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Understanding the Foot & Ankle

  • Common Conditions affecting the Foot & Ankle

    The foot and ankle are solid, complex mechanical structures joined together by an extensive network of ligaments, muscles and tendons which work together to provide firm support and mobility to the body. 3 bones make up the ankle joint, which facilitate up and down movement. The foot consists of 28 bones and over 30 joints that allow for a wide range of movement. Ligaments connect the bones and keep joints in place, whereas muscles and tendons provide joint support and movement support.

    Foot and ankle injuries are among the most frequently occurring musculoskeletal injuries, at times requiring surgery. Here are common conditions affecting the foot and ankle, and the treatment options available.

    Common Foot & Ankle Injuries

    foot-ankle-common-injury

    Often, foot and ankle injuries happen due to impact during sports, recreational activities and accidental falls. Most minor injuries such as cuts and bruises heal on their own, but certain injuries may lead to serious conditions that can affect foot and ankle function in the long run. Common injuries include:

    Fracture

    Fractures can occur in the ankle or to the bones in the feet. Fractures in the foot or ankle may cause difficulty in weight bearing and may cause you to be unable to walk. If the bone is displaced from its original position, surgery may be required.

    Symptoms of fracture in the foot or ankle include pain, tenderness, swelling, deformity at the area of the fracture and not being able to apply any weight to the injured foot. For cases where the broken bones are not displaced and a stress x-ray confirms that the injury area is stable, treatment usually requires immobilisation with cast support until the bone fragments heal, which can take up to several months. Surgery may be required if the foot or ankle is unstable or if the fracture is displaced. Consult with your doctor to understand the treatment options available.

    Arthritis

    Arthritis is a condition where inflammation occurs in one or more joints. In the foot and ankle, osteoarthritis and rheumatoid arthritis are common. Osteoarthritis is where the protective cushion between the joints (cartilage) can wear out due to ageing or wear and tear. Genetic factors, joint instability, and injury may also contribute to osteoarthritis.

    Rheumatoid arthritis is an autoimmune disease whereby the immune system attacks the own tissues. Immune cells attack the synovium covering the joint, causing swelling. Over time, the swollen synovium invades and damages the surrounding bone, cartilage, ligaments and tendons, possibly resulting in severe joint deformity and losing the ability to walk. Swollen, inflamed synovium and joint deformity are common signs for rheumatoid arthritis.

    In general, symptoms of arthritis in the foot and ankle area include pain, stiffness, limited movement, swelling, and difficulty walking.

  • Achilles Tendonitis

    achilles-tendonitis

    The Achilles tendon connects the calf muscles with the heel bone. Being the largest tendon in the body, the Achilles tendon is able to withstand immense stress from the actions of walking, running, and jumping. However, repetitive stress, overuse, and age-related wear and tear may lead to inflammation of the tendon (tendonitis).

    Signs & Symptoms

    Achilles tendonitis may be accompanied with:

    - Pain at the back of the heel area that worsens with movement
    - Stiffness along the Achilles tendon
    - Thickening of the tendon leading to a protrusion at heel area

    Consult with your doctor if you suspect a problem with your Achilles tendon, be it tendonitis or a tear / rupture.

    Diagnosis

    Your doctor may check your medical history and perform a physical examination. The following diagnostic tests may be used to further assess the injury.

    - X-ray
    - Magnetic resonance imaging (MRI)

    Treatment

    Your doctor may also prescribe a cortisone injection to help alleviate the pain. You may be recommended to undergo surgery if symptoms persist. The type of surgery will depend on the severity of the injury and the location of the tendonitis. Consult with your doctor to understand the treatment options available.

  • Bunions

    foot-bunion

    The foot bunion, known as hallux valgus, is a painful, bony bump that develops within the foot around the joint area of the big toe. The condition develops gradually and causes a change in normal bone structure, leading to a deformity where the big toe leans towards the second toe. Poorly fitted shoes that squeeze the toes together increase the pressure on the big toe. This leads to the bunion worsening and enlarging, resulting in pain, discomfort and difficulty walking. Other factors that contribute to bunions include hereditary and medical conditions such as rheumatoid arthritis.

    Signs & Symptoms

    Apart from a visible bump at the big toe joint area coupled with the deformity of the big toe leaning towards the second toe, common symptoms include:

    - Inflammation and redness
    - Pain
    - Tenderness at the joint area
    - Stiffness in the big toe
    - Callus on the bump

    Diagnosis

    Your doctor may check your medical history and perform a physical examination. An x-ray may be prescribed to further assess the condition.

    Treatment

    In most cases, a change to footwear that fit properly and do not compress the toes can help to alleviate and manage the pain. Your doctor may also prescribe non-steroidal anti-inflammatory medication (NSAIDS) or corticosteroids to help alleviate the pain and reduce swelling. If symptoms persist, you may be recommended to undergo surgery. The goal of the surgery is to realign the bone and soft tissues to restore the big toe to a normal position. Speak to your doctor to understand the treatment options available.

  • Plantar Fasciitis

    plantar-fasciitis

    The plantar fascia is the flat band of tissue (ligament) that connects the heel bone to the toes, while supporting the arch of the foot. Plantar fasciitis is the inflammation of this ligament, and one of the most common causes of heel pain. It is commonly seen in runners, people with a high foot arch, people who are overweight, and those who wear ill-fitted shoes that provide inadequate support. Repeated strain on the ligament causes tiny tears, which can lead to swelling and pain.

    Signs & Symptoms

    The condition typically starts with gradual, mild pain felt at the heel bone. Other common symptoms include:

    - Pain right after getting out of bed in the morning, after a long period of rest, or after exercise
    - Pain at the bottom of the foot, near the heel area

    Diagnosis

    Your doctor may check your medical history and perform a physical examination. The following diagnostic tests may be used to determine that the heel pain is caused by plantar fasciitis:

    - X-ray
    - Magnetic resonance imaging (MRI)

    Treatment

    Your doctor may prescribe non-steroidal anti-inflammatory medication (NSAIDS) or corticosteroids to help reduce inflammation and pain. You may be recommended to undergo surgery if symptoms persist. Consult with your doctor to understand the treatment options available.

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