Foot & Ankle problems

Foot & Ankle problems

Ankle pain

There are many causes of ankle pain both within the sporting and the general population. Dr Davies is experienced at assessing a wide variety of ankle pain. A thorough history is always taken followed by a detailed examination. If investigations are required Dr Davies will advise and arrange these as necessary. Dr Davies will oversee your ongoing management back to full recovery with a holistic approach.

Ankle instability

This is a common problem particularly in younger adults. Some people are born with more mobile ankles which can become unstable but some people develop ankle instability following injury. Such injury can damage the lateral (outer) ankle ligament which can lead to ankle instability. Initially this condition is usually managed conservatively following appropriate investigations where necessary. Targeted rehabilitation can enable an ankle stability to be corrected in many cases. Patients who fail an appropriate rehabilitation programme may be candidates for a surgical reconstruction of the affected ligament. Dr Davies can facilitate this as needed.

Ankle Impingement

There are 2 main types of ankle impingement, anterior and posterior. Anterior impingement produces ankle pain on the front of the joint made worse by ankle dorsi-flexion (pointing the toes up) while posterior impingement produces pain at the back of the ankle joint made worse by platarflexion (pointing toes down). This can occur following and acute injury or can develop over time as an overuse type injury. The impingement can be caused by bone or soft tissue or a combination of both. Investigations including x-rays and sometimes ultrasound or MRI scan s may be needed. Soft tissue impingement often settles with local steroid injection combined with appropriate lower limb rehabilitation. Bony impingement may sometimes require keyhole surgery.

Sinus tarsi syndrome

This condition presents with local pain on the outside of the ankle. It can occur gradually as an overuse type injury or following an ankle ligament injury. Sometimes the shape of the foot can predispose to this condition. Investigations are not commonly required as it is usually a clinical diagnosis. Physiotherapy input is often successful. Sometimes a podiatrist may need to review the biomechanics and issue orthotics (insoles). Resistant cases often respond well to steroid injections. For this particular problem up to 3 injections may be needed.

Tarsal tunnel syndrome

This condition is similar to the carpal tunnel syndrome in the wrist. The posterior tibial nerve is compressed within the tarsal tunnel at the inside of the ankle joint. It can cause pain, tingling & burning on the inside of the ankle & foot. Treatment may include orthotics (insoles) and steroid injections. In more resistant cases nerve conduction studies may be considered prior to potential surgical release procedure.

Plantar fasciitis

This is a pain arising from the heel at the origin of the plantar fascia on the inside of your heel bone on the sole of your foot. The plantar fascia is a strong band of tissue that stretches from your heel to your mid-foot and helps to create the inner foot arch. This region can become inflamed and very painful, often for no apparent reason. The pain is usually worst first thing in the morning or when you start walking after a period of rest. It is often described as like “walking on a stone”.

 

It is thought that repetitive microtrauma (small, usually unnoticed injuries caused by repeated overuse) to the tissue of the fascia at the heel produces the pain. There are several factors that could lead to plantar faciitis. These include changes in exercise routine-how much you’re doing or a change to the surface on which you’re exercising – for example from running indoors to outdoors. Other causes can be arch problems, lower limb muscle tightness, carrying too much weight or just gradual wear and tear.

 

It is a surprisingly common problem. Up to one in 10 people will get it at some time in their life. It is most common between people aged 50-60 and twice as common in women as it is in men.

 

It is a usually diagnosed clinically by your GP or specialist and x-rays are generally unhelpful. The presence or absence of a heel spur on x-ray is generally of no significance. If there is uncertainty around the condition, an ultrasound scan by a radiologist or sports physician can confirm the diagnosis.

 

There are a number of treatments which can be used to relieve heel pain and speed up recovery time. These include using well-cushioned footwear and avoiding walking barefoot when possible. A heel raise inserted into footwear can also be helpful, as well as adopting orthotics (insoles). Gentle stretching exercises can also be performed.

If symptoms don’t settle with these approaches then second line treatments should be considered. Shockwave treatment (ESWT) and injections of autologous (own) blood or Platelet Rich Plasma (PRP), which can help to speed up your own body’s healing processes, can work wonders in resistant cases. Steroid injections can be very useful for alleviating pain in the short to medium term only. Surgery is rarely needed.

Achilles tendinopathy (tendonitis)

This common condition can be quite debilitating particularly for runners. It presents with painful swelling an inch or two above the insertion on the heel bone. It is thought that repetitive micro-trauma – small, usually unnoticed injuries caused by overuse – to the tendon produces the pain.
Many factors can make you susceptible to its development including overuse, over-training, change in footwear or training surfaces as well as bio-mechanical factors within the body, like foot arch problems or calf muscle tightness. Usually the diagnosis is made by a clinical examination, but in stubborn cases a diagnostic ultrasound scan can be performed by a radiologist or sports physician. This will confirm the diagnosis and exclude other potential issues, like partial tearing within the tendon.

Surgery is rarely needed. Specific exercises, including calf stretching and an eccentric strengthening programme are usually required – often supervised by a physiotherapist. A podiatrist may recommend arch supports to aid management. Usually symptoms settle over two to three months with appropriate treatment.

There are a variety of second line treatment which includes extracorporeal shock wave treatment and autologous blood or platelet rich plasma injections, often under ultrasound guidance. These procedures help to speed up the body’s own repair mechanism. Steroid injections are generally best avoided as they may actually weaken the tendon. Dr Davies can perform these treatments when indicated.

Morton’s neuroma

This painful condition usually affects the spaces between your metatarsal bones in your feet, most commonly between the 2nd / 3rd and 3rd / 4th spaces. Thickening of connective tissue produces a painful collection of nerves which are very sensitive to pressure. Pain and tingling / burning sensations can be felt within the affected area. It commonly affects the 50-60 yr age group. Treatment includes change of footwear, insoles and sometimes a steroid injection. Usually it is a clinical diagnosis but a diagnostic ultrasound scan can confirm the diagnosis in difficult cases. A small number fail to respond to conservative measures and may require surgical excision.