Ankle and Feet Injuries

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ANKLE FRACTURES

An ankle fracture usually involves the medial or lateral malleolus; these are the bony prominences that can be felt on the inner and outer aspect of the ankle. Theses bony prominences help to keep the ankle stable whilst allowing normal movement. The general aim of treatment of an ankle fracture is to achieve bony healing in a good position with the minimum if inconvenience. High energy ankle injuries may be complex serious problems which are not discussed here but fall within our expertise.

Key Points — Mechanism and symptoms

Usually a twisting injury
Pain and bony tenderness over the bony prominences of the ankle
Difficulty weightbearing
Sometimes there is obvious deformity

Key Points — Diagnosis

Once suspected the diagnosis is confirmed with X-ray
Sometimes CT scan is required to confirm pattern of injury

Key Points — Treatment

The surgeon will assess the fracture using imaging and examination
Many stable fractures which are in a good position can be treated with a removable splint for comfort. Weight bearing may begin as soon as comfort allows
An unstable or mal-positioned fracture may require manipulation and cast or an open operation with internal fixation. Weight bearing may be restricted for six weeks.

FOOT INJURIES

Most foot fractures are the result of twisting injuries or falls. Stress fractures are also common in the foot. High energy foot injuries may be complex serious problems which are not discussed here but fall within our expertise

5th Metatarsal fractures

The base of the 5^th metatarsal is the bony prominence which can be felt half way along the outer border of the foot
The 5^th metatarsal is usually fractured as the result of a twisting injury
Most are adequately treated with splintage and progressive increase in activity.
Some patterns of fracture have a tendency to be slow to heal , for these patterns there is a discussion required on an individual basis on the potential benefits of surgery
The fractures generally heal over a period of about 6 to 8 weeks

Stress fractures

The foot particularly the metatarsals are some of the commonest sites for stress fractures.
Stress fractures result from repetitive minor forces rather that a a normal fracture which results from a single large force. The is usually the consequence of sudden increased activity such as marathon training
The diagnosis is often missed initially but is suggested by an appropriate history and localised tenderness
Diagnosis can be confirmed with X-rays and possibly MRI scan
Treatment is generally to appreciate the nature of the injury, reduce activity and splint
Recovery is very dependent of compliance with treatment, but is generally about six weeks.
It is sometimes necessary to consider aspects of bone-health to ensure there are no underlying cause for the fracture.

ACHILLES TENDON RUPTURE

The Achilles tendon is the easily felt strong cord which joins the calf muscles to the heel bone. It is usually injured by a sudden stress, often during sport. Sometimes the tendon may have been weakened by medications such as steroids or even some antibiotics but most cases occurs in people with no previous problems. An Achilles tendon rupture is much easier and more reliably treated if diagnosed soon after injury. If suspected do not delay seeking advice.

Key Points – Symptoms

Sudden onset pain in back of heel during exertion (often patients feels that they have been kicked)
loss of power and weakness

Key Points – Diagnosis

There may be an easily felt gap in the Achilles tendon
Ultrasound can confirm the exact site of the injury and the size of the gap

Key Points – Treatment

May be operative or non-operative and will be discussed with your surgeon
Whichever is chosen the rehabilitation is similar with an average of 6 months before return to sport.
Most are treated without an operation and require splintage and physiotherapy
Should there be a large gap in the tendon in a young active patient there may be advantages of key-hole surgery – your surgeon will discuss the best treatment for specific injury