Ankle pain – getting the diagnosis right.

Written by: Mr Paul Hamilton
Edited by: Cal Murphy

Ankle pain is an extremely common complaint that often has a very significant impact on one’s life.

Whether it is daily pain causing a significant reduction in the ability to walk, or exercise-related pain causing the inability to perform sports, the key to successful foot and ankle pain treatment is an accurate diagnosis. Orthopaedic surgeons should aim to provide individualised ankle pain treatment plans focusing on returning patients to their previous level of activity in a multi-disciplinary way, using modern techniques of diagnosis and management.

In this article we outline some common conditions and some of the ankle pain treatments available.

Ankle sprain

A sprain is a common source of ankle pain. Most ankle sprains do not require medical input, but those with more severe injuries that fail to resolve over a short period of time may require investigation and a more focused treatment protocol. These treatments include patient- and injury-specific rehabilitation with the more severe injuries requiring repair or reconstruction of damaged ligaments and possibly key-hole (arthroscopic) surgery.

Achilles tendon tear (rupture)

In recent years there has been a shift from surgical repair of Achilles tendon injuries to non-surgical care with an accelerated rehabilitation protocol with excellent outcomes in both groups.  The preferred treatment for an Achilles tendon tear should be discussed with each specific patient and the different options should be discussed.

Achilles tendinopathy/Plantar fasciitis (Heel pain)

Morning stiffness and pain around the heel are common and may relate to activity. Onset is usually slow but can often be put down to an ‘overuse’ phenomenon. In recent years the understanding of the causes and abnormalities seen within the Achilles tendon has led to new techniques in the treatment of heel pain, including physiotherapy, shockwave therapy, injection therapy and surgery to off-load the tendon, as well as the more traditional surgical treatments.

There are many other causes for both acute and chronic problems around the ankle. We have outlined three of the most common causes of ankle pain. For an acute diagnosis and management plan we recommend seeing an orthopaedic surgeon with an interest in foot and ankle conditions to allow early diagnosis and to guide and plan necessary individualised treatment.

By Mr Paul Hamilton
Orthopaedic surgery

Mr Paul Hamilton is a top orthopaedic consultant based in Surrey and London. He specialises in adult foot and ankle surgery and trauma surgery, including forefoot reconstruction, arthroscopy and arthroplasty, and is an expert in treating sport injuries, Morton's neuroma, arthritis and bunions.

After qualifying from St Bartholomew's and the Royal London Medical School, he completed three medical fellowships in the UK and a travelling fellowship to Boston, USA, giving him extensive specialist training. In addition to his private and NHS practices, Mr Hamilton is actively involved in research, and has published and presented his work in orthopaedics around the world.

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