Foot and ankle injuries are extremely common, accounting for an estimated quarter of all visits to Accident and Emergency Departments in the UK each year. Equally, many people put up with gradual 'wear and tear' which can result in rising levels of foot discomfort, pain and loss of overall mobility. It can be difficult to know when a nagging injury or problem requires the attention of a consultant orthopaedic surgeon in a specialist foot centre.A classic example is 'the ankle sprain which does not heal'. The standard advice for an ankle sprain is the so-called PRICE approach (protect, rest, ice, compression and elevation). Most people will find the sprain heals within six to eight weeks. However, if you are still in pain after this period, or if there remains swelling and/or difficulty weight bearing, you should go to a specialist foot centre for treatment. If you have a feeling of your ankle 'giving way' while walking or standing, this is another reason for seeing a speci alist, as there may be some ankle instability which should be investigated. Standard x-rays do not pick up ligament damage or fractures of smaller bones, so it is very important that you pay attention to your symptoms and act if you are still experiencing problems six to eight weeks after your initial fracture.Damage to the Achilles tendon is an area where prompt attention from a specialist foot centre is vital. Achilles tendon rupture is an injury most likely to affect the so-called 'weekend warrier' - typically male, with an average age of 32.5 and of a professional background. Ruptures are most likely to occur during sports with sudden bursts of running, twisting and jumping. For some people, the sudden 'snap' is a very clear sign that something serious is wrong and specialist attention is needed at a foot centre. But this is not always the case. Foot surgeons report a number of cases where people with Achilles tendon rupture are misdiagnosed as having a 'partial tear' or ankle sprain. They say in fact, partial tears are incredibly rare; the most likely diagnosis is a rupture and it is essential that treatment takes place as soon as possible. A foot specialist will carry out a simple test known as the 'calf squeeze test' to confirm diagnosis, along with ultrasound and MRI imaging. There are two distinct treatments - the conservative approach, when the ankle is fully immobilised for eight weeks to allow healing to take place. Alternatively, surgery involves stitching the tendon to reconnect both ends and is recommended for younger, more active people. Another common reason for a consultation at a specialist foot centre is concern about flat feet. About one in five adults have flat feet, although for many, the condition will not cause any significant problems. The main rule of thumb for going to a foot centre is if you are experiencing any pain as a result of your foot structure. This may result in some swelling around the ankle. More rarely b ut very seriously, flat feet can lead over time to the spread of arthritis through the hind foot. It can also be the case that flat feet cause pain elsewhere in the body, sometimes the knees, the back and even neck pain. If this is the case, it can be very difficult to identify flat feet as the cause of the problem. At a specialist foot centre, a podiatrist will be able to carry out a gait analysis, which is an assessment not only of your feet but also your whole lower limb muscular-skeletal structure and the impact of the structure and your gait (walking style) upon your joints. Often simple changes such as wearing orthotics (supports within shoes) can provide an effective remedy to the effects of a flat foot structure.
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