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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


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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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.

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.