Mr Paul Hamilton

Mr Paul Hamilton
Orthopaedic surgery
Epsom


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Mr Paul Hamilton Orthopaedic surgeon in
Epsom
Ashtead &
London

FRCS (Tr & Orth)


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Mr Paul Hamilton areas of expertise:

Professional statement

Mr Paul Hamilton is a top orthopaedic consultant based in Surrey and South London. He specialises in adult foot and ankle surgery and trauma surgery, including forefoot reconstruction, arthroscopy and arthroplasty, and is an expert in treating sport injuries, Morton's neuroma, arthritis and bunions. After qualifying from St Bartholomew's and the Royal London Medical School, he completed three medical fellowships in the UK and a travelling fellowship to Boston, USA, giving him extensive specialist training. In addition to his private and NHS practices, Mr Hamilton is actively involved in research, and has published and presented his work in orthopaedics around the world.


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 Credentials

GMC: 4533254

 Professional experience

• More than 20 years of experience
• Consultant Orthopaedic Surgeon, South London Foot and Ankle (present)
• Consultant Orthopaedic Surgeon, Epsom and St Helier Hospitals NHS Trust (2011-present)

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 Sub-specialties

• Bunions
• Achilles tendon
• Ankle arthritis
• Foot arthritis
• Morton's neuroma
• Plantar fasciitis

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 Teaching posts

• Examiner, MSc in trauma and orthopaedics, Brighton University
• Teaches on several FRCS (Tr and Orth) courses

 Education

• Postgraduate Diploma in trauma and orthopaedics.
• MB BS, St Bartholomew's and the Royal London Medical School (1998)
• Specialist training in trauma, foot and ankle surgery, Addenbrooke's Hospital Cambridge

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 Professional membership

• Fellow of the Royal College of Surgeons
• Member of the British Orthopaedic Association
• Member of the British Foot and Ankle Society

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Languages spoken

  • English

Diseases, Medical Tests and Treatments

Achilles tendon

Achilles tendinitis (Achilles tendon) is the most frequent type of ankle tendinitis. This tendon connects the calf muscles (gastrocnemius) to the heel ...

Ankle arthroscopy

Ankle arthroscopy is a minimally-invasive surgical technique that lets you view and work directly inside the joint, without opening, thanks to a tiny ...

Arthritis

What is arthritis? Arthritis is a disease that causes inflammation of the membrane that covers the joints. There are more than 100 different types ...

Bunion (hallux valgus)

What is a bunion?   The hallux valgus or bunion is a bony deformity at the base of the big toe on the inside of the foot. It occurs when th ...

Morton's neuroma

Morton’s neuroma or Morton neuritis is a thickening of the interdigital nerve in the space between the third and fourth toes. It occurs as a result of chronic compression. Sometimes it causes intense pain in the front area of the foot, metatarsal level, close to the 2nd or 3rd interdigital space. ...

Plantar fasciitis

Plantar fasciitis is the inflammation of the plantar fascia, which is the ligament that connects the heel bone to the toes. People more at risk of developing fasciitis are those who play sports very often, obese people, patients with tight Achilles tendon, or those with problems in the arch of the foot. Generally, this injury causes pain and stiffness in the bottom of the heel, although the sole can also ache or burn. The treatment involves medication, stretching the heel and toe, night splints, rest and wearing proper shoes. However, in some cases the patient requires surgery. ...

Ankle arthrodesis

Ankle arthrodesis is an operation performed to correct a deformity or unhealed injuries as a result of arthritis, or to relieve pain in the ankle. Arthrodesis fuses the two bones that form the joint together. ...

Ankle tendonitis

Ankle tendonitis is inflammation of the tendons that make up the ankle. The tendon attaches muscle to bone and repetitive motion during this tendon can become inflamed, leading to tendonitis. The most common is the Achilles tendonitis, but you can also inflame other as the extensor tendons, typical of the big toe. ...

Cavus foot

Cavus foot is a human foot when the foot is malformed with an extremely high arch. It can cause the toes to remain stiff or bend inward. It is hereditary in 80% of cases. The most appropriate treatment should be determined by a specialist, and it may include doing specific exercises or wearing orthotics (insoles).   ...

Diabetic foot

Diabetic foot is a set of complications of vascular and nervous conditions that affects patients with chronic diabetes. The effect of irregular blood sugar levels on the vascular system may lead to arterial blockages that impede blood supply to the feet and in severe cases can cause gangrene. On a neurological level, the effect can be on a motor skill or sensory level. The sensation for the patient is the feeling of wearing a tight or excessive cold or heat sock, and the loss of muscle mass at foot level. Both causes, vascular and neurological, can result in of neuropathic diabetic foot ulcers, which can often be complicated by infection. A diabetic foot is often very delicate and vulnerable to discomfort when wearing shoes, although in many patients the symptoms are painless. ...

Flat feet

What are flat feet? The arch, or instep, of the foot is the part in the middle of the foot that is usually raised off the ground. Flat feet are when the arches of the feet are very low or non-existent, in some cases lying completely flat against the ground. They may occur due to weakness in the tendons in that area. It is a common condition, especially in children, whose arches may develop as they grows up. There are two types: rigid flat foot, which has no arch under any circumstances; and flexible flat foot (the most common type), in which the foot flattens when pressed on the ground, but when raising it, the arch reappears.   What are the symptoms of flat feet? Before two years of age, flat feet are impossible to detect, because until then the feet have a layer of fat and soft tissue on the sole. The insteps form in most children between the ages of 3 and 5. After this age, the key symptom is the flat appearance of the foot, without an arch. Generally, flat feet do not cause pain when walking or making any movement, but some patients may experience pain in the feet, ankles, or even higher up in the legs, hips and lower back. This pain may get worse when moving around, and swelling can occur around the ankles.   What causes flat feet? There are several possible causes of flat feet. In babies and toddlers, flat feet are normal, as the arch hasn’t formed yet. Even older children may have flexible flat feet, where the arch only appears when the child is not putting pressure on the sole of the foot, e.g. when sitting. As this is due to the fact that the arch is still developing, most children with flexible flat feet will grow out of them. In other cases, flat feet may be caused by the following: Genetics – if your parents had flat feet you are more likely to also have them. Congenital conditions – if the foot bones didn’t form properly in the womb, flat feet may be the result. Conditions such as Ehlers-Danlos or Marfan syndrome. Conditions that affect the muscles or nerves, such as spina bifida or muscular dystrophy. Overuse, injury, ageing, and general wear-and-tear can cause the arch to collapse in adults, leading to flat feet. Contributing factors could include unsupportive footwear, obesity, or rheumatoid arthritis.   Can flat feet be prevented? Most of the causes of flat feet are impossible to prevent. However, you can minimise your chances of developing flat feet in adulthood by taking care of your feet. Some steps you can take include: Make sure your shoes are the correct size, and fit well, supporting the foot. Try not to over-exert your muscles when doing sport or exercise. If you notice that the arch in one or both of your feet is disappearing, visit your doctor, who may recommend exercises or therapy.   What is the treatment? Most cases of flat feet do not cause the patient any problems, in which case, no treatment is necessary. In cases where flat feet cause pain, the following treatments may be advised by the patient’s doctor: The use of insoles, supportive shoes or arch supports when walking. If the patient is overweight or obese, losing weight is strongly recommended. Painkillers and anti-inflammatories can help manage the discomfort and any inflammation Physiotherapy and stretching exercises can help to strengthen the connective tissue, particularly in cases of overuse and injury. If more conservative treatments fail, or if there is an underlying condition, there are surgical options. If bones are abnormally shaped or joined together, surgery may involve straightening and separating them; if the problem is in the connective tissue, surgery may involve lengthening or repairing this tissue. ...

Foot arthrodesis

Foot arthrodesis is a surgical technique that fuses the bones that form the joint. The aim of the intervention is to relieve pain or the deformity of the foot caused by poorly healed fractures, arthritis, infections, or birth defects. In foot arthrodesis, two different techniques are used: open, in which a long incision and direct visualization of the joint is performed; or arthroscopic, where small incisions are made in the skin through which a thin arthroscope with a small camera connected to a monitor is inserted. With this camera the doctor can see each step of the operation. The joints take four months to fuse completely, and then the patient requires rehabilitation treatment with a physiotherapist. ...

Foot fracture

A foot fracture is a break in any of the bones of the foot (tarsus, metatarsals and phalanges). The injury occurs by direct trauma or excessive load on the bone. The foot fracture causes pain, swelling, numbness of the fingers or toes, decreased range of motion, inability to walk comfortably, and a lump or visible deformity over the fracture zone. Depending on the severity of the fracture, the patient could undergo surgery or have a splint or cast. The metatarsal bones and phalanges can be fixed in a period ranging from three to six weeks, but the tarsal bones take longer to heal, usually six to ten weeks. ...

Fractured ankle

A fractured ankle is a break in one of the ankle bones (tibia, fibula and talus). These fractures may be partial (partially cracked bone), complete (perforated in two parts and bone) or may occur on one or both sides of the ankle. The injury may be caused by a fall or trauma. Symptoms may include pain and swelling in the injured ankle, unable to move or inability to bear weight. And, if the fracture is severe, you may notice that the parts of the fractured bone show through the skin. In the latter case, the injury may require surgery, including the use of metal pins, screws or plates to hold the bones in place while the fracture heals. If the ankle fracture is treated without surgery, it is likely that the patient must wear a cast for at least six weeks. Most people need at least a period of between six and ten weeks to fully recover from a broken ankle. ...

Ganglion or cyst

Ganglions or cysts are benign lumps that often grow without a specific cause in the hand and wrist. These cysts can be especially painful just at the time of their appearance or by the constant use of the hand. Ganglions may vary in size and may also disappear completely spontaneously. Before opting for a treatment, the doctor usually observes their evolution to avoid intervention. But if the ganglion is painful, you could aspirate the fluid with a needle or use a splint to prevent the movement of the hand. If these treatments fail, surgery should be used to remove the cyst, although it should be noted that these cysts may reappear. ...

Heel spur

A heel spur is a calcium deposit which causes a bony protrusion on the underside of the heel bone. It is associated with plantar fasciitis, and causes pain and swelling in the surrounding area. Heel spurs are normally caused by high arched foot, overweight, wearing inappropriate footwear or continuous poor posture when standing. The treatment is based on the use of orthotics insoles that relieve the tension on the heel, night splints, stretching exercises or injections of anti-inflammatory drugs, which are effective to eliminate or reduce pain. If these treatment techniques fail, in severe cases the heel spur can be corrected with surgery. ...

Metatarsal bones

The five metatarsal bones, which make up the metatarsus, are a group long bones located the foot, between the tarsal bones of the hind- and mid-foot and the phalanges of the toes. ...

Minimally invasive bunion surgery

The minimally invasive bunion surgery or percutaneous surgery is a new technique for treating hallux valgus. This procedure decreases the potential complications of this disease and shortens the process of postoperative recovery. This type of surgery involves making small incisions in the skin to correct the deviation of the foot bone. The procedure is simple, lasts ten to fifteen minutes and is a type of ambulatory surgery. The patient can go home the same day of the operation, since only local anaesthesia is used. Generally, minimally invasive bunion surgery is indicated in cases where the patient has severe pain or who cannot walk normally. ...

Orthopaedic surgery

Orthopaedic surgery treats muscular, bone and joint system disorders, and also the ligaments and tendons. It applies medical and surgical methods to treat illnesses of the musculoskeletal system. ...

Osteoarthritis

Osteoarthritis is a degenerative disease that affects the joints and cartilage. As cartilage breaks down and pain sets in, the bone reacts by growing on either side of the cartilage and becoming deformed.  ...

Osteoarthritis of the ankle

Osteoarthritis of the ankle is a degenerative disease of the joint, which is caused by wear of the cartilage that covers the bone. If the tissues disappear, the bone cannot cushion the loads supported by the ankle. The causes include aging, sequelae of trauma and fractures or sequelae of an ankle osteochondritis. The patient feels pain in the foot, a feeling of pressure that makes the patient feel tired and walk with difficulty. In addition, the walking time decreases and the person ends up not being able to walk even a few meters at a time, and in more serious cases causes the total impossibility of walking. Initial treatment of ankle osteoarthritis involves the use of insoles to better accommodate the foot and reduce the impact force on the ankle when walking. Surgery is recommended in more advanced cases, and in others it is possible to choose to implant an ankle prosthesis. ...

Osteotomy

What is an osteotomy? An osteotomy is a surgical procedure, carried out using general anaesthesia, that repairs damaged joints by cutting and reshaping the bones.  An osteotomy can be performed on the following joints: Knee Hip Spine Jaw Chin Big toe Why is an osteotomy done? An osteotomy will fix problems experienced in different bones and joints. Knee – if the kneecap is misaligned or damaged from arthritis then a knee osteotomy cuts either the tibia or femur to take pressure of the damaged knee joint. Hip – the hip socket is reshaped so that the socket aligns better with the ball of the joint. Spine – a wedge of spinal bone can be removed to improve a hunched back. Jaw – in misaligned jaws, a lower jaw osteotomy can reposition the jaw. Chin – an osteotomy can narrow a very square chin. Most often this is performed by plastic surgeons. Big toes – a wedge of bone is removed to prevent the big toe obstructing your other toes. What does an osteotomy involve? Due to the complexity of an osteotomy, a hospital stay will be required. General anaesthesia is used, meaning you are asleep during the operation. The surgeons makes an incision over the area of bone that is being remodelled. Using a special surgical saw, a section of bone will be removed. The cut edges of bone are then secured together with metal hardware or special bone grafts. For a bone graft, a wedge of bone is usually taken from the pelvis, and it is secured with metal hardware. How do you prepare for an osteotomy? Before surgery you won’t be able to eat or drink and certain medications will have to be stopped. You will receive special instructions from your specialist.  Aftercare following an osteotomy You can expect to stay in hospital for a couple of nights. Depending on the type of osteotomy performed, crutches are likely to be needed for a couple of months. Full rehabilitation can take up to 6 months. In most cases, physical therapy exercises will be needed to help restore strength, stability and movement to the bones. Alternatives to an osteotomy An osteotomy is often an alternative to larger surgical procedures, such as hip and knee replacements which are serious operations with very lengthy recovery times, and often revision surgeries too. Discussing your treatment options with your specialist is essential in making a treatment decision.  ...

Percutaneous foot surgery

Percutaneous foot surgery is a new surgical technique to treat foot pathologies such as bone or soft tissue disorders. Thanks to this type of minimally-invasive surgery, the treatment of these pathologies is achieved with a 2-3mm incision on the skin. Conventional surgical techniques require large incisions (or even the elimination of joints in very serious cases). Some of the pathologies most frequently treated with this technique include: hammer fingers, metatarsalagias, bunions, heel spur, and others. However, according to the level of severity of each patient, it will be the physician who will ultimately have to evaluate whether this technique is the most appropriate for treating the pathology. After the operation, the patient should wear a type of wide footwear and a rigid sole that reduces the load on the operated foot, so having surgery in both feet at the same time is not recommended. ...

Shockwave therapy

Shockwaves have a therapeutic effect and cause the regeneration of injured or diseased tissues. Shockwaves are acoustic waves which have high power mechanical and biological effects. Such treatments are primarily used for treatment of diseases which require tissue regeneration. ...

Sport orthopaedic

Sport orthopaedic involves the study and treatment of injuries sustained in sports. These can occur violently, due to accidents or excessive training, technical deficiencies, lack of fitness, among other causes. ...

Sport surgery

Sports surgery is a specialty that deals with injuries incurred during sports.       

Sports injuries

Sports injuries occur due to bad habits during training, improper use of equipment, lack of warm-up exercises, or insufficient stretching. The most common sports injuries are sprains or strains of ligaments, muscle and tendon tears, knee injuries, muscle swelling, injury to the Achilles’ tendon, shin pain, fractures or dislocations, among other conditions. Treatment varies depending on the severity of the injury, and can include either physical therapy or surgery. ...

Sprained ankle

Ankle sprain is an injury to the ankle ligaments. The sprain can be caused by a direct blow to the ankle or as a result of a fall, poor support or poor movement. There are three types of ankle sprain according to their severity. First-degree sprain is minor, since the ankle ligaments are not broken, the area is slightly swollen, painful, and fluid may appear. In this case it is possible to return to physical activity in a short time with a functional dressing. In second-degree sprain, there is partial or total tear of ligaments, pain and swelling are greater and fewer foot movements can be performed. In third-degree sprain, there is total ligament rupture, pain is intense, foot mobility is reduced and injury is accompanied by a much greater fluid leak. Therefore, surgery is sometimes required. ...

Tendinopathy

What is tendinopathy? Tendinopathy is an umbrella term for diseases of the tendons. Tendons are fibrous cords of tissue that hold muscles to bone, and in order to do their job, they must be strong and flexible. Despite this, they can be injured due to overuse. Tendinopathy broadly refers to three varieties of tendon injury, and is often confused with, or used synonymously with them. They are: Tendonitis/tendinitis – inflammation of a tendon, usually due to acute injury caused by overuse or repetitive strain. Tendinosis – chronic tendon injury with little or no inflammation, involving micro-tears in the affected tendon. Tendinosis causes long-term pain and is degenerative. Paratenonitis – inflammation of the outer sheath (paratenon) that surrounds certain tendons, such as the Achilles. There is some debate as to whether this should be considered separate from tendonitis. All of these conditions increase the risk of a more serious tendon tear, or rupture.   What are the symptoms of tendinopathy? The common symptom of all types of tendinopathy is pain in or around the tendon, most commonly in the place where it attaches to the bone. Other symptoms depend on the type of tendinopathy – for example, tendonitis is characterised by inflammation, including heat, swelling and redness, while tendinosis is a chronic ache, pain or stiffness without much, if any inflammation. The pain is usually worse during and after activity, and the area around the joint can be stiffer the following day. There are tendons in many parts of our bodies, and tendinopathy can occur in any of them. It most commonly strikes in tendons such as those in the arms, shoulder, hands, and the Achilles tendon (in the heel).   What causes tendinopathy? It is thought that the biggest factor in most tendinopathies is overuse, although there are many theories regarding other possible factors, such as thermal damage and load-induced ischemia. Both sudden bursts of exertion leading to injury and repetitive movements are thought to be the main causes of tendonitis, and obesity is thought to be a risk factor. In the case of calcific tendonitis, calcium deposits in the tendon are the cause of the inflammation, but why they build up in the first place is not fully understood.   How can tendinopathy be prevented? While it is impossible to prevent with 100% certainty, the best way to prevent tendinopathy is to look after your muscles and tendons by not over-exerting yourself, but keeping them strong and flexible by doing exercise. Warming up before exercise and cooling down afterwards by stretching your muscles is also recommended.   What is the treatment? The treatment may depend on the kind of tendinopathy, but in most mild cases the RICE therapy is advised: Rest until the injury improves Ice – apply cold Compress the injury with a bandage or brace Elevate – keep the injured tendon raised while at rest. Painkillers may be prescribed to deal with the pain – particularly NSAIDs if there is inflammation. In more severe cases, shockwave therapy or even surgery may be necessary. ...

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