Who is Mr Shelain Patel?

Mr Shelain Patel (BSc, MBBS, DipSEM, FRCS) is a consultant orthopaedic surgeon who works exclusively on foot and ankle conditions in London and Stanmore. He is one of only four foot and ankle surgeons at the Royal National Orthopaedic Hospital, the UK's top rated orthopaedic institution.

What conditions does Mr Shelain Patel treat?

He treats the full range of foot and ankle disorders including ankle sprains, ligament damage and instability, ankle arthritis and cartilage injuries, Achilles tendon tears and pain, bunions and big toe arthritis, flat feet and tibialis posterior tendon dysfunction, plantar fasciitis and heel pain, Morton's neuroma, foot drop following nerve and spine injuries, congenital and complex acquired deformities, and trauma including osteochondral lesions.

What surgery does Mr Shelain Patel perform?

Procedures include bunion correction, ankle replacement, ankle fusion, keyhole ankle arthroscopy and microfracture, Broström-Gould ligament repair, Achilles tendon repair and Haglund excision, big toe replacement and fusion, Morton's neuroma excision, flat foot and cavus foot reconstruction, minimally invasive metatarsal osteotomy, and tibialis posterior tendon transfer for foot drop. Only about one in three consultations leads to a discussion of surgery.

Where does Mr Shelain Patel practise?

His private practice is in the Harley Street district of Central London at HCA Princess Grace Hospital and King Edward VII's Hospital, and in North London at Spire Bushey, Elstree Waterfront and RNOH Private Care in Stanmore. The consultation address is 30 Devonshire Street, London, W1G 6PU.

How do I book a consultation with Mr Shelain Patel?

Consultations can be booked by contacting his secretary on 020 3960 1705 or by email at patelpa@gop.health. He accepts both private medical insurance and self pay patients.

Does Mr Shelain Patel offer second opinions?

Yes. Through his role at the Royal National Orthopaedic Hospital he provides specialist second opinions for patients facing complex foot deformity or who have had unsuccessful previous treatment.

Causes of ankle arthritis

Shelain Patel

Ankle arthritis occurs when the smooth cartilage that covers the bones forming the ankle joint becomes damaged or progressively worn. As the cartilage deteriorates, the joint can become painful, stiff and swollen, and movement may become increasingly restricted.

Unlike arthritis affecting some other joints, ankle arthritis is often associated with a previous injury. Ankle fractures, ligament injuries, recurrent ankle instability and previous surgery can all contribute to the development of arthritis later in life.

Understanding why ankle arthritis has developed is important because the cause, degree of joint damage, alignment of the ankle and condition of the surrounding foot can all influence treatment.

Mr Shelain Patel is a Consultant Orthopaedic Foot & Ankle Surgeon in London and Consultant at the Royal National Orthopaedic Hospital (RNOH), with specialist expertise in ankle arthritis, ankle replacement and complex foot and ankle reconstruction.

What are the main causes of ankle arthritis?

There are several different causes of ankle arthritis.

Post-traumatic ankle arthritis

Previous injury is one of the most common causes of ankle arthritis.

Arthritis can develop following:

ankle fractures
severe ankle sprains
ligament injuries
syndesmotic injuries
ankle dislocations
pilon fractures
cartilage injuries
previous surgery around the ankle

The risk depends on the severity and nature of the original injury. Damage to the cartilage or an alteration in the alignment of the joint can increase the likelihood of developing arthritis.

Read more about [post-traumatic ankle arthritis].

Ankle fractures

A fracture involving the ankle joint can damage the cartilage directly. Even when the fracture heals successfully, changes in the shape or alignment of the joint can increase the stresses placed across the ankle.

More complex fractures, including pilon fractures, can result in substantial cartilage damage and may lead to significant arthritis years after the original injury.

Pilon fractures

A pilon fracture affects the lower end of the tibia and involves the weight-bearing surface of the ankle joint.

Because the fracture can damage the joint surface itself, post-traumatic arthritis is a recognised long-term consequence. Previous metalwork, bone loss, deformity and altered ankle alignment can make treatment particularly complex.

Previous ligament injury and ankle instability

Repeated ankle sprains or chronic ankle instability can alter the way forces pass through the ankle.

Long-standing instability may contribute to abnormal loading of the cartilage and, over time, may contribute to degenerative changes.

Not everyone with ankle instability develops arthritis, but recurrent symptoms should be assessed if they are affecting activity or function.

Primary osteoarthritis

Primary osteoarthritis occurs without a clearly identifiable major previous injury.

It is less common in the ankle than in the hip or knee. The ankle is particularly well adapted to transmitting load, and significant ankle arthritis often has another identifiable cause.

Inflammatory arthritis

Conditions such as rheumatoid arthritis and other inflammatory arthropathies can affect the ankle joint.

Inflammation can damage cartilage and other structures around the ankle. Treatment may involve a combination of medical management and specialist orthopaedic treatment.

Previous infection

An infection involving the ankle joint can damage cartilage and lead to arthritis.

This can sometimes occur many years after the original infection. Previous infection is particularly important when considering surgery because the possibility of persistent or recurrent infection may need to be investigated.

Previous ankle surgery

Previous surgery does not necessarily cause arthritis, but some patients who have undergone significant surgery around the ankle may subsequently develop degenerative changes.

Previous procedures, metalwork, altered alignment, scar tissue and bone loss can all be relevant when planning further treatment.

Congenital or developmental abnormalities

Abnormal alignment or development of the foot and ankle can alter the distribution of forces through the joint.

Examples include significant deformity of the hindfoot or ankle, although these causes are considerably less common than post-traumatic arthritis.

Can ankle arthritis be prevented?

Not all ankle arthritis can be prevented. After a significant ankle injury, however, appropriate diagnosis and treatment may help restore alignment and stability. Rehabilitation following injury can also be important in restoring movement, strength and function.

If you have recurrent ankle sprains, persistent pain following an ankle fracture or progressive stiffness, specialist assessment may help identify problems before they become more advanced.

When should I see a foot and ankle specialist?

Consider specialist assessment if you have:

persistent ankle pain following an injury
progressive ankle stiffness
recurrent ankle swelling
difficulty walking longer distances
pain on uneven ground
recurrent ankle instability
increasing difficulty with sport or exercise
a previous significant ankle fracture
previous ankle surgery with ongoing symptoms

An assessment does not necessarily mean that surgery is required. Many patients can be managed with non-operative treatment.

How is ankle arthritis diagnosed?

Diagnosis usually involves a combination of your symptoms, clinical examination and imaging. Weight-bearing X-rays or CT scans are particularly useful for assessing the degree of joint-space narrowing, deformity and alignment.

Depending on the circumstances, CT or MRI may provide additional information about the bone, cartilage and surrounding structures.

Read more about [how ankle arthritis is diagnosed].

How is ankle arthritis treated?

Treatment depends on the severity of arthritis, your symptoms, activity requirements, age, general health, ankle alignment and the condition of the rest of the foot.

Treatment may include:

activity modification
physiotherapy
footwear modification
orthotics
medication
injections
treatment of associated instability or deformity
ankle replacement
ankle fusion
other reconstructive procedures

Read more about [non-surgical treatment for ankle arthritis].

For selected patients with advanced arthritis, [ankle replacement surgery] may be an option. In others, ankle fusion may provide a more appropriate solution.

Frequently Asked Questions

Is ankle arthritis always caused by an injury?

No. Previous injury is an important cause of ankle arthritis, but arthritis can also develop because of inflammatory disease, previous infection, instability, primary osteoarthritis or other abnormalities.

Can an old ankle fracture cause arthritis years later?

Yes. Post-traumatic ankle arthritis can develop many years after an ankle fracture, particularly when the original injury involved the joint surface or resulted in altered alignment.

Can ankle sprains cause arthritis?

Repeated or severe ankle injuries can contribute to degenerative changes, particularly when they result in persistent instability or cartilage injury.

Can ankle arthritis be cured without surgery?

There is currently no treatment that reliably reverses established cartilage loss. However, symptoms can often be improved without surgery through a combination of exercise, physiotherapy, footwear, orthotics, medication and injections.

Does everyone with ankle arthritis need an ankle replacement?

No. Treatment needs to be individualised. Some patients may benefit from non-operative treatment, while others may be considered for ankle replacement, fusion or another procedure.

Book a consultation

If you have persistent ankle pain, stiffness or arthritis following an injury, a specialist foot and ankle assessment can help establish the cause of your symptoms and discuss the available treatment options.

Mr Shelain Patel provides specialist assessment and treatment for ankle arthritis and complex foot and ankle conditions in London.

[Book a consultation]