Malhotra Foot and Ankle

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Malhotra Foot and Ankle

Karan Malhotra is a Consultant Orthopaedic Foot & Ankle Surgeon specialising in all Adult Foot & Ankle Conditions.

He treats patients in London & Hertfordshire (Bushey, Elstree & Stanmore). I am a consultant orthopaedic surgeon specialising in foot and ankle surgery. My NHS base is at the Royal National Orthopaedic Hospital, Stanmore, which is consistently ranked by Newsweek as the top orthopaedic institution in the UK, and as one of the top 10 best orthopaedic institutions in the world. I am also an Honorary Associate Professor with University College London, which is also ranked as one of the top 10 universities world-wide. Privately I am part of the Stanmore Foot & Ankle Specialists group of surgeons, consulting in central London, Stanmore, Bushey, and Elstree alongside my colleagues, with whom I work closely in both the NHS and private sectors. I graduated with Honours from the University of Manchester and undertook my orthopaedic training in Yorkshire and London. I completed renowned fellowships in Foot and Ankle surgery in Australia and the UK and undertook a travelling fellowship to Singapore. I deliver both operative and non-operative treatment for a wide variety of conditions such as bunions, toe deformities, tendon disorders, plantar fasciitis, sports injuries, and arthritis of the foot and ankle. For information, including about my many prizes, research and educational activities, and my involvement in Foot & Ankle Surgery nationally, visit my website.

18/09/2025

A great showing for the Foot & Ankle Team at . We had 3 back to back at the session.

These papers all had a theme of using to analyse deformities and glean new insigthts into how the foot and ankle functions.

Our presented work included:
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👣 Examining the link between clinical signs of and metatarsal pronation (there's no link and you can't use toe pronation to judge metatarsal rotation!)

👣 Examining the link between the and (there is a link and an abnormal DMAA should prompt a suspicion of metatarsal pronation)

🦶 Examining the effect of sagittal plane balance on patient outcome after (the angle between the tibial shaft and the sole of the foot is the most important determinant of subjective sagittal balance for patients, so is a good clinical marker when fusing the hindfoot / ankle)
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This was all done silent disco style with headphones!
Well done to all our team members who presented our work!

22/08/2025

Calling all London interested in
Join us in our Complex Foot & Ankle MDT: September 15th @ 18.30 at the Institute of Sports Exercise & Health (ISEH), 170 Tottenham Court Road, London, W1 7HA.

FREE talks, case discussions, & examination of patients. Sandwiches & Refreshments provided.

Scan the QR code or follow the link below to let us know you can make it!
https://forms.gle/gMeD9dp8wbhg6vEx7

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We are the Stanmore Foot & Ankle Specialists ( ) - 4 consultant orthopaedic foot and ankle surgeons seeing private patients in London & Hertfordshire. Our NHS base is at the Royal National Orthopaedic Hospital (Stanmore). We see and treat all adult foot and ankle conditions, including the most complex problems.

We have regular MDT meetings and feel that open and honest discussion is one of the cornerstones for improving our practice. We are all heavily involved with research and education and hope that you will be able to join us for an informative and thought-provoking evening!

17/07/2025

What is a Type 3 cavovarus foot??

are complex! Not only are the deformities in 3 planes, but they are dynamic and they change over time. You can think of it almost like a 5D deformity!

However the goal of treatment is simple - you get the heel under the body, get the talonavicular joint reduced and then balance the front of the foot to restore the foot . . Finally we do the tendon transfers to keep it all moving well.

In most cases, the steps to sort out the heel, the talonavicular joint, and the tendons at the end are quite similar! The variation comes in which bits of the forefoot need addressing. But how do you know what to do for the forefoot?

Fortunately some of our previous work look at distinguishing 3 main of residual forefoot deformity. This video describes Type 3, which is the least common.

In a Type 3 deformity, after reducing the hindfoot, the forefoot is overall still adducted compared to the rest of the foot. There may also by plantarflexion and rotation as well, but adduction is the primary deformity. In this case, just raising up the metatarsals won’t create a balanced foot! You have to get all the metatarsals pointing the right way. One way to do this is by cutting out a wedge of bone from the side of the foot (cuboid and navicular cuneiform joint). This is called a wedge tarsectomy and it does a great job in correcting deformity in the most difficult cases.. I’ve already published videos on Types 1 and 2, so be sure to check those out!

Link to Paper: https://doi.org/10.1177/10711007241242779

14/07/2025

What is a Type 2 cavovarus foot??

are complex! Not only are the deformities in 3 planes, but they are dynamic and they change over time. You can think of it almost like a 5D deformity!

However the goal of treatment is simple - you get the heel under the body, get the talonavicular joint reduced and then balance the front of the foot to restore the foot . . Finally we do the tendon transfers to keep it all moving well.

In most cases, the steps to sort out the heel, the talonavicular joint, and the tendons at the end are quite similar! The variation comes in which bits of the forefoot need addressing. But how do you know what to do for the forefoot?

Fortunately some of our previous work look at distinguishing 3 main of residual forefoot deformity. This video describes Type 2, which is the second most common.

In a Type 2 deformity, after reducing the hindfoot, all of the 1st, 2nd and 3rd metatarsals are relatively plantarflexed to the rest of the foot. In fact, they often form a cascade with the 2nd being more plantar flexed than the 3rd and the 1st being the most plantarflexed. In this case, just raising up the 1st ray won’t create a balanced foot! You have to raise up all 3 metatarsals, but by different amounts. My preferred method is to fuse the 1st-3rd TMTJ as it’s more powerful and versatile. I’ve already published a video on Type 1, but stay tuned for my next video describing Type 3!

Link to Paper: https://doi.org/10.1177/10711007241242779

11/07/2025

What is a Type 1 cavovarus foot??

are complex! Not only are the deformities in 3 planes, but they are dynamic and they change over time. You can think of it almost like a 5D deformity!

However the goal of treatment is simple - you get the heel under the body, get the talonavicular joint reduced and then balance the front of the foot to restore the foot . . Finally we do the tendon transfers to keep it all moving well.

In most cases, the steps to sort out the heel, the talonavicular joint, and the tendons at the end are quite similar! The variation comes in which bits of the forefoot need addressing. But how do you know what to do for the forefoot?

Fortunately some of our previous work look at distinguishing 3 main of residual forefoot deformity. This video describes Type 1, which is the most common.

In a Type 1 deformity, after reducing the hindfoot, only the 1st metatarsal is relatively plantarflexed to the rest of the foot. And so it follows that raising up just the 1st ray is all that’s needed to create a balanced foot! Of course, that’s simple as it’s what we are used to doing for most patients. Stay tuned for more videos describing Types 2 and 3!

Link to Paper: https://doi.org/10.1177/10711007241242779

07/07/2025

The ! It keeps us standing and stops us falling into the centre of the Earth! 🤔

This is perhaps my most crazy video yet, although it was a lot of fun coming up with it! Madness aside, the topic is an important one.

When we think of our , and the forces acting on them, we often think of our weight. But the reality is that the forces actually act from the ground up! Sure, our weight does play a role, as the heavier we are the more force is needed to stop us crashing through the ground, like this unfortunate Mr Blue Shirt…. However, as humans, we actually have the ability to ALTER our ground reaction force! 💪

How?? Well we do it all the time when we walk, when we get up from crouching, when we jump. By using our muscles we can push down on the ground, and the ground reaction force increases. If it increases enough, then it will propel us into the air! 🚀

This is very important for many problems we see in the . A ground reaction force which aligns with the rest of the leg, will keep us balanced, no problem! However, in a the ground reaction force may be ‘off axis’ which will create a ‘turning’ force. This can cause bits of bone to rub on each other, which aren’t meant to, causing and making the deformity worse.

Whether with , or , the goal of treatment is to realign the ground reaction force with the rest of the leg, restoring !

27/06/2025

This week marked the 12th Annual Meeting for , a significant event that has, since 2011, united leading from the UK and beyond to tackle challenging issues and reach on best practices in foot and ankle care.

Having attended these meetings as a scribe in 2017, 2018, and 2019, I was thrilled to step into the role of speaker and session chair this year.

The programme was nothing short of outstanding, focusing on a vital but often overlooked topic in surgical circles - . While our primary goal is to avoid complications, it is equally crucial to confront them head-on when they arise. Over three intense days, we engaged in insightful discussions on preventing and managing complications in every facet of foot and ankle surgery.

I had the privilege of presenting on the management of complications in and while chairing that very session. Additionally, I shared my expertise on preventing and managing recurrent deformities following correction of , a topic close to my heart.

A heartfelt thank you to Orthosolutions for their unwavering support and flawless organization of this event, which not only fosters our professional growth but also champions best practices across the UK. The entire team was exceptional, ensuring the event ran seamlessly, as they have done for every round table meeting since its inception.

Lastly, my deepest appreciation goes to my mentor, Dishan Singh, who has been the driving force behind this meeting since its inception in 2011. His commitment to advancing foot and ankle surgery in the UK continues to inspire us all.

16/06/2025

This weekend I attended and presented at the 1st in-person Fellows' Forum. This was an amazing with keen and enthusiatic fellows and much interesting debate and discussion. It was a forum for consultant from all over Europe and UK to come together and learn about / discuss the management of conditions.

It was superbly organised and run by and MANUEL MONTEAGUDO, and I am ever so grateful that they invited me as a speaker amongst so many other renowned speakers!

I presented on the surgical management of , a special interest and passion of mine. I discussed surgical principles and my operative algorithms, alongside our new system of of cavovarus feet, which helps guide management.

12/06/2025

💥Latest Publication! In this biomechanical study, we investigated the influence of screw design on compression and pull-out strength. One newer screw design feature is an opposing flank angle.💭But is this better than other screws? We put that to the test! 🧪

We compared 4x 4.0mm cannulated screw designs: 1 headed screw design, and three headless screw designs: 2 with opposing flanks and 1 with conventional, parallel flanks. We inserted these into saw bone and measured the compression and pull out resistance.

An opposing flank design demonstrated the highest compression and pull-out strength amongst all screws. However, the conventional flank design outperformed the other opposing flank design. All headless compression screws outperformed the headed screw in both compression and pull-out strength.

This work highlights that although an opposing flank design has the potential to confer greater compression than parallel flanks, other design features also play a crucial role. Of course this is in sawbone and headed screws are still useful in closing a gap and are often used with a washer. Furthermore, the forces generated by all screws were sufficient for early mobilisation.

It is important that orthopaedic surgeons understand the design elements of the tools they use to optimise constructs and support early mobilisation in patients.

The full paper can be accessed here: https://gbr01.safelinks.protection.outlook.com/?url=https%3A%2F%2Fkwnsfk27.r.eu-west-1.awstrack.me%2FL0%2Fhttps%3A%252F%252Fauthors.elsevier.com%252Fc%252F1lCRS3PuWSjNZj%2F1%2F0102019734ab8992-18d82989-1a51-4fde-9729-b356f4df6dce-000000%2FTKBy4iR-3V7HrLqf1-Q24iz0410%3D428&data=05%7C02%7Ck.malhotra%40nhs.net%7Cd5e2df04b7984016ede908dda26f649f%7C37c354b285b047f5b22207b48d774ee3%7C0%7C1%7C638845321512640158%7CUnknown%7CTWFpbGZsb3d8eyJFbXB0eU1hcGkiOnRydWUsIlYiOiIwLjAuMDAwMCIsIlAiOiJXaW4zMiIsIkFOIjoiTWFpbCIsIldUIjoyfQ%3D%3D%7C0%7C%7C%7C&sdata=wI1Wo%2Bb97qv08y%2BCiMA8o8XuIa89TW8t7C%2BXJP6NENM%3D&reserved=0

09/06/2025

Got painful ankle arthritis but still have good movement? Wondering about solutions? 🤔 Yes, we absolutely do ! This is an excellent operation for easing that pain.

During the procedure, we remove the worn-out bone from either side of the joint. Then, we fit a shiny metal component onto your tibia (shin bone), and onto your talus (the other ankle bone), and place a smooth plastic spacer in between. This allows your joint to move fluidly again, and since metal doesn't have nerves, your pain significantly improves!

The huge bonus? It preserves your natural movement and protects your other joints! This makes it a fantastic option, especially if you have some existing wear and tear in the surrounding joints. However, isn't suitable for everyone, and they don't last forever, so if you're younger, it requires careful consideration.

But it's definitely a conversation worth having if you're dealing with end-stage ankle arthritis. This video gives a brief overview of what this surgery might look like!

05/06/2025

Got a stiff, arthritic ankle that's limiting your pain-free walks? 🚶‍♀️ While many treatments exist for ankle arthritis, remains the 'gold standard' for a reason!

So, what exactly is an ankle fusion? It's a procedure for where we remove the worn-out cartilage and bone (either via open surgery or ), correct any deformity, and then use screws (sometimes with plates) to hold the bones together. This makes the body think they are just one bone and they join together as one solid unit.

Once fused, that joint is solid and pain-free forever! 🤩 And don't worry too much about stiffness – whilst it’s true you will lose the ankle movement, most people don’t have that movement anyway by the time they are ready for surgery… and your other foot and ankle joints are incredibly adaptable and will pick up the slack. Check out my other videos for examples!

This video gives you a quick overview of the ankle fusion process!

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