Publications and teaching
31 peer-reviewed papers and book chapters, with invited lectures and teaching roles. Figures quoted are those reported in the published papers.
Fractures and orthopaedic trauma 11
Current concepts and challenges in managing ankle fractures in the presence of diabetes: a systematic review
Forty studies reviewed. Complications after an ankle fracture are more common in diabetes, and more common again when diabetes is poorly controlled, insulin-dependent or complicated by neuropathy or vascular disease. Non-operative treatment did poorly. Supplementary fixation was associated with fewer complications. In stable fractures without neuropathy, early weight-bearing gave results similar to people without diabetes. External fixators as definitive treatment carried high complication rates.
doi.org/10.1016/j.jcot.2021.01.016To plate, or not to plate? A systematic review of functional outcomes and complications of plate fixation in patellar fractures
A systematic review of plate fixation for kneecap fractures, the alternative to tension-band wiring. Plating gave satisfactory knee movement, good function and low pain, with a complication rate of 10.4% and uncommon reoperation, mostly to remove metalwork. The authors call for randomised comparison with wiring.
doi.org/10.1007/s00590-023-03597-9Visualising the future of orthopaedic surgery: a novel application of wireless smart glasses to visualise intraoperative imaging
A case report of wireless smart glasses worn during hindfoot nailing for a complex open ankle fracture, displaying live X-ray images in the surgeon's line of sight. The surgeon reported better posture and fewer interruptions, and the signal held throughout.
doi.org/10.7759/cureus.22004Opportunities and challenges of using augmented reality and heads-up display in orthopaedic surgery: a narrative review
A review of 42 articles, filtered from just over a thousand, on augmented reality and heads-up displays in orthopaedic surgery. Reported benefits were better accuracy, shorter operations, less radiation and value in teaching. The barriers are cost, the learning curve and usability.
doi.org/10.1016/j.jcot.2021.04.031Does 3D CT reconstruction help the surgeon to preoperatively assess calcaneal fractures?
Six surgeons of differing experience assessed ten heel fractures on 2D and then 3D CT, twice, four weeks apart. Adding 3D images improved agreement on classification and on the planned operation, and changed the plan more often. Less experienced surgeons gained most. Since 3D reconstruction adds no cost or radiation, the authors recommend it for planning and teaching.
doi.org/10.1016/j.foot.2019.101659Simultaneous bilateral total hip arthroplasty dislocation with unilateral foot drop following closed reduction
A rare case in which both hip replacements dislocated at once, followed by a foot drop on one side after closed reduction, with no nerve recovery at six months.
doi.org/10.1136/bcr-2016-217230An unusual prepatellar bursa swelling: patellar button dissociation and migration
A very rare complication in which the kneecap component of a knee replacement loosened and migrated into the bursa in front of the knee eleven years after surgery.
doi.org/10.1155/2016/8208271Is a single-use portable incisional negative pressure wound therapy system suitable for revision arthroplasty?
Thirty-six revision hip and knee replacements, half with a standard dressing and half with a single-use negative pressure dressing at 80 mmHg. Wound complications occurred in three patients with standard dressings and one with the negative pressure dressing, with no dressing-related complications.
doi.org/10.1155/2015/247324Loin to groin pain: the importance of a differential diagnosis
A young man developed severe one-sided loin-to-groin pain after weightlifting and was initially misdiagnosed; the cause was acute paravertebral lumbar compartment syndrome. The report describes this rare condition and argues for a systematic approach to loin pain.
doi.org/10.1016/j.ijscr.2015.09.032Simultaneous dislocation of both interphalangeal joints in the middle finger
An uncommon injury, usually seen in the ring and little fingers. Closed reduction and splinting gave full movement at follow-up.
doi.org/10.1136/bcr-2014-207839Systematic review of outcomes following fixed angle intramedullary fixation of distal radius fractures
A review of 14 papers covering 357 patients with simpler wrist fractures treated with intramedullary devices. Function scores were as good as those after volar plating, with a complication rate of 19.6%, no tendon ruptures and temporary radial nerve irritation in 11.4%. The devices are unsuitable for complex joint fractures.
doi.org/10.1007/s00264-015-2763-1
Diabetic foot and Charcot 12
Time critical Charcot foot reconstructions can be safely performed in the absence of optimal preoperative glycaemic control when delivered by MDT
A review of 18 consecutive planned Charcot reconstructions (8 midfoot, 2 hindfoot, 8 combined) with at least a year of follow-up. Guidelines suggest waiting until HbA1c is below 8.5%; seven of these patients did not reach that target and the team went ahead anyway. There were four complications, all settled without further surgery, and no kidney or heart complications. At one year 11 patients (61%) were walking in shoes, and results did not differ between those who met the target and those who did not.
doi.org/10.1016/j.fas.2025.10.001Investigation and management of diabetic foot osteomyelitis: an update for the foot and ankle orthopaedic surgeon
A review of bone infection in the diabetic foot, written for surgeons. It covers diagnosis with MRI, bone scans and bone biopsy, culture-guided antibiotics often given for long periods, and surgery ranging from drainage to debridement and bone resection. It also sets out how recurrence is prevented: glucose control, foot care, patient education, restoring blood supply where needed, and early review of any new wound.
doi.org/10.1016/j.jcot.2023.102330Combined Charcot hindfoot and midfoot reconstruction using internal fixation: surgical technique and single-surgeon series
Around a third of Charcot deformities needing limb salvage involve both the hindfoot and the midfoot. This paper describes the technique — hindfoot first, then midfoot, with long rigid internal fixation — in 34 patients (35 feet) treated between 2009 and 2019, eleven of them in two stages because of active infection. At a mean of 53 months, 11 of 13 ulcers had healed and 33 feet were fully weight-bearing in surgical shoes or a brace. Metalwork failed in five feet and four patients needed revision.
doi.org/10.21037/aoj-22-23Etiology, epidemiology and outcomes of managing Charcot arthropathy
An invited review of what causes Charcot arthropathy, the factors that influence the outcome of treatment, and what the condition costs health systems. Surgery for Charcot is becoming more common, driven by rising prevalence, a better understanding of the cause, and better identification of the patient factors that can be improved before an operation.
doi.org/10.1016/j.fcl.2022.03.002Predictors of metalwork failure and non-union after hindfoot Charcot reconstruction
Seventy hindfoot reconstructions with an intramedullary nail between 2007 and 2019, followed for a mean of 54 months. The hindfoot fused in 83% and 74% were fully weight-bearing at final review. Age, weight, HbA1c and previous vascular surgery made no difference to union. What did: a nail that filled the tibial canal, an additional hindfoot compression screw (95% union against 78%), and an intact medial malleolus. Metalwork failed in 19%. These findings shape how the construct is built.
doi.org/10.1302/0301-620X.104B6.BJJ-2022-0127Charcot hindfoot deformity reconstruction using a hindfoot nail: surgical technique
A step-by-step account of the operation for the collapsed Charcot ankle and hindfoot: assessment, planning and timing, the approaches and bone cuts, nail insertion and locking, and the additional screw or plate that adds rotational stability. It is written to shorten the learning curve for other surgeons.
doi.org/10.1016/j.jcot.2021.02.007Charcot foot reconstruction outcomes: a systematic review
Every published series of Charcot reconstruction from 1993 to 2018: 1,116 feet in 1,089 patients. Internal fixation was used in 65%, external fixation in 31% and both in 4%, with no technique clearly better than another. Overall bone fusion was 86%, a technique-related complication occurred in 36%, the amputation rate after reconstruction was 5.5% and 91% returned to walking. The authors note that the quality of the evidence is low.
doi.org/10.1016/j.jcot.2020.03.025Modern orthopaedic inpatient care of the orthopaedic patient with diabetic foot disease
A review of 30 admissions in 19 complex patients needing surgery for infected ulcers, Charcot deformity or both, managed by the multidisciplinary team as a series of key events with close microbiological and blood-test monitoring. There were three minor amputations and no major amputations. Podiatry swabs matched the surgical bone specimen in only two of nine pairs, which is the reason bone is sampled.
doi.org/10.1177/1534734615596114The medial column Synthes Midfoot Fusion Bolt is associated with unacceptable rates of failure in corrective fusion for Charcot deformity
The first nine patients (ten feet) in whom a single 6 mm bolt was used to fuse the inner column of the foot. The deformity was corrected well — the mean Meary angle improved from 26° to 1° — but in all but two feet at least one joint failed to fuse, the bolt migrated in six, and four needed revision, which then united. The device could not be recommended in that form; midfoot fixation moved to long beams and plates.
doi.org/10.1302/0301-620X.97B6.34844Outcome of one-stage correction of deformities of the ankle and hindfoot and fusion in Charcot neuroarthropathy using a retrograde intramedullary hindfoot arthrodesis nail
Twenty patients (21 feet) with severe ankle and hindfoot deformity, 15 of them with long-standing ulcers, treated with single-stage correction and a retrograde hindfoot nail. At a mean of 26 months every limb had been saved, 80% of ulcers had healed and all but one patient walked independently. One nail broke and was revised. Standard screws migrated where hydroxyapatite-coated screws did not. Function and quality-of-life scores improved significantly.
doi.org/10.1302/0301-620X.97B1.34542Plantar fascia calcification: a sequela of corticosteroid injection in the treatment of recalcitrant plantar fasciitis
A case report. Two and a half years after a steroid injection for severe heel pain, a calcified lump under the skin ulcerated and became infected, leading to a diabetic foot infection that needed a long course of intravenous antibiotics.
doi.org/10.1136/bcr-2013-200303Time critical Charcot foot reconstructions can still be performed in the absence of preoperative glycemic control when delivered by MDT
The conference abstract of the Foot & Ankle Surgery paper above, reporting the same group of 18 patients (10 with type 1 and 8 with type 2 diabetes) and the same conclusion.
doi.org/10.1177/2473011424S00561
Books and book chapters 5
Surgical Techniques in Charcot Neuroarthropathy Reconstruction
A chapter on the surgical management of Charcot neuroarthropathy, setting out the techniques used and weighing the advantages and disadvantages of operating.
doi.org/10.1007/978-3-031-93742-2_16Limb Salvage for the Diabetic Foot
Written with plastic surgeons Camilla Stewart and Naveen Cavale. The chapter covers assessment and optimisation by the team, clearing infection before reconstruction, and how the size, site and anatomy of the defect guide the choice of cover. It follows the reconstructive ladder: healing by secondary intention, split skin grafts, tissue advancement, local rotation flaps and free tissue transfer. The hand-drawn anatomical illustrations used on this site come from this chapter.
doi.org/10.1007/978-3-319-17918-6_9The Response to Injury in the Child and Bone Healing
The opening chapter of the book, on how a child's tissues respond to injury and how bone heals.
doi.org/10.1007/978-1-4471-6756-3_1Orthopaedic surgery chapter
The orthopaedic and trauma chapter of a handbook on obtaining informed consent for common surgical procedures.
Surgical SBAs for Finals with Explanatory Answers
A book of single best answer questions with explanatory answers for medical students, combining clinical and basic science questions set in clinical scenarios.
Earlier research 3
The association between metal ions from hip resurfacing and reduced T-cell counts
Sixty-eight patients with well-fixed, symptom-free hips: 34 metal-on-metal resurfacings and 34 metal-on-polyethylene replacements. Blood cobalt and chromium were significantly higher after resurfacing and CD8+ T-cell counts were significantly lower, with no evidence that patients came to harm.
doi.org/10.1302/0301-620X.88B4.17216A hypothesis and model of reduced fetal movement as a common pathogenetic mechanism in clubfoot
A hypothesis paper proposing that reduced movement in the womb, a key signal in joint development, is the common factor across the causes of clubfoot, and that this could simplify how the condition is understood and classified.
doi.org/10.1016/j.mehy.2009.04.056Discordant practice and limited histopathological assessment in gastrointestinal neuromuscular disease
A multicentre letter reporting inconsistent practice and limited tissue assessment in gastrointestinal neuromuscular disease.
doi.org/10.1136/gut.2009.184572
Teaching roles
AO Foot & Ankle UK
Chair of AO Foot & Ankle UK, which runs surgical education courses for trainees and consultants.
King's Fellowship
Lead of the King's College Hospital Foot & Ankle Fellowship programme.
King's College London
Honorary Senior Clinical Lecturer.
Cadaveric courses
Faculty and course organiser for hands-on cadaveric workshops in Charcot and foot and ankle reconstruction.
Invited lectures and faculty 12
IADFS, Padua
Staged Charcot foot reconstruction for the infected, ulcerated Charcot foot (Orthoplastics session).
Hyderabad, India
Biology of fracture healing in the diabetic foot; bone graft and biologics in Charcot reconstruction, with operating and teaching.
CX Symposium, London
Invited faculty: new techniques in Charcot reconstruction.
King's Diabetic Foot Conference, London
What to do in the failed vascular patient; how I manage infected Charcot foot deformities; current orthopaedic trends in ischaemic Charcot reconstruction.
King's Diabetic Foot Conference, London
Midfoot Charcot reconstruction.
Turkey
Two-stage reconstruction for the infected Charcot foot; the hindfoot nail construct; the origin of long-segment rigid fixation; diabetic foot ulcers; midfoot cadaveric workshop.
King's Charcot Midfoot Cadaver Workshop, London
Faculty: surgical approaches, osteotomy planning, beaming and plating.
IADFS, Goa
Tips and tricks in hindfoot nailing in Charcot arthropathy.
KDFS, London
Rotational control in hindfoot nailing.
KDFS and IADFS
Hindfoot nail for Charcot reconstruction; outpatient tendon balancing procedures.
WIROC, Mumbai
Invited faculty: diabetic foot case-based discussions.
EFORT, Lisbon
Complications of ankle fracture in diabetes: a systematic review (poster).