Foot and Ankle

Ankle Fracture refers to a break in one or more of the bones that make up the ankle joint—typically the tibia, fibula, or talus. It usually results from a twisting injury, fall, or direct impact and can range from a minor crack to a complex break involving multiple bones.

Common symptoms include:

• Sudden pain and swelling
• Bruising
• Difficulty bearing weight
• Deformity or abnormal positioning of the ankle

Diagnosis is confirmed with an X-ray. Treatment depends on the severity of the fracture and may include:

• A supportive boot or plaster cast
• Realignment of bones (manipulation)
• Surgery to fix the bones with plates or screws

Recovery typically takes 6 to 8 weeks but may be longer for more severe injuries. Physiotherapy is often recommended to restore movement and strength. Follow-up care is essential to ensure proper healing and prevent complications such as stiffness or arthritis.

• NHS UK: Broken Ankle
• Physiotherapy Following an Ankle Fracture

Metatarsal and phalangeal fractures are common injuries of the foot, affecting the bones in the forefoot. The foot's anatomy includes five metatarsal bones, which connect the ankle to the toes, and 14 phalangeal bones that form the toes. Fractures to these bones can be caused by direct trauma, such as dropping a heavy object on the foot, or by repetitive stress, often seen in athletes.

Types of Fractures

• Metatarsal Fractures: These breaks can occur in any of the five metatarsal bones. The fifth metatarsal, on the outer side of the foot, is particularly prone to injury, with common types including Jones fractures (a break in a specific area of the bone with poor blood supply) and avulsion fractures (where a tendon or ligament pulls a small piece of bone away).
• Phalangeal Fractures: These are toe fractures, often caused by stubbing a toe or a crush injury. Most toe fractures, especially in the smaller toes, are treated conservatively and heal well. However, fractures of the great toe may require more attention due to its crucial role in weight-bearing.

Common symptoms of both types of fractures include immediate pain, swelling, and bruising. You may also have difficulty walking or putting weight on the injured foot. Treatment depends on the severity and location of the fracture.

Conservative Treatment: Many non-displaced fractures can be managed with rest, ice, compression, and elevation (R.I.C.E.). Immobilisation with a stiff-soled shoe, walking boot, or "buddy taping" (taping a fractured toe to an adjacent, healthy one) is also a common approach.

Surgical Intervention: In more severe cases, such as displaced fractures or multiple breaks, surgery may be necessary to realign the bones. This may involve using pins, screws, or plates to hold the bones in place while they heal.

• Discharge advice following metatarsal and phalangeal fracture

Ankle Arthritis is a condition that causes pain, stiffness, and swelling in the ankle joint due to the breakdown of cartilage. It can significantly affect mobility and quality of life. While it often results from wear and tear (osteoarthritis), it may also follow injury, repeated sprains, infection, or be linked to inflammatory conditions such as rheumatoid arthritis.

• BOFAS information: Ankle Arthritis

Ankle Instability refers to a condition where the ankle frequently gives way, especially during walking or physical activity. It often develops after repeated ankle sprains or ligament injuries, particularly affecting the lateral ligaments such as the anterior talofibular and calcaneofibular ligaments.

Symptoms may include a feeling of weakness or looseness in the ankle, recurrent sprains or rolling of the ankle, pain, swelling, or bruising, or difficulty walking on uneven surfaces.

• BOFAS Information: Ankle Instability

Big Toe Arthritis, also known as 1st metatarsophalangeal joint (MTPJ) osteoarthritis or hallux rigidus, is a degenerative condition affecting the main joint at the base of the big toe. It typically develops due to wear and tear, previous injury, altered foot mechanics, or underlying conditions such as rheumatoid arthritis or gout.

• BOFAS Information: Big Toe Arthritis

High Arched Feet, also known as Pes Cavus, describe a foot shape where the arch is significantly raised and does not flatten with weight-bearing. While some people have naturally high arches without symptoms, others may experience pain, instability, or deformities such as clawed toes or calluses.

• BOFAS Information: Cavus Feet (high arched feet)

Flat Feet, also known as Pes Planus or "fallen arches," occur when the arch on the inside of the foot is low or absent, causing the entire sole to touch the ground when standing. This is common in children and often part of normal development, with most developing an arch by age 10.

• BOFAS Information: Flat Feet (fallen arches)

Haglund’s Deformity is a condition characterised by a bony prominence at the back of the heel, where the Achilles tendon attaches to the heel bone. This lump can cause irritation, inflammation, and pain, especially when wearing rigid footwear that rubs against the area.

• BOFAS Information: Haglund's deformity (Heel bumps)

Plantar Fasciitis is a common cause of heel pain, resulting from irritation or damage to the plantar fascia—a strong band of tissue that connects the heel bone to the toes and supports the arch of the foot. It typically causes sharp pain under the heel, especially noticeable with the first steps in the morning or after periods of rest.

The condition is often linked to repetitive strain, poor footwear, tight calf muscles, increased activity levels, or being overweight. People with flat feet or high arches may also be more prone to developing plantar fasciitis.

• Plantar Fascia Pain

Bunion Surgery is a procedure to correct a deformity at the base of the big toe, known as a bunion or hallux valgus. This condition causes the big toe to drift towards the second toe, creating a bony lump that can become painful and make footwear uncomfortable.

Surgery is typically considered when non-surgical treatments—such as wider footwear, orthotics, or pain relief—fail to manage symptoms effectively. The operation usually involves realigning the bones of the big toe and foot.

• BOFAS Information: Bunion Surgery

Gastrocnemius Release is a surgical procedure used to treat tightness in the calf muscle, specifically the gastrocnemius, which can contribute to foot and ankle problems such as plantar fasciitis, Achilles tendinopathy, flatfoot deformity, and forefoot overload.

• BOFAS Information: Gastrocnemius Release (Calf Muscle Surgery)