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OARS study

Harrogate joins OARS study

We completed the registration process in Harrogate in July 2016 to participate in the multi-centre OARS study, funded by Arthritis UK and led by the University of East Anglia. I have recruited 2 patients thusfar and performed a total ankle replcement in the first last week. Collaborative projects such as the OARS study are very important to help guide future practice and give patients the best possible information.

Ankle osteoarthritis affects more than 29,000 patients annually in the UK. Advances in the design of ankle replacements have led to its increasing use in the treatment of end stage ankle arthritis, however knowledge of how well these implants perform in individual patients is currently lacking and the patient perspective has not yet been measured in a consistent or reliable way.

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Minimally invasive calcaneal osteotomy

Foot Ankle Int. 2015 Mar;36(3):248-52.

Medial displacement calcaneal osteotomy using minimally invasive technique.

Kheir E, Borse V, Sharpe J, Lavalette D & Farndon M.


Medial displacement calcaneal osteotomy is a common procedure often used as part of pes planovalgus deformity correction. Traditionally the osteotomy is performed using a direct lateral or extended lateral approach, which may carry the risk of wound problems, infection and neurovascular injury. The authors describe a minimally invasive technique to perform the osteotomy and achieve the desired correction. The article illustrates our experience and learning curve with the use of this technique as an option for calcaneal osteotomy.


We retrospectively reviewed the records of a sequential series of patients since 2011 whose calcaneal osteotomies were performed by 2 surgeons, after cadaveric training using a minimally invasive operative approach. Prior to 2011, similar surgeries, performed by the senior authors, were undertaken using a direct lateral approach. Thirty cases were identified; 29 had tibialis posterior reconstruction coupled with calcaneal osteotomy for acquired flexible planovalgus deformity and 1 patient had surgery for a malunited calcaneal fracture.


Radiological and clinical union occurred in all 30 cases (100%). The radiographs of all cases were reviewed by a specialist musculoskeletal radiologist. There were no neurovascular or wound complications. All patients had restoration of neutral hindfoot alignment. One patient required screw removal after union, resolving all symptoms.


This series suggests that minimally invasive calcaneal osteotomy surgery can achieve excellent union rates aiding correction of deformity with no observed neurovascular or soft tissue complications. For surgeons experienced in open surgery, there is a short learning curve after appropriate training.

Foot & Ankle Surgery

Complex ankle & hindfoot fusion using angled blade plate

Foot Ankle Surg. 2015 Dec;21(4):240-4.

The use of the 4.5 mm 90° titanium cannulated LC-angled blade plate in tibiotalocalcaneal and complex ankle arthrodesis.

Kheir E, Borse V, Bryant H & Farndon M.


Tibiotalocalcaneal arthrodesis is used to manage end stage arthritis, often associated with severe bone loss. The goal is to relieve pain through a stable, well-aligned hindfoot and ankle. We describe our initial results and outcome of ankle and tibiotalocalcaneal arthrodesis using a 90° blade plate.


We retrospectively reviewed the records of patients managed at our institution between 2010 and 2014. Twenty cases were identified who had either talocrural (n = 9) or TTC fusion (n = 11) with 1 patient having both ankle and then TTC fusion in separate sittings.


Fusion occurred in 18 of the 20 cases (90%) with correction of angular deformity and restoration of hindfoot alignment. None of the 18 patients developed complications and all discharged to follow-up when independently mobile and satisfied with the outcome.


This study demonstrated that using a 90° blade plate for ankle or TTC arthrodesis in a diverse group of complex primary and revision indications associated with severe deformity and bone loss resulted in a high rate of bony union and stable deformity correction.

European Foot & Ankle Society, 2014

European Foot & Ankle Society, October 2014

I attended the 10th European Foot & Ankle Society (EFAS) International Congress, to present our initial experiences and learning curve with minimally invasive calcaneal osteotomy as part of adult flexible flatfoot correction.

Since 2011 we have performed all of these operations minimally invasively with good results.

We have found considerable advantages over the older open technique which requires a large skin incision. At the European Foot & Ankle Society International Congress in October 2014, we reported the results of the first 30 cases we performed as early adopters of this new technique in the UK.

A very enjoyable couple of days! A really interesting meeting in a very beautiful city.

Local anaesthetic ankle block – EFORT, Berlin, 2012

Elective foot and ankle surgery is traditionally viewed as a painful experience.
Modern specialist practice involves the use of selective injections of long lasting local anaesthetic agents (a local anaesthetic ankle block) to numb the nerves in the foot and ankle before surgery commences.
Surgery is undertaken under a general anaesthetic, though supplemented by the local anaesthetic ankle block.
Most patients will have little or no pain in the recovery room following completion of surgery if these methods are used by specialists.

We found that there was little difference in the excellent pain relief obtained by an experienced specialist anaesthetist or surgeon undertaking a local anaesthetic ankle block. The vast majority of patients had a pain score of zero in recovery after a wide variety of elective (planned) forefoot operations.

We presented our results to the annual EFORT Congress meeting in Berlin in 2012.