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Professor Nat Padhiar

Nat

Lead for Podiatric Sports Medicine and Module (2) Leader

Centre: Experimental Medicine & Rheumatology (Sports & Exercise Medicine)

Email: n.padhiar@qmul.ac.uk
Telephone: +44(0) 20 8504 4546

Profile

ORCID iD: 0000-0002-0352-4534

Nat Padhiar was appointed Consultant Podiatric Surgeon at The Royal London Hospital between 1991-2011. He has a private practice at The London Independent Hospital. 

He is an Honorary Clinical Professor, Course Director (Podiatric Sports Medicine), Internal Examiner, and Module Leader at the Centre for Sports & Exercise Medicine (CSEM), William Harvey Research Institute, St Bartholomew’s and the Royal London School of the Medicine and Dentistry, Queen Mary, London University. In the last 3.5 decades, he has supervised over 150 research projects submitted by MSc, iBSc & PhD students in SEM. 
 
Nat Padhiar was a member of the Medical Service Team, the Clinical Lead and Team Leader for Podiatric Sports Medicine at The London 2012 Games and was based in the Polyclinic, Olympic Village in Stratford for the entire period of Olympic & Paralympic Games 2012. 
 
Nat holds membership in various surgical and SEM institutions. Nat is on the Editorial Board of the Sports Medicine section of Grand Rounds, the online medical journal, and the review panel for SEM and Foot Surgery journals. 
 
Clinical interests: (1) Foot Surgery, (2) Foot and ankle problems in Sport, (3) Exercise Induced Leg Pain in Sport, (4) Image-guided lower limb injections, (5) Sports Medicine and injury of the Lower Limb, (6) Dynamic intra-compartment pressure investigation for Chronic Exertional Compartment Syndrome; with a special interest in Exercise Induced Leg Pain and Achilles tendinopathy.
 
Nat Padhiar is a keen sportsman who continues to play cricket and tennis and participates in endurance sports (37 marathons, 2 Ultra-marathons and over 200 half marathons). He has represented Uganda School boys in cricket. In his professional capacity he has been part of the medical team and has attended World Student Games (1991), Commonwealth Games (2002), Island Games (2003), Everest Marathon (1993,1995), Mongolian Sunrise to Sunset Marathon (2001-2003), Daily Telegraph/British Brain & Spine Foundation London Marathon Team (1999-2007), London Triathlon (2005) and London 2012 Olympic & Paralympic Games (2012). 
 
He is not formally attached to professional football, rugby, or athletic clubs, but many clubs refer their sportsmen to him at his private clinics at London Independent Hospital. 

Research

Group members

CSEM, QMUL: Prof Dylan Morrissey, Dr Simon Lack, Dr Stuart Miller, Mr Trevor Prior, Dr Manuela Angio, Dr Nikos Malliaropoulos, Dr Katrine Kryger, Mr Ian Griffiths, Dr Dev Pyne, Dr Angela Pakozdi, Dr James Sarkodieh, Dr Saira Chaudhry, Dr Brad Neil, Mr Zubair Haleem, Dr Roger Wolman, Dr Catherine Lester, Ms Fatma Bosnina, Dr Otto Chan. 

Summary

A particular focus of my research has been exercise-induced leg pain (EILP) which is typically poorly managed, disabling and career ending for athletes if not optimally managed. Innovation has included novel diagnostic, measurement, and management approaches through award-winning contributions (e.g., BASEM Gold Medal) and papers in top-ranked journals (e.g., BJSM, BMJ, CJSM). In combination with my clinical work, my research has made me world-leading in this field.

The area of research is focused on Achilles Tendinopathy with innovating high volume image guided injection (HVIG) for the treatment of mid-portion Achilles tendinopathy (AT) which is now widely accepted as first line treatment of AT (JDR 2008, JSMS 2009, JMT 2010). 

Key Publications

  1. Mifsud T,  Gatt A, Micallef-Stafrace K, Chockalingam N, Padhiar N. Elastography in the assessment of the Achilles tendon: A systematic review of measurement properties. JFAR. 2023 Apr 27;16(1):23.
  2. Mifsud T, Chatzistergos P, Maganaris C, Gatt A, Micallef-Stafrace K, Chockalingam N, Padhiar N. Supersonic shear wave elastography in human tendon in vivo is associated with tendon stiffness over small strains. J Biomechanics. 2023 May;152:111558, 1-6.
  3. Malliaropoulos N, Bikos G, Tsifountoudis I, Alaseirlis D, Christodoulou D, Padhiar N, Maffulli N. Therapeutic ultrasound related pain threshold in elite track & field athletes with tibial bone stress injuries. Surgeon. 2023,21,225-229.
  4. Padhiar N. Podiatric Sports Medicine. BASEM Today. 2022,61(Winter),18-20.
  5. Padhiar N, Lester C, Wolman R, Morrissey D. Guest Editor. Celebrating 40 years of SEM Education. BASEM Today. 2021,57(Winter),21-41.
  6. Maffulli N, Quaranta M, Poeta N, Oliva F, Padhiar N, Chan O. Minimally invasive fasciotomy for symptomatic tibialis anterior muscle hernia. The Surgeon. 2022 Feb 12;S1479-666X(22)00021-X. doi: 10.1016/j.surge.2022.01.005.
  7. Cowell L, Padhiar N. Use of homeopathic medication and compression therapy in the treatment of  non-union fracture of the tibia in an active 62 year old female. Journal of Homeopathy for Everyone. 2021, March 19. https://hpathy.com/scientific-research/use-of-homeopathic-medication-and-compression-therapy-in-the-treatment-of-non-union-fracture-of-the-tibia-in-an-active-62-year-old-female/  
  8. Padhiar N, Curtin M, Aweid O, Aweid B, Morrissey D, Chan O, Malliaras P,  Crisp T. The effectiveness of prolotherapy for recalcitrant medial tibial stress syndrome: a prospective case series. J Foot Ankle Res. 2021 Apr 16;14(1):32.
  9. Padhiar N, Chadwick P, Ashford R. COVID-19. Guidance on safety of steroid injections and alternative suggestions in the management of the musculoskeletal problems encountered in podiatric practice. Podiatry Now. 2020,Sept,30-33.
  10. Lohrer H, Malliaropoulos N, Korakakis V, Padhiar N. Exercise-induced leg pain in athletes: diagnostic, assessment, and management strategies. Phys Sportsmed. 2019 Feb;47(1):47-59.
  11. Dixit V, Pegrum J, Padhiar N, Nugent I. The new algorithm for the management of stress fractures of the foot. Osteoporosis International,2018,29,S561-S561.
  12. Leung R, Malliaropoulos N, Korakakis V, Padhiar N. What are patients' knowledge, expectation and experience of radial extracorporeal shockwave therapy for the treatment of their tendinopathies? A qualitative study. J Foot Ankle Res. 2018 Apr 5;11:11.
  13. Malliaropoulos N, Bikos, G, Meke M, Korakakis V, Valle, X, Lohrer H, Maffulli, N, Padhiar N. Higher frequency of hamstring injuries in elite track and field athletes who had a previous injury to the ankle - a 17 years observational cohort study. Journal of Foot and Ankle Research (2018) 11:7,1-8.
  14. Malliaropoulos N, Ghrairi M, Al Hashimi M, Padhiar N. Inspiring excellence in musculoskeletal sports medicine. Br J Sports Med 2017;51:1575.
  15. Thompson D, Malliaropoulos N, Padhiar N. Sesamoid osteonecrosis treated with radial extracorporeal shock wave therapy. BMJ Case Rep. 2017 May 22;2017.
  16. Chan O, Havard B, Morton S, Pritchard M, Maffulli N, Crisp T, Padhiar N, Perry JD , King JB, Morrissey D. Outcome of prolotherapy in intra-tendinous Achilles tears - a case series. Muscle Ligament Tendon J.,2017;7(1):78-87.
  17. Chan O, Morton S, Pritchard M, Parkes T, Malliaras P, Crisp T, Padhiar N, Maffulli N, King JB, Morrissey D. Intra-tendinous tear of the achilles tendon – a new pathology? Analysis of a large 4 year cohort. Muscle Ligament Tendon J.,2017;7(1):53-61.
  18. Abdulhussein H, Chan O, Morton S, Kelly S, Padhiar N, Valle X, King JB, Williams S, Morrissey D. High Volume Image Guided Injections with or without Steroid for Mid-portion Achilles Tendinopathy: A Pilot Study. Clin Res Foot Ankle.2017,5:3. DOI: 10.4172/2329-910X. 1000249.
  19. Malliaropoulos N, Ghrairi M, Zerguini Y, Padhiar N. Soft tissue injuries are still a challenge in musculoskeletal sports and exercise medicine. Br J Sports Med 2016;50:1487.
  20. Chatterjee R, Malliaropoulos N, Padhiar N. Diagnosis and management of plantar plate tear in an elite 400m hurdler. J. Musculoskelet. Res,2016,19(2),1672002.
  21. Malliaropoulos N, Jury R, Pyne D, Padhiar N, Turner J, Korakakis V, Meke M, Lohrer. Radial extracorporeal shockwave therapy for the treatment of finger synovitis (trigger digit).Open Access Journal of Sports Medicine,2016,7,143-151.
  22. Malliaropoulos N, Crate G, Meke M, Korakakis V, Nauck T, Lohrer H, Padhiar N. Success and Recurrence Rate after Radial Extracorporeal Shock Wave Therapy for Plantar Fasciopathy: A Retrospective Study. Biomed Res Int. 2016;2016:9415827.
  23. Alagha B, Padhiar N. Partial tear of plantar fascia in a professional dancer. J. Musculoskelet. Res. 2015,18,1572001,[5 pages] DOI: 10.1142/S021895771572001X.
  24. Korakakis V, Malliaropoulos N, Baliotis K, Papadopoulou S, Padhiar N, Nauck T, Lohrer H. Cross-cultural Adaptation and Validation of the Exercise-Induced Leg Pain Questionnaire for English- and Greek-Speaking Individuals. J Orthop Sports Phys Ther. 2015 Jun;45(6):485-96.
  25. Nauck T, Lohrer H, Padhiar N, King JB. Development and validation of a questionnaire to measure the severity of functional limitations and reduction of sports ability in German-speaking patients with exercise-induced leg pain. Br J Sports Med. 2015 Jan;49(2):113-7.
  26. Malliaropoulos N, Korakakis V, Christodoulou D, Padhiar N, Pyne D, Giakas G, Nauck T, Malliaras P, Lohrer H. Development and validation of a questionnaire (FASH--Functional Assessment Scale for Acute Hamstring Injuries): to measure the severity and impact of symptoms on function and sports ability in patients with acute hamstring injuries. Br J Sports Med. 2014 Dec;48(22):1607-12.
  27. Aweid O, Gallie R, Morrissey D, Crisp T, Maffulli N, Malliaras P, Padhiar N. Medial tibial pain pressure threshold algometry in runners. Knee Surg Sports Traumatol Arthrosc. 2014 Jul;22(7):1549-55.
  28. Pegrum J, Crisp TA, Padhiar N. Diagnosis and management of bone stress injuries of the lower limb in athletes. BMJ (Clinical research ed.). 01/2012; 344:e2511.
  29. Papalada A, Malliaropoulos N, Tsitas K, Kiritsi O, Padhiar N, Del Buono A, Maffulli N. Ultrasound as a primary evaluation tool of bone stress injuries in elite track and field athletes. Am J Sports Med. 2012 Apr;40(4):915-9.
  30. Aweid O, Del Buono A, Malliaras P, Iqbal H, Morrissey D, Maffulli N, Padhiar N. Systematic review and recommendations for intracompartmental pressure monitoring in diagnosing chronic exertional compartment syndrome of the leg. Clinical journal of sport medicine: official journal of the Canadian Academy of Sport Medicine. 05/2012; 22(4):356-70.
  31. Pegrum J, Crisp T, Padhiar N, Flynn J. The pathophysiology, diagnosis, and management of stress fractures in postmenopausal women. Phys Sportsmed. 2012 Sep;40(3):32-42.
  32. Crisp TA, King JB, Chan, Padhiar N. Crisp-padhiar syndrome. Br J Sports Med 2011;45:e1.
  33. Davis A, Pemberton T, Ghosh S, Maffulli N, Padhiar N. Plantar pressure of clipless and toe-clipped pedals in cyclists - A pilot study. Muscles Ligaments Tendons J. 2011 Oct 30;1(1):20-4.
  34. Curtin M, Crisp T, Malliaras, Padhiar N. The effectiveness of prolotherapy in the management of recalcitrant MTSS: a pilot study. Br J Sports Med. 2011,45(2),e1-e1.
  35. Padhiar N, Jones PR, Curtin M, Malliaras P, Chan O, Crisp TA. The effectiveness of prolotherapy for recalcitrant medial tibial stress syndrome: a prospective case series. British journal of sports medicine. 12/2011; 45(15):A16.
  36. Zhang JM, Bader D, Twycross-Lewis R, Padhiar N. A prospective cohort study of vertical pressure on hands of sitting volleyball players using Tekscan pressure mat. Br J Sports Med. 2011,45(2),e1-e1.
  37. Divani K, Chan O, Padhiar N, Twycross-Lewis R, Crisp T, Morrissey D, Maffulli N. Site of maximum neovascularisation correlates with the site of pain in recalcitrant mid-tendon Achilles tendinopathy. Manual therapy. 10/2010; 15(5):463-8.
  38. Tsintzas D, Ghosh S, Maffulli N, King JB, Padhiar N. The effect of ankle position on intracompartmental pressures of the leg. Acta Orthop Traumatol Turc. 2009 Jan-Feb;43(1):42-8.
  39. Padhiar N, Allen M, King JB. Chronic exertional compartment syndrome of the foot. Sports medicine and arthroscopy review. 10/2009; 17(3):198-202.
  40. Humphrey J, Chan O, Crisp T, Padhiar N, Morrissey D, Twycross-Lewis R, King JB, Maffulli N. The short-term effects of high volume image guided injections in resistant non-insertional Achilles tendinopathy. Journal of science and medicine in sport / Sports Medicine Australia. 11/2009; 13(3):295-8.
  41. Padhiar N, Al-Sayeagh H, Chan O, King JB, Maffulli N. Pennation angle of the soleus in patients with unilateral Achilles tendinopathy. Disability and rehabilitation. 06/2008; 30(20-22):1640-5.
  42. Crisp T, Khan F, Padhiar N, Morrissey D, King JB, Jalan R, Maffulli N, Chan O. High volume ultrasound guided injections at the interface between the patellar tendon and Hoffa's body are effective in chronic patellar tendinopathy: A pilot study. Disability and rehabilitation. 06/2008; 30(20-22):1625-34.
  43. Chan O, O'Dowd D, Padhiar N, Morrissey D, King JB, Jalan R, Maffulli N, Crisp T. High volume image guided injections in chronic Achilles tendinopathy.Disability and rehabilitation. 06/2008; 30(20-22):1697-708.
  44. Sharma P, Padhiar N, Kyriakides C. Popliteal cystic adventitial disease causing intermittent claudication in a young athlete: a case report. Southern medical journal. 12/2008; 101(11):1154-6.
  45. Tzortziou V, Maffulli N, Padhiar N. Diagnosis and management of chronic exertional compartment syndrome (CECS) in the United Kingdom. Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine. 06/2006; 16(3):209-13.
  46. D Pyne, A S M Jawad, N Padhiar. Saphenous nerve injury after fasciotomy for compartment syndrome. British journal of sports medicine. 01/2004; 37(6):541-2.
  47. Birtles DB, Rayson MP, Jones DA, Padhiar N, Casey A, Newham DJ. Effect of eccentric exercise on patients with chronic exertional compartment syndrome. Eur J Appl Physiol. 2003 Feb;88(6):565-71.
  48. Jawed S, Jawad AS, Padhiar N, Perry JD. Chronic exertional compartment syndrome of the forearms secondary to weight training. Rheumatology (Oxford). 2001 Mar;40(3):344-5.
  49. Padhiar N, Cowley E, Prior TD, Rome K. Roundtable discussion - plantar heel pain. Podiatry Now. 2016,19(3):18-23.
  50. Nikos M, Valle X, Tsapralis K, Lohrer H, Padhiar N, Maffulli N. My experience from ECOSEP Bauerfeind Travelling Fellowship 2013. Muscles Ligaments Tendons J. 2014 Feb 24;3(4):359.
  51. Morton S, Chan O, Pritchard M, Parkes T Malliaras P, Maffulli N, Crisp T, Padhiar N, King JB, Morrisey D. 70 Intratendinous tears of the achilles tendon- A new pathology? Br J Sports Med,2014,48(2),A45-A46.
  52. Malliaropoulos N, Padhiar N, King JB, Maffulli N. The effect of physical exercise on musculo-skeletal metabolism: a systematic review of the role of rank/rankl/opg pathway. British journal of sports medicine 07/2013; 47(10):e3.
  53. G Schiffer, O Chan, R Jalan, N Padhiar. Retrospective review of injection therapy in Morton's neuroma. British journal of sports medicine 07/2013; 47(10):e3.
  54. Keramaris N,Malliaropoulos N, Padhiar N, King JB, Maffulli N. The effect of physical exercise on musculoskeletal metabolism: A systematic review of role rank/rankl/opg pathway. Br J Sports Med,07/2013, 47(10)e3-e3.
  55. Malliaropoulos N, Padhiar N, King JB, Maffulli N. The effect of physical exercise on musculo-skeletal metabolism: a systematic review of the role of rank/rankl/opg pathway. British journal of sports medicine 07/2013; 47(10):e3.
  56. Malliaropoulos N, Ritsioudi M, Finellis V, Padhiar N, Maffulli N. Dynamic foot pressure measurements in elite track and field athletes. British journal of sports medicine 07/2013; 47(10):e3.
  57. N Padhiar, D Pyne. Guest Editors of the Special feature of BASEM Today, 2013, Issue 25, winter.
  58. Morton S, Crisp, T, Morrissey, D, Chan, O, Padhiar, N. Autosomal dominant type 2 accessory navicular: a family of crisp-padhiar syndrome? SportEX Medicine. 2012,52, p7-11.
  59. Padhiar N, Acharya N, Chan R, Divani K, Chan O, Crisp O, Goodier WD, Jalan R, King JB, Morrissey, Maffulli N, Webborn N. Achilles tendinopathy Part 1 – Pathophysiology and Clinical features. SportEX Medicine.2010,45(7),23-30.
  60. Padhiar N, Acharya N, Chan R, Divani K, Chan O, Crisp O, Goodier WD, Jalan R, King JB, Morrissey, Maffulli N, Webborn N. Achilles tendinopathy Part 2 – Management. SportEX Medicine.2010,46(10),6-10.
  61. Padhiar N. Chronic Compartment Syndrome of the leg. SportEX Medicine.2009;40(4),16-22.
  62. Padhiar N. Foot orthoses and their role in injury prevention. SportEX Medicine.2001;8(4).
  63. Padhiar N. The biomechanics of gait and running. SportEX Medicine.2000;4(4).
  64. Padhiar N, Morrissey D. Leg and related ankle injuries – a differential diagnosis. SportEX Medicine.2000;4(4).
  65. Padhiar N, King JB. Foot orthoses can change compartmental pressures in the leg. BJSM. 1998;32(1).
  66. McGuinness M, Padhiar N. Necrobiosis lipoidica diabeticorum. The Foot. 1997;7(1); 47–51.
  67. Crisp TA, Padhiar N, King JB, Allen M, Barnes M. Compartment syndrome of the lower leg – Underwater hockey. J Med & Sci in Sports & Exercise.1997;29(5),S233.
  68. Padhiar N, Bader D, King JB. A pilot study to identify pathomechanical factors in exercise induced leg pain. JBritPodMed. 1997;52(1),3-8.
  69. Lee S, Padhiar N, Barker JR. Delayed presentation and ultrasonography evaluation of a false aneurysm following acute trauma to the ankle. The Foot. 1997;7,174-175.
  70. Padhiar N, King JB. Exercise induced leg pain-chronic compartment syndrome. Is the increase in intra-compartment pressure exercise specific? Br J Sports Med. 1996 Dec;30(4):360-2.
  71. Sandhu MA, Khan F, Padhiar N. A benign solitary Schwannoma in the foot. JBritPodMed. 1995;50(7),105-106.
  72. Padhiar N, Bristow W. Autonomic Dysrelexia – a serious consideration in Podiatry, illustrated by 2 case histories. JBritPodMed. 1995;50(6),89-90.
  73. Padhiar N, King JB. An overview of chronic compartment syndrome: commonest exercise induced leg pain in young athletes. JBritPodMed. 1995;50(4),50-53.

Published books and chapters in books/textbook

  1. Chan O, Crisp TA, Padhiar N, King JB, Maffulli N. 2010. Conservative management of tendinopathy of the main body of the achilles tendon with high volume image guided injection (HVIGI). In: Calder J, Karlsson, Maffulli N, Thermann, Niek van Dijk C. ed. Achilles Tendinopathy-Current Concepts.Surrey,UK: DJO Publications, 119-130. ISBN:978-0-9558873.
  2. N Padhiar, D Pyne. Guest Editors of the Special feature of BASEM Today, 2013, Issue 25, winter.
  3. Padhiar N, English B. Podiatric Medicine & Surgery; In Oxford Textbook of Musculoskeletal Medicine; Hutson M, Ward A (2nd Ed),492-514; New York, USA, Oxford University Press; 2016. ISBN 978-0-19-967410-7.
  4. English B, Padhiar N. Biomechanics of the foot; In Oxford Textbook of Musculoskeletal Medicine; Hutson M, Ward A (2nd Ed),458-468; New York, USA, Oxford University Press; 2016. ISBN 978-0-19-967410-7.
  5. Burrow G, K Rome, N Padhiar. Neale’s Textbook - Disorders of the Foot 9th Edition, 2017-2019. ISBE 978-0-702-06223-0.

Collaborators

Malta: Ms Tiziana Mifsud, Prof Alfred Gatt, Prof Nachi Chockalingam, Dr Kirill Straface-Micallef.
Germany: Prof Heinz Lohrer.
Spain: Dr Xaviar Valle.
Greece: Prof George Georgoudis, Dr Nikos Keramaris.
Italy & UK: Prof Nicola Maffulli

News

  • Hospital Doctor, 4 September 1997 – Rheumatology team award.
  • Guernsey Press, 13 October 1999 – Health.
  • The Daily Telegraph, 12 January 2001 – London Marathon tips.
  • The Daily Telegraph, 12 April 2002 - David Beckham metatarsal fracture.
  • Guernsey Press, 19 April 2002 -  David Beckham metatarsal fracture.
  • The Yenicag Gazete, 15 December 2009 – Injury to Trabzonspor footballer.
  • Runner’s World UK Forum, 2 January 2011 – Compartment Syndrome.
  • Express, 6 June 2012 – Jog fans run into problem.
  • Dailymail, 1 June 2012 – Thousands wrongly diagnosed with shin splints.
  • Bauerfeind Life Magazine International, Issue 2, 2012 – Foot as an interface.
  • SportEX Medicine, 2000, 2001, 2009, 2010, 2012 – Various SEM articles

Teaching

Nat Padhiar is the module lead for (1) Sports Injuries and Podiatric Assessment, and (2) Advanced Clinical Practice.

His main pedagogic aim for the students is to further their vocational and liberal education (Sanderson, 1993) through professional socialisation, engaging in dialogue with a Socratic approach, to stimulate critical thinking. The aim is to achieve a qualification in SEM & PSM but more importantly, it is the knowledge and skills acquired that students could use with confidence in their clinical speciality.

He has expertise in Foot & Ankle problems in sport with a keen interest in Achilles tendinopathy, Exercise Induced Leg Pain in Sports with a keen interest in Chronic Exertional Compartment Syndrome of the foot and leg, and Image-guided injections.

Disclosures

No disclosures.

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