Foot and ankle injuries are common injuries in patients of all ages. Unfortunately, as with wrist fractures, ankle fractures are often treated without the input of an orthopaedic surgeon. This inevitably leads to suboptimal results. The reasons for this are many, some of the commoner issues are the lack of proper immobilisation, insufficient X-ray surveillance and failure to recognise fracture patterns that require surgical fixation. Regardless of the type of treatment, early physiotherapy with range of motion exercises is imperative to prevent stiffness and a permanent limp. Other complications may include abnormal or arrested growth in children, rapid onset arthritis and chronic ankle instability.
Achilles tendonitis is a common problem in recreational runners and is usually responsive to nonsurgical treatment, which must include activity modification. Very rarely, surgical debridement of the tendon is required.
Achilles tendon ruptures are common sporting injuries, often found in “weekend warriors”. Often these injuries are preceded by a period of tendonitis. Although there is scope for nonsurgical treatment of these injuries, the results are suboptimal due to the fact that stiffness is difficult to avoid the re-rupture rate is also problematic. We advocate surgical treatment in most cases in order to improve outcomes. These tendon repairs should be carried out by surgeons with experience in soft tissue reconstruction. Based on this practice’s extensive hand surgery involvement, we feel that we are uniquely placed in tis regard.
Forefoot fractures are common in all age groups and management varies widely. While many of these fractures may be treated non-surgically, the fractures themselves may be subtle pointers to far more serious injuries such as mid foot dislocations. If these are missed, the extensive swelling and the associated compartment syndrome may cause limb loss soon after the injury. Late complications include foot deformity as well as severe early onset osteoarthritis.
Hind-foot fractures and dislocations are devastating problems which rarely have good outcomes in adult patients. The correct assessment requires specialised imaging as well as specialist review. While surgery is often required, timing of the procedure as well as correct treatment in the interim in order to impose complications is all-important. If this is neglected and these injuries are injudiciously managed, surgical wound infection is a significant risk. If this occurs, the final outcome may be chronic bone infection and sometimes limb loss.
Ankle ligament injuries are common sports injuries and may be associated with pull-off (avulsion) fractures round the ankle. Treatment is mostly non-surgical. Specialist sports orthopaedic judgement and advanced imaging investigations (ultrasound and/or MRI scan) are often required to select out the patients who require surgery. The results of these imaging investigations effectively confirm clinical assessment findings as to which parts of the various ligaments are injured. This has bearing not only on who requires surgery, but also on the type of- and length of splint age required and the specific physiotherapy regimen.
Foot problems which are not trauma related are many and frequent and they range across the age spectrum. As per the standard of care of the Constantiaberg Arthroplasty Unit, these problems are referred to our resident foot and ankle specialists.
