Services
Foot and Ankle Surgery
Matrix Foot and Ankle provides current cutting edge surgical and conservative treatment options in conditions ranging from bunions, toe deformity, foot arthritis, flatfoot deformity, foot fractures, and sports injuries such as ankle instability and Achilles problems.
Gait Analysis and Orthotics
When assessing and diagnosing injuries of the lower leg, we often classify them as mechanical, acute traumatic or systemic causes.
Mechanical injuries of the muscles, tendons, ligaments and bones can often be related to the way in which your foot, leg and pelvis move, or importantly don’t move.
Undertaking a gait analysis (the way someone walks or runs), and then a biomechanical assessment (the position and function of joints) can help uncover whether the structure or function of the lower leg is causing the specific problem in the foot or lower leg.
Sometimes this requires the use of supports to go into your shoe and sometimes it requires further treatment or intervention from a physiotherapist or other medical specialty.
Orthotics are devices that go into shoes to help aid or resolve foot and lower leg injuries and can help prevent surgery, or be used in conjunction with surgery to the foot.
They can be prefabricated, i.e. made from a standard shape, or bespoke, i.e. made specifically to the patient’s shape of their foot.
Not all foot or lower leg injuries require orthotics, and many can be resolved with pre-fabricated devices.
In some special cases, we will use highly specialised braces to manage more complex foot and ankle problems.
After a thorough gait and biomechanical assessment, we will advise what is most suitable for your needs and what design is best to meet your activity and footwear requirements.
Extracorporeal Shockwave Therapy (ESWT)
Extracorporeal Shockwave Therapy treatment is a highly effective treatment available for patients with chronic tendon and soft tissue disorders. This is a very successful treatment and can be used in conjunction with other treatments such as orthotic inserts and appropriate physiotherapy.
Shockwave therapy is a non-surgical treatment, and works by delivering impulses of energy, targeted to specific damaged tissues. This increases the blood flow within the affected area, stimulating cell regeneration and healing, and decreasing local factors which can cause pain.
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A probe is pressed on to the affected area and the shockwaves are delivered through the skin (a gel like substance is also applied to the area to promote the process).
The impulses are delivered through the skin as a shockwave that spreads inside the injured tissue as a radial wave. These radial or focused shockwaves initiate an inflammation-like response in the injured tissue that is being treated, and prompts the body to respond naturally by increasing blood circulation, the number of blood vessels and therefore metabolism in the injured tissue.
The shockwaves are felt as pulses which can be uncomfortable but not too painful. The treatment was originally used as a treatment for kidney stones, and has been re-developed for the use in treating tendon and other soft tissue conditions.
Patients are treated in an outpatient environment and the procedure does not require any type of sedation or anaesthetic.
Conditions recommended for treatment with shockwave therapy:
Plantar fasciitis
Achilles tendon injuries
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As shock-wave therapy is recommended by NICE most private medical insurers will cover such treatment. However, it is essential that patients consult their insurance companies prior to starting treatment. Self-funding packages are available.
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A clinical assessment by your podiatric surgeon is required to ensure that the diagnosis is correct and that shockwave therapy treatment is the most appropriate for your condition. This assessment may involve the need for diagnostic ultrasound or MRI scan.
What can I expect after my shockwave treatment?
Many patients experience an improvement in symptoms almost immediately while others take several weeks to respond. There may be a transient reddening or swelling of the area with some patients experiencing a brief increase in pain. It may take several weeks or months to see an overall benefit. It is suggested that your podiatric surgeon reviews you between 6-12 weeks to assess your overall progress.
Injection Therapy
Injection therapy can help relieve pain, reduce inflammation, and support healing in the foot and ankle. Treatment options include cortisone injections to calm inflammation, hyaluronic acid injections to ease stiffness and improve joint movement, and PRP or autologous blood injections that use your body’s own healing properties to repair damaged tissue. Please get in touch for advice and guidance in choosing the most suitable option for your condition and recovery goals.
Cortisone Injection Therapy
Cortisone is a hormone that is naturally produced by your body's adrenal gland as a response to stress. Cortisone injections contain a synthetic version of this substance and are given as an injection directly into the injured tissue. Unlike natural cortisone, synthetic cortisone is not injected into the blood stream and therefore has no effect on the rest of the body.
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Cortisone is a powerful anti-inflammatory substance. It can lead to significant relief of pain. If your body responds well to cortisone, you are likely to experience relief within 1-3 weeks that can last for many months. Some patients may require multiple injections before complete relief is experienced or may require on-going injections to manage pain. It is important to understand that cortisone injections are not recommended in isolation and are likely to only work in the long-term if administered as part of a comprehensive treatment plan.
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Before taking any drug, it is important that you discuss its risks, benefits and possible side effects with your podiatric surgeon. Unfortunately, use of cortisone does carry risks. One of the main risks of having a cortisone injection can be a 'cortisone flare', in which pain actually initially gets worse before it improves. Pain can go on for several days before relief is experienced. This side effect occurs in about 5% of cases but does not effect the overall success of the injection.
A side effect sometimes experienced by patients is a lightening of the skin colour at the treatment site. This is termed hypopigmentation. This is painless.
Facial flushing has also been reported in rare cases
Multiple injections of cortisone in the same area can cause a natural reduction in the local soft tissue padding. This may cause joints to become more pronounced which can be a source of pain in some parts of the foot.
The risks of tendon or ligament rupture and localized infection at the injection site have also been reported in the literature but such complications are extremely rare.
Are Cortisone Injections covered by private medical insurance?
Yes all private medical insurance companies cover cortisone injections. Most will allow up to three injections per condition. Self-funding packages are also available.
Foot and ankle conditions that can be treated with cortisone injections:
Plantar fasciitis
Mortons neuroma
Joint arthritis or inflammation
Some tendon disorders
Some nerve injuries
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A consultation will be required to assess your foot problem and determine the most appropriate course of treatment. Diagnostic imaging such as ultrasound or MRI scan may need to be performed.
Injections are administered under aseptic conditions. Some injections are given under local anaesthetic block or the steroid is mixed with local anaesthetic. After the injection the area will feel numb. It is important to rest the foot for the remainder of the day and avoid prolonged standing or walking. Also it is recommended to avoid activities that make your pain worse for 2-3 days after the injection to maximize the positive effect of the injection.
Hyaluronic Acid Injections
Joints are like gears – they work best if they are well lubricated. In a healthy joint, a thick substance called synovial fluid provides lubrication, allowing bones to glide against one another. Synovial fluid acts as a shock absorber, too. In people with osteoarthritis, a critical substance in synovial fluid known as hyaluronic acid breaks down. Loss of hyaluronic acid appears to contribute to joint pain and stiffness.
Hyaluronic acid injections are one treatment option to consider to help reduce the pain and stiffness of an arthritic joint. Most studies of hyaluronic acid injections have involved the knee joint. There is now growing evidence of their use for foot and ankle joint arthritis.
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About 30 percent of people who undergo hyaluronic acid injections become virtually pain free, and symptom relief may last up to two years. Unfortunately another 20 percent of patients experience no benefit at all. It is currently not possible to predict who is going to have an outstanding response versus a modest response versus no response at all. One of the main benefits of injections of hyaluronic acid over cortisone is that repeated injections of hyaluronic acid cause no long-term damage to the joint or soft tissues which is not the case with multiple cortisone injections. This means that this treatment can be repeated many times if required over many years.
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Hyaluronic acid may act as a lubricant and shock absorber. Hyaluronic acid also has other functions in the joint such as reducing inflammation by interfere with prostaglandins and cytokines (naturally occurring compounds that promote inflammation). Injecting hyaluronic acid may coax the joint into increasing its own production of this important substance, which may in turn help to preserve cartilage.
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You can drive to and from your appointment. The injection is administered under aseptic technique. It is recommended that you do not strain your joint for two days after receiving the injection and avoid activities such as sports, heavy lifting, or prolonged standing on your feet.
Temporary pain or swelling in the joint may occur after receiving hyaluronic acid injection.
It takes about five weeks, on average, before a patient experiences the full benefits of hyaluronic acid. Large research reviews found that the pain-relieving benefits of hyaluronic acid occur at peak levels about three months after the injection.
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Pain in the injected joint
Swelling or redness in the joint
Less common;
Blistering, discoloration of the skin, feeling of pressure, hives, itching, lumps, numbness, pain, rash, redness, or warmth at the injection site.
Autologous Blood Injections
Autologous blood injections involve administering an injection of the patients own blood into a damaged tissue. This can either be whole blood or a component of the blood called Platelet Rich Plasma (PRP).
Whole blood injections have been recently studied to determine the benefit of treating common foot problems such as Plantar fasciitis with encouraging results.
Platelet-rich Plasma (PRP) injections have been used for over 20 years in the treatment of many sports and overuse injuries.
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Laboratory studies have demonstrated that the increased concentration of growth factors in PRP or increasing the level of blood within tendon/ligament/fascia can help the body’s natural healing process. Other studies have not shown much beneficial effects.
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It is not generally considered to have any major harmful effects, because apart from a patient’s own (autologous) blood, no other constituents are added to the injection. For that reason, it is popular with patients who want more of a ‘natural approach’ to dealing with their injuries.
Foot and ankle conditions that can be treated with PRP:
Plantar fasciitis
Achilles tendon injuries
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Yes but currently not all insurance companies cover this injection treatment. You should check with your insurance company prior to starting this treatment. Self-funding packages are also available.
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An initial consultation is required to assess your problem. Diagnostic imaging such as an ultrasound scan or MRI are often needed before deciding on treatment to ensure the diagnosis is correct and other similar conditions have been ruled out.
If a condition is deemed to be suitable for this treatment, your consultant will explain the procedure, risks and aftercare involved to ensure you are fully aware of the treatment process. You should use this opportunity to ask any questions you may have about the treatment.
Blood is obtained by the process of venesection, similar to a routine blood test. This is stored in a sterile syringe to prevent infection and contamination and for the PRP injection the blood is then centrifuged. The plasma-rich layer is then extracted and injected back into the same patient under sterile conditions. The injection is performed under a local anaesthetic block.
Sports Injuries
The nature of sports injuries is different to other non-sport injuries, as there are greater forces involved. These injuries can be acute or chronic in nature, and the right management is key to a safe return to activity.
Mr. Yates, who holds a master’s degree in Sports Injuries and Rehabilitation, has also worked with professional rugby and cricket teams. His expertise in managing a wide range of foot and ankle injuries will help you get back to the sports you most enjoy.