Mr Ray welcomes patients for consultation with problems causing pain around the ankle.
Advances in understanding of the special features of the ankle joint and the pathogenesis of degenerative joint disease have led to new approaches in the treatment of ankle arthritis.
Unlike the hip and knee, which are prone to develop primary osteoarthritis, the ankle develops arthritis usually because of a traumatic event.
Clinical experience and published reports of the treatment of ankle osteoarthritis indicate that primary ankle osteoarthritis is rare and that secondary ankle osteoarthritis, which develops after ankle fractures or ligamentous injury, is the most common cause of ankle osteoarthritis.
Taking a good history and performing a careful physical examination are essential. First, to determine if there is a clear history of trauma contributing to the development of ankle arthritis. Although a past fracture is the most common cause of ankle degeneration, recurrent sprains (or even one major sprain without resolution) can also be responsible.
All patients get X-rays of the ankle. Further imaging is usually an MRI scan or a CT scan.
Mr Ray usually uses diagnostic injections in the foot joints to determine the affected joints.
This is done under x-ray control in theatre.
Once the diagnosis is made the treatment modalities include conservative and operative methods. Non-operative treatment includes advice on anti-inflammatory and weight relieving modalities like a walking stick. The decision to operate on ankle arthritis requires a clear assessment of the patient's functional needs and a complete understanding of the cause of the patient's problem.
Mr Ray offers his patients injections of Durolane or Synvisc for early osteoarthritis.
He offers ankle arthroscopy ( key hole surgery) for assessment and treating intra articular pathologies Surgical procedures for ankle arthritis include primary fusion and ankle replacement.
In a general sense, ankle fusion has a few clear advantages over other techniques. When the pain originates within the ankle joint, a successful fusion usually eliminates it. Short-term results and complication rates have been markedly improved by modern techniques of limited periosteal stripping, rigid internal fixation, and meticulous attention to alignment and position. Pain relief is more reliable with fusion than with most other techniques. Secondary operations, other than occasional hardware removals, are relatively rare.
Mr Ray uses the most modern techniques and hardware to fuse the ankle joint resulting in good and lasting results. He offers both open and arthroscopic assisted ankle fusion.
Mr Ray is one of the few surgeons offering an ankle replacement for arthritis. He uses the Mobility and the Salto ankle replacement. He chooses his patients according to age, extent of arthritis and patient expectation. Ankle replacements are a viable alternative to ankle fusion. He now has a 4 year experience performing ankle replacement.