Foot and ankle conditions

After one or more sprains, the ankle may remain unstable and roll easily, particularly on uneven ground or when changing direction. Pain on the outer side, swelling and apprehension when bearing weight may occur.

The assessment considers the ligaments, muscle control, alignment and associated cartilage or tendon injuries. Treatment usually begins with rehabilitation to improve strength, balance and proprioception; ligament reconstruction is considered when instability persists.

The big toe moves towards the other toes, while the prominence along the inner side of the foot may become red and painful in shoes. Calluses, overlapping toes and pain under the forefoot may also develop.

Weight-bearing X-rays complement the examination. Wide-fitting shoes and protective pads may reduce symptoms but do not correct the bone deformity. Surgery is considered for persistent pain and functional limitation, not for cosmetic reasons alone.

Osteoarthritis of the joint at the base of the big toe causes stiffness, pain during push-off and sometimes a bony prominence on the top of the joint.

In the early stages, shoes with a stiff or rocker sole and activity modification may help. In selected cases, the joint can be preserved with cheilectomy; fusion is a commonly considered option for advanced osteoarthritis.

Hammer, claw, overlapping or stiff toes can cause pressure in footwear, calluses and pain beneath the forefoot. The deformity may be flexible at first and become rigid later.

The assessment identifies the affected joints and pressure distribution. Shoes with a wide toe box, protective pads and orthotic insoles may relieve flexible deformities; surgical correction is individualised when pain or difficulty wearing shoes persists.

Flatfoot may be flexible and longstanding, or may develop progressively in adulthood as the posterior tibial tendon, ligaments and joints become affected. Pain along the inner side of the ankle, fatigue when walking and displacement of the heel may occur.

Examination is performed while standing and walking, with weight-bearing X-rays. Treatment may include suitable footwear, insoles, a brace and rehabilitation. Surgery is tailored to the stage of the condition, its flexibility and the joints involved.

A high arch concentrates pressure on the heel, forefoot and outer edge of the foot. Calluses, recurrent ankle sprains, toe deformities, peroneal tendon problems and stress fractures may develop.

The assessment considers flexibility, strength and neurological status, complemented by weight-bearing X-rays. Surgical correction is personalised when the deformity is progressive, painful or causes instability.

Ankle osteoarthritis causes deep pain and stiffness; subtalar osteoarthritis causes pain below the ankle, particularly on uneven ground; midfoot osteoarthritis is felt across the top of the foot and during prolonged walking. The cause is often post-traumatic.

Weight-bearing X-rays help identify the joint responsible for the pain, while CT, MRI and diagnostic injections have selective indications. Treatment may include braces and adapted footwear, joint-preserving procedures, fusion or, for the ankle, joint replacement in carefully selected cases.

Tendinopathy causes progressive pain and stiffness at the back of the ankle, often in the morning or during activity. A rupture may be accompanied by a snapping sound, the sensation of being kicked in the calf and loss of strength when rising onto tiptoe.

For tendinopathy, treatment is based on load management and progressive rehabilitation. A rupture requires prompt assessment, and the choice between functional treatment and surgery is individualised.

After ankle sprains or overuse, pain when bending the ankle, swelling, locking or the sensation of a loose body may persist. The cartilage of the talus and tissues at the front or back of the ankle may be involved.

The examination and X-rays are supplemented selectively by MRI or CT. Rehabilitation and activity modification are often the first steps; arthroscopy is appropriate only for clearly defined lesions that match the symptoms.

Diabetes can reduce sensation, circulation and healing, allowing a wound to go unnoticed and progress to an ulcer or infection. In Charcot foot, the foot may become red, warm and swollen with little pain, then progressively deform and become unstable.

An ulcer, infection or suspected Charcot foot requires prompt and often multidisciplinary assessment. Offloading and immobilisation play a central role; reconstruction is reserved for cases in which deformity, instability or risk to the skin justifies it.