Ben Yates Consultant Podiatric Surgeon
Wiltshire
Foot Surgery Services
Mr Ben Yates
Consultant Podiatric Surgeon
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Ankle problems

Repetitive Ankle sprains
This is often termed ankle instability (link to section in sports injuries). After a bad ankle sprain the ligaments and soft tissues around the ankle can be damaged and become weak. This may lead to the ankle becoming unstable and the person frequently re-sprains the joint. This can often be resolved through building up the strength and proprioception (body balance and awareness) around the joint through targeted physiotherapy. Sometimes orthotic insoles, the use of a brace and careful footwear selection are also required. 
If conservative care fails then surgery will often be needed. This type of surgery is usually day case and can be performed under general anaesthetic, sedation or local anaesthetic. The ligament repair is protected in a cast or ski  boot (cam walker) for up to 4 weeks and this is followed by post-operative physiotherapy. Surgery is generally successful although occasionally the ankle can become unstable again over time.
 
Ankle arthritis
The pain and stiffness you feel in your ankle as you grow older could be arthritis. If left untreated, this nagging pain can grow worse, eventually becoming so painful that it can stop you walking even short distances. Severe arthritis can restrict your mobility and limit your quality of life, but with proper treatment, you can slow the development of arthritis and lead a more productive life.
 
What is Arthritis? 
Arthritis is a broad term for a number of conditions that damage the normal structure and function of a joint. For most people this is associated with a gradual stiffness of the joint with pain and localized inflammation. In some cases the joint will become deformed.
 
Arthritis may occur in your back, neck, hips, knees, shoulders or hands, but it also occurs in your feet and ankles. Almost half of people in their 60s and 70s have arthritis of the foot and/or ankle that may or may not cause symptoms.
There are many different types of arthritis. The most common type, osteoarthritis (OSS-tee-oh-ar-THRI-tiss), results from the "wear and tear" damage to joint cartilage (the soft tissue between joint bones) that comes with age. The result is inflammation, redness, swelling and pain in the joint.
Also, a sudden and traumatic injury such as a fracture, torn ligaments or severe ankle sprains can cause the injured joint to become arthritic in the future. Sometimes a traumatic injury will result in arthritis in the injured joint even though the joint received proper medical care at the time of injury.    
The other common types of arthritis are known as a group called inflammatory arthritis. Rheumatoid arthritis is the most common and is caused by an irritation of the joint lining (the synovium). People with rheumatoid arthritis for at least 10 years almost always develop arthritis in some part of the foot or ankle.
Other types of inflammatory arthritis include gout, ankylosing spondylitis and psoriatic arthritis.
 
Treatment of Foot and Ankle Arthritis
The first part of treatment of the arthritis involves diagnosing which type of arthritis you have and which joints are affected. This involves a through examination and history taking. X-rays and laboratory tests often can confirm the type and extent of the arthritis. Other specialist tests such computed tomography (CT) scan, ultrasound or magnetic resonance imaging (MRI) may be used to evaluate your condition.
There are many treatment options available for arthritis and these will be discussed with you in detail during your consultation. Options include pain medications, anti-inflammatory medications, injection therapy, orthotic insoles, footwear advice, physiotherapy, weight loss. Surgery may be necessary. This may involve removing the inflammation and bony spurs around the arthritic joint, realigning the joint, eliminating the painful motion of the joint, replacing the joint with an artificial joint or a combination of all these.
 
Bone Bruise
This can occur to any bone in the body usually after a traumatic injury. The ankle is very prone to this condition due to its bony architecture and the type of injury patterns that often occur. Most bone bruises will heal uneventfully and not cause long-term damage to the joint. However, it can take many months for the bone to settle and the joint often needs to be protected during this time.
If the bruise occurs close to the joint surface then the blood supply to the cartilage (the soft tissue lining of the bone surface at a joint) can be damaged. This can cause an osteochondral lesion to develop. This is a more serious condition and often causes more chronic pain to the ankle. Osteochondral lesions often require surgical intervention to try and reduce pain and promote a healing response by the bone to the injury. Despite such treatment osteochondral lesions will often lead to arthritis developing in the joint.
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