Mr Devendra Mahadevan

As a doctor who specialises in diagnosing and treating foot and ankle problems, I see a lot of people who are struggling with a painful, swollen Achilles tendon.

Tendons connect bone to muscle and are heavily involved in helping to cause movement when our muscles are contracted or relaxed. The Achilles tendon is the largest tendon in the body and connect the calf muscle to the heel. It is used whenever you undertake weight bearing activities such as walking, running, stair climbing and so forth.

When the Achilles tendon is weakened over time or as a result of heavy use, small (or large) tears can occur in it, causing pain and swelling. This is known as Achilles tendinopathy.

Do I have Achilles tendinopathy?

Achilles tendinopathy is one of those conditions where you don't fully appreciate how frustrating and limiting it can be until you have it yourself!

Most of us move around every day with minimal awareness of the work our heels and ankles are doing; I can guarantee that somebody with Achilles tendinopathy is extremely aware of them. Even the simple act of walking can cause really quite significant pain and discomfort.

Many of the people I see with Achilles tendinopathy are keen sportspeople. The Achilles tendon is placed under significant load during sports involving repetitive impact work (for example, those involving jumping movements). Having said that, Achilles tendinopathy is not a problem exclusive to people who play sports and it can occur in people of all ages and activity levels.

How is it diagnosed?

Fortunately, it is usually very simple for me to diagnose Achilles tendinopathy from talking with you about your symptoms and carrying out an examination. By gently pressing on the affected area, I will be able to determine the location of any pain, tenderness or swelling you have.

The most common indicators I'll be looking for are pain around the Achilles tendon and a thickened tendon. The type and severity of the pain will differ for each person, ranging from sharp and severe to dull and generalised.

Many people tell me they feel the worst symptoms the morning following exercise, a result of the Achilles tendon becoming stiff overnight.

You may need additional diagnostic scans to assess for other co-existing problems around the tendon.

How is it treated?

There are a few different treatment options available for Achilles tendinopathy, conservative (non-surgical) and surgical. I will always advise non-surgical treatment first.

Physiotherapy can be very good at helping relieve your symptoms (i.e. getting you out of pain) and helping to prevent future damage to the tendon. Your physiotherapist will be able to show you gentle stretching and strengthening exercises to carry out that will normally be very helpful. Using a heel lift insole is an effective way of off-loading the tendon, which will help reduce the pain further.

Pain relief medication and anti-inflammatories can also be of help and I'll talk with you about this when we meet. If these simple measures do not help, ultrasound therapy (shockwave) or a high-volume injection around the tendon may be recommended.

If the damage to your tendon is more significant and conservative treatment is ineffective, surgery may be needed. Should this be the case, I will talk you through the operation, explaining how it will be done and what you should expect you recovery to be like. The decision to have surgery is always yours to make, I will help ensure you have all the information you need to make an informed choice. 

Your consultation is also a very good time to ask me any questions you have about treatment options, or to talk through any concerns with me. I am always happy to help.

Can I help you?
Pain and swelling in the Achilles tendon can have a surprisingly big impact on our ability to walk, to move and to take part in everyday activities and sports.

When the pain is mild or intermittent, it can be easy to ignore it and put off getting it treated. When it becomes more painful, or painful for longer, most people start to think about getting expert help!

If you're at the stage of looking for help, it is very easy to arrange to see me at Circle. My private secretary will be delighted to schedule a time that's convenient for you. When we meet, I'll talk about your symptoms with you and will examine your foot and ankle to assess things. Once we know exactly what is causing your pain, I'll talk with you about the most suitable treatment options, so that you can decide what would be best for you.  

A painful Achilles tendon can be frustrating and limiting. I will help get you out of pain so that you can get back to your normal activities again as soon as possible.

Arthritis is a condition that can affect any joint of the body. It can occur in people of all ages and can cause significant pain and discomfort.

As a specialist in treating problems in the foot and ankle, I see a lot of people who are really struggling with ankle arthritis. Long-term pain and stiffness in the ankle can affect so much of normal, everyday life. When I talk with people and explain that their pain can often be managed well with a range of treatments, it is often such a big relief to them.

If you have arthritis in your ankle, or think you might, why not arrange a consultation with me? With no waiting lists, I can see you quickly and help get you out of pain as quickly as possible.

Do you have ankle arthritis?

There are a number of different types of arthritis and the one I see most commonly is known as osteoarthritis. Osteoarthritis causes the smooth articular cartilage at the ends of bones to wear down far more quickly than normal. In a healthy joint, the bone surfaces move freely and smoothly over one another. In a joint with osteoarthritis the bones begin to rub when they move, causing causes pain, stiffness and swelling in the joint.  New bony growths called osteophytes can also form in the ankle, making the joint much stiffer.

As the arthritis progresses, the symptoms also tend to become worse.

At your consultation, I will talk with you about your specific symptoms. I'll want to know how long you've had them, whether they have been getting worse and how they are limiting or affecting your normal life. I believe treatment should be tailored to fit the individual, and this starts with getting to know you, your situation and what you would to see as a result of any treatment.

I'll examine your foot and ankle, to assess how the joint is currently working and to see when it is causing problems or discomfort for you. I will normally arrange for you to have an X-ray of your ankle, as this can help assess the extent of arthritic damage to the joint. If you need any additional diagnostic scans, I will arrange those for you.

Treating ankle arthritis

Unfortunately, there isn't yet a 'cure' for arthritis. There are however some very good treatments available to help get you out of pain and back to being able to do the things you love.

Treatments fall into two categories; non-surgical (known as 'conservative') and surgical. In nearly all cases, I will always start with conservative treatment. Surgery is most appropriate for more severe arthritis when the joint is damaged extensively. 

Conservative treatment includes pain relief medication, splints  braces  and corticosteroid injections into the ankle joint. The best one(s) for you will be decided when we know the extent of the arthritic damage in the joint.

If these non-surgical treatments don't give you the pain relief you want, or stop being as effective, I may advise you to have ankle surgery.  There are two surgical procedures I can carry out:

Ankle arthrodesis (fusion): Using metal plates or screws, the bones in the ankle are permanently joined together. Although you would expect to have less mobility as a result, the numerous joints in the foot are often able to compensate to a remarkable degree.
Total ankle replacement surgery: The damaged, worn surfaces of the joint are removed and resurfaced with a cobalt/chrome metal joint. High-density polyethene sits between the metal surfaces and acts as a bearing surface. This surgery maintains movement in the ankle joint and removes the cause of your chronic pain.

Can I help you?

Living with arthritis in any joint can be challenging. When it's in the ankle, the pain and problems are often magnified as a result of how involved the ankle joint is in moving and everyday activity. 

When the arthritis is in its early stages, your pain may be mild or intermittent. As the arthritis develops, your ankle will become stiffer and more painful and it will become much harder to ignore.

Good help is available for arthritis in the ankle. If you would appreciate talking with someone about managing and treating your arthritis, it would be a real pleasure to help. It is very easy to arrange to see me at Circle, my private secretary will be delighted to schedule a time that's convenient for you.

When we meet, I'll talk about your symptoms with you and will examine your foot and ankle to assess things. Once we know exactly what we are dealing with, I'll talk with you about the most suitable treatment options, so that you can decide what would be best for you.

Get in touch today to get your ankle pain under control as quickly as possible.

A bunion (also known as Hallux Valgus) is a deformity of the big toe. Your big toe starts to point inwards towards the other toes, and you may notice a bony lump beginning to form on the inside of your foot at the base of the big toe.

Surgery is available to correct bunion deformities when they become painful and to straighten the big toe. As a doctor who specialises in treating foot and ankle problems, I've seen first-hand the difference bunion removal surgery has made to the lives of countless people. I would love to help you too.

Why do you have a bunion?

A bunion can form for a number of reasons. They tend to run in families, although I always tell people that this doesn't mean their children will definitely have them as well. They are also more common in women than men.

Shoes that fit poorly, or that squeeze the toes unnaturally, can increase the chance of developing a bunion, as can wearing high heels.

Are bunions bad?

When a bunion develops, our shoes can begin to rub against our foot at the point the bunion is growing out to the side, causing pain and discomfort. The smaller toes can also start to deform as they come under increasing pressure themselves.

Each foot contains 26 bones. A deformity or problem in just one of these bones may mean that extra pressure is placed on other bones to compensate. This can cause pain under the ball of your foot, normally noticed more when walking or weight-bearing.

You may also be at a greater risk of developing arthritis in the joint, which will cause more pain.

Do you need surgery?

The good news is that just because you have a bunion, you won't necessarily need to have surgery. Many people with bunions are able to reduce pain sufficiently by wearing wide, well-fitting shoes and avoiding high heels. Small pads placed on the bunion can relieve the pressure, which helps to reduce the pain.

However, some people will find that these options don't help them as much as they would like. This is the point I would talk to you about surgery, discussing the benefits, potential risks and what you can expect your treatment to be like.

Bunion surgery is a "catch all" term as there are actually a number of different surgical options available to treat bunions. While the non-surgical options described above can often help relieve the symptoms, the only way to get rid of a bunion is with surgery.

The exact surgery I carry out will be decided based upon a range of factors, including the size and shape of your bunion. I'll talk through the operation beforehand so that you know exactly what will be done. The important thing to know is that any bunion surgery I carry out will be aimed at correcting the deformity in your big toe and giving you a narrower foot once again. 

The surgery will be carried out under general anaesthetic, and is a day-case procedure, meaning you'll be able to go home afterwards. During the surgery, I'll make two small cuts, one on the side of your big toe, the other over the top of the foot. I'll then cut the long bone at the base of your big toe as much as is needed and move it across to correct the bunion deformity. One / two small screws will be used to fix it in position. Additional bone cuts may be required to reduce the deformity.

As with any operation, it will take time for your to fully recover. You will be allowed to walk on the heel of the operated foot immediately after surgery in a specialised sandal. However, I always emphasise the importance of rest and of elevating your foot as much as possible for the first few weeks to help minimise swelling. It can take a couple of months for any swelling to go fully down.

Can I help you?

From talking with many patients over my years as a specialist foot and ankle surgeon, I know just how frustrating and painful a bunion can be. For such a small part of the foot, it can often have a surprisingly big impact on our ability to walk, to move and to take part in our everyday activities and sports.

In the early stages of a bunion, your pain may be tolerable and easy to ignore it. As it becomes more pronounced and the pain increases, expert advice and treatment can be a real benefit.

If you're at the stage of looking for help, it is very easy to arrange to see me at Circle. My private secretary will be delighted to schedule a time that's convenient for you. When we meet, I'll talk about your symptoms with you and will examine your foot. Once I've thoroughly assessed your bunion and the problems it is giving you, I'll talk with you about the most suitable treatment options, so that you can decide what would be best for you.

Hallux rigidus is the medical term for arthritis in the big toe. Arthritis is a condition that can affect any joint of the body, can occur in people of all ages and that can cause significant pain and discomfort.

As a specialist in treating problems in the foot and ankle, I see a lot of people who are really struggling with arthritis in their big toe. For such a seemingly small joint, it can have a big impact on everyday life. While you may think of arthritis as being more common in older people, arthritis in the big toe can begin very early in life, even in your teens. Fortunately, if you do get arthritis in your big toe when you're young, it doesn't mean that you are consequently more likely to develop arthritis in other joints as you get older. 

If you have arthritis in your big toe, or think you might, why not arrange a consultation with me? With no waiting lists, I can see you quickly and help get your pain managed as quickly as possible.

Do you have arthritis in your big toe?

There are a number of different types of arthritis, the one I see most commonly in the big toe is known as osteoarthritis. Osteoarthritis causes the smooth articular cartilage at the ends of bones to wear down far more quickly than normal. In a healthy joint, the bone surfaces move freely and smoothly over one another. In a joint with osteoarthritis the bones begin to rub when they move, causing causes pain, stiffness and swelling in the joint.  New bony growths called osteophytes can also form in the big toe, making the joint much stiffer.

As the arthritis progresses, the symptoms also tend to become worse.

At your consultation, I will talk with you about your specific symptoms. I'll want to know how long you've had them, whether they have been getting worse and how they are limiting or affecting your normal life. I believe treatment should be tailored to fit the individual, and this starts with getting to know you, your situation and what you would to see as a result of any treatment.

I'll examine your foot to assess how the big toe joint is currently working and the extent of the discomfort it is causing you. If you need any diagnostic X-rays or scans, I will arrange those for you.

Treatment

Unfortunately, there isn't yet a cure for arthritis. There are however some very good treatments available to help get you out of pain and back to being able to do the things you love.

Treatments fall into two categories; non-surgical (known as 'conservative') and surgical. In nearly all cases, I will always start with conservative treatment. Surgery is most appropriate for more severe arthritis when the big toe joint is damaged extensively. 

Conservative treatment includes wearing shows with stiffer soles (to reduce the amount of movement the big toe joint makes when walking), pain relief medication and a corticosteroid injection into the big toe joint. The best treatment(s) for you will be decided when we know the extent of the arthritic damage in the joint.

If these non-surgical treatments don't give you the pain relief you want, or stop being as effective, we may discuss surgery to treat the problem. There are a few different types of surgery I can do, and the one used will depend on a number of factors, including the location, extent and severity of the arthritis.

These surgical options range from a trim and wash out of the joint (cheilectomy), fusion (arthrodesis) or the implantation of a synthetic joint spacer. I will talk you through the operation that I believe would be best for you, based on my years of experience. If you have any questions or concerns, this is a great time to talk through them with me, I am always very happy to help.

I will make sure you have all the information you need to make a sensible, informed decision about your treatment.

Can I help you?

Living with arthritis in any joint can be challenging. When it's in the big toe, the pain and problems are often magnified as a result of how involved the toe is in moving and everyday activity. 

When the arthritis is in its early stages, your pain may be mild or intermittent. As the arthritis develops, your big toe may become stiffer and more painful. These problems will usually become much harder to ignore.

Good, effective help is available for arthritis in the big toe. You don't need to suffer in silence. If you would appreciate talking with someone about managing and treating your arthritis, it would be a real pleasure to help. It is very easy to arrange to see me at Circle, my private secretary will be delighted to schedule a time that's convenient for you.

Morton's neuroma is a painful condition that occurs when a nerve in your foot becomes thickened or irritated. It causes pain or numbness in and around the ball of the foot and some people I talk to say it feels like they have a small stone in their shoe (as you can imagine, this can get pretty annoying after a short time, especially as you can't just take your shoe off and shake the stone out). Over time, these symptoms may get worse, with a sharp, shooting pain around the ball of the foot.

How is it diagnosed?

Fortunately, it is usually fairly straightforward for me to confirm a diagnosis of Morton's neuroma when you see me. I will talk with you about your symptoms and carry out an examination. The 'classic' test is for me to squeeze your forefoot. If you do have a neuroma, this squeezing will increase the pressure on it, causing you some pain.

If there is any doubt about the diagnosis, I will arrange an ultrasound or MRI scan to help clarify things, and these can both be carried out at Circle. The key thing to point out is that diagnosis isn't a long, drawn out process; it is normally very quick, meaning we can start treating you and getting you out of pain quickly. 

Treatment

If you are diagnosed with Morton's neuroma, there are some good treatments available to help get you out of pain and back to being able to do the things you love.

These treatments fall into two categories; non-surgical (known as 'conservative') and surgical. In nearly all cases, I will always start with conservative treatment. Surgery may be advised when conservative treatments aren't working as well as expected.

Wearing shoes that are slightly wider than normal can help relieve symptoms. You can also buy special foot pads to put inside your shoe that can help reduce the pressure on the nerve.

I may recommend a corticosteroid injection into the painful area of your foot. This has both pain-relieving and anti-inflammatory properties and is usually very good at taking away pain fast. It can be a good way of getting you out of pain quickly without the need for surgery.  

If your symptoms are more severe and these treatments aren't giving you the relief I would expect, I will talk with you about surgery to remove the painful neuroma. I will explain how the operation will be done and what you should expect you recovery to be like. As with any surgery, you should be aware of all the facts about it before making a decision to go ahead with it or not. The decision to have surgery is always yours to make, I will help ensure you have all the information you need to make an informed choice. 

Your consultation with me is also a very good time to ask me any questions you have about treatment options, or to talk through any concerns with me. I am always very happy to help.

Can I help you?

Morton's neuroma can be a very painful condition to have. When the pain is mild or intermittent at the early stages, it can be easy to ignore. As the neuroma becomes more painful, it is definitely worth getting expert medical advice.

If you're at the stage of looking for help, it is very easy to arrange to see me at Circle. My private secretary will be delighted to schedule a time that's convenient for you. When we meet, I'll talk about your symptoms with you and examine your foot. Once we know exactly what is causing your pain, I'll talk with you about the most suitable treatment options, so that you can decide what would be best for you.

I will help get you out of pain so that you can get back to your normal activities again as soon as possible. 

Our ankle joint is remarkable, helping us to move, walk, run and stand. In fact, our ankle is involved in some way nearly every time we move. This means that any problem with the ankle can cause us quite a lot of difficulty moving and going about our daily activities.

Ankle sprains are very common and many of us will have experienced the pain, discomfort and swelling that tends to follow a sprain. Keen sportspeople are particularly prone to ankle sprains, and many athletes (at all levels) frequently come to me for help getting them out of pain and back to the sport they love as quickly as possible.

Fortunately, most ankle sprains are fairly mild and will heal naturally with rest. You may have heard the old R-I-C-E principal; Rest, Ice, Compression, Elevate. Some sprains however will not heal naturally over time and will need expert help, possibly even surgery, to fix. This is where I can help.

What is an ankle sprain?

Your ankle joint is formed by the lower shin bone (tibia) and the ankle bone (talus). Strong ligaments between these bones help hold the joint securely in place.

When we twist our ankle, which usually happens when walking or running, these ligaments can become damaged. If the twist is particularly violent, the ligaments may even tear (rupture) completely.

If the ligaments have been damaged, the ankle sprain may never fully heal naturally.

Do you have recurrent ankle sprains?

People who come to see me for help with ankle sprains tend to complain of one or many of the following:

feeling unsteady or weak around the ankle
swelling
ankle giving way, especially on uneven ground
If you've had a particularly nasty sprain, you may feel that you ankle has never really felt right again. If you can relate to this, it can be helpful to get an expert assessment of things to see if there are any treatments that could help take your pain away and restore stability in your ankle.

A consultation with me can be a really good way of finding out what's wrong with your ankle and what can be done to help fix it. I'll talk with you about how your ankle feels and behaves and will carry out a thorough examination of the ankle.

I will usually arrange for you to have an X-ray of the ankle as this can help assess the extent of any problems. If any further diagnostic scans are needed to confirm diagnosis or to plan treatment, I will arrange those to be carried out for you as well.

Treatment options

I know that recurrent ankle sprains can be really frustrating. The good news is that I also know there are a number of good, effective treatments available that can help get you out of pain and back to better ankle strength, stability and movement.

These treatments fall into two categories; non-surgical (known as 'conservative') and surgical. In nearly all cases, I will always start with the conservative treatment, which is physiotherapy, as this can be very effective in managing ankle sprains and reducing the likelihood of getting them in the future. Using a number of specific exercises, your ankle will be strengthened and stabilised. Physiotherapy isn't an instant cure; it will take time and effort, but the results can be really very good.  

Sometimes, physiotherapy may not be able to give you the results you would like. In these cases, surgery to repair the ligament can be helpful.

If I believe surgery will be the best treatment option for you, I will always talk with you about how the operation will be done and what you should expect you recovery to be like. As with any surgery, you should be aware of all the facts before making a decision to go ahead with it or not. The decision to have surgery is always yours to make, I will make sure you have all the information you need to make an informed choice. 

At your consultation, you are always very welcome to ask me any questions you have about treatment options, or to talk through any concerns. I am always very happy to help.

Can I help you?

Ankle sprains can be painful, frustrating and limiting. Recurrent ankle sprains multiply those problems. Rather than just putting up with things, why not come and see me for help?

It is very easy to arrange to see me at Circle, my private secretary will be delighted to schedule a time that's convenient for you. I will help you get the best treatment for your ankle sprain so that you can get back to your normal activities as soon as possible.