The ankle is the hinge between the foot and the leg. This joint is composed of the lower part of the leg bones (tibia and fibula) and talus from the foot. The joint itself is quite stable and the stability is maintained by the ligaments and tendons etc. This joint is quite vulnerable to injury in all age groups. Injuries can lead to instability of the joint and ankle arthritis is not uncommon.
A sprain to this joint is quite common and can be disabling. It can happen to people of all ages and is very common with sports people. Initial assessment includes an appropriate X-ray to exclude any bony injuries. It is not absolutely necessary to put the leg in plaster, as it can be treated with splints (supports). These splints can be accommodated inside the shoe giving the patient more freedom to walk around.
These are quite common and dependent upon the displacement and age, these can be treated either by plaster, splints or surgery.
Often following injury patients complain of their ankle joint giving way when walking. This is a symptom of ankle instability which is mainly due to ligaments injury. After initial X-rays an MRI is carried out to assess the exact status of the ligaments. Thereafter the ankle joint stability could be assessed with the patient anaesthetised and at the same time keyhole surgery can take place to look inside the ankle joint. This is usually carried out as a day case, however if there is significant instability, the joint could later on be stabilized by reconstruction of the ligaments.
Initially the ankle arthritis should be treated with painkillers, ankle support, modification of shoes, walking aids etc. Arthroscopy of the ankle and debridement can give temporary relief of symptoms. If the pain and deformity persists there are 2 surgical option ie ankle fusion and joint replacement. Ankle fusion helps to make a painful stiff joint a pain free stiff joint. Fusion is advocated for younger patients. For the more elderly population ankle arthritis could be treated by total ankle joint replacement. This type of joint replacement is not as successful as knee and hip replacements. Nonetheless as technology improves, so too does the success rate. As ankle joint replacement maintains the movement of the joint, younger patients are accepting this option rather than fusion, even knowing that the joint replacement could fail at some stage in the future.
This is a condition where the tibialis posterior tendon which runs along the inner side of the ankle joint, fails to work properly resulting in the flattening of the arch of the foot. There are various stages of this disease which result in the flattening of the foot which gives rise to considerable deformity and disability. If identification is made in the early stages, it could be treated by non-surgical means. If the problem is more advanced, then surgery in the form of tendon transfer, osteotomy (cutting the heel bone and shifting it), arthrodesis (fusion) of the joints are advocated.
OCD can occur in many joints particularly the ankle joint as the talus bone is quite vulnerable. This is usually as a result of trauma where a piece of the bone becomes abnormal. Symptoms are considerable discomfort, pain, instability and stiffness. This condition is unfortunately not easy to treat, however investigations such as an MRI can identify the defect much more accurately. Initially non-operative treatment is the best course of action and later keyhole surgery and specific treatment of OCD can be considered to alleviate the symptoms.
All of the toe joints have a joint at their base (metatarso-phalangeal joints), as well as other small joints beyond this (interphalangeal joints). This particular part of the foot is referred to as the forefoot. Many deformities can occur in this area which may be due to familial, neurological or following trauma and arthritis. Reconstruction of these joints in general is called forefoot arthroplasty. Deformities of the small joints of the toes can be corrected by dealing with the soft tissues or fusing the joints. Metatarso- phalangeal disease could be treated by joint replacement particularly for the big toes. The big toe can be affected by arthritis, resulting in stiffness of the joint (hallux rigidus). Either half or full joint replacements are available which can give significant comfort to the patient.