Ask an Orthopaedic Surgeon: Dr Kannan Kaliyaperumal from Mount Elizabeth Novena Hospital Singapore

Ask a Doctor ForumCategory: Orthopaedic SurgeryAsk an Orthopaedic Surgeon: Dr Kannan Kaliyaperumal from Mount Elizabeth Novena Hospital Singapore
Dr Kannan asked 5 months ago
I am Dr Kannan Kaliyaperumal, Orthopaedic Surgeon practicing at the Specialist Orthopedic Centre at Mount Elizabeth Novena Hospital Singapore. Ask Me Anything!

I am a fellowship trained orthopedic surgeon with a subspecialty interest in Lower Limb (Leg) and Foot & Ankle disorders.

I obtained my postgraduate qualification from the Royal College of Surgeons in Edinburgh. I was awarded the prestigious MOH Scholarship by the Ministry of Health (Singapore) to pursue further training in the field of Lower Limb Reconstructive Surgery (LLRS) with special emphasis on Foot and Ankle (F&A) Reconstruction.

I completed my subspecialty training in Switzerland and in the Netherlands, subspecializing in F&A reconstruction and in Minimally Invasive Surgery (MIS) where I was involved with the surgical teams treating elite European athletes. Prior to commencing private practice, I held the appointment of Chief, Foot & Ankle Surgery at a restructured hospital in Singapore.

I am an active member and faculty of the following international societies:

  1. American Foot & Ankle Society (AOFAS)
  2. European Foot & Ankle Society (EFAS)
  3. British Orthopedic Foot & Ankle Society (BOFAS)
  4. AO Trauma (AOT)
  5. International Cartilage Research Society (ICRS)
  6. American Academy of Orthopedic Surgeons (AAOS)
  7. Society for the Study of Minimally Invasive Surgery of the Foot & Ankle (GRECMIP)
  8. European Society for Sports Traumatology, Knee Surgery & Arthroscopy (ESSKA)

My clinical subspecialty expertise is in the following areas of lower limb surgery:

  1. Sports injuries, ligament injuries & tendinopathies of the knee, foot and ankle
  2. Arthroscopic (keyhole) surgery for management of cartilage defects, ligament repair and impingement in the knee and ankle
  3. Forefoot deformity correction (Bunions and lesser toe deformities)
  4. Management of foot pain (metatarsalgia)
  5. Management of Diabetic foot ulcers, Charcot’s joints & wounds
  6. Management of fractures around the knee, foot & ankle
  7. Correction of flatfeet & high arched feet
  8. Management of arthritis including Total Ankle Replacement and osteotomies
  9. Conventional & Robotic Total Knee Replacement Surgery
  10. Lower Limb deformity correction including limb lengthening & pediatric conditions

I have extensive experience in reconstructive lower limb and foot and ankle surgery, being one of a very small number of sub specialists in this area in Singapore & the region. I am well published with articles in international peer reviewed journals. My particular research interest is in cartilage regeneration and management of cartilage defects. I did the first case of artificial scaffold reconstruction in Singapore for a talus osteochondral defect.

My passion for teaching has seen me being appointed as a clinical Senior Lecturer of the Yong Loo Ling School of Medicine, National University of Singapore involved in undergraduate medical education in Singapore. I am also a faculty member of the National Healthcare Group Residency program, involved in the teaching of Residents.  I am also an International Faculty member of the AO trauma group where I have taught in China, India, Indonesia, Malaysia, Hong Kong and Singapore. I am also passionate in developing the Foot & Ankle specialty in the region. I have conducted numerous courses and have been invited as chairperson to various F&A courses and symposiums.

Learn more about me here: https://patients.smarterhealth.sg/specialist-doctor/kannan-kaliyaperumal/

I am excited to be here to share/discuss Foot and Ankle disorders with everyone. I will be actively answering questions. If you’ve got questions about foot and ankle reconstruction, foot and ankle injuries, foot and ankle surgeries, ask me anything!

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19 Answers
Cindy answered 5 months ago
Hi Dr Kannan

I would like to ask, what is the downtime for TKR for elederly patients avove 70. Would TKR be recommended?

How can i make an appt to bring my mom to consult you?

thank you

Dr Kannan
replied 5 months ago

Thank you for your question.

Before Total Knee Replacement (TKR) surgery is planned some surgical considerations are as follows:

1. General health of the patient
2.X-rays of the knee
3.Mobility status of the patient

The majority of healthy 70 year olds are suitable for surgery. TKR surgery is now a routine operation with minimal risks and downtime. Patients are able to walk the next day after surgery and are discharged from hospital within 3days.

TKR surgery provides predictable pain relief, good mobility and a better quality of life for the elderly. So that they can engage independent in activities of daily living without pain.

You can contact the clinic to make an appointment at 6272 0933 or email contact@specialistortho.com.sg

Kok Leong answered 5 months ago

I am 34 years old this year and have gained weight rapidly over the past 6 years due to work stress and overeating. I am now close to 100kgs at 1.68m tall. I have noticed that whenever I climb up stairs or walk for too long, my knees shake and there is pain. Sometimes there is swelling. I have seen a local GP and the advice was for me to lose weight and the issue should resolve. However, I am not sure if this is purely a weight issue. Should I wait and observe to see if the pain goes away when I gradually lose weight? Or would you recommend I do a scan?

Dr Kannan
replied 5 months ago

Hi. Thank you for your question. Pain in the knees is not always due to weight gain, though it may be one of the reasons. There may be other causes of knee pain when one overloads the knee.

For example the knee pain can arise from a meniscal tear or from knee cap overloading, which is known as patella femoral joint overload. Sometimes there can be an underlying cartilage injury. Especially if the knee joint pain is associated with swelling.

It may be something that is worth investigating and addressing. Sometimes an MRI of the knee with x-rays is useful in addressing the underlying pathology. It is advisable to investigate the symptoms earlier than later and our clinic can assist with your insurance claims.

Darren answered 5 months ago

My father is 72 years old. His feet shake when he stands. He also mentions feeling something like an electric shock in his knees. Is this arthritis, Doctor? What treatment should he undergo?

Dr Kannan
replied 5 months ago

Tremors in the feet could be a sign of muscle weakness where his body weight cannot be supported by the knees or the ankles. This could be an indication of degenerative joint disease or otherwise known as arthritis.

In someone in their 70s, if there are some muscle tremors or instability, it is best to check for conditions like Parkinsonism or some other neurological condition. It is best to see a specialist to distinguish between a mechanical cause and a neurological cause.

WenWei answered 5 months ago

I am 28 years old. I have a problem with recurring plantar fasciitis. I have done shock wave therapy several times but each therapy session works only temporarily to relieve the pain. Is there any permanent solution you would recommend? I don’t wish to keep going through therapy when I’m still so young.

Dr Kannan
replied 5 months ago

You may be suffering from recurrent chronic plantar fasciitis. 80-90% of patients with plantar fasciitis improve with physiotherapy , medications or shockwave treatment with some footwear modification with insoles. Some may need injection of cortisone into the plantar fascia insertion, but this should not be repeated often.

There are some other reasons for chronic heel pain. This could be related to abnormal feet shape like flatfeet, high arch feet , wrong footwear or a plantar fascia tear. An MRI scan and weight bearing feet x-rays are sometimes necessary to formulate an appropriate treatment plan.
It is best to seek an assessment with a foot & ankle specialist surgeon.

Jimmy Ang answered 5 months ago

I am 48 years old. I spend most of my time working behind a desk. However, at night, after work, my calves are always tight and painful, and it feels as though I’ve walked a long distance. It happens almost every day. What is the cause? Is this dangerous?

Dr Kannan
replied 5 months ago

Hi. Thank you for your question. Calf tightness in common in patients who have a sedentary lifestyle or those who do not stretch adequately before or after exercising.

In your case, it is very possible that the calf muscles tighten up after prolonged hours of sitting. The condition is likely due to gastrocnemius muscle tightening from a contracted posture. Simple stretching, shockwave therapy and muscle releases can help to alleviate this problem.

Jason answered 5 months ago

I had a traffic accident when I was 7 and since then I have been walking with a limp. I am now 20 years old and am considering seeking treatment to fix the limp. Is it possible to treat so I can walk normally?

Dr Kannan
replied 5 months ago

Hi. Thank you for your question. It’s always important to approach a limp systematically. We need to establish if the limp is due to a true shortening of the lower limb (for example, due to bone loss from the accident) or if it’s compensation due to muscle contraction.

It is indeed possible to fix a limp if we can establish the cause of the limp. There are various options and it is best discussed with a specialist with experience in this field together , like a lower limb surgeon, with the relevant investigations. The range of modalities can vary from simple insoles, physiotherapy, muscle lengthening procedures or more complex limb lengthening procedures.

Enghui answered 5 months ago
I am a 67 year old male. I have a history of arthritis in my knee. These 3 days, I have been feeling something like an electric shock in the sole of my left foot. Is this also linked to my arthritis or is it a totally different condition? What is the best treatment for this?
Dr Kannan
replied 5 months ago

Thank you for your question. Knee arthritis is usually localised and the pain is usually mechanical in nature. For example if there is excessive activity, there can be knee pain or swelling within the arthritic knee.

Sensation of numbness or hypersensitivity in the sole of the foot could be related to a nurse irritation or to a localised inflammation of the plantar fascia. It is unlikely that the knee arthritis and the heel symptoms are linked.

However if you have a fixed flexion deformity of the knee or if you weightbear abnormally you can unknowingly shift the weight onto the foot and it can cause some foot pain and symptoms. It would be best to seek an opinion or advice from a orthopaedic specialist.

Anthony answered 5 months ago
My father has been complaining about numbness in his toes lately. He is 56 years old with a history of diabetes. He said the area near the toes is thickened and painful if he walks too far. I have consulted a GP and he was advised to do physiotherapy. I also bought him thick comfortable shoes. But all of these is not leading to any improvement in his condition. What would you recommend? I need your opinion
Dr Kannan
replied 5 months ago

Thank you for your question. Numbness in the toes in a diabetic patient is related to sensory peripheral neuropathy in a diabetic patient. he may be losing sensation in the sole of the foot and therefore he is putting a lot of pressure on the foot this could contribute to a thick skin known as a callosity.

It is important to get some x-rays to make sure that the callosity is not related to an underlying bone deformity . A bone deformity in a diabetic is known as a Charcot’s foot.

I would strongly encourage a review with the orthopaedic foot and ankle specialist and further evaluation.

Benny Wah answered 5 months ago
I’ve been taking a long break from jogging and started again two days ago. About 2 hrs after my run, I felt my calves were very tight and painful when I stood up from my seat. The tightness and pain is lasting till now. I doubt it is DOMS (delayed onset muscle soreness), because it happened right after the jog. What could have happened here?
Dr Kannan
replied 5 months ago

Thank you for your question. Calf pain after running is usually related to tight gastrocnemius muscle is or could be related to in adequate warmup or stretching prior to running.

A rarer condition that persists awhile even after stopping exercise it’s known as compartment syndrome. It is usually related to excessive rise in the pressure within the calf muscles after prolonged activity.

If the pain and tightness persists , it is best to seek medical attention to ensure that there is no abnormal pathology within the calf muscles and the blood vessels within the calf. The orthopaedic specialist will usually run some tests and sometimes even perform an MRI scan.

Azmi answered 5 months ago

I am 44 years old this year and I run almost 30km a week. Lately I have been noticing a burning sensation in my knee joints after running. The soles of my feet will burn as well, and my toes will itch. I will then have to massage my joints, feet and toes for quite some time before the burning goes away. Is this a sign that I have overworked my legs? Do i need to go for any tests and consider treatment? Thank you for sharing.

Dr Kannan
replied 5 months ago

Thank you for your question. Burning sensation is quite hard to define it could represent an inflammation or an effusion, which basically means swelling within the knee.

If the sensation also involves your feet as well as your knees it could be down to muscle fatigue and overuse of this muscles. Rest between runs as well as physiotherapy and massage to the muscles and joints will help.

Occasionally when patients experience these symptoms in the lower limb it may be appropriate to run some biomechanical tests to check for electrolytes like sodium and potassium. It could be an early sign of and electrolyte abnormality. It is best checked with a specialist.

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