North London Foot & Ankle and Sports Injuries Clinic

Royal Free Hospital NHS Foundation Trust

Spire Bushey Hospital
Kings Oak Hospital
BMI Cavell Hospital
Highgate Hospital

Private Secretary
Mrs Mary Zazzi
Tel: 0208 920 2507

NHS Secretary
Mrs Rubeka Orchudesh
Tel: 0208 216 4373

Contact Mr Pinak Ray by emailing: Here

Sports Injuries

Sports participation has become a fundamental characteristic of our society. All sports and recreational activities carry an inherent risk of injury. Intrinsic and extrinsic factors have a potential role in the cause of injury to the athlete.

Certain underlying anatomic conditions are often related to athletic injuries. Many runners and coaches place abnormal foot biomechanics in this category in the belief that the runner who overpronates has an innately higher risk for sustaining a running-related injury. A lack of flexibility has often been cited as the factor responsible for various sports-related complaints. The running surface is also a cause of injuries as is often seen.

Whatever the cause, sports injuries and trauma is an integral part of Mr Ray's expertise. He welcomes all patients with sports related injuries to one his many clinics in north London and Harley Street.

Lateral Ankle Sprain

Lateral ankle sprains are the most common injury in sports.
The lateral ligament complex of the ankle consists of three ligaments: the anterior talofibular, the calcaneofibular, and the posterior talofibular.
Each of the ligaments has a role in stabilizing the ankle and subtalar joint, depending on the position of the foot and ankle From a literature review, laboratory studies, clinical experience, and surgical findings, the most common ligament disruption by far involves the ATFL.
Patients with a lateral ankle sprain often describe a popping or tearing sensation in the ankle and occasionally an audible noise. Often they remember only the pain and loss of support. The injuries occur during running or cutting or while landing from a jump.
Physical examination reveals swelling and tenderness over the affected ligaments.
Stress tests may be positive.
Patients will usually have an X-ray.
For accurate documentation and diagnosis an MRI scan is necessary.

Nonsurgical treatment is the mainstay of management for the vast majority of ankle sprains, even in the athletic population In general, functional treatment provides the most rapid recovery, with earlier return to work and physical activity without necessarily affecting mechanical stability.
The first phase of functional treatment includes RICE (Rest, Ice, compression and elevation).
This is followed by functional treatment with active dorsiflexion and mobilisation. An aircast ankle brace is said to give better outcome as compared to soft ankle support.

Quite often Mr Ray sees patients with chronic ankle instability. Patients usually have had a history of ankle sprain(s). Their main symptom is usually is instability. Following diagnostic tests and stress tests if the ankle remains unstable he offers ankle ligament anatomical repair (Brostrom) as well as tendon augmentation.

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Fractures Around the Ankle

Very common injury especially following trauma in contact sports.
Diagnostic investigations involve X-Rays and if necessary MRI scan.
Undisplaced fractures are treated functionally in a plaster initially, followed by functional bracing and physiotherapy.
Displaced fractures need internal fixation to get back anatomy. Internal fixation and restoration of joint congruity gives the best functional outcome.

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High Ankle Sprains

This is a sprain of the syndesmotic ligaments ( ligaments between the tibia and fibula ). This produces more disability for an athlete than a lateral ankle sprain.
Injury usually involves an external rotation element.
Pain is usually around the ankle not dissimilar to the common ankle sprain.
Diagnosis is usually by a standard X-Ray, stress views.
MRI scan has become the preferred investigation of choice for formal diagnosis.
Sprains without diastasis are treated non-operatively.
Sprains with diastasis are treated with surgery.

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Sinus Tarsi Syndrome

Pain in the lateral part of the ankle and hindfoot over the sinus tarsi, often related to a prior inversion mechanism injury, is the primary complaint. Symptomatic instability is generally absent, and swelling is variable. Tenderness over the sinus tarsi is mandatory for this diagnosis. Other subjective and objective findings are absent or minimal.
X-rays are usually normal. Role of MRI scan is questionable.
If diagnosed an injection of local anaesthetic usually relieves pain. This is followed by a steroid injection.
If after 2-3 injections pain does not settle then open or arthroscopic surgery is warranted.

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Achilles Tendon Injury

Achilles tendon problems have been associated very closely with sporting injuries.
Whether the problem is peritendinitis, tendinitis, or rupture, the player's ability to continue or return to sports participation is jeopardized.
Inflammation of the tendon presents as a acute or a chronic problem. Diagnostic tests usually include an ultrasound scan or an MRI scan. Treatment is usually conservative with physiotherapy, alteration of training methods and if necessary injections. Surgical decompression is indicated only in chronic cases following adequate non-operative treatment.
Acute achilles tendon tear usually presents with a sudden feeling of someone having hit the back of the heel. Usually associated with immediate inability to continue playing, bruising and pain. This is a clinical diagnosis. Mr Ray usually treats these traumatic ruptures of the Achilles tendon surgically. He believes internal repair gives a better functional outcome. Rerupture rate is significantly low following surgical repair.

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Stress fractures of the foot and ankle

Stress fractures typically afflict runners, dancers, military enlistees, and anyone involved in repetitive lower extremity activity or an exhaustive training regimen. Athletes usually will have a prodromal stress reaction which eventually can develop into a frank fracture.
Imaging includes X-Rays and MRI scans.
Most stress fractures will need immbbilisation for a period of time either in a cast or a boot. These fractures usually take 6-12 weeks to heal. Surgical treatment is unusual and very rare.

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Knee Sports Injuries

Mr Ray treats sports related injuries of the knee. He welcomes patients to his NHS and Private clinics with problems of the knee. These include;

1. Meniscal injuries
2. Anterior cruciate ligament injuries
3. Traumatic osteochondral defects
4. Patelar dislocation and fractures
5. Fractures around the knee

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Meniscal Injuries

This is a common sports related injury of the knee. Usually the history is a twisting type of injury. The knee does not swell up immediately. One can carry on playing for a short time but has to give up. Later on patients can get symptoms of "giving way" and "locking" of the knee.
Following the initial examination Mr Ray sends his patients for a diagnostic MRI scan. If positive, patients are offered an arthroscopy (key hole syrgery) of the knee. At surgery Mr Ray either repairs the meniscus or stbilises the torn meniscus by trimming the torn area. Usual recovery time is about 3-4 weeks.

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Anterior Cruciate Injury

This is as a result of a significant injury to the knee, usually following a bad tackle in a game of football or Rugby. This can happen in any contact sport. Usually one will not be able to continue playing and will have to be supported off the field. The knee swells up immediately.
Following the initial examination patients usually have an X-Ray and a MRI scan for evaluation.
My Ray then offers them an arthroscopy to initially deal with any meniscal injury. Following this initial evaluation patients are sent for a rehab programme.
This is followed by an ACL reconstruction in 6-8 weeks.
Rehabilitation period can vary from 6 months to 9 months.

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Private Clinis

Monday PM
 - Kings Oak Hospital

Monday EVE
 - Highgate Hospital

Tuesday EVE
 - Spire Bushey Hospital

Wednesday Eve
 - Kings Oak Hospital

Thursday Eve
 - Cavell Hospital

Private Operating Sessions

Monday AM
 - Highgate Hospital

Friday AM
 - Spire Bushey and
    BMI Cavell Hospital
    (alternate weekend)