Flat Feet by Joseph Loria Week 1.

Another great Testimonial about Mr Barry Francis “the foot surgeon” and the Hyprocure Implant service at the Fyfield Clinic. My name is Joe and I am a 31 yr old male. I chose the ‘Hyprocure’ sinus tarsi implant in an attempt to stabilise my ‘flat feet’ and relieve their associated symptoms. This blog documents my progress and aims to help anyone considering the operation.

Day of surgery

As it was possible to have the procedure performed under local anaesthetic, I ate and drank as normal ahead of my appointment. Upon arrival I was greeted by Mr Francis and his team who discussed the surgery and informed of any potential complications before welcoming any final questions. I was offered refreshments and plenty reassurance which helped matters. I was then taken into a room adjacent to the operating theatre and given the anaesthetic in the ankle region of my right foot. There was roughly 15 mins waiting here then I was moved through. During the operation, the screen was drawn across the surgical area and I read a newspaper to try and focus my attention elsewhere. It took 20 mins to complete and felt no discomfort. The team checked I was happy throughout and
brought me back to the previous area once the suture and dressing had been applied. Mr Francis then prescribed a short course of painkillers, anti-inflammatories and antibiotics. A team member took an x-ray and fitted an open-ended sock/post-operative shoe ready to be discharged. The whole process was a pain free experience, delivered in good spirits in under an hr. I left using the self provided crutches and rested in the back of the car with my leg elevated for the return journey. The rest of the evening was spent relaxing in
bed. I woke a few times during the night due to a mixture of soreness and difficulty finding a comfortable resting position.

Week 1

I felt pain and tenderness in my ankle the morning after though this soon subsided once I took the medication. The vast majority of the day was spent in bed only moving to use the bathroom. I created a temporary living space downstairs ahead of surgery with everything close to hand. This made a considerable difference as attempting the stairs later in the week proved to be such an ordeal. Learning to accept the limitations was frustrating initially as I tend to move around a lot and tried to resist remaining stationary. I was also lucky to have a parent at home to provide meals and company. Mr Francis’ P.A called
to enquire how I was feeling and check the operation went well. The whole week’s events generally mirrored this day; immersing myself in media whilst elevating my foot and taking the medication. In hindsight, I could have eased off the tablets after a few days and became slightly more active as the pain and swelling had greatly diminished by this time. I was perhaps overcautious due to it being a new experience and for fear of migrating the stent. My sleep became more restful with each night and as the follow up appointment
approached, I felt much stronger and more positive. The return to the clinic involved a redressing and check of the incision area. Everything was fine and I was issued an ‘Aircast’ to resume walking, still aided by crutches for balance and weight distribution. Mr Francis advised switching to mild pain killers and ‘Arnica’ to reduce the bruising still present. A further review was made for a week’s time.

Joseph Loria

This testimonial from Joseph will continue about Hyprocure Implant and Mr Barry Francis “the foot surgeon” and his staff at the Fyfield Clinic Enfield and 9 Harley Street, London.

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Hyprocure Implant

Following on from the testimonaial and first week from Susan here is week 2.

“Week 2 began with a trip to my local podiatrist to have the dressing changed and to be fitted with a boot supplied by Mr. Francis.  I’m not sure what I was expecting, but the image conjured up by the word “boot” is certainly not the jaw-dropping, knee high contraption I was presented with! 

I’m now the proud owner/user of an Aircast XP Walker Extra Pneumatic which takes a little while to get on and inflated correctly each time, but makes it amazingly easy to get around on two feet again.  Having nothing at all in common with a mountain goat when it comes to sure-footedness, I’d put off trying to shower balancing on one leg for fear of slipping.   However, although it’s a bit of a struggle to get the recommended Limbo waterproof cast protector over the Aircast, it is manageable and having a shower for the first time in what seems like forever was very nice. 

At the moment wearing the boot does aggravate the wound site which starts to throb after a short while. Leaving it on whilst resting (even if deflated) is also not very comfortable as the foot is kept at a rigid right angle position to the leg and everything goes numb unless you constantly wiggle your toes.   I therefore tend to take it off and rest at regular intervals which keeps the discomfort to a minimum.  Hopefully, as the wound heals completely the soreness when wearing the boot will subside.  In any event, life is definitely much easier with the mobility that the Aircast provides.”

Susan Knott

For more help and advice on Hyprocure Implants please do not hesitate to contact Mr Bary Francis “the foot surgeon” at eithe the Fyfield Clinic in Enfield or in Harley Street, London.

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Small bone

Mr Barry Francis  “the Foot Surgeon” picked this up while on the train reading the Daily Mail last week. One of the less common problems that can occur with the foot is a small extra bone at the back of the ankle.  Often people go through life happily with this but if it becomes amaged then it can cause pain and a change in function.  The bean-shaped bone is called an os trigonum.  In the Daily Mail last Tuesday a keyhole surgery approach is described in removing this bone.

Problems with it often follow a small accident, such as a wrench of the ankle or sprain, and the patient will often experience a clicking sensation in the ankle with pain.  The ankle itself might feel unstable.  Proper diagnosis is important and this often requires a CT and/or MRI scan.  The procedure can be carried out under minimal incision or perhaps more often through open incision from the side of the ankle.

Until the next time Barry.

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Mr Barry Francis the foot surgeon” thought he would put a recent testimonial from Sue Knott on a Hyprocure Implant.

“I have worn expensive custom-made orthotics for several years now and, although they relieved a lot of the discomfort I experienced daily due to hyperpronation, this never truly disappeared.  Wearing fashionable shoes with a small heel at my son’s wedding for a few hours resulted in no sleep at all that night due to aching and a throbbing pain which did not respond to painkillers and only subsided with a few days rest.  At that point it was either continue wearing flat shoes with orthotics to keep the discomfort minimal or investigate a more suitable and, hopefully, successful alternative.

An internet search led me to the Hyprocure site and eventually, through a local podiatrist, to Barry Francis.  X-rays and an ultrasound were carried out to make sure I was a suitable candidate for the procedure and, this being the case, the surgery took place on 8 September 2011.

I felt at ease at the clinic as the atmosphere was relaxed and friendly and the only slight discomfort I experienced during the whole procedure was the administration of local anaesthetic injections prior to having the stent inserted.  Probably my biggest fear at having the procedure carried out under local anaesthetic was that the latter might not work effectively, but Mr. Francis tested several areas around the operation site prior to making the first incision and I can honestly say that, other than being aware that something was being done to my foot through feeling pressure being exerted, I was in no pain at all from start to finish.  The operation is quite quick and, in fact, the longest part of the procedure is having the anaesthetic
injected and waiting for it to take full effect.  A post-op X-ray was taken to confirm that the stent was in the correct position and, with my foot heavily bandaged and sporting a trendy velcro fastening black boot, I was discharged home to the sofa with the instruction to remain non-weight bearing on the foot for a full seven days.

Six days later I can report that, aside from numbness in three toes which has now gone, I’ve experience very little discomfort from the foot itself, despite having to stop taking the co-codamol painkillers after one day as they made me feel queasy and lightheaded.  I’ve continued to take the anti-inflammatory medication three times a day and, apart from slightly swollen toes which appear to be turning green with bruising and muscles I never knew I had strained from trying to get about on crutches, I’m getting along just fine
with no other painkilling medication.”

Sue Knott

For help and advice please do not hesitate to contact Mr Barry Francis the foot surgeon” or his staff at The Fyfield Clinic, Enfield or in Harley Street, London. For details please visit our website at www.thefootsurgeon.co.uk

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Curling Toes

Once again over his mid morning coffee break Mr Barry Francis the foot Surgeon” is looking and reading a recently published article by Linda Kelsey discusses a condition called dystonia. What she had noticed was that she began to walk in a very odd manner and that her toes were curling underneath her foot in a painful spasm.   This was also affecting her right ankle.  Within a short while she developed an ungainly limp and had to stop every few paces to relax the foot before she could get going again.  She saw various specialists including her GP and a specialist orthopaedic surgeon without any progress.  Curiously she found that when she danced things were absolutely fine.  She eventually saw a Professor Kailash Bhatia, a neurologist at the Institute of Neurology in London.  He is a leading expert in the field of movement disorders.  Professor Bhatia confirmed that she had dystonia and explained that dystonia is an abnormal posture of a body part thought to stem from a malfunction of the part of the brain that helps regulate muscle movement.
There are many presentations of dystonia and about 70,000 people in the UK are thought to be affected (the Dystonia Society).  The condition is often mistaken for stress or
psychogenic disorder and occasionally is associated with Parkinson’s Disease.  This was not however the case with Ms Kelsey.  She had various treatments but eventually Professor Bhatia suggested that she should have botox injections.  These were administered under electromyography guidance and after two treatments she noted a significant difference.  She now finds that she can walk at least two miles without a problem.  She has the botox injections every few months and this treatment is available for her on the NHS.

For more help and advice on curling toes please do not hesitate to contact “the foot surgeon” Mr Barry Francis or his staff at the Fyfield Clinic in Enfield and Harley Street.


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Toe Deformities

Once again Mr Barry Francis “the foot Surgeon” at the Fyfield Clinic refers to a recent article in the daily press regarding the correction of toe deformities (hammer toes and the like) by minimal incision surgery.  This was an interesting article particularly as it was written by an orthopaedic surgeon, although the initial work into minimal incision surgery was in fact carried out in the US by podiatric surgeons some 20 odd years ago.  Mr Francis has long used minimal incision surgery at the Fyfield Clinic to deal with a variety of foot problems.  Not every patient is suitable for this approach and careful evaluation is always made before the recommendation is given.  As far as correction of toe deformities is concerned we have modified the minimal incision approach a little.  We believe now that we can offer a procedure where any scars are hidden and are minimal in size in any event
with good correction.  In most cases the use of a k-wire or other metalwork is not required and we hope to maintain flexibility of the toe wherever possible, although this is not always the case.

The procedure of cutting bone away and leaving a space rather than fusing it with a k-wire is one which has been long advocated by podiatric surgeons and used since they first introduced this form of treatment in the early seventies. It is good to see the wider medical/surgical community accepting its use in toe correction.  Further information
regarding these types of procedures may be had either at a consultation or from our website at www.thefootsurgeon.co.uk

Until the next time from Mr Barry Francis and the team at the Fyfield Clinic Enfield and Harley Street London.


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Woman’s feet

Barry Francis “the foot surgeon” at the Fyfield Clinic refers to an article on the increasing size of Woman’s feet in the Daily Mail of Monday 8th August 2011, they discussed in “Life
& Style” the increasing size of women’s feet and how difficult it was to obtain shoes.  The writer, Ellen Burgess who is a size nine, first noticed the size of her feet as a child when she saw that a boy in her school was wearing the same pair of Hush Puppies as herself.  She longed to wear prettier, more feminine type shoes.  She remembered from her childhood some poetry including a quote from Frida Wolfe’s Choosing Shoes: “Flat shoes, Fat shoes, Stump-along-like-that shoes, Wipe-them-on-the-mat shoes.  That’s the sort they’ll buy”.  She goes on to describe how difficult it is to buy feminine shoes in her size and finished by
saying that she is largely restricted now to Clarks, Birkenstocks and Converse trainers.  She has custom-made Trippen boots and a pair of Tracey Neuls pumps.

Until the next time Barry Francis “the foot surgeon”


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Infected Toenail

Barry Francis “the foot surgeon” was thinking how many of you have a work colleague like one of our team here at the Fyfield Clinic has had a fungal infection of a toenail now for about 2½ years.  They have tried various kinds of topical medications but unfortunately these have been ineffective in this particular case.  This individual is also unwilling to take any drugs orally.  They therefore considered the options including a possible new treatment involving the use of laser.  The team member attended for treatment this week.

The treatment is usually a one-off, although in many cases it is two treatments with four months in between, and any progress won’t be seen for several months or until the nail starts to re-grow. Watch this space for further information as to whether this technique is
going to be effective in this case. So for help and advice on all foot queries please contact us at The Fyfield Clinic, Enfield or in Harley Street, London.

Barry Francis


Telephone  0208 3634808

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“Fastest Man”

An interesting article noticed by Mr Barry Francis “The Foot Surgeon” as he travelled to the Fyfield Clinic, Enfield on the tube a few days ago on the 9/8/11 issue of Metro Free paper where there is an article by Tariq Tahir on the activities of Oscar Pistorius.  He has been described as the “fastest man on no legs”, who has fought to be allowed to race on artificial limbs as an able bodied athlete.  He hopes to be on track for London 2012.

Oscar is a 24 year old South African who took the International Association of Athletic Federations to appeal and then to the Court of Arbitration for Sport so that he could compete as an able bodied athlete on his carbon fibre legs, known as cheetahs.  He qualified for this year’s World Championships in South Korea after clocking 45.07 on  a 400m run. Pistorius was born without fibulas (the thinner bone in the leg below
the knee).  As a result of this he eventually had his legs and feet amputated below the knee.  He has completed in the past in rugby, water polo, tennis and wrestling, but after a rugby injury he took up running, using the specially made artificial legs with which he won gold in the 2004 Athens Paralympics, breaking the 200m world record. He is also known as the “blade runner”.

Carbon fibre cheetahs are about half the weight of an able bodied sprinter’s lower leg.
Oscar can swing his lower leg through the air between strides 15.7% more quickly than a 100m world record holder. He actually spends 34% less time in the air between steps.  His “foot” is in contact with the ground 14% longer on each sprinting step.

Until the next time Barry Francis.

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Barefoot Running

In the Sunday Times on 31/07/11 there was discussion about barefoot running. Francesca Hornak said “if you have ever sprinted for the bus in ballet pumps you will know it is a different sensation to pounding a treadmill in boingy trainers”.  Some runners believe
trainers actually do more damage.  She went on to say that barefoot running had been around for ever but in the last ten years it had gained more credibility as shown by the success of Christopher McDougall’s 2009 book Born to Run and Nike’s popular Free Run+line of featherlight footwear.

The article stated that consideration should be given to the fact that nearly three-quarters of runners sustained injury every year, a statistic barefoot runners suggest is a onsequence of poor technique caused by snazzy trainers.

They feel that we have forgotten to run properly and that our “sticky” jogging stride and forward leaning posture is synthetic and a direct result of over-cushioned modern
running shoes.  Barefoot runners advocate a more nature forefoot landing which, besides minimizing injury, also results in more steps per minute than heel striking and actually burns more calories.  Not everyone is convinced and sceptics argue that our evolutionary heritage accounts for little after a lifetime of wearing shoes.  Be warned, undoing habits takes time.  You cannot just shed the shoes and go.  “As long as you can do a barefoot squat with your heels on the ground, that’s a good first step”.  Every four year old can run perfectly.  The challenge is reawakening our innate ability.

A full copy of this short article can be obtained from the Fyfield Clinic along with help and advice from Barry Franics “the foot surgeon”


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