Ankle treatments & procedures
Achilles tendon
An Achilles tendon problem needs to be diagnosed and treated as soon as possible. The Achilles tendon is located just behind and above the heel and connects the calf muscle in the leg to the heel itself.
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Two major problems are ruptures and tendonitis. The Achilles is a very strong tendon, but it can rupture when there is a sudden force or stress – particularly during sports and activities.
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Tendonitis (inflammation of the Achilles) can lead to weakness and other medical conditions. Rheumatoid arthritis, gout and lupus can all leave the Achilles prone to a rupture injury.
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In the case of an Achilles tendon rupture, the tear is often described as 'partial' or 'complete'. In a partial tear, there is still some degree of connection to the calf muscle. If there is a complete tear, all connection has been severed. Urgent treatment is vital.
Ankle instability
Ankle instability is characterised by a feeling that the ankle is about to 'give way' or a feeling that the ankle feels 'wobbly', particularly on uneven surfaces.
Two main ligaments support the ankle. The outer ligaments are known as the lateral ligaments and have three components which stop the ankle from rolling and sliding forward. These ligaments are attached to the fibula (a small bone next to the shin), the talus (the ankle bone) and the calcaneus (heel bone).
An ankle sprain can stretch or tear these ligaments and if the sprain doesn't heal well, ankle instability can develop.
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'Giving way' often takes place on the outer side of the ankle and can occur during sports and walking. It can also occur whilst standing and may be accompanied by swelling, tenderness and significant pain.
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Chronic instability often follows an undiagnosed ankle sprain that was not diagnosed and treated. An ankle sprain stretches and tears the connective tissues, known as the ligaments.
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When this happens, nerve sensors in the ligament are often damaged. These nerve sensors give your brain information about the position of your joints, allowing you to protect them.
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If these nerve endings are not working properly, your brain does not get reliable information and the muscles around your ankle may not operate in unison. This causes the ankle to 'give way'.
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Ankle instability can lead to further sprains, which in turn weaken the ankle even more. With every additional sprain, ligaments are significantly weakened. If your ankle feels unreliable and gives way repeatedly, or you are prone to ankle sprain injury, a consultation would be beneficial.
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First the foot will be examined for evidence of swelling. By stretching the ankle in different directions, it is possible to determine if the ankle ligaments are compromised. X-rays and an MRI scan may also be taken.
Treatment depends upon the severity of the condition and the patient's activity levels.
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Physiotherapy is effective for many cases. Surgery may be considered if ankle instability fails to improve following non-surgical treatment. There are two main surgical procedures for ankle instability:
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1. Damaged ligaments are tightened and re-attached to the bone. This type of operation is highly successful and is appropriate for people with active lifestyles.
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2. A tenodesis procedure involves relocating hamstring tissue to recreate ligaments. This procedure should only be considered when the instability is profound and there is a great deal of stress on the ankle.
aThis operation is very successful but can cause ongoing stiffness.
Ankle osteoarthritis
Cartilage allows smooth movement of joints. Ankle osteoarthritis results from damage to the cartilage. Loss of, or damage to the cartilage causes inflammation of the joint and can lead to deformity.
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Ankle osteoarthritis can cause stiffness, pain, swelling, deformity and problems with mobility. Some patients suffer a bony protrusion known as an osteophyte or spur and this can lead to pinching of the lining of the joint. Osteoarthritis of the foot and ankle can reduce the ability to walk and stand for prolonged periods.
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In the early stages, pain may only occur at the beginning and at the end of an activity but as the condition progresses the pain occurs more frequently to the extent that it can occur with each step and even at rest.
The most common incidence of ankle osteoarthritis is following a fracture of the ankle or repeated sprains. Other causes of are flat feet or high-arches of the feet.
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The diagnosis of ankle osteoarthritis is made on the basis of the patient history, examination the surgeon and is confirmed with weight-bearing x-rays. MRI scans can also be helpful.
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Non-surgical treatment of includes footwear modification, anti-inflammatory medication and physiotherapy in order to promote flexibility. Injections to lubricate the ankle joint or cortisone to damp down inflammation can help but their effect is only temporary.
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Arthroscopy (keyhole surgery) for ankle osteoarthritis allows the surgeon to assess and treat the joint from the inside using very small incisions. Arthroscopy however, does not cure the condition or halt the progression of the condition.
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After two or three small incisions, fine surgical instruments are employed to remove any fragments of bone, cartilage and inflamed tissue. The cartilage surfaces of the joint are also 'smoothed' during the procedure.