosity of the forefoot
Decreased forefoot clearance on heel walking
Left untreated, calf tightness can lead to various problems as already discussed above.
If you develop increasing pain and spasms in your calf muscle this needs to be investigated and treated.
Non-operative management for calf tightness aims at relieving pain and return to full activity, including sports whenever possible.
It should always be the first line of treatment. Options include:
A period of rest from sports and exercise that bring on symptoms. New training regime and exercise program.
Massaging the affected muscle can alleviate cramps.
Calf stretches (particularly eccentric) as part of a comprehensive physiotherapy program can be very successful in stretching out the calf muscles.
The following exercises are recommended as part of any physiotherapy program:
Please read here for more details about the exercises.
Surgical management is reserved for patients who have failed to respond to non operative treatment.
Patients should understand that the decision to undergo surgery should not be taken lightly.
Any intervention is considered in a step wise manner, with the least invasive procedure carried out first.
Releasing the calf tightness may be done as a sole procedure or in conjunction with another operation. It may be done at the same time as the foot operation or as a staged procedure depending on the condition being treated.
This operation involves making a small 2cm incision at the back of the knee and releasing the medial head of the gastrocnemius muscle. It lengthens the calf muscle and relieves the tension across the Achilles tendon. It is very effective in reducing pain and improving function. It has a 85-90% success rate.
The operation is carried out under local anaesthetic and a short sedation. It is a day case procedure so you can expect to go home the same day. As the wound itself is small and the operation involves cutting fascia and not muscle most patients are able to walk out of hospital without crutches and are able to drive within 4 to 5 days. Calf stretching exercises are recommended for 2 weeks post surgery to help maintain the increased length obtained by surgery.
Expect to feel the benefit of the operation 6 to 8 weeks post surgery.
A typical wound following a proximal medal gastrocnemius release
It should be borne in mind that complications can result from a condition with or without surgery.
Complications can occur as with any type of surgery. Please see Complications for more detailed explanation of post surgical complications.
Please read the information regarding what to expect post surgery on this website.
Remember that below is a guide to recovery and that everyone heals at different rates and some people do take longer. Use this information to help you understand your condition, possible treatment and recovery. The timeframes given below are a minimum, it is important that you appreciate this when considering surgery as your healing and recovery may take longer.
The operation will be done as a day case procedure.
Following a proximal medial gastrocnemius release –
You will have a small waterproof dressing applied to the back of the knee. It is advised not to remove this until seen at clinic by Mr Malik at the 2 week follow up.
For 2 weeks following surgery it is recommended that you keep the area dry. You may wish to get a Limbo bag which will stop the wound getting wet.
Most patients are able to walk comfortably without any aids after the operation. If both legs have been operated on then crutches maybe necessary. A physiotherapist will guide you before your discharge from hospital. Please ensure someone is able to drive you home after the operation. It is important that you commence calf stretching exercises as soon as possible after the operation. Activities can be gradually increased as pain allows.
You will be reviewed at the clinic and your dressings removed. Your wound will be checked and if completely healed you will be given advice regarding soft tissue massage and scar desensitisation. Scar desensitisation should start as soon as the wound has completely healed. You can do this by massaging cream (E45 for example) into the scar and around the wound area. You may shower and get the area wet only if the wound has completely healed and is dry.
At this stage if your healing is progressing satisfactorily swelling and bruising should have subsided considerably and most patients can sense an improvement in their symptoms and improvement in the calf tightness.
Final clinical examination. Discharge if satisfactory.
This is probably the most common question asked of surgeons. Total operation time is different from the actual total surgical time. For example a flight involves not just the flying time, but the time checking in, going through security and boarding the plane for example.
The time given below is only a guide to the actual surgical time.
For a proximal medial gastrocnemius release
15 minutes
Most patients are able to drive within a week or two. Please see guidance below.
Most patients are able to return to work within 3 to 5 days.
Excellent pain relief and return to sports by 3 to 6 months in approximately 90% of patients.
As soon as you feel safe to do so and can do an emergency brake.
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A bursa is a fluid-filled sac that acts as a cushion to reduce friction between tissues of the body such as tendons and bones. When a bursa becomes inflamed, the condition is known as bursitis.
At the back of the heel there is a superficial (just under the skin) bursa which acts to cushion and reduce the friction in the underlying Achilles tendon. Irritation and inflammation of the bursa results in superficial calcaneal bursitis. This is one of several causes of heel pain as shown in the image below.
An MRI of the hindfoot and the common causes of heel pain – note the site of superficial calcaneal bursitis
Superficial calcaneal bursitis is often caused by excessive friction on the skin overlying the Achilles tendon. This can be caused by:
Pain and swelling are the most common symptoms of superficial calcaneal bursitis.
Pain
Tenderness directly over the bursa. May be worse after activity and exercise for example at night or the next morning. Eventually the pain will become more severe and limit exercise and activity. Some patients may find themselves limping.
Swelling
Posterolateral heel swelling. Can become very swollen and red. Wearing shoes may become very difficult due to pressure and pain.
Clinical picture of a patient with an inflamed superficial calcaneal bursa
Usually the diagnosis can be made, based on the history and clinical examination.
Radiographs (x-rays) are a useful first line investigation to rule out any other problems in the hindfoot.
Ultrasound is used to confirm the diagnosis, and to see if there is anything else that may be causing the symptoms for example retrocalcaneal bursitis.
Occasionally MRI is useful in confirming the diagnosis and ruling out other causes of heel pain. It provides excellent high definition static images.
Most patients heal very well and quickly with proper management.
Patients with superficial calcaneal bursitis who ignore their symptoms or who are mismanaged may develop chronic swelling and pain.
Clinical picture of the foot in a patient with severe superficial calcaneal bursitis
Non-operative management for superficial calcaneal bursitis aims at relieving pain and return to full activity including sports whenever possible.
A short period of rest from sports and exercise that bring on symptoms. Fitness can be maintained by other non impact activities such as swimming and pool based exercises.
Minimising pressure on the heel will ease the pain. Shoes with soft padding at the heel, using sandals and avoid heel straps. Avoid or minimise the time spent wearing high heels if not already doing so.
Application of ice for regular periods during the acute stage of bursitis may alleviate painful symptoms.
The use of non-steroidal anti-inflammatory drugs (NSAIDs) can decrease discomfort in patients with superficial calcaneal bursitis.
The use of paracetamol and other painkillers to help reduce pain levels.
Physiotherapy is important with this condition to hasten the healing process, ensure an optimal outcome and prevent recurrence.
Treatment may comprise:
Patients who fail to benefit from conservative (non-operative) management, may benefit from an ultrasound guided steroid injection.
Steroids reduce inflammation. The aim of the injection would be to reduce the inflammation in the bursa and ease symptoms.
Prior to the injection the bursa may be aspirated (fluid drained).
The outcome of the injection may be:
Surgical management is reserved for patients who have failed to respond to non operative treatment. Surgery for this condition is extremely rare.
Please discuss with your surgeon Mr Malik for further information.
Please see foot & ankle anatomy for more information about the talonavicular joint.
Arthritis is disease (damage) of cartilage. Cartilage lines the surface of the bones where two or more bones form a joint. Cartilage allows smooth and frictionless movements. Disease of cartilage leads to roughened surfaces which causes friction and increased wear and tear in the joint. This in turn can cause inflammation, pain, and joint deformity.
Talonavicular arthritis is when arthritis involves the talonavicular joint.
A – Normal radiograph of the foot lateral view B – Talonavicular arthritis
Any condition that damages the cartilage (joint surface) will cause talonavicular arthritis to develop.
The common conditions that cause subtalar arthritis are:
Typical symptoms of talonavicular arthritis include:
Investigations help confirm the diagnosis, grade the severity of the condition and where applicable, aid in pre operative planning.
Plain radiographs are a quick and effective way of confirming arthritis in a joint. In the early stages when there is inflammation with no damage to the joint they maybe normal. Most people however present when there is some structural damage.
The following are features of arthritis on a plain radiograph:
Plain radiograph (x-ray) of the foot showing talonavicular joint arthritis (blue arrows)
MRI provides excellent high definition static images. It is useful in pre operative planning and to exclude any other pathology in the hindfoot. It is also useful in monitoring healing.
MRI of an ankle (side view) demonstrating severe talonavicular arthritis, note the presence of fluid (oedema) shown as a lighter grey colour in the talus and navicular bone compared to the surroudning darker bones, as well as the presence of a large cyst, all indicative of severe talonavicular arthritis
A – MRI of a normal talonavicular joint B – MRI of diseased Talonavicular joint, note darkened area representing damage to bone and cartilage
CT images give excellent information on bone structure and is superior to plain radiography in that respect.
CT is particularly useful in the following cases:
Ultrasound is a quick, painless and non invasive method of assessing soft tissue structures.
Ultrasound is particularly good at ascertaining:
Bone scan is a non specific test. It utilises a radioactive dye, absorbed by the body and taken up by areas of high metabolic activity such as inflammation and infection. It will not tell you what the diagnosis is, but will usually tell you if an abnormality is present.
This test is done in special circumstances.
Picture of a bone scan showing increased uptake in the foot
The natural history of talonavicular arthritis is very variable, some patients describe a rapid deterioration, while others take many years to get worse.
The changes associated with arthritis are irreversible, the joint will never return to its normal healthy state. That is not to say that all patients are symptomatic, some patients describe stiff joints with mild ache and are able to manage their symptoms with activity modification. However some patients describe significant pain and functional limitation.
You should see an Orthopaedic Foot & Ankle Surgeon if one or more of the following applies to you:
As the arthritis becomes more severe and any deformity becomes fixed, adjacent joints will also become involved and become arthritic.
Radiographs demonstrating how talonavicular arthritis can get worse A – normal talonavicular joint (blue line) B – severe end stage talonavicular arthritis C – in addition highlighting severe excess bone growth (shaded blue area), subtalar arthritis (yellow line)
Grading a disease in medicine is used for the following reasons:
There are a number of grading systems used for arthritis. We use the following grading system based on radiographic (x-ray) features at The London Foot & Ankle Clinic:
Non-operative management for ankle arthritis aims at relieving pain and return to full activity including sports whenever possible. It is likely to be most effective in the early stages of the condition.
A period of rest from sports and exercise that bring on symptoms. Avoiding high impact activities with lots of turning and twisting.
Wearing above ankle boots that give more support to the joint. The use of a shoe with a rocker bottom sole can also help as it helps spread the load away from the midfoot.
Custom orthotics that stiffen the mid portion of the foot can ease symptoms.
The use of non-steroidal anti-inflammatory drugs (NSAIDs) can decrease discomfort in patients with talonavicular arthritis by reducing inflammation in the joint.
Physiotherapy works by strengthening muscles around not only the joint but the whole kinetic chain. Calf stretches can also help reduce loads and forces going across the midfoot.
Results are variable with arthritis and depend really on the severity of the disease. In a very stiff and damaged joint, physiotherapy may make your symptoms worse. Your surgeon will guide you.
The use of a walking stick or cane to reduce the forces going across the damaged joint.
Can relieve the pressure on painful damaged joints.
These are increasingly popular with people who have arthritis. The cartilage found in joints, normally contains glucosamine and chondroitin. It is thought that taking supplements of these natural ingredients may help to improve the health of damaged cartilage.
Research has provided mixed results but on the whole suggests that glucosamine sulphate is more likely to be helpful than glucosamine hydrochloride. If you are thinking of taking glucosamine, we suggest taking 1,500 mg per day of glucosamine sulphate. If you notice no improvement in your symptoms after 3 months then you should probably discontinue it. If you do find it improves your symptoms then you ned to continue taking the supplements. There is no extra benefit in taking glucosamine and chondroitin.
Remember that supplements also have side effects and it is advisable to discuss with your GP before starting any new treatment.
There is no one treatment that has a reliably successful, quick and easy cure for arthritis. Therefore researchers and doctors are constantly looking for new and better ways of treating arthritis.
Many treatments have come into fashion and then gone away over the years once results had shown that the initial promise was premature and misplaced.
At The London Foot & Ankle Clinic we do not promote or discourage new treatment options for arthritis. We would however advise a cautious approach to relatively untested treatment modalities with little or no evidence to back their use. Patients undergo these treatments at their own risk.
There are a number of treatments that involve an injection or series of injections for the treatment of talonavicular arthritis.
This injection serves as both a therapeutic and diagnostic intervention. Steroids reduce inflammation and can ease painful symptoms. The local anaesthetic numbs an area of the body for roughly 12 to 48 hours.
The steroid is unpredictable in its success at easing painful symptoms but has very low risk of complications and therefore is an attractive therapeutic option prior to further more invasive surgical intervention. The local anaesthetic on the other hand is very predictable in its action. If there is an area of damage it will definitely ease symptoms for 12 to 48 hours. If symptoms do not ease during this period, one has to question whether the diagnosis is correct.
Steroids reduce inflammation and ease pain when injected directly into an arthritic joint. It is most likely to be effective in the early stages of arthritis.
We carry out almost all injections under a short general anaesthetic (1 minute) as injecting into a painful joint can be quite sore. While you are asleep and lying still a small needle is inserted into the joint and the position is confirmed using an x-ray in theatre. A small amount of dye is injected first to make sure the needle is in the correct spot and then a mixture of Depomedrone (steroid) and Bupivacaine (long lasting local anaesthetic) is injected. Undertaking the injection in this manner ensures a pain free experience for the patient and the best outcome clinically as there is no doubt about the placement of the injection.
The local anaesthetic will cause numbness in the area injected for approximately 12 to 48 hours. This action is predictable. What is not predictable is the duration of action of the steroid. It may work for one month, several months or even more than a year.
Injections are not repeated less than 6 monthly intervals.
Please read here for more information regarding injections and possible complications.
Normal joints have lubrication fluid called synovial fluid. A major constituent of synovial fluid is a substance called hyaluronic acid. This helps not only lubricate the joint but also act as a shock absorber easing the load across the joint.
It has been noted that people with arthritis tend to have lower concentrations of hyaluronic acid than normal.
Viscosupplementation involves injecting hyaluronic acid into arthritic joints. The procedure would be carried out as for a steroid injection under a short general anaesthetic and x-ray control.
This operation has excellent outcomes in terms of pain relief and return to activities of daily living.
It involves removing all remnants of the diseased joint (cartilage) and fusing the the bones so that no joint exists. With no more joint there will be no more movement and therefore no more pain. The aim is to sacrifice painful movement for pain relief.
The majority of patients when they first hear about this procedure are quite apprehensive. This is understandable, joints exist to allow movement. A fusion is the total opposite to this, and therefore most patients perceive it as unnatural. However contrary to what most people think, after a fusion you will be less likely to limp and be a lot more active including the ability to exercise and do sports. Please read this blog for more details.
The operation is usually carried out through one or more incisions on the top (dorsum) of the foot. The operation is undertaken under a general anaesthetic and patients usually require an overnight stay in hospital.
The main complication is non union (the bones not fusing together). This is reported in numerous studies to be around 5 to 10%. In the event of this complication, the operation is repeated with bone graft to stimulate the healing and given time most patients eventually heal.
Currently talonavicular fusion remains the treatment of choice for end stage talonavicular arthritis. There is no talonavicular joint replacement.
A – Lateral radiograph of a foot pre operatively demonstrating severe bone on bone talonavicular arthritis B – Post operative radiograph at 6 weeks with successful fusion at the talonavicular joint
A – Oblique radiograph pre op demonstrating severe talonavicular arthritis B – Post op radiograph demonstrating successful fusion of talus and navicular bones
In some patients who have had arthritis in the joint for a long time, adjacent joints can become damaged as well. The talonavicular, calcaneocuboid and subtalar joint in a normal foot work work in a similar fashion. Damage to one, puts increased strain on the others.
If there is evidence of damage to the other two joints, your surgeon Mr Malik may advise you to have all three joints fused to provide you with the best outcome.
A – Normal foot & ankle radiograph B – patient with severe talonavicular arthritis and subtalar joint involvment C – post triple joint fusion – made made an excellent recovery with increased range of motion, complete relief of pain and full function
All surgical procedures for talonavicular arthritis will be carried out under a general anaesthetic.
You will have a backslab applied post operatively for two weeks. You will spend one night in hospital after your operation and receive intravenous antibiotics the next morning.
Please do not remove your backslab until you are seen by your surgeon Mr Malik at the two week post operative clinic appointment.
You will be non weight bearing for approximately 6 to 8 weeks. The physiotherapist will guide you with the use of crutches after your operation and before your discharge from hospital.
For the first two weeks following your surgery please keep your foot elevated to the level of your heart for 95% of the time.
A picture demonstrating high elevation
Naturally most people do not have a hospital bed at home. The same effect can be achieved by lying in a bed or lengthways on a sofa, with pillows behind your back and under your foot. You cannot have your leg elevated sitting in a chair. It is strongly advised that during the first two weeks you are house bound.
To minimise risk of infection keep the foot dry and cool. Avoid humid and hot environments. Keep the foot dry and when showering wear a Limbo bag.
To minimise the risk of blood clots please move your foot and ankle at regular intervals. Please ensure you are well hydrated. If you have a risk of blood clots please notify Mr Malik who may organise for you to have blood thinning injections as a precaution.
You will be reviewed at the clinic and your dressings removed. Your wound will be checked to see that it has healed and there are no signs of infection.
At this stage if the swelling has subsided sufficiently you will be advised to keep your foot in an elevated horizontal position whenever possible to minimise swelling.
You will be placed in another non weightbearing cast for a further 4 to 8 weeks. Short trips can be made outside, within limits of pain and swelling.
At this stage if your healing is progressing satisfactorily swelling and bruising should have subsided considerably, although expect some degree of swelling for at least 4 to 6 months.
Depending on the x-ray findings you will either go into a walker boot and be allowed to weight bear through the operated foot, or you will have to remain non weight bearing in plaster.
If your x-rays are encouraging and your wounds completely healed you will be given advice regarding soft tissue massage and scar desensitisation. Scar desensitisation should start as soon as the wound has completely healed. You can do this by massaging cream (E45 for example) into the scar and around the wound area. You may shower and get the area wet only if the wound has completely healed and is dry.
Check radiographs should show signs of bone healing. You will be able to start wearing normal footwear (swelling permitted), although stiff soled shoes are advisable. You will require physiotherapy for approximately 3-6 months. This will help optimise the outcome of your operation.
For a talonavicular fusion
Up to 90 minutes.
For a triple fusion
Up to 120 minutes.
Depends on the side operated on and whether you drive an automatic car. If the car is manual then regardless of the side operated on it will be roughly 3 months post surgery. If you drive an automatic and the left foot has been operated on then it will be roughly 4 weeks before you can drive short distances.
Please see guidance above and information here. Ultimately it is the responsibility of the patient to decide if they are safe to drive. A good way of knowing is if you can stamp your right foot heavily on the ground to mimic an emergency brake. If you have any hesitation or pain then it should suggest you are not safe to drive. Remember prolonged driving involves keeping your feet in a dependant position. This will worsen the post operative swelling.
This really depends on you and your job. If you have a job that involves a lot of standing, walking and is manual it may be 8 to 12 weeks. If you have a sedentary job, for example in an office and you have a reasonable commute you may be able to go back to work at 2 weeks, although this would be exceptional and not the norm.
Excellent pain relief and return to full activities of daily living.
“I only wish I had been referred to Mr Malik earlier. I have suffered with Rheumatoid Arthritis since 2012, and have suffered pain and swelling in the mid foot region of my left foot on and off since diagnosis.
In May this year the pain became constant, and despite 2 courses of steroids, there was no improvement. It was then I was referred to Mr Malik, who following MRI scan and X-Rays diagnosed talonavicular arthritis with severe bone marrow oedema. He suggested 6 weeks of touch weight bearing to reduce the swelling, but there was no improvement, so surgery was the only option to relieve pain, and make me mobile again.
In October Mr Malik performed a talonavicular fusion with bone graft. Mr Malik is a fantastic surgeon, extremely informative, skilled and reassuring. 2 weeks post op when the backslab was removed the wound had healed beautifully with no bruising what so ever. The anaesthetist Dr Size was amazing too. He performed the surgery under a General anaesthetic, with a popliteal nerve block.
I can honestly say I had no ill effects from the GA, and I experienced no pain post operatively at all. The nerve block lasted 36 hours.
My recovery is going very well. Thank you very much Mr Malik and Dr Size.”
Katherine Rasinksy – 18/11/2016
Orthopaedic Outpatient Department 30 Devonshire Street, London, W1G 6PU
tel: +44 (0) 203 7956053
Mon - Fri (8am-8pm) Sat (9am - 5pm)
info@lfaclinic.co.uk
