Conseravtive treatment of intermetatarsal neuroma

Conservative treatment of intermetatarsal neuroma

We presented this study looking at the success of a single surgeon administered injection (without image guidance) for the conservative treatment of intermetatarsal neuroma to the SICOT Orthopaedic World Congress in Rome, September 2016.


conservative treatment of intermetatarsal neuroma

We looked back at the experiences of patients after a single injection in the outpatient clinic with local anaesthetic and corticosteroid  for the conservative treatment of symptomatic neuromata.  When followed up for a mean of 29 months, approximately 60% of patients did not progress to require surgical treatment. There is rarely additional benefit in a second or third injection if the initial effect wears off quickly (within 6 weeks).

If conservative treatment of Mortons neuroma is unsuccessful then surgical treatment can be very effective for some patients:



Conservative treatment of Mortons neuroma
Conservative treatment of Mortons neuroma – ultrasound imaging of neuroma in the 3/4 webspace


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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cartilage damage

Osteochondral injury ankle

After a seemingly innocent ankle twist whilst walking that failed to settle as expected, my physio suggested referral for surgical opinion and recommended Mr Mark Farndon.

Excellent imaging and initial consultation with Mr Mark Farndon diagnosed significant damage to the cartilage (Osteochondral defect) on my left ankle bone (Talus), the following week I had ankle arthroscopy to recover the loose bits, and micro fracture to repair the damage. The day case surgery was straight forward, following surgery I was without need of pain relief and have been to this day. Two further consultations guided my rehab and physio before being discharged from care.

I would recommend Mr Mark Farndon without hesitation, efficient process, reassuring informed consultations and excellent clinical outcome.

Thank you Mark, your expertise and care is much appreciated.

Mr A Lane, Harrogate

osteoid osteoma 4th metatarsal

Osteoid osteoma in the 4th metatarsal.

Osteoid osteoma in the fourth metatarsal. A previously undescribed cause of forefoot pain.
Presented to the 28th Annual Meeting of the Musculo-Skeletal Oncology Society, Athens, April 2015

A. Kinghorn, R. Afinowi, J. Sharpe, M. Farndon
Harrogate District Hospital, Harrogate, United Kingdom

Osteoid osteomas are small, benign, bone tumours and it is estimated that between 2% and 11% occur in the foot. However, there are no documented cases in the medical literature of isolated lesions in the fourth metatarsal. We present the case of a 26 year old man with persistent pain in his left foot. Despite previous consultation and investigation, the cause of his symptoms had remained elusive for over six years.

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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.

navicular stress fracture

Navicular stress fracture

I had struggled with a stress fracture to my navicular for 18 months. I had been in and out of plaster but no further treatment was given. Mark was recommended to me by a physio I knew, after an initial consultation he made it clear that it was very unlikely the bone was not going to heal on its own. Read more

Chronic navicular stress fractures, EFORT, 2015

We presented this unusual case as a podium presentation to the EFORT  Annual Congress in Prague, May 29th 2015. Chronic navicular stress fractures were diagnosed in an individual referred for an opinion regarding longstanding ankle pain.

Sequential fixation using calcaneal bone graft was undertaken, successfully treating the patient’s pain and symptoms, allowing a return to full function.

Bilateral chronic navicular stress fractures are uncommon and infrequently reported, particularly in a non-athletic population. A brief review of the literature and presentation of the surgical tecnique employed in the treatment of this patient were described.

The axial CT image demonstrates the chronic navicular stress fractures clearly.

The subsequent XR images demonstrate the post-operative appearances after fixation using 2 double pitched titanium cannulated screws. The bone graft harvest from the ipsilateral calcaneum can also be seen on the lateral XR.

efort-2014bilateral chronic navicular stress fracturesnavic2 navic1


pan arab orthopaedic association

Pan Arab Orthopaedic Association, Muscat, 2014

I was given a fantastic opportunity to participate directly in the 18th International Congress of the Pan Arab Orthopaedic Association, held in the beautiful city of Muscat, Oman in November 2014.

The chance to visit old friends and make new ones, to co-chair part of the foot & ankle session and ‘great debate’ concerning ankle fusion versus ankle replacement was a real pleasure.

We discussed the international variance in ankle replacement practice, with speakers representing the German, Greek, Moroccan, UK, Egyptian and Omani perspectives. Ankle replacement remains a controversial issue and is not universally practiced in all of the represented nations.

It was a great honour to be given the opportunity to give invited lectures on ‘minimally invasive foot and ankle surgery’ and ‘revision forefoot surgery’.

Muscat is a beautiful city and the chance to visit the Sultan Qaboos Grand Mosque and Muttrah Souk was unforgettable.

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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.