- Ankle Conditions
Ankle Conditions
Eight conditions affecting the ankle and Achilles tendon, explained clearly from first symptoms through to diagnosis, treatment and recovery, under the care of a Consultant Foot & Ankle Surgeon.
Ankle arthritis occurs when the smooth cartilage lining the ankle joint becomes worn, resulting in pain, stiffness, and loss of movement. Unlike hip and knee arthritis, ankle arthritis most commonly develops following a previous injury such as an ankle fracture or recurrent sprains, although inflammatory arthritis and age-related wear can also be responsible.
SYMPTOMS
- Pain during walking and weight bearing
- Swelling around the ankle
- Stiffness, particularly first thing in the morning
- Difficulty walking on uneven ground
- Reduced walking distance
- Loss of ankle movement
Diagnosis
Diagnosis involves a detailed clinical assessment together with weight-bearing X-rays. CT or MRI scans may occasionally be required to assess the extent of arthritis and assist surgical planning.
Treatment
Many patients benefit from non-operative treatment including activity modification, physiotherapy, supportive footwear, ankle braces, anti-inflammatory medication, and image-guided steroid injections. If symptoms continue to interfere with daily activities, options include ankle arthroscopy, joint-preserving procedures, total ankle replacement, or ankle fusion.
Recovery
Recovery varies depending on the procedure performed. Most reconstructive procedures require a period of protected weight bearing followed by physiotherapy to restore movement, strength, and function.
Expected Outcome
The aim of treatment is to relieve pain, improve mobility and enable patients to return to an active lifestyle.
Total ankle replacement is an advanced joint replacement procedure in which the damaged ankle joint is replaced with a modern artificial implant. It preserves ankle movement whilst relieving the pain caused by arthritis. Modern ankle replacement has become an excellent option for carefully selected patients, providing significant improvements in pain, mobility, and quality of life.
Who Is Suitable
- End-stage ankle arthritis
- Good bone quality
- Stable ligaments or correctable instability
- Reasonable foot alignment
- A desire to maintain ankle movement
The Operation
Mr Rashid performs modern total ankle replacement using contemporary implant systems and advanced surgical techniques. Where necessary, associated procedures such as ligament reconstruction, tendon balancing, deformity correction, or osteotomies are performed at the same operation to optimise implant function and longevity.
Recovery
Patients generally spend one or two nights in the hospital. The ankle is initially protected in a splint or boot. Weight-bearing recommendations vary according to the complexity of the procedure and any additional surgery performed. Physiotherapy forms an important part of recovery.
Expected Outcome
Most patients experience excellent pain relief while maintaining useful ankle movement, allowing improved walking ability and enhanced quality of life.
Ankle fusion involves permanently joining the ankle bones together to eliminate movement within the arthritic joint. Although movement is lost at the ankle itself, surrounding joints compensate remarkably well, allowing most patients to walk comfortably without pain.
Usually Recommended For
- Persistent pain
- Significant stiffness
- Loss of function
- Failure of conservative treatment
The Operation
The damaged cartilage is removed, and the bones are stabilised with screws and, where appropriate, plates, until the joint heals into a single solid bone.
Recovery
Patients are usually non-weight-bearing for approximately six weeks, followed by progressive weight bearing in a walking boot once healing is demonstrated on X-rays.
Expected Outcome
Ankle fusion provides reliable long-term pain relief with excellent patient satisfaction and remains an excellent option for many patients.
Most ankle sprains recover without surgery. However, some patients continue to experience repeated episodes of the ankle giving way due to stretched or torn ligaments known as chronic ankle instability.
SYMPTOMS
- Recurrent ankle sprains
- The ankle giving way
- Pain around the outside of the ankle
- Swelling after activity
- Reduced confidence on uneven ground
Diagnosis
A careful clinical examination is combined with X-rays and, when required, MRI scanning to assess ligament injury and identify associated cartilage damage.
Treatment
Initial treatment includes physiotherapy to improve strength, balance and proprioception. Surgery is considered if instability persists despite rehabilitation.
Recovery
Most patients are protected in a walking boot following surgery before commencing physiotherapy. Return to sport generally occurs between four and six months, depending on the level of activity.
Expected Outcome
Ligament reconstruction restores ankle stability in the vast majority of patients, reducing further sprains and allowing a safe return to sport and everyday activities.
Ligament reconstruction is performed when damaged ankle ligaments fail to heal adequately following repeated sprains or significant injury. The operation restores stability while preserving normal ankle movement.
The Operation
- Anatomical reconstruction using the patient's own tissues
- Modern fixation techniques
- Supplementary procedures where additional instability exists
Recovery
Patients are initially protected in a boot before gradually progressing through physiotherapy. Driving usually resumes once safe control of the foot has returned, and sporting activities are reintroduced gradually.
Expected Outcome
The vast majority of patients regain a stable ankle with excellent functional outcomes and a low risk of recurrent instability.
Achilles tendinopathy is a common cause of pain at the back of the heel. It develops through gradual degeneration of the tendon rather than a sudden injury, and is often associated with increased sporting activity or age-related changes.
SYMPTOMS
- Pain at the back of the heel
- Morning stiffness
- Swelling or thickening of the tendon
- Pain during walking or running
- Difficulty with sporting activities
Treatment
Most patients improve with physiotherapy, calf strengthening exercises, activity modification, and shockwave therapy. Surgery is reserved for patients whose symptoms persist despite prolonged conservative treatment.
Recovery
Recovery following surgery is gradual, and rehabilitation is essential. Return to sporting activities usually occurs several months after surgery.
Expected Outcome
Most patients experience substantial improvement in pain and function following appropriate treatment.
The Achilles tendon is the strongest tendon in the body. A rupture usually occurs during sudden sporting activity and is often described as feeling like being kicked in the back of the leg.
SYMPTOMS
- Sudden pain
- A popping sensation
- Difficulty walking
- Inability to stand on tiptoes
- Weakness of the ankle
Diagnosis
Clinical examination is usually diagnostic and may be supported by ultrasound or MRI scanning.
Treatment
Both non-operative and surgical treatment can provide excellent outcomes. The choice depends upon the patient’s age, activity level, general health, and personal goals. Mr Rashid discusses the advantages and disadvantages of each approach before recommending the most appropriate treatment.
Recovery
Both treatments involve early functional rehabilitation in a walking boot with gradual progression of weight bearing under specialist physiotherapy supervision.
Expected Outcome
Most patients regain excellent function, although full recovery of strength may continue for 9–12 months.
Several important tendons pass around the ankle, including the peroneal tendons, posterior tibial tendon, tibialis anterior tendon, and flexor tendons. These structures may become inflamed, torn, or unstable following injury or overuse.
SYMPTOMS
- Pain around the ankle
- Swelling
- Weakness
- Clicking or snapping sensations
- Difficulty walking or participating in sport
Treatment
Treatment depends upon the tendon involved and may include physiotherapy, orthotics, injections, or reconstructive surgery. Some patients require tendon repair or tendon transfer procedures to restore normal foot function.
Recovery
Recovery depends upon the procedure performed. Most tendon reconstructions involve a period of protected weight bearing followed by physiotherapy.
Expected Outcome
With appropriate treatment, most patients achieve excellent pain relief and restoration of normal function.
About Mr Rashid
Mr Anjum Rashid is a Clinical Lead and Consultant Orthopaedic Foot and Ankle Surgeon at James Cook University Hospital, Middlesbrough. He also works at Tees Valley Hospital, Woodlands Darlington, and Tyneside Surgical Services Newcastle.
Contact Info
Middlesbrough · Darlington · Newcastle