Foot and ankle pain consistently ranks as one of the top five reasons for consulting a GP. The number of people suffering without any medical attention is even higher, as our feet tend to be a particularly neglected part of our bodies. When people first experience pain, their first port of call is often a podiatrist or physiotherapist and indeed, this is the right approach for many foot and ankle conditions. For a common problem such as heel pain, conservative methods such as wearing orthotic supports and stretching exercises are sufficient to resolve the problem for about 80 per cent of sufferers.
However some foot and ankle conditions do require an assessment by a specialist - that is a consultant orthopaedic surgeon and ideally one concentrating wholly upon the foot and ankle. Seeing a surgeon will not lead you inevitably to surgery . Specialist foot and ankle surgeons work closely with podiatrists and physiotherapists and will try conservative methods where appropriate, often with great success. In recent years, there has also been great advances in the range of injections available for foot and ankle pain (steroid injections are not the only options) plus more evidence that extracorporeal shockwave therapy is effective for pain, particularly plantar fasciitis.
People who suffer ankle sprains are often unsure when to 'let nature take its course' and when they need medical attention. Surgeons suggest that the ankle sprain which does not heel within six weeks should be a cause for concern. You may have had an x-ray in your local Accident and Emergency Department but ligament damage is unlike to be evident on this imaging. However untreated ligament damage can lead to ankle instability and a cycle of that instability causing further sprains and exacerbating weakness.
Persistant stiffness and pain, particularly in and around the ankle, midfoot and big toe is likely to be due to arthritis. Many people endure serious pain from arthritis, finding ways of working around the condition rather than seeking treatment. But a diagnosis when arthritis is at a relatively early stage means you have a far wider range of options available to you than waiting to see a specialist once the condition is advanced. At an early stage, scar tissue can be removed from the joint using keyhole surgery. Although this will not prevent the condition from progressing, it can do a great deal to reduce pain and improve mobility. At an advanced stage of arthritis, fusion surgery is a very effective way of eliminating pain by preventing arthritic bone surfaces from rubbing together. For patients who do not want the degree of flexibility lost by fusion, ankle replacement surgery is a much improved area. Ankle replacement surgery had remained behind knee and hip replaceme nt surgery in terms of success rates, but improvements in medical technology mean the new ankle replacements are now much more durable and effective.
For people enduring heel pain, specialists suggest trying conservative treatments for six months - including rest, orthotics and stretching exercises. After this period, if you remain in serious pain, you are likely to have a more intractable problem which requires 'second line' treatment. This usually does not entail surgery. Most heel pain problems can be treated with shockwave therapy or injections, with a much smaller percentage benefitting from a small surgical procedure in which the calf muscle is stretched in a very controlled way by the surgeon.
Bunions are another major foot problem which people tend to put off seeking specialist help. Some people are concerned about bunion surgery, their fears often coming from accounts of people who have had older methods of surgery causing extensive pain and a long recovery. There are now very good, established minimally invasive surgery methods to treat bunions, much reducing pain and improving the post-operative experience. Surgeons will emphasise that if the bunion is causing no pain, surgery is not required and should not be embarked upon for cosmetic reasons. However once the bunion is causing pain, treatment must be considered, not only to address the pain but also to prevent the bunion from causing further deformity such as hammer toe and mobility problems.
The rule of thumb with all forms of foot and ankle problems if that if you are in significant pain for more than a couple of weeks, you should see a foot and ankle consultant. Unlike back pain, foot and ankle pain does not tend to 'just go away' and ignoring or working around problems is likely to exacerbate your condition in the longer term.
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