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.

Post-traumatic ankle arthritis

Shelain Patel

Post-traumatic ankle arthritis develops following an injury to the ankle. It can occur after fractures, severe ankle sprains, ligament injuries or other trauma that damages the joint.

Symptoms may develop relatively soon after the original injury or may become apparent many years later.

Treatment can be more complex when arthritis is associated with previous fractures, deformity, metalwork or multiple previous operations.

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 and complex foot and ankle reconstruction.

Why does trauma cause ankle arthritis?

The ankle is a highly congruent joint. Damage to the cartilage or alteration of the alignment of the joint can change how forces are transmitted through it.

Following significant injury, arthritis may develop because of:

direct cartilage damage
fracture involving the joint surface
altered alignment
ligament damage
chronic instability
damage to the underlying bone
previous infection
complications following surgery

Which injuries can lead to post-traumatic arthritis?

Post-traumatic ankle arthritis can follow:

ankle fractures
pilon fractures
ankle dislocations
severe ankle sprains
syndesmotic injuries
cartilage injuries
recurrent instability
previous surgery

A particularly important group are patients who sustained a major ankle fracture earlier in life and subsequently develop progressive pain and stiffness.

How long after an injury can arthritis develop?

There is no fixed timescale. Some patients develop symptoms relatively soon after a significant injury, while others remain relatively symptom-free for many years before developing arthritis. The severity of the original injury, cartilage damage, alignment and subsequent joint mechanics all influence the course.

What are the symptoms?

Symptoms may gradually increase over time and can include:

ankle pain
stiffness
swelling
reduced walking distance
pain on uneven ground
difficulty with stairs
reduced sporting ability
grinding or catching
progressive deformity

How is post-traumatic arthritis diagnosed?

Assessment generally includes a detailed history, examination and imaging. Previous X-rays and operative records can be particularly useful.

Weight-bearing X-rays can demonstrate:

joint-space loss
deformity
previous fractures
alignment
bone changes

CT may provide additional information about bone anatomy, previous fractures, bone loss and retained metalwork. MRI can be useful when further assessment of soft tissues, cartilage or bone is required.

Why is post-traumatic ankle arthritis sometimes complex?

Previous trauma can leave several problems that need to be considered together. These may include:

deformity
bone loss
retained metalwork
ligament instability
altered hindfoot alignment
stiffness
previous infection
arthritis in neighbouring joints

Consequently, treating the arthritis may require more than simply addressing the ankle joint itself.

Can post-traumatic ankle arthritis be treated without surgery?

Yes. Treatment may include:

activity modification
physiotherapy
footwear modification
orthotics
medication
injections
walking aids

The appropriate combination depends on symptoms and functional requirements.

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

Ankle replacement after previous fracture

Ankle replacement can be considered in selected patients with post-traumatic arthritis. Previous fractures does not automatically exclude someone from replacement surgery, however, the surgeon needs to assess factors such as:

ankle alignment
bone quality
previous metalwork
bone loss
ligament stability
associated deformity
previous infection
condition of the surrounding foot

Additional procedures may sometimes be required.

Read the [complete ankle replacement surgery guide].

Ankle fusion after previous fracture

Ankle fusion remains an option for selected patients with advanced post-traumatic arthritis. It may be particularly relevant when there is substantial deformity, bone loss or other factors that make replacement less suitable.

Read more about [ankle fusion for arthritis].

Previous metalwork

Some patients with post-traumatic arthritis still have plates, screws or other implants from their original fracture surgery. Whether metalwork should be removed depends on its position, symptoms, interference with future surgery and the condition of the bone. Removal is not automatically necessary.

Previous infection

A history of infection is particularly important when considering further surgery. Additional investigation may be necessary to determine whether there is any evidence of ongoing or previous infection before undertaking reconstructive surgery or ankle replacement.

Complex reconstruction

Some patients require correction of alignment or associated problems before, or at the same time as, treatment of the arthritic ankle.

Possible procedures may include:

osteotomy
ligament reconstruction
tendon procedures
hindfoot reconstruction
correction of deformity
management of bone loss

Treatment needs to be planned around the whole foot and ankle rather than the arthritic joint alone.

Frequently Asked Questions

Can an old ankle fracture cause arthritis?

Yes. Post-traumatic arthritis can develop years after an ankle fracture.

Can ankle replacement be performed after a fracture?

In selected patients, yes. Previous fracture is not automatically a contraindication, but the anatomy and previous surgery need careful assessment.

Does previous metalwork prevent ankle replacement?

Not necessarily. Some patients can undergo replacement with existing metalwork, while others may require removal or additional procedures.

Is ankle fusion better after a fracture?

The appropriate operation depends on the individual anatomy, symptoms, deformity, bone quality and previous surgery. Both fusion and replacement may be considered in selected patients.

Can post-traumatic ankle arthritis be treated without surgery?

Yes. Non-operative treatment can reduce symptoms and may be appropriate for many patients.

Book a consultation

If you have developed persistent ankle pain or stiffness following an old fracture, ankle sprain or other significant injury, specialist assessment can establish the cause and identify appropriate treatment options.

[Book a consultation with Mr Shelain Patel]