Important Information

My philosophy

My Philosophy

The foot contains 28 bones and many more ligaments and tendons. As such it is often difficult to get a clear diagnosis as to what exactly is causing your symptoms. My philosophy is that to successfully treat your problem, I need to identify and fully understand the root cause of your symptoms.

 

To achieve this, I take you through an extremely thorough history and physical examination, looking at the alignment of your legs, the tightness in the muscles, the shape of your foot and then focussing on the areas that are causing your symptoms. If needed I will arrange for you to have appropriate X-rays and scans and make sure that we are happy that we know exactly what the problems that we are dealing with are.

I am a firm believer in a multidisciplinary approach to the management of foot and ankle conditions and I work with trusted physiotherapists, orthotists, podiatrists, and other medical specialists to ensure that we take a comprehensive approach to the management of your condition. I find that with this approach we can design a personalised treatment plan to get you back to fitness and in many cases avoid surgical interventions. One of my key priorities is educating my patients so that they can maintain self-care and reduce the risk of suffering from the same problems again.

If surgery is required, I am a specialist fellowship-trained foot and ankle surgeon and my elective practice is based solely on foot and ankle surgery. I have experienced the best methods of practice in London, Scotland, Australia, and Canada. I use this training to provide a busy high-quality NHS practice at Kings NHS trust south sites and bring the same focus to my private practice with a more personalised experience.

Aftercare protocols

I prefer to use individualised rehabilitation programmes which are goal-based rather than time-based, as everyone has different things they want to do and people get better after surgery at their own pace. This is why I prefer to use a patient-specific goal-directed rehabilitation programme, with a stepwise increase in activity from walking on the flat, to jogging to sports-specific training.

All patients have different goals and when we discuss your surgery, part of planning is making a list of your goals and a step-wise plan. A lot of this will be done in conjunction with your rehab therapist. Every patient will be given a plan for their immobilisation and early appointments and recovery and again this will be based on the type of procedure we agree is best suited to your problem.

I make every effort to take your life situations and lifestyle into account when planning for your recovery and the timing of your surgery.

Aids

I am a huge believer in advanced aids to help patients recover from surgery. I will discuss this with you in detail if it is appropriate for your care. Some examples of aids are the “even up” shoe.

This is a slip-on shoe that you put over a trainer if you have to wear a boot for any period of time. Evening up your leg length can increase your mobility and decrease hip and back pain. In fact, my recently published paper in Foot and Ankle International, which won the 2018 national society prize showed that if patients have to wear a recovery shoe that causes a mismatch in leg length this significantly reduces their satisfaction with their recovery and holds them back from early recovery.

I also recommend my post-surgical patients use a LIMBO device and I can arrange this in the clinic. This is a very convenient plastic sleeve with a suction cup that you can use to bathe and shower whilst keeping your surgical site clean and dry.

Other aids I commonly use are the i-walker, knee rollator, beagle brace, and the VACOped Boot. I will discuss all appropriate aids with you in the clinic.

Preparing for your clinic appointment

General information

I will do everything possible to make you feel at ease at your clinic appointment and get to the bottom of your symptoms. Although I endeavour to run on time, I never rush my patients and a consultation can sometimes take longer than expected. Please bring some refreshments and reading material for whilst you wait.

Patient questionnaire and outcomes

My team will send you a patient information questionnaire and outcome scores by email or post as is convenient for you. You can complete this on your computer and return it via email or just fill it in at home and bring it in with you. If you happen to forget the questionnaire it is not a problem, as we can give you a new one but it is more convenient and efficient for you to complete this before your appointment.

Scans and referrals

Please bring a copy of your medication and any scans, xrays or referral letters with you. It will make it much easier for me to get a handle on what treatment you have had so far and focus on what we need to do to help you recover.

Preparing for surgery

How to prepare

Once we have decided that surgery will help you, you will need to learn what to expect from the surgery and we will create a treatment plan for the best results afterward. Preparing mentally and physically for surgery is an important step toward a successful result. Understanding the process and your role in it will help you recover more quickly and have fewer problems.

Working together

Before surgery, I will perform a complete physical examination to make sure you don’t have any conditions that could interfere with the surgery or the outcomes. Routine tests, such as blood tests and X-rays, are usually performed a week before any major surgery.

Discuss any medications you are taking with me and your family physician to see which ones you should stop taking before surgery.

Discuss with me about options for preparing for potential blood replacement, including donating your own blood, medical interventions, and other treatments, prior to surgery.

If you are overweight, losing weight before surgery will help decrease the stress you place on your foot and ankle and help with recovery. However, you should not crash diet during the month before your surgery as it can actually slow down your healing. If we are concerned that your weight is a significant contributor to your problem, I can arrange for a referral for you to see a dietician to help with this.

If you are taking aspirin or anti-inflammatory medications or warfarin or any drugs that increase the risk of bleeding you will need to stop taking them one week before surgery to minimize bleeding.

If you smoke, you should stop or cut down to reduce your surgery risks and improve your recovery.

Have any tooth, gum, bladder or bowel problems treated before surgery to reduce the risk of infection later.

Eat a well-balanced diet, supplemented by a daily multivitamin with iron.

Report any infections to me leading up to the surgery. It is much safer to delay your surgery until infections have cleared up.

Arrange for someone to help out with everyday tasks like cooking, shopping and laundry.

Put items that you use often within easy reach before surgery so you won’t have to reach and bend as often.

Remove all loose carpets and tape down electrical cords to avoid falls.

Make sure you have a stable chair with a firm seat cushion, a firm back and two arms.

Preparing for Procedures

If you are having Day Surgery, remember the following:

  • Have someone available to take you home, you will not be able to drive for at least 24 hours
  • Do not drink or eat anything in the car on the trip home

The combination of anaesthesia, food, and car motion can quite often cause nausea or vomiting. After arriving home, wait until you are hungry before trying to eat. Begin with a light meal and try to avoid greasy food for the first 24 hours.

For the first few days after surgery, keep the foot elevated as much as possible and use ice for the swelling. This will help decrease swelling and pain.

Take your pain medicine as directed. Begin the pain medicine as you start getting uncomfortable, but before you are in severe pain. If you wait to take your pain medication until the pain is severe, you will have more difficulty controlling the pain.