The Foot and Ankle Clinic

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AJump to: A B C D F G H I L M N O P R S T W TOPA close up view of the degenerate section of the tendon
A complete rupture of the tendon ,showing just a few fibres still attached to tendon insertion.
A further small area requiring treatment.
A guide wire being placed across the ankle prior to screw fixation.
A large calcified mass being removed from the centre of the tendon (1) along with removal of all other unhealthy tendon tissue. The FHL tendon has been detached ready for transfer (2).
A large guide wire being placed across the ankle.
A needle being used to allow a direct view with the camera where to place the second arthroscopy portal.
A postero-medial skin incision
A second osteotome introduced to "open up" the osteotomy.
A second parallel guide wire being placed across the ankle (from the medial tibia to the talus)
About The Foot and Ankle Clinic
About the Clinic - Clinical Specialist Foot and Ankle Orthotist
About the Clinic - Facilities / Commercial interests
About the Clinic - Podiatrists
About the Clinic - Specialist Physiotherapists
About the Clinic - Specialist Physiotherapists in London
About the Clinic - Who are we?
Access to talo-navicular joint.
Achilles paratenon stripping and tendon incision - operative image
Achilles paratenon stripping and tendon incision - operative image
Achilles paratenon stripping and tendon incision - operative image
Achilles tendonitis
Achilles tendonitis post-operative
Achilles tendonitis treatments
Achilles tendonosis
Adjustment of cutting jig , to place jig at estimated level of ankle joint.
After ankle fusion
After the arthroscopic ankle fusion operation
After the bunion operation
All the talar cuts complete.
Ankle Arthroscopy Testimonials
Ankle Fusion Testimonials
Ankle Replacement Testimonials
Ankle arthritis
Ankle arthroscopy - Complications
Ankle arthroscopy - How is it done?
Ankle arthroscopy - Operative footage
Ankle arthroscopy - The operation stills
Ankle arthroscopy - What conditions can be treated?
Ankle arthroscopy - What does the inside of my ankle look like?
Ankle arthroscopy - What happens after my ankle arthroscopy?
Ankle arthroscopy - what is it?
Ankle arthroscopy operative still
Ankle arthroscopy operative still
Ankle fusion - What if these joints are also arthritic?
Ankle fusion - what is a fusion?
Ankle fusion operations
Ankle replacement - After the operation
Ankle replacement - Contraindications to ankle replacement
Ankle replacement - Contraindications to ankle replacement
Ankle replacement - How do I decide between a replacement or fusion of my ankle?
Ankle replacement - How does an ankle replacement work?
Ankle replacement - Operative footage
Ankle replacement - Operative stills
Ankle replacement - Post operative movement and Gait
Ankle replacement - The operation gallery
Ankle replacement - When and for whom?
Ankle replacement - what is it?
Ankle replacement approach
Ankle replacement cutting jig
Ankle replacement implanted components
Ankle replacement incision
Ankle replacement movement dorsally
Ankle replacement movement plantar wards
Ankle replacement talar resection
Ankle replacement tibia preparation
Ankle replacement tibia prepared
Ankle replacement tibial cut
Ankle replacement trial components
Ankle sprain
Ankle surgery
Arthroscopic ankle fusion - Before and after X-rays
Arthroscopic ankle fusion - Operative stills
Arthroscopic ankle fusion - What is the ideal fusion?
Arthroscopic ankle fusion compared standard Open fusion
Arthroscopic joint debridement - How long will it last?
Arthroscopic joint debridement - The operation gallery
Arthroscopic joint debridement - What is it and how does it work?
Avoiding the cutaneous nerve.
BJump to: A B C D F G H I L M N O P R S T W TOPBig Toe Fusion Testimonials
Big toe replacement - arthritic joint
Big toe replacement - components inserted
Big toe replacement - components spacer
Big toe replacement - drilling metatarsal stem
Big toe replacement - drilling phalynx
Big toe replacement - insertion of metatarsal
Big toe replacement - metatarsal head guide
Big toe replacement - metatarsal head resected
Big toe replacement - resecting phalynx
Big toe replacement - trial stem
Blunt dissection into the joint using antero-medial portal.
Blunt trochar in place (a hollow tube through which the camera passes ).
Bunion Testimonials
Bunion surgery
Bunion surgery
Bunion surgery complications
Bunion with Bunionette and Metatarsalgia post-operative image
Bunion with Bunionette and Metatarsalgia post-operative x-ray
Bunion with Bunionette and Metatarsalgia pre-operative x-ray
CJump to: A B C D F G H I L M N O P R S T W TOPCase history
Checking the guide wires position
Claw toe intra-operative image
Claw toe intra-operative image
Claw toe intra-operative pictures
Clinic Locations
Clinic and Operating Timetable
Close up of prepared joint surface.
Close up of the arthritic joint. The "bare bone" of the metatarsal head (1), the dorsal spur/ shelf of additional arthritic bone (2) and the proximal phalynx(3) are all visable.
Close up of the graft before final impaction.
Completing the holes for tibial component.
Compressive fixation with screws across the subtalar(1), talo-navicular(2) and calcaneocuboid(3) joints
Contact the Clinic
Corrected 2nd toe with strapping
Cutting jig ready to guide removal of 5 mm of tibia.
Cutting the sides of the talus.
DJump to: A B C D F G H I L M N O P R S T W TOPDefining the position for the osteotomy with the ankle joint open and talus visible anteriorally.
Diagram 1:The intermetatarsal block
Diagram 1:The intermetatarsal block
Diagram 2:Ankle block
Diagram 2:Ankle block
Diagram 3: Intra-articular ankle block
Diagram 5: Sciatic nerve block.
Difference between an ankle sprain and an ankle ligament rupture
Dorsal foot incision for talo-navicular joint
Drilling
Drilling holes of pre-determined depth for tibial component.
Drilling the cylindrical lug holes to allow anchorage of the tibial component.
FJump to: A B C D F G H I L M N O P R S T W TOPFHL transfer for severe tendonopathy - operative image
Fixation of the basal plate. Note the "box" section of the plate maintaining the opening wedge osteotomy.
Fixation of the displaced osteotomy with the guide wire for the Barouk screw
Flat foot pre-operative image
Flat foot pre-operative x-ray
Foot and Ankle Clinic - Physiotherapy (Birmingham)
Foot and Ankle Clinic - Physiotherapy (London)
Foot and Ankle Clinic - Podiatry (Birmingham)
Foot and Ankle Clinic - Podiatry (London)
Foot and Ankle Clinic - partner clinics
Foot and Ankle Clinic - partner clinics
Foot and Ankle Clinic - partner clinics
Foot and Ankle Clinic - partner clinics
Foot and Ankle Clinic - partner clinics
Foot and Ankle Clinic - partner clinics
Foot and Ankle Clinic - partner clinics
Foot and Ankle Clinic - partner clinics
Foot and Ankle Clinic - podiatry and physiotherapy
Foot and Ankle Clinic - post-operative advice
Foot and Ankle Clinic Testimonials
Foot and Ankle Medical Glossary
Foot and ankle articles
Foot flat (The "Ankle rocker" has been used and progressing onto the "Midfoot rocker")
Foot surgery
Full thickness flaps are raised
GJump to: A B C D F G H I L M N O P R S T W TOPGuide wire across subtalar joint prior to drilling and screw insertion.
Guide wire from talar neck across subtalar joint.
HJump to: A B C D F G H I L M N O P R S T W TOPHagglunds Deformity
Hallux Interphalangeus post-operative x-ray
Hallux Interphalangeus pre-operative x-ray
Hallux Rigidus - After the operation
Hallux Rigidus - After the operation
Hallux Rigidus - The operation
Hallux Rigidus - What causes it ?
Hallux Rigidus - What is it?
Hallux Rigidus - What treatments are available?
Hallux valgus (bunion) - If I leave things for now and they get much worse will you still be able to do something?
Hallux valgus (bunion) - Operative stills-The Arthrex Basal plate.
Hallux valgus post-operative image
Hallux valgus post-operative image
Hallux valgus post-operative x-ray
Hallux valgus post-operative x-ray
Hallux valgus post-operative x-ray
Hallux valgus post-operative x-ray
Hallux valgus pre-operative image
Hallux valgus pre-operative image
Hallux valgus pre-operative x-ray
Hallux valgus pre-operative x-ray
Heel Lift (The weight has progressed onto the "Forefoot rocker")
Heel strike (the start of the "ankle rocker")
IJump to: A B C D F G H I L M N O P R S T W TOPIdentifying the location of the ankle joint before injecting sterile fluid.
Ilizarov joint distraction - How does it work?
Ilizarov joint distraction - after the operation
Ilizarov joint distraction - what is it?
Immediate post operative AP xray showing large gap at the fusion site (not an infrequent appearance).
Immediate post operative lateral xray showing large gap at the fusion site (not an infrequent appearance).
Impaction of the graft.
In this case the insertion of the Achilles tendon into the calcaneum (heel bone) has not needed to be detached (1).The FHL tendon (2) and muscle belly (3) are rerouted through the defect in the tendon. The FHL is finally anchored to the bone (calcaneum) with an Arthrex bio-tenodesis screw (not illustrated)
Incision for lateral soft tissue release
Injecting fluid to distend the joint.
Inserting the cannulated (hollow) screws over the guide wire.
Insertion of a cannulated compressive screw over the wire.
Insertion of screw across subtalar joint, from talar neck.
Insertion of the second screw across the joint ,to stabilise and compress . The first screw ,already in place , is labelled 1.
Insertion of the second screw. Guide wires are then removed.
Insertion of two DePuy guide wires across the Scarf osteotomy ,once displaced into new position.
LJump to: A B C D F G H I L M N O P R S T W TOPLongitudinal incisions through the unhealthy tendon, in the line of its fibres
MJump to: A B C D F G H I L M N O P R S T W TOPManouvering the Arthrex "corer" into position to remove the Osteochondral defect.
Measuring the depth of the tibia before drilling holes for tibial component.
Midfoot Surgery Testimonials
Mobility Ankle replacement - operative stills
Mortons Neuroma - What is a Neuroma?
Mortons Neuroma Testimonials
Mortons neuroma - After the Operation
Mortons neuroma - Revision case
Mortons neuroma - Surgical excision of a Mortons neuroma
Mortons neuroma - What treatments are available?
Mortons neuroma - Why does it occur
Mortons neuroma revision case interoperative image
Mortons neuroma revision case interoperative image
Mortons neuroma revision case interoperative image
Mortons neuroma revision case post-operative image
NJump to: A B C D F G H I L M N O P R S T W TOPNote the subtly swollen right tendon compared to the normal left side
OJump to: A B C D F G H I L M N O P R S T W TOPOpening the osteotomy to gain access to the medial talus and ankle.
Orientation for the first talar jig, the anterior lip of the tibia ,being marked on the cut talar surface.
Orthotics
Osteochondral defects and treatments
Osteochondral defects and treatments - After the operation
Osteochondral defects and treatments - After the operation
Osteochondral defects and treatments - Operative Footage
Osteochondral defects and treatments - Operative stills
Osteochondral defects and treatments - Operative stills
Osteochondral defects and treatments - What are the treatments ?
Osteotome introduced into the basal osteotomy.
Other toe deformities
Other toe deformities - HALLUX INTERPHALANGEUS
Other toe deformities - Operative Stills
Other toe deformities - THE HAMMER TOE
Overdrilling of the guide wire to allow insertion of the DePuy Barouk screws.
PJump to: A B C D F G H I L M N O P R S T W TOPPain relief
Pain relief - Post operative splintage
Placing the second talar jig, for posterior and anterior cuts.
Plantar Fascitis
Pre and post operative images of bunion surgery
Pre operative AP (front to back) Xray projection.
Pre-drilling the medial malleolus before performing the osteotomy at the marked level in the periosteum. The Tibialis posterior tendon is defined and visible posteriorally.
Pre-operative lateral (side on) Xray projection of ankle.
Pre-operative picture
Prominences at the first and fifth MTP joints
RJump to: A B C D F G H I L M N O P R S T W TOPReleasing the hyperextension
Removal of bone from the tibia, guided by the jig - operative image
Removing the prominent bone from the MTP joint
Repair of the remaining extensor tendon
Replacement of the medial malleolus and fixation with screws in the pre-drilled holes/position.
Rotaglide big toe replacement - operative stills
SJump to: A B C D F G H I L M N O P R S T W TOPScarf Osteotomy operative stills
Scarf osteotomy operative schematic
Scarf osteotomy operative schematic
Scarf osteotomy operative schematic
Scarf osteotomy operative schematic
Scarf osteotomy operative still
Scarf osteotomy post-operative image
Scarf osteotomy post-operative x-ray
Scarf osteotomy pre-operative image
Scarf osteotomy pre-operative x-ray
Scarf osteotomy x-ray
Search results
Significantly lax lateral ligaments, allowing a divot to appear in the soft tissues (1). More correctly known as the Sulcus sign
Sitemap for The Foot and Ankle Clinic website
Skin incision extending from lateral arthroscopic portal(1) to peroneal tendons(2)
Smith and Nephew arthroscopic shaver
Sports Injuries Testimonials
TJump to: A B C D F G H I L M N O P R S T W TOPTalo-navicular joint exposed
Talo-navicular joint prepared back to healthy bone.
Tendon Surgery Testimonials
Tendon transfer post-operative
Terminal midstance(The weight is about to progress forward from "Midfoot" onto "Forefoot")
The "PIP joint" being excised
The "dome" of the talus being removed.
The "side walls" of the talus removed(1 and 2) .
The Ankle replacement with final meniscus inserted.
The Arthrex Basal plate inserted into the osteotomy. Note the medial opening.
The Arthroscopic set up
The Bio-Tenodesis screw being inserted into a predrilled tunnel to anchor the tendon.
The Calcaneocuboid joint exposed and prepared back to healthy bone, 1.
The Clinic Links
The Clinic Location
The Clinic News
The FDL tendon Detached and ready to transfer.
The FDL tendon marked in preparation for fixation with the Arthrex Bio-Tenodesis screw.
The FHL (1) muscle belly lying directly beneath the Achilles tendon (2). The posterior tibial nerve (3) identified and avoided
The FHL muscle and tendon are identified in front of the Achilles
The FHL tendon being traced into the sole of the foot (1) from behind the heel. Here it is detached and pulled back to use as a tendon transfer
The Foot and Ankle Clinic
The PIP joint opened
The Scarf Osteotomy
The V shaped incision being closed in a lengthened position, forming a Y shape.
The V shaped incision to allow access for lengthening of tendons and release of contracted joint.
The achilles tendon - Achilles paratenon stripping and tendon incision - Operative stills
The achilles tendon - FHL transfer for severe tendonopathy - Operative Stills
The alignment jig applied to the tibia prior to cutting a space for the joint.
The alignment jig, to guide tibial and talar cuts, in place.
The anterior talar cut.
The apperance at three months post operatively showing complete union of the ankle at the Tibio-talar articulation.
The apperance at three months post operatively showing complete union of the ankle at the Tibio-talar articulation.
The approach for the metatarsal ostetomy
The approach to the PIP joint
The approach to the joint, just lateral to Tibialis anterior(1). The ankle joint is open and marked as 2.
The approach to the subtalar joint
The approach to the subtalar joint-dissecting free and avoiding the sural nerve
The approach to the subtalar joint-exposing the extensor digitorum brevis which over lies the joint.
The arthritic joint.
The base of the metatarsal exposed through the medial incision.
The bone impactor to ensure correct size of the groove.The bone impactor to ensure correct size of the groove.
The bone trimmed flush at the metatarsal head
The calcaneal osteotomy being displaced.
The calcaneal osteotomy completed.
The calcaneal osteotomy fully shifted medially and temporarily held with a wire.
The camera (left) and arthroscopic shaver (right) (Smith and Nephew). The inside of the joint is shaved out.
The camera inserted through the trochar.
The capsule and ligaments being tightened with multiple sutures.
The capsule and ligaments tightened and closed
The capsule opened anteriorly and ATF ligament divided
The closed (and lengthened ) Y shaped scar.
The completed Scarf osteotomy (note its "z shaped" profile)
The completed osteotomy
The completed release showing the !st MTP joint open(arrow).
The compressive dressing to be worn for 2 weeks post operatively.
The corrected 2nd toe
The corrected 2nd toe with strapping.
The corrected 5th toe with strapping in place(required for 6 weeks).
The corrected foot
The cutting block for the tibia in place.
The defect "cored out" using the Arthrex Oats instruments.
The distal tibia(1) and talus(2) more widely exposed. A large anterior spur of bone is visible from the tibia(3).
The distal tibial bone being removed.
The distal tibial cut being made.
The exposure extended back towards the peroneal tendons(1). The inside of the ankle joint is visable(2). The CFL ligament sits beneath the peroneal tendons and is also to be exposed
The few remaining attached tendon fibres.
The final talar jig , for producing a central space to allow anchorage by the talar implants fin or keel.
The finished ankle replacement with talus (1) and Tibia(2) resurfaced and a UHMWPE meniscus(3) inbetween.
The first of the three cuts of the Scarf osteotomy. The metatarsal joint is open and marked with an arrow
The flat foot - After the operation
The flat foot - After the operation
The flat foot - Is a flat foot always a bad thing ?
The flat foot - Is a flat foot always a bad thing ?
The flat foot - Operative stills
The flat foot - What and why?
The flat foot - What can cause a flat foot and how ?
The flat foot - What happens if I leave my flat foot untreated ?
The flat foot - What happens if I leave my flat foot untreated ?
The flat foot - What symptoms might I get ?
The flat foot - What treatments are available for a painful flat foot?
The flat foot - When might there be a problem ?
The flat foot - pre and post operative appearance
The flat foot operation
The flat foot operation
The forefoot is narrowed by the translation away from the inner border of the foot of the lower portion of the metatarsal.
The gap produced by removing the tibial bone. The talus(1) remains to be prepared.
The graft seated.
The healthy bone beneath the arthritic surface has been exposed.
The incision deepened between the metatarsals to reveal the neuroma(1).
The incision, between the two affected toes into the web space.
The intermetatarsal ligament exposed in the sole of the foot
The jig applied to remove 4mm of bone from the Talus.
The joint exposed.
The lateral approach(extended lateral) to the calcaneum.
The lateral capsular structures and ligaments exposed
The lateral wall of the calcaneum exposed.
The medial approach
The medial approach to the Tibialis Posterior tendon.
The medial incision to the joint
The medial incision(for a postero-medial OCD)
The medial incision-The Dorsomedial nerve dissected free and avoided.
The medial malleolar osteotomy using a MicroAire saw.
The metatarsal exposed. The area of the "bunion" is seen to the right of the picture
The mortons neuroma (1)
The nerve at the point of branching(2) where the neuroma occurs.
The nerve identified
The nerve removed
The neuroma being dissected free.
The neuroma excised.
The orientation of the "z shaped" saw cuts of the osteotomy.
The osteotomy following displacement, to narrow the front of the foot
The paratenon being stripped from the tendon. Note how the quality of the tendon changes to the left hand side .It becomes whiter, swollen and the fibres less distinct. This is an early tendinopathy
The paratenon dissected free. It is thickened and inflamed. Note the underlying tendon and its tightly packed longitudinal fibres
The paratenon layer is identified
The post operative bandage, required for 2 weeks.
The posterior Talar cut.
The postero-medial skin incision
The proximal end of the nerve(1), now divided, the neuroma(2) and the two digital nerves(3) into which it splits.
The remaining "stump" of the Tib post tendon (1) and the Flexor digitorum longus (FDL ,2) tendon being mobilised.
The rigid right flat foot from the front. Note how the foot is turned away from the midline.
The saw in position to begin the calcaneal osteotomy.
The screw being "driven home"
The screw being driven home.
The second (antero-lateral portal)
The second graft in situ.
The second more proximal screw being inserted
The second screw fully inserted.
The skin incision, skirting Tibialis Anterior tendon.
The sole of the foot with abundant callous under 2-4 metatarsals.
The sprained ankle - How soon will it get better?
The sprained ankle - What treatments are available?
The sprained ankle - When would an operation be appropriate?
The spur being removed to allow identification of the actual level of the joint.
The subtalar (1) and calcaneo-cuboid(2) joints exposed by reflection of the extensor muscle
The subtalar joint opened (1-peroneal tendons, 2-talus, 3-posterior facet subtalar joint)
The subtalar joint prepared back to healthy, bleeding bone. (1-posterior facet subtalar joint, 2-anterior facet)
The surgically corrected right foot(following triple fusion) sitting directly underneath the leg
The sutured wounds
The sutures being tied. The superficial peroneal nerve, dissected free and avoided is visible (1).
The talar component in situ and holes in the tibia ready for the tibial component.
The talar component inserted.
The talar dome now resected(1) the space produced is large enough to accept the joint replacement. Further fine finishing of the bones is required .
The talar jig for fine cutting the front(1) and back (2) faces of the talus.
The talar sizing jig applied ,prior to removing the "side walls" of the talus
The third talar jig applied and producing the central "keel" for the implant.
The tibia ready for the tibial component.
The tibial component being inserted.
The tibial component being inserted.
The transferred tendon in its new position.
The transverse metatarsal ligament being partially sectioned(1) to gain access to the nerve.
The trial meniscus being inserted.
The trial talus(1), spacing block(2) and Woods' jig(3) in situ in readiness for final preparation of the tibia.
The under surface of the metatarsal is lowered by the plantar orientation of the saw cuts
The unstable ankle - Lateral Ligament Reconstruction - Operative stills
The unstable ankle - How likely is this to work?
The unstable ankle - The operation
The unstable ankle - What happens after the operation?
The unstable ankle - Why is it important to know which of these it is?
The unstable ankle - what is it?
The valgus and fixed right heel pre and post corrective triple fusion. The correctly aligned heel sitting squarely beneath the leg.
The varus stress test for lateral ligament laxity. See text for full discussion on testing the ligaments
The void filled by a similarly sized "graft" of a bone and cartilage from the knee.
The void left by removing the defect.
The working position of the instruments.
The wound closed with absorbable suture
The wound closed with absorbable suture.
The wounds after closure.
Toe Off(The final phase of the "Forefoot rocker", with the foot about to leave contact with the ground and "swing" forwards as the opposite foot starts the same "Stance" cycle
Transferring the extensor tendon into the joint.
Trimming the excess overhanging bone with a saw
Two screws required to hold this osteotomy.
WJump to: A B C D F G H I L M N O P R S T W TOPWhat is a flat foot ?
What is a surgeon?