Foot and Ankle

Hastings and Rother Musculoskeletal (MSK) Service

The foot and ankle form a complex system of bones and joints that allow multidirectional movement, that is especially important in ambulation (walking, running etc).

Walking is socially embedded, and deeply health promoting. An injury to the foot and ankle can impede someone’s walking greatly and significantly impact their independence.

Your GP, Advanced Practitioner or Physiotherapist might have given you a diagnosis already, and directed you here.

Below you will find some of the more common presentations of foot and ankle injuries.

Whether you are undergoing treatment, or waiting to be seen, you might find some helpful resources below to get you started on your journey to improving your foot and ankle pain.

If you would like a more in depth understanding of the anatomy of the foot or ankle, Check out AnatomyZone – Your Guide to Human Anatomy and search ‘foot’ or ‘ankle’.

Accordion

What is it?

A traumatic moment of injury where the load placed on the Achilles is greater than the load it can tolerate – and thus the tendon ruptures. Normally this is a sporting injury, and casualties describe a sense of being hit with an object and/or hearing a snap.

Will a scan help?

A thorough examination of events plus the physical presentation will be able to diagnose a rupture. An Ultrasound scan might be useful to determine which method of management is best.

What are the options?

  1. Immobilisation in a boot to allow healing then Physiotherapy for return to function
  2. Surgery to attach the two tendon ends together, then the boot and Physiotherapy

Self help and resources

Achilles Tendon Rupture – Important Questions to Consider

What is it?

Alongside Plantar fasciitis, Achilles tendinopathy is the most common non-traumatic foot/ankle injury we see. And closely related, but thankfully less frequent is the Achilles Rupture.

Like most lower limb tendon issues, it is characterised by pain on walking and running that typically gets better the more you move, but then can become stiff and sore after getting going again after a period of rest. Therefore the first steps in the morning can be difficult, especially descending the stairs!

Achilles pain can normally be traced back to a period of change – e.g. new job involving more walking, new shoes, new hobby, new running route, but its not always easy to identify.

Will a scan help?

Not routinely. Diagnosis is made by a clinician.  More stubborn cases that have not responded to traditional management might benefit from an Ultrasound, or even MRI to assess the tissues further.

What are the options?

  1. Physiotherapy or Podiatry – Education, Activity modification, heel raises and a ‘gradual loading’ programme is the gold standard management.
  2. Extracorporeal Shockwave Therapy (ESWT) – A non-surgical procedure where shockwaves are applied to the area in an attempt to stimulate healing, see below for more information.
  3. Very rarely surgery may be offered to ‘debride’ the tendon (remove damaged tissue).

Self help and resources

Physiotherapy information for Achilles Tendinopathy

Extra Corporeal Shockwave Therapy (ESWT) for Gluteal, Patella and Achilles tendinopathy or Plantar Fasciopathy

What is it?

Most people have ‘gone over on’ or ‘rolled’ an ankle when out and about or playing sport. Usually accompanied by swelling and bruising around the outside (lateral aspect) of the ankle. Although this injury is common, self-management with a bit of patience often see’s people recover fully. Use the acronym POLICE – Protect, Optimally Load, Ice, Compress, Elevate.

Will a scan help?

Yes, but not always. If there is bruising/swelling, you are unable to weight-bear and have some specific tender spots – an X-Ray will help to rule out a fracture.

What are the options?

  1. Physiotherapy – If recovery does not occur naturally over 6 to 12 weeks – Manual therapy and strengthening exercises are some options to get the ankle more mobile and stronger, respectively.
  2. Advanced Practitioner – if pain persists beyond accepted recovery times, then our AP team can assess for post injury complications and discuss the merits of medical imaging.

Self help and resources

Ankle Soft Tissue Injury

Accordion

What are they?

There are various types of foot and ankle fractures. Most commonly these occur from an excessive twisting, over ‘inversion’ injuries (the same motion as described in the ankle sprain section), falls and road traffic collisions. Ankle fractures are classified and subsequently managed by how ‘stable’ they are – this can depend on where the fracture(s) are, and if the ligaments are damaged also. Different fracture classifications are described below, including two types of foot fracture.

Will a scan help?

Yes. An X-Ray will initially diagnose if there is a fracture. If the ‘stability’ is inconclusive – other tests such as an MRI or CT are useful.

What are the options?

  1. Simple and stable fractures can be managed with sensible footwear or a boot, and using pain as a guide.
  2. If there is uncertainty over the stability, or more than one fracture, a cast or boot will be provided to immobilise the leg, and allow healing to occur.
  3. Complex or unstable fractures will be treated surgically with pins and plates to immobilise.

Self help and resources

Ankle Fracture – Weber A

Ankle Fracture – Weber B

Fracture of the base of the 5th metatarsal (Jones)

What is it?

Alongside Achilles Tendinopathy, Plantar fasciitis is another common non-traumatic injury.

It is characterised by pain during walking and running, on the underside of the heel. Typically it gets less painful the more you move, but then can become stiff and sore after getting going again after a period of rest (stop/start pain). Therefore the first steps in the morning can be difficult, especially descending the stairs, in a similar behaviour to Achilles Tendon pain.

Will a scan help?

Not routinely. Diagnosis is made by a clinician.  More stubborn cases that have not responded to traditional management might benefit from an Ultrasound, or even MRI to assess the tissues further.

What are the options?

  1. Podiatry (or Physiotherapy) – Education, Activity modification, soft insoles and a ‘gradual loading’ programme is the gold standard management.
  2. Extracorporeal Shockwave Therapy (ESWT) – A non-surgical procedure where shockwaves are applied to the area in an attempt to stimulate healing, see below for more information.
  3. In extreme cases an ultrasound guided corticosteroid injection might be offered, but not routinely, as there are associated risks.

Self help and resources

Heel pain and Plantar Fasciopathy (pain beneath the heel)

Extra Corporeal Shockwave Therapy (ESWT) for Gluteal, Patella and Achilles tendinopathy or Plantar Fasciopathy

What is it?

Conditions of the ‘Hallux’ refer to foot conditions involving the big toe (first metatarsophalangeal joint) causing stiffness, pain and difficulty walking.

Hallux Rigidus/Limitus refers to a reduced movement as the big toe becomes increasingly harder to bend – especially upwards, as required for walking.

Hallux Valgus refers to a gradual deviation of the big toe towards the other toes. Early stages are not painful, but later stages can be painful and lead to the formation of a ‘Bunion’

Will a scan help?

An X-Ray of the foot is not necessary for diagnosis, but may be informative in later stages – when considering corrective surgery, and to rule out other causes in atypical presentations.

What are the options?

  1. Podiatry – to discuss footwear, orthotics (insoles), exercises and more
  2. Corticosteroid injection if symptoms are more severe or surgery is not an option
  3. Surgery – for those having significant impact on quality of life – explained in more detail in the below document

Self help and resources

Bunions (Hallux Abducto Valgus)