Foot and ankle
Pain, deformity or instability can limit walking and the choice of footwear. Assessment considers the underlying cause, the overall alignment of the limb and the patient's functional goal.
Clinical principle
The foot and ankle work together. A seemingly local problem can alter weight-bearing, alignment and the way a person walks.
The decision is not based on X-rays alone, but also on symptoms, clinical examination, the type of deformity, the condition of the skin and circulation, activity level and the patient's expectations.
Areas of expertise
Surgical procedures
This list explains procedures that are commonly performed, but it is not a recommendation for surgery. The choice is made only after the symptoms, clinical examination findings and investigations have been considered together.
Book an assessmentThe position of the first metatarsal and big toe is corrected using osteotomies, soft-tissue balancing or a Lapidus fusion, depending on the deformity and instability.
The procedure is chosen on the basis of weight-bearing X-rays, not simply the size of the bunion.
Cheilectomy removes bone spurs and preserves the joint in selected cases. In advanced osteoarthritis, fusion of the metatarsophalangeal joint offers predictable pain relief, at the cost of movement in that joint.
The choice depends on the severity of the osteoarthritis and the patient's functional needs.
Treatment may combine tendon releases and transfers, osteotomies and joint procedures to correct the deformity and painful pressure areas.
The forefoot imbalance that caused the deformity must also be addressed, not just the affected toe in isolation.
Stability is restored after recurrent sprains when appropriately performed rehabilitation has not controlled episodes of giving way. The procedure may use the patient's own ligaments or a graft reconstruction.
An associated arthroscopy allows cartilage injuries and mechanical impingement to be assessed.
The reconstruction combines procedures on tendons, ligaments and bone to restore the arch and alignment. Calcaneal osteotomies, lateral column lengthening, procedures on the posterior tibial tendon or joint fusion may be needed.
The flexibility of the deformity and the presence of osteoarthritis determine the strategy.
The procedure redistributes load and corrects alignment through osteotomies, tendon transfers and, for rigid deformities, fusion. Ankle instability and peroneal tendon disorders are treated at the same time when necessary.
In neuromuscular conditions, it is important to assess the cause and progression.
Fusion eliminates painful movement by uniting the joint, while total ankle replacement aims to preserve some movement. Both can be used to treat advanced ankle osteoarthritis.
Biological age, alignment, bone quality, ligaments, adjacent joints and activity level all influence the choice.
Painful arthritic joints in the hindfoot or midfoot are selectively fused. The aim is to reduce pain and achieve a stable foot with the most even possible weight distribution.
Planning aims to preserve as many healthy joints as possible.
Treatment may include repair of a tear, removal of degenerative tendon tissue, reattachment, tendon transfer or correction of associated bony factors.
The type and age of the injury and the quality of the tissue determine the technique and pace of recovery.
Charcot reconstruction is reserved for selected cases with instability, collapse, bony prominences and recurrent ulcers that cannot be protected with conservative measures. It may include removal of bony prominences, correction of deformity and extensive fusion.
Control of infection and diabetes, adequate blood supply and the ability to comply with offloading are essential.
Consultation and diagnosis
The onset of symptoms, tolerated footwear, previous injuries and the patient's goals are reviewed. Weight-bearing examination assesses gait, alignment, movement, stability and areas of excessive pressure.
Weight-bearing X-rays are essential for many deformities. CT, MRI, ultrasound or vascular investigations are recommended when they may clarify the diagnosis or change the plan.
Diabetes, circulation, bone quality, smoking, current treatments and the ability to follow postoperative protection instructions influence both the decision and the timing of surgery.
Choosing treatment
Surgery is not always the first step. Depending on the diagnosis, treatment may include adapted footwear, braces or orthotic insoles, rehabilitation, activity modification or injections in selected cases.
For diabetic or Charcot foot, offloading, immobilisation and special protection of the skin may be required.
Surgery is considered when pain, instability, progressive deformity or risk to the skin justifies the procedure and conservative treatment does not provide sufficient control.
The plan may include soft-tissue procedures, osteotomies, ligament reconstruction, joint procedures or fusion. The technique is chosen according to severity, the joints affected and functional needs.
After treatment
Recovery differs considerably between forefoot correction, ligament reconstruction and complex Charcot surgery.
The plan specifies immobilisation, when weight-bearing can begin, wound care, swelling control, clinical and radiological follow-up, and the gradual return to walking. Bone healing, protection of the correction and the condition of the skin are monitored.
Further information
No. Surgery is considered when pain, difficulty wearing shoes or associated deformities affect function and conservative measures are no longer sufficient.
Assessment usually begins with weight-bearing X-rays of the foot and, when necessary, the ankle. Further investigations are chosen according to the flexibility of the deformity and the structures involved.
Not automatically. Proprioceptive rehabilitation and muscle strengthening are important; ligament reconstruction is reserved for carefully selected cases with persistent instability.
No. Offloading and immobilisation often play a central role. Surgery is considered when the deformity causes instability, pressure areas or recurrent ulceration and cannot be protected by conservative measures.
The appearance of an ulcer, discharge, redness, local warmth, marked swelling or a new deformity requires prompt medical assessment. Fever or deterioration in the patient's general condition requires attendance at an emergency department.
Appointment
For persistent symptoms, progressive deformity or instability, a consultation allows the diagnosis to be established and the options appropriate to the clinical situation to be discussed.
This website does not provide emergency care. In an acute or life-threatening situation, call 112 or go to the nearest emergency department.