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"This is about an Ankle fusion"
"Did you have subtalar fusion?"
"After several years of managing with a bunion and painful hammer toe, I decided to have an operation on the advice of Mr Malik, because of the ..."
Mr E Titcomb
(Hallux Valgus Bunion and second toe correction)
"I saw Mr Malik a couple of months ago, as I was experiencing terrible pain in my foot and ankle - particularly on getting up in the morning, and ..."
(Debilitating pain in foot and ankle)
"I contacted Mr Malik as he had treated my husband and a friend already. I had been suffering from pain in my 2nd toe for some time and was struggling ..."
(Hallux Valgus - Bunion correction with 2nd toe correction)
"I have nothing but praise for the way Mr Malik handled both my operation and the after care. He was highly professional throughout and whereas before ..."
"1st class treatment."
"Everything.......very accommodating when booking my surgery, very personable, and brilliant post op follow up!!! Thank you!!"
"My procedure involved an operation to remove a bony growth on my big toe which had become rather unsightly under my toenail.
From the first ..."
(Bone exostosis excision (bony lump on big toe))
"It's a rare skill to be able to convey complex details of an operation in a simple and understanding way whilst making you feel at ease. To have a ..."
(Lateral Ligament and High Ankle Sprain)
"I was referred to Mr Malik by my physiotherapist, following several months of treatment. He was immediately able to diagnose the problem for me. I ..."
(Plantar Fasciitis treated with Proximal Medial Gastrocnemius Release)
"In April 2016 I suffered a trimalleolar fracture of my left ankle. I underwent open reduction/internal fixation and had several months of non ..."
"I had 8 weeks of physiotherapy before being referred to see Mr Malik. Following MRI scan and X-rays was diagnosed with Morton's Neuroma. He ..."
"Mr Ahmad Malik made an instant and correct diagnosis of a problem that nobody else had managed to do during 5 years of intense pain and my inability ..."
"Mr Malik and his team did an amazing job. I would recommend Mr Malik to everyone as he is a very caring and kind consultant. I was terrified to go ..."
"It was the phrase "but Mum, it's not going to get any better is it?" that spurred me on to seek medical advice about an increasingly painful big toe ..."
(1st MTP joint fusion for big toe arthritis)
"I was referred to Dr Malik by a work colleague and I have to say I was completely satisfied with the way he treated me from start to finish. What I ..."
(Dislocated peroneus longus & brevis tendons )
"I only wish I had been referred to Mr Malik earlier. I have suffered with Rheumatoid Arthritis since 2012, and have suffered pain and swelling in the ..."
"Having had both ankles fused as a result of Avascular Necrosis of the Talus I am now pain free and wish I had not waited so long - I can walk, drive, ..."
"Mr Malik was brilliant! He gave me two injections under general anaesthetic, very quick and easy. I am completely fixed! No pain in my ankle and I ..."
(Arthritis in my right ankle)
"In January 2012 I broke the 5th metatarsal when I stumbled into a pot hole, A&E advised me it was a Jones fracture and would heal on its own, (but it ..."
(1st, 2nd and 5th Metatarsal fracture fixation and Pes Cavus foot correction)
"Right from the very first time meeting Mr Malik, he helped me understand the extent and significance of my ankle injury, clearly indicating what ..."
(Severe left ankle sprain: Injury to AITFL, ATFL, CFL, PFL and Deep Deltoid complicated by intense bone marrow oedema of the talus managed non operatively)
"Mr Ahmad Malik undertook to revise a really bad previous operation on my big toe, done at another hospital. He said it would be a challenge, but we ..."
"After about 15 years of pain and mis diagnosis I was recommended to see the wonderful Mr Ahmad Malik Consultant Orthopaedic Surgeon. I was in shock ..."
"Mr Malik and his team provide first class care, for which I am very grateful. Mr Malik is an excellent consultant, he was caring, thoughtful and ..."
"I found that I had to adjust the way that I walked because I had pains in both my 4th toes whenever I walked, this caused ankle pains because of the ..."
"Mr Malik recommended this operation as I was experiencing increasing pain when walking due to tightness in my calf muscles. The information he gave ..."
"Mr Malik operated on my right foot in April 2016, very good surgeon and post op care very good also. Thank you to Mr Malik & team.
(1st MTP joint arthritis treated with 1st MTP joint fusion)
"I had a hip arthrodesis following an accident in 1988. I have since been a very active person despite one leg being 4cm shorter than the other. About ..."
"Mr Malik was brilliant in dealing with my condition, he was very open and honest and completely put me at ease. He took time to understand issues ..."
"I had put up with severe pain for 4-5 years in my big toe joint; living on a diet of Ibuprofen and having gone down the whole podiatry route of ..."
"Mr Malik and his team provided a first class service from initial examination, operation, recovery procedure, cast to boot, and follow up advice on ..."
"As above I would not improve on the care I received and I would recommend Mr Malik to anyone with a similar injury."
"After weeks of incorrect diagnosis and treatment at local surgery level, Mr Malik identified the problem precisely, and provided appropriate ..."
"On the 19th of December 2015 I left the x-ray room with the technician stating that my ankle was the worst fracture he had ever seen. After 2 ..."
(Fracture dislocation trimalleolar ankle - Open reduction and internal fixation)
"Dear Mr Malik
I want to thank you for all the care you took to ensure my operation was a success and for your follow up consultations. I am so ..."
(Right 1st MTP joint fusion)
"Dear Dr Malik
I would like to thank you and all the team at Wycombe Hospital for my treatment yesterday.
I did not realise how many people are ..."
(Cortisone injection ankle)
"Caring, positive, reliable, expert.
I felt I received the best possible care."
"Why did you have your Achilles tendon reconstructed?
I needed an Achilles tendon reconstructed (FHL tendon transfer) because I ruptured it during a ..."
"Mr Malik's bed side manner was impeccable from the outset, he explained thoroughly the operation, and plans for recovery, and put me completely at ..."
"I can honestly say I would recommend Mr Malik to anyone. He is so kind and put me at ease from the off. He operated in October on my left foot and ..."
(Bunion and 2nd Hammer Toe)
"Very pleased with the way I was treated. I would recommend Mr Malik to anyone with a foot problem. I am so glad I was referred to him. I was Lucky."
"Mr Malik is a very professional surgeon and puts you at your ease. Lovely sense of humour too. Job very well done. Thank you Mr Malik."
"Cut waiting times,keep Mr Malik at all costs he is a surgeon who cares and is good at his job as is his team."
"Mr Malik operated on my daughters ankle after a complicated break, very neat piece of surgery indeed and top notch follow up. Top job thanks."
"My operation was a total success with no post operative pain due to the excellent treatment plan put into place by Mr Malik. Recovery with this ..."
(Achilles tendon debridement & FHL tendon transfer)
"I had a painful big toe (1st MTP) joint for some time before having it investigated by Mr Malik. I was shocked to see how much damage had occurred ..."
(Big toe (1st MTP) joint arthritis treated with a 1st MTP joint fusion)
"An ankle fusion is a daunting prospect. Have confidence in the advice you are being given. The success rate alone justifies that. In my case Mr Malik ..."
"Having broke the talus bone in my right foot and being told it's a very rare and difficult break to fix I was afraid, anxious and didn't really know ..."
(Talus fracture fixation)
"Many thanks to Mr Malik and his team.
Mr Malik's approach put me at ease from the first time we met, he is an excellent dedicated surgeon who I ..."
(Severe Big Toe Arthritis & Deformity Treated with Interpostion Arthroplasty and Correction of 2nd Toe Deformity)
"I am delighted with the results achieved by Mr Malik. He put me at ease from the first appointment, explained everything in plain English and ..."
"I am absolutely delighted with my treatment from Mr Malik and all his team. I had a bone growth on top of a bunion! Now the bump has gone and with ..."
(1st MTP joint arthritis treated with minimally invasive surgery (MIS) cheilectomy)
"Over a period of two years or more Mr Malik has reduced my pain level from 8 out of 10, to 3 out of ten, while all the time being charming and ..."
(Severe midfoot arthritis treated with image guided injections)
"The whole experience was good. Having healthy feet is so important and being able to walk pain free after a speedy recovery is great. I strongly ..."
Mrs. C. Sidenius
"I was referred to Mr Malik having developed incredible pain in the left foot on standing and walking. Following the consultation we agreed a plan of ..."
Ruth - Plantar fasciitis
"I was referred to Mr Malik after previous surgery on my Achillies Tendon. I was in a lot of pain, couldn't sleep and couldn't live my life how I ..."
"My wife was treated at Dr Malik's clinic for problems due to arthritis in her big toe. From the time of her first appointment to her final discharge ..."
Mrs Avril Edwards
(Big toe arthritis (1st MTP joint arthritis) treated using minimally invasive surgery)
"My right ankle was in a terrible state. I had 4 broken ankles in my teenage years and early twenties - after playing football for 30 years I was in ..."
"Very satisfied and reassured with the superb surgery and care, now having the other foot operated on soon. Thank you Mr Malik and team."
"I was referred to Mr Malik due the severity of the shattered ankle bone. My previous consultants highly recommended Mr Malik carried out my surgery ..."
(Spiral tibia break and shattered ankle)
"What can I say about Mr Malik, a pure genius, from my first appointment to the last Mr Malik is vastly experienced and dedicated in this field, I ..."
"I had a lump appear between my toes on the left foot. It was ok to begin with then it started getting sore and restricting what shoes I wore. Dr ..."
(Lump between toes - benign tumour)
"After suffering with severe foot and ankle pain, I saw Mr Malik, who put me at ease with his expertise and kindness. Now thanks to him making the ..."
(Talus insufficiency fracture/avascular necrosis)
"I am now the proud possessor of two new feet - all due to the skill, care and friendly attention Mr. Malik gave to the daunting task of ..."
"Nothing to worry about. Excellent surgeon, now happy to have the other foot done."
(Bunion with severe arthritis and 2nd hammer toe deformity)
"I severed one Achilles tendon and damaged the other one.
Mr Malik did a superb repair operation on the one and a gastroc release operation on the ..."
(Achilles tendon repair and Gastrocnemius release contralateral side)
"My mum's foot was in such a terrible state, as a family we were very concerned that the surgery would be too drastic to undertake, as she is a lady ..."
"For the love of sport!
Since my early thirties after playing football, tennis and badminton since as far back as I care to remember, I started to ..."
(Osteoarthritis in right ankle - treated with ankle fusion)
"Thank you so much Mr Malik and team for the excellent operation on my toes. It is early days but I am feeling much better and without pain now. I can ..."
Mrs Maureen Sellar
(Bunion and disfigurement of toes)
"On 13th of August 2015 Mr Malik carried out the above procedure. After surgery, Mr Malik came to see me in recovery to reassure me that the operation ..."
(1st MTP Joint Fusion)
"Thank you Mr Malik for the speedy recovery from my broken foot, and the great care Mr Malik and team showed to me during and after the surgery. I ..."
(2nd & 3rd metatarsal fracture fixation)
"For some time I suffered pain and a lack of mobility in my left ankle, I gained limited success from physiotherapy. On referral to Mr Malik the ..."
(Achilles Insertional Tendinopathy)
"I had bunions on both feet which where very painful, I got referred to Mr Malik. Mr Malik knew exactly what needed to be done and explained it all in ..."
"I am a 67 year old woman who loves to walk, play golf and travel but for the last few years have had increasing pain and discomfort in my feet which ..."
(Right foot bunion (hallux valgus) and left big toe arthritis (hallux rigidus))
"I like to walk and was experiencing increasing discomfort when exercising friend's dogs and even when doing my lollypop job for the local council. ..."
(Osteoarthritis in my left ankle - treated with Arthroscopic Ankle Fusion)
"Thank you to Mr Malik, for my lovely new ankle, I am pain free in that foot now and no longer have to wear the boot. I didn't want the general ..."
"I have Rheumatoid arthritis and osteoarthritis in most of my joints, I had already had a right hip replacement but had been getting terrible pain in ..."
(Left ankle Arthritis : Treated with a total ankle replacement)
"I am thoroughly grateful to the professional service and empathetic nature of Mr Malik. I suffer from Mallett toe in both feet, not to the extent ..."
"In December 2014 after seeing Mr Malik I decided to go ahead with the operation. February 2015 the operation was successfully done. Felt good - two ..."
(1st MTP joint fusion for severe arthritis and 2nd toe relocation for dislocated 2nd toe)
"A year ago I had been suffering for some time with an infected hammer toe, together with a bad bunion and overlapping toes. Walking had become ..."
(Bunion, overlapping toes and infected hammer toe)
"I had surgery to straighten the claw toes on my right foot. They were broken, reset and pinned. All due to painful arthritis. I cannot say it has ..."
"Having broken my ankle about 20 years ago playing netball, I have suffered with ligament issues on and off for years. Recently the pain has become ..."
(Achilles tendinopathy and other related issues.)
"Having suffered terrible pain for over 5 years and walking with a limp, I met Mr malik who reassured me he could help me. True to his word I'm back ..."
(Ankle arthritis treated with Ankle fusion)
"I first met Mr Malik last September. I had problems with my foot for quite some time. I had an x-ray then the consultants apptointment. The spur was ..."
(Calcified heel spur as a result of insertional Achilles tendinopathy treated with Achilles speed bridge)
"I have had excellent care from Mr Malik. I am a GP myself and it was quite frightening to be on the other side of the NHS when I accidentally fell ..."
"Mr Malik is courteous, personable and highly professional. He gave me clear advice on what was involved in my operation and firm instructions on what ..."
(Lesser metatarsal head resection (Rheumatoid arthritic foot))
"Having originally been misdiagnosed with ruptured ligaments when I turned my ankle on a kerb (leaving my doctor's surgery for something unrelated!), ..."
"Having had a left 1st MTP (big toe) fusion by another surgeon that had been unsuccessful, I was referred to Mr Malik. I have spent a year under his ..."
"Very happy with results of 2nd mallet toe deformity surgery. "
"Due to house move to another part of the country, unable to follow on the recommended surgery for arthritic bunion. Great shame as I felt that Mr. ..."
(1st MTP joint and Midfoot Arthritis)
"I first met Mr Malik a year ago with my condition. I found him to be professional, caring and extremely positive about my forthcoming operation. I ..."
(1st MTP joint fusion and second toe correction)
"Having suffered from very bad bunions since my teen years and having a morbid fear of surgery, time and time again I have postponed seeking any sort ..."
Mrs P McNeil
(Bunion with 1st MTP joint arthritis)
"I was happy to follow all of the advice that Mr Malik gave me and I am very pleased with the result. It is wonderful to be free from pain."
Mrs J Everill
"I met Mr Malik for the very first time in September 2014, having finally decided to do something about bunions that I had been suffering from for ..."
"Mr Malik recommended non-invasive treatment for my cuboid avascular necrosis. The treatment was 100% successful and avoided the need for surgery. Mr ..."
(Cuboid avascular necrosis)
"On 15 Jan 2010, while cleaning my fish tank, I slipped and fell off the steps, hurting my left ankle. I was unaware just how serious the injury was. ..."
W M Fuge
(Post traumatic ankle arthritis - treated with ankle fusion)
"Do exactly what Mr Malik recommends! In my case, by patiently sitting out the post-surgery weeks and not rushing my foot back to recovery, I was ..."
"I'm immensely grateful to Mr Malik for his treatment of my ATFL injury. His explanations of the injury and treatment course were clear and helpful, ..."
"I had been suffering from a extremely painful (R) ankle for over a month when I was referred to Mr Malik. The minute I met him I was instilled with ..."
(Right Distal Tibial Stress Lesion - Non operative treatment)
"I would wholeheartedly endorse previous testimonials that refer to Mr Malik as a brilliant surgeon. He is extremely approachable, courteous and fills ..."
(Pes Cavus Foot)
"I would like to say a very big THANK YOU to Mr A Malik for the successful operation on my bunion.
I was amazed to have hardly any pain, just a few ..."
Mrs J H.De-Beger
"I'd seen Ahmad previously when I'd fractured the 5th metatarsal of my right foot (treated non operatively) so was pleased he agreed to see me again ..."
(Fracture of 5th Metatarsal Bone)
"Mr Malik and his team have given me 1st class NHS service before during and after my foot surgery.
I would recommend Mr Malik (already have ..."
(Massive rheumatoid nodule excision)
"I am currently 7 weeks into recovery from having a very large and unusual rheumatoid nodule removed from the ball of my left foot by my wonderful ..."
(Removal of Rheumatoid nodule on left foot)
"Mr Malik made me feel at ease from start to finish, his calm approach was reassuring, and he just gave me so much confidence in him, he explained the ..."
(Bunion removal on both feet 16th December 2014)
"Having struggled for six weeks following a fall at home I saw Mr. Malik who thoroughly x-rayed both feet/ankles and explained to me how to proceed to ..."
(Left foot 3 fractured toes, right ankle fracture)
"I came under the care of Mr Malik at Stoke Mandevile Hospital in 2012 following a serious break in my ankle resulting in debilitating arthritis. ..."
"Mr Malik, I can’t thank you enough for fixing me up so well, and making it possible for me to get back to my usual activities again – I am very ..."
(Left 1st MTP Toe Fusion)
"For many years I have needed my car adapted due to a dropped right foot, basically I have no power or sensation in the foot. Also people with severe ..."
"Transported to Stoke Mandeville by ambulance in April 13 from a high fall, with my left leg was barely together. I was seen by Mr Malik a Trauma and ..."
(Spiral break of the Tibia and Fibula)
"From my first operation to the 2nd, which was a right ankle OCL debridement and micro fracture and then a lateral ligament reconstruction. I knew ..."
"No recommendation, only praise for this fantastic information for foot and ankle patients. Over the last 18 months I have exhausted the internet for ..."
"Dear Mr Malik, Thanks again for the wonderful work you performed on my foot. I will always be grateful. Yours truly, Brian."
(Complex Forefoot Reconstruction - Post Keller and Lesser Toe Deformity Correction)
"Mr Malik's manner is reassuring and informative. He gives clear explanations and instructions in a calm, considerate way instilling complete ..."
(Right 1st MTP joint fusion)
"I broke my big toe in an awful impact on the ground. Ahmad took the time to make sure that every care was taken to ensure my foot was well on the ..."
"Mr Ahmad Malik recently removed a urate lesion from the sole of my right foot at The Chiltern Hospital in Great Missenden which was causing ..."
(Lump under sole of the foot)
"Following my clinic appointment, I was admitted for Day Surgery, all was very professionally done. I was pain free and continued to have minimal ..."
"I had broken my ankle in the previous year and had an operation at an NHS hospital which had successfully knitted the bones but had left me with ..."
(Broken Tibia and Fibula)
"I would like to thank you for fixing my ankle. I broke my ankle 19 years ago and had it pinned and plated. I developed arthritis and had it fused in ..."
"After much delay in diagnosis of the rupture of my Achilles tendon and having had to arrange a private MRI scan I sent the scan to Mr Malik and ..."
(Chronic Achilles Tendon Rupture)
You asked for a progress report around Christmas. Well I am thrilled, thank you SO much! I have been playing tennis for 1.5 hours each ..."
(Plantar Fasciitis treated with Proximal Medial Gastrocnemius Release)
"I fractured my ankle in two places and tore the deltoid ligament in a fall. Mr Malik was very kind and reassuring and did a lovely neat job on my ..."
"When you meet Mr Malik for the first time you know you are in the right hands, he puts you straight at ease. He is an excellent Consultant Trauma & ..."
"After a year long battle with infection following a big toe amputation and three operations, losing a bit of bone each time.
The surgeon at that ..."
"What can I say, since having this operation my foot has been great no more pain !!! Thank you so much."
(Hallux Rigidus - 1st MTP joint fusion operation)
"I was admitted to orthopaedics on Juy 29th this year for a complicated triple arthrodesis on my left foot under Mr A Malik consultant surgeon.
(Severe Arthritis - Triple Joint Fusion)
"I would highly recommend Mr Malik to anybody seeking orthopaedic foot surgery. His approach was very caring - I felt like an individual throughout ..."
"In my opinion, Mr Malik is dynamic, passionate about his work and dedicated to improving his patients' health. His treatment of conditions is ..."
"Mr Malik explained very clearly the procedure and that it was important that I followed his post operative instructions afterwards, if I wished to ..."
"From the moment I met Mr Malik in January 2014, I felt 100% confident with him. His professionalism and thorough approach reassured me immediately. ..."
"Ahmad Malik took over my case following a botched operation by a podiatrist. My initial procedures were – right foot 1st metatarsal osteotomy and ..."
(Revision 1st MTP Joint Fusion)
"Mr Ahmad Malik has the aesthetic sense of a sculptor, the precision of an engineer, the charm and helpfulness of a first-class hotel concierge. As a ..."
(Bilateral 1st MTP Joint Arthritis)
"I was recommended to get in touch with Mr Malik to get a second opinion on some foot surgery that was diagnosed for my mother. I was not only ..."
(Ankle Osteochondral Lesion and Midfoot Arthritis)
"How do you say in a few words the gratitude I feel to Dr Malik for his professionalism, incredible confidence he inspired, and his personable manner. ..."
(Lesser Toe Deformity)
"November 2013 I had an ankle fusion surgery done by Mr Malik. Although this was a difficult decision, so far the benefits of the surgery are far ..."
(Arthroscopic Ankle Fusion for Post-traumatic Ankle Arthritis)
"I remain extremely grateful to Mr Malik's skill and kindness in successfully repairing my torn Achilles tendon allowing me to walk again without a ..."
(Chronic Achilles Tendon Rupture and Reconstruction)
"I am taking this opportunity to send a huge thank you to Mr Malik who has improved my quality of every day life beyond my expectations.
I was ..."
(2nd Metatarsal Instability/Crossover Toe)
"Mr Malik has an excellent patient/doctor relationship. Mr Malik is patient, professional, kind and caring. He is always happy to answer questions and ..."
(Post-traumatic Ankle Arthritis Treated by Arthroscopic Ankle Fusion)
"I was a patient of Mr Malik for twelve months and during that time I had three operations for 3 different conditions. Prior to each operation he ..."
(Ankle Arthritis and Bilateral Crossover 2nd Toes)
"I was referred to Mr Malik after a long standing issue with my right foot. The initial consultation gave me great confidence that he knew the best ..."
"Having heard from a physiotherapist of the expertise of Ahmad Malik, I decided he was the surgeon to consult when I injured my ankle. He diagnosed a ..."
(Achilles Tendon Reconstruction Following Missed Rupture)
"From the outset I felt reassured by your confidence and the determined approach taken to identifying the source of the niggling pain in my left foot ..."
"I found Mr Malik to be both a caring and courteous surgeon, and felt in very experienced hands. I would have no hesitation in returning to him if I ..."
(1st MTP joint and Midfoot Arthritis)
"Mr Malik was a true professional and trusting throughout my treatment, from beginning to the end Mr Malik has always been there and any questions of ..."
(Revision Lateral Ligament Reconstruction and Peroneal Tendon Reconstruction)
"I didn't think I'd need to write a testimonial for Ahmad Malik. Once you've met him, he is so charming and friendly and puts you right at ease. I am ..."
"Took my lovely feet for a walk on Bondi beach.
"I was originally diagnosed as having a collapsed arch under the care of Oxfordshire NHS. Mr Malik listened to, and assessed on how I presented, ..."
"Mr Malik puts you at ease from the moment you meet him. He is charming and empathetic, as well as being an excellent consultant and surgeon. He ..."
(Clawing of toes)
"I am very happy to say that following a quick and courteous consultation, my toe was quickly dealt with and I have had no issues and recurrence"
(Ingrowing toe nail)
"Professional yet friendly service, thanks for sorting out my foot."
(Benign Foot Lesion)
"I have been having treatment from Mr Malik for well over a year and have found it to be very successful. He has a warm and caring manner and is ..."
"I would like to thank Mr Malik for not only repairing my badly damaged ankle tendons but for providing me with a constantly up-to-date "as it is" ..."
(Peroneal Tendon Surgery)
"Mr Malik is a highly-experienced and hard-working surgeon who constantly updates his skill and is passionate about good patient care and outcomes. ..."
(Arthroscopic Ankle Fusion for Post-traumatic Ankle Arthritis)
"Just a brief testimonial to say that Mr Malik has been very attentive and detailed in his assessments. He gave sensible options for me to consider ..."
(Treatment of Damaged and Infected Nailbed)
"Ahmad was outstanding from the very beginning. His personable approach meant that everything was discussed openly and in a very easy manner to get ..."
(Excision of Large Benign Bone Tumour)
"It was my daughters first operation and on her ingrowing toenail. Mr Malik made her feel at ease with the process, explained the procedure in ..."
Mr E Titcomb
(Hallux Valgus Bunion and second toe correction)
Orthopaedic Outpatient Department
30 Devonshire Street, London, W1G 6PU
tel: +44 (0) 203 7956053
Mon - Fri (8am-8pm)
Sat (9am - 5pm)
Queen Alexandra Road
tel: +44 (0) 149 4426432