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    Foot and Ankle

    Overview
    Causes
    Diagnosis
    Treatment
    Where to Seek Treatment
    Singapore General Hospital
    Contributed by Dept of Orthopaedic Surgery

    Overview

    The foot and ankle bears the stress of our body weight as we go about our daily activities. This stress is relentless. As we walk over uneven ground, it allows us to accommodate to the undulation, further adding stress to the numerous joints in the foot.

    Fashionable footwear has further added problems as women squeeze their feet into shoes of all shapes and sizes. Sporting injuries and fractures are also very common in the foot.

    The critical thing about the foot is that an injury or abnormality in one joint, can rapidly cause additional injuries to its neighbouring joints due to the close proximity and relationships. Hence, prompt diagnosis and appropriate management is crucial to having a good outcome.


    Causes


    The main causes of chronic foot pain are either degenerative or arising from a previous injury.

    Painful degenerative problems can affect the joints of the foot, or the tendons or fascia (soft tissue). Some common diagnosis will include plantar fasciitis, hallux valgus, collapsed arches in adults, osteoarthritis of the small joints or the ankle.

    Injuries of the foot and ankle can arise from sports or normal daily activities. Occult fractures can occur or the soft tissues can be damaged. The soft tissues refer to ligaments and fascia which hold the bones together, or the tendons which moves the bones. They can be stretched, torn or dislocated.


    Diagnosis


    Generally, an Orthopaedic consult would include radiological investigations. Your surgeon will order the appropriate x-rays.

    Occasionally specialised investigations like Computer-Tomography (CT) scans, Magnetic Resonance Imaging (MRI), or ultrasound scans may be needed. Some investigations are better meant to look at the bones and joints, and others to look at the soft tissues. Sometimes, you may be required to undergo some blood tests to rule out especially, inflammatory arthritis.


    Treatment

    As in most degenerative problems, the initial management can include a period  of rest, change of activities and anti-inflammatory medications. Finding a pair of shoes that helps to relieve the pain is also useful. Most family physicians can adequately manage the majority of such conditions conservatively.

    If a period of rest or oral anti-inflammatory medications does not adequately relieve the pain, then a referral to the orthopaedic surgeon might be necessary.

    Having made the proper diagnosis, your surgeon will discuss with you, the options available. If you have tried conservative options but have had no relief of symptoms, you might be offered surgery.

    Surgery

    Surgery can range from key-hole or arthroscopic surgery, to major deformity corrections. Painful deformities can be reliably corrected via osteotomies (bone re-shaping) without sacrificing or fusing any joints. With modern internal fixation devices, the outcome of surgery has improved and patients can expect to move about fairly conveniently.

    In advanced deformity with arthritis, fusion might have to be done. This will mean that the diseased joints are permanently held together and movement is sacrificed. These are usually salvage procedures for end stage diseasesTherefore, early diagnosis and treatment might allow us to avoid this. In the ankle however, advanced osteoarthritis can be treated with total ankle replacement. This involves implanting an artificial ankle joint.

    Soft tissue injuries can variably be treated by surgical repair or by transplanting healthy soft tissue to the damaged area (reconstruction). Common procedures performed would be ligament reconstruction of an unstable ankle and arthroscopic (key-hole) ankle surgery to resect painful soft tissue impingement at the ankle.

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