Ankle pain

The causes of ankle pain are many and varied. In many instances, diagnosis can be made using the Centre's advanced ultrasound scanner. In other instances MRI, CT ankle arthroscopy is required to diagnose the problem accurately.

Symptoms are often due to the injury of tendons surrounding the ankle joint although other causes include arthritis, ligaments sprains and nerve related pain. The vast majority of patients respond well to conservative treatment. This will often require computerised gait analysis (please refer to gaituk.com, our dedicated web site on gait analysis)

Many patients, particularly those active in sports attend the Centre complaining of chronic ankle instability. Often, the problem can be treated conservatively with appropriate rehabilitation, orthoses, footwear advice and specialised braces.

ANKLE SURGERY

The London Podiatry Centre offers a full and extensive range of procedures for the ankle. The tendons surrounding the ankle sometimes become inflamed, requiring specialist ultrasound guided injections. In other instances the tendons require surgery to repair or remove abnormal fibrous tissue so that they can function normally again. The tendons and soft tissue structures may be injured because of an abnormality in bony architecture/shape. In such cases the bones will be operated on to re-align the foot so that the tendons can function normally.

Operations of the ankle including tendon lengthening and tightening is often required during flat foot surgery which is also offered at the centre.

Key hole surgery (arthroscopy) is offered through the centre and this is particularly useful for the treatment ankle joint problems.

Some patients repeatedly turn their ankles due to ligament damage. When conservative treatment fails, the centre uses corrective surgical techniques to repair the damaged ligaments which have led to instability. Surgery can often be performed under local anaesthetic. Some common conditions encountered at our Centre include:

ACHILLES TENDON PAIN

In most cases pathology of the Achilles tendon can be treated without surgery. Various forms of injection including "high volume and hydro-dissection techniques" can be utilised prior to considering surgery. At times though, the problem can become chronic and surgery is advised. This can consist of removal of the fibrosed damaged tissue around the tendon and repair of any tears or diseased fibres. Surgery can often be performed under local anaesthetic on a day care basis.

A common condition of the Achilles is often referred to as insertional tendinopathy. This condition occurs where the tendon inserts into the bone and at this level the patient may experience pain and inflammation with bone production and spur formation. Treatments for the condition include shock wave and injections but sometimes part of the Achilles is released to removed the spurs and allow for healing.

The London Podiatry Centre also offers shockwave therapy for the effective management of achilles tendon pain. This is a non-invasive technique with an excellent success rate. See our shockwave therapy page for further information.

TIBIALIS POSTERIOR TENDON INJURY

The tibialis posterior tendon is a very important tendon that helps to support the arch. It is commonly injured, particularly in people with flat, pronated feet. If the injury is caught early then conservative treatment is generally successful especially if there is no tear or significant damage to the tendon. However in chronic, often neglected cases the tendon can become weak and thickening giving rise to secondary deformity which can prove more difficult to manage. Regardless it is always important to treat the structure of the foot to reduce the functional demands on the tendon and address the underlying cause. In such instances gait analysis is indicated and this often leads to gait re-education with physiotherapy. We will assess all factors that may have contributed to the condition and sometimes orthoses and specialised anti-pronation shoes are required. When symptoms persist despite conservative care, specific to the tendon specific treatment to the tendon is required. This initially consist of non-invasive treatments such as shockwave therapy followed by minimally invasive treatments such as injection therapy and radiofrequency. Less frequently, open surgery to repair the tendon and in some instances to rebuild the foot, is needed. Our Centre offers the full range of treatments for injuries of the Tibialis Posterior Tendon

INJURIES TO THE LATERAL (OUTSIDE) OF THE ANKLE

Our centre routinely treats patients who present with pain on the outside of the ankle. Sometimes this develops for no obvious reason and in such instances there is usually an underlying biomechanical problem that requires thorough assessment often using computerised gait analysis. In other cases injury may be the result of a sprain. When treating lateral ankle pain, the first stage is to obtain an accurate diagnosis. In most cases this can be achieved with our advanced on-site ultrasound technology. Sometimes further scans are required and one of the most common is an MRI scan. Following a bad sprain, patients will have damaged one or more of the ligaments on the outside of the ankle and there may be associated damage of tendons, called the peroneal tendons. Our on-site physiotherapists will help to manage the sequelae of a sprain and conservative care is often, successful. Specialist ankle supports and other appliances may be required to facilitate the recovery. In cases where the ligaments are badly damaged it may be necessary for the patient to undergo a repair. Such repairs can be undertaken in our on-site surgical facility and are generally performed under local anaesthetic. One of the most common operations is called a Brostrum Gould procedure which involves repair of the capsule and ligament. Sometimes, it is necessary to repair the peroneal tendons if they have become torn and in severe cases where there is a rupture the tendons may have to be sewn against each other for support and better function.

When there is an underlying biomechanical problem, analysed through gait analysis a specific date education program will be required. Gait analysis often involves the evaluation of balance using our postural sway software which scientifically evaluate deficits in control which can then be treated. Specialist ankle supports are sometimes used and certain types of shoe an orthotic can also help to support and reduce the risk of recurrence, whilst facilitating recovery.

POSTERIOR ANKLE PAIN (pain at back of ankle)

Pain at the back of the ankle can develop for a variety of reasons. Any sport that involves extensive downward pointing of the foot and ankle places a person at greater risk. Footballers and ballet dancers are particularly predisposed.

Often, posterior ankle pain is the result of the tissues at the back of the ankle becoming pinched and irritated. A tendon called flexor hallucis longus may become involved and such patients often respond well to an ultrasound guided injection. Sometimes arthritis or bony injury develops especially when patients have an inherited and extra bone at the posterior ankle called an OS Trigonum. As is nearly always the case, successful treatment relies in part on eradicating the reason for the problem. This is less relevant during a single acute injury but in many cases posterior ankle pain is the result of chronic repetitive irritation at the back of the ankle. The biomechanical scenario that has led to this needs to be fully investigated using gait analysis and a biomechanical evaluation. Where possible causes are mitigated through measures such as gait re-education, a change in training method when sport related, physiotherapy, joint mobilisation and medical appliances such as orthoses. Sometimes the problem becomes chronic and surgery is required. This may require an arthroscopy. Ankle arthroscopy (keyhole surgery) of the posterior ankle is highly specialised and we work closely with experts who offer this service.

ANTERIOR ANKLE PAIN

Pain at the front of the ankle can be the result of a number of conditions. Sometimes, the capular tissue (a anatomical bag that keeps fluid in the joint) at the front of the ankle becomes thickened and irritated. This in turn may arise from bony changes to the ankle including early arthritis. Arthritis often results in the formation of bone spurs which can then irritate the capsule so causing pain. Sometimes the tendons and nerves at the front of the ankle can become irritated whilst in other instances there is damage deep within the ankle joint.

One common condition is an osteo control defect where the cartilage within the ankle becomes damaged and the bone underneath is often weakened.

Once a diagnosis has been established at our centre, we will utilise our extensive range of treatment options to manage the problem.