Ankle pain, injury and surgery
We have an expert team of orthopaedic consultants and foot and ankle surgeons at Parkside Orthopaedics and Sports Medicine Centre. If you suffer from ankle pain, we can make a fast diagnosis and offer a full range of treatments.
The structure of the ankle
The ankle is a complex joint, which allows your foot to move upwards, downwards and sideways. It is made up of three different bones:
• The tibia is the shinbone down the front of the leg. It forms the inside part of your ankle.
• The fibula is a thinner bone in the lower leg. It forms the outside part of your ankle.
• The talus is a small bone above the heel. It connects your foot to the tibia and fibula in your lower leg, which run parallel to each other.
Strong bands of connective tissue called ligaments hold these three bones together. Muscles and tendons (tissue that connects muscle to bone) also support the ankle joint. The ends of the bones that meet at the joint are covered with an elastic layer called cartilage. This layer helps your bones to glide over each over smoothly when you move.
Common injuries affecting the ankle are:
• Ankle sprains and strains: You can sprain or strain your ankle if you roll, twist or turn it in an awkward way. This can stretch or tear the ligaments that connect your ankle bones. You may have pain, tenderness or weakness around the ankle, especially when you put weight on it. The injured area may also be swollen or bruised.
Most injuries are straightforward sprains or strains, but sometimes small pieces of bone tear off. It is also possible to damage the cartilage lining and tendons around the ankle. If you repeatedly sprain your ankle, the joint can become unstable over time.
• Ankle fractures: If you break one or more of the bones in the ankle joint, this is called a fracture. You can fracture your ankle during a twisting movement, fall or accident. The ankle ligaments and cartilage may also be damaged.
Sometimes an ankle fracture can be mistaken for a sprain because the symptoms are similar. You may hear a popping or cracking sound when you fracture your ankle. You are likely to have immediate, severe pain over the ankle bones and then get a lot of swelling or bruising. It may be hard to put any weight on the ankle.
In serious cases, your fractured ankle may look different from the other ankle. If a bone breaks through the skin, this is called an open or compound fracture. Both of these situations require immediate emergency treatment.
Arthritis in the ankle
If you have arthritis in the ankle, the joint and soft tissue become inflamed (swollen). A previous injury or wear and tear can damage the cartilage protecting your ankle bones. Without this protective layer, the bones rub against each other. Nearby soft tissue may also wear away. This can cause pain or tenderness, swelling, stiffness and loss of joint movement.
The three most common types of arthritis that affect the ankle are:
• Osteoarthritis: This is where the cartilage in the ankle joint slowly wears away over time. The bones in the ankle then start rubbing and you may get painful growths called bone spurs. Osteoarthritis is most common in older people and anyone who is overweight, has a family history of the condition or previously suffered an ankle injury.
• Rheumatoid arthritis: This is an autoimmune disease, where the immune system attacks the ankle joint lining by mistake. The joint becomes swollen and the cartilage and nearby bone can get damaged over time. Rheumatoid arthritis commonly affects both ankles.
• Post-traumatic arthritis: This is where the cartilage in the ankle joint wears away following an injury. Post-traumatic arthritis can develop many years after the original injury to the ankle.
Diagnosing ankle pain
If you get pain in the ankle, you can have a detailed assessment at Parkside Orthopaedics and Sports Medicine Centre. A specialist orthopaedic consultant asks about your symptoms, medical history and any recent or previous injury. The consultant then carefully examines your ankle, checks your range of movement and watches how you walk.
To make an accurate diagnosis, your consultant arranges one or more of these imaging tests:
• Digital X-rays while you stand
• Bone scan
• CT scan
• MRI scan
Our Diagnostic Imaging Suite has advanced equipment, which produces high quality pictures of any bone damage and joint changes. You may also have blood tests to help diagnose rheumatoid arthritis.
Treatments for ankle pain
Parkside Orthopaedics and Sports Medicine Centre has four modern operating theatres, a rehabilitation gym and a large hydrotherapy pool. We offer these treatments for ankle pain:
• Treatments for ankle sprains and strains: Most ankle sprains and strains are minor. They can often be treated by resting, using an ice pack, wearing a bandage and keeping the ankle raised. If your symptoms do not improve soon, you may need hospital treatment.
Your consultant may recommend that you use crutches, an ankle support brace, a cast or a walking boot to treat a bad sprain. They may prescribe anti-inflammatory medicines and our physiotherapists can teach you exercises.
If you keep spraining your ankle, the ligaments get weaker and your ankle joint can become unstable. In some cases, our expert surgeons can perform an ankle ligament operation to tighten or replace the weak ankle ligaments.
• Treatments for ankle fractures: The treatment that you need depends on what type of fracture you have and whether the broken bone is out of place.
You may not require surgery if your ankle is stable. In some cases, you can put weight on your leg straight away. Sometimes we put your ankle in a plaster cast for six to eight weeks to hold the broken bone in place while it heals. We may give you crutches or a walking frame to avoid putting weight on the ankle. After four weeks, we may replace the plaster cast with a removable cast or special boot. You can then start to put some weight on your injured ankle.
If you have a more serious fracture, you may need an operation to fix the broken bone. We can carry out a procedure called open reduction and internal fixation. You usually have a general anaesthetic, which means that you are asleep during the procedure.
Your surgeon makes cuts over the ankle and moves the pieces of broken bone into the correct position. The broken bones are held together with small metal pins, plates, wires or screws. This metalwork is normally left in the ankle. The surgeon then closes the cuts with staples or stitches and puts your lower leg in a protective splint, cast or boot.
If you have lasting damage or pain, there may be other options such as ankle arthroscopy, fusion or replacement surgery (please see below).
• Treatments for ankle arthritis: If the cartilage in your ankle joint is damaged by arthritis or a bad fracture, we offer various treatments. Non-surgical treatments include changes to your activities, weight loss, anti-inflammatory medicines, physiotherapy, an ankle brace or shoe inserts (orthotics).
A steroid injection in the ankle joint can temporarily reduce pain and inflammation. Medicines called disease-modifying drugs can control and slow down rheumatoid arthritis.
If you are still in a lot of pain, your consultant may recommend surgery:
– Ankle arthroscopy: An ankle arthroscopy is a type of minimally invasive or keyhole surgery. It can help in the early stages of arthritis or following an ankle fracture. You usually have a general anaesthetic.
Your surgeon makes tiny cuts over the ankle and inserts a long, thin tube with a camera called an arthroscope. They then clean the ankle joint and remove any loose cartilage, damaged tissue or bone spurs (growths) that restrict your movement.
– Ankle fusion surgery: Ankle fusion is an operation to join two or more ankle bones permanently into one piece. This makes the joint stiff and stops the bones from rubbing painfully against each other. The procedure is used to treat advanced arthritis or ongoing pain after an ankle fracture. You usually have a general anaesthetic and another injection called a peripheral nerve block to help block pain after the procedure.
Your surgeon makes a cut at the ankle joint. If they use a minimally invasive method, this cut will be much smaller. The surgeon removes the damaged cartilage and connects the ankle bones in the right position with metal screws. Your lower leg is put in a plaster cast. Over time, your ankle bones grow together and fuse.
– Ankle replacement surgery: Ankle replacement is an operation to replace a severely damaged, weakened or worn out ankle joint with an artificial joint. This procedure is best suited to less active people over the age of 60. You usually have a general anaesthetic and another injection called a peripheral nerve block to help block pain after the procedure.
Your surgeon makes a cut at the ankle joint and removes the damaged bone and cartilage. The damaged areas are replaced with two metal, ceramic or plastic parts, which the surgeon fixes to your ankle bones. These parts are coated with a substance that encourages your bone to attach to the new surface. Your surgeon inserts a piece of plastic between the two parts to allow movement and puts your lower leg in a lightweight cast.
Research shows that about 85 to 90% of ankle replacements last at least 10 years.
If ankle pain is affecting your daily activities, Parkside Orthopaedics and Sports Medicine Centre provides specialist advice and treatment without delay. We offer all-inclusive price packages for most ankle procedures. For information about prices, please call 020 3925 1062 or complete this form online.
To make an appointment at Parkside Orthopaedics and Sports Medicine Centre, please call 020 3944 0568 or complete this form online. Appointments are available six days a week.
Ankle pain, injury and surgery Consultants