Ankle & Foot Disorders

Each foot carries your whole body weight over twenty-six bones, a set of arches and a network of tendons and ligaments that hold those arches up. Every step loads them several times over, and a person on their feet all day loads them thousands of times. Most foot and ankle problems begin as an overload of one structure that was already working close to its limit.

The overload comes from three directions. Activity and surfaces change the load: more walking, harder floors, worn or unsupportive footwear. Shape changes the load: a flattened arch, a high arch, or a toe that has drifted out of line shifts weight onto tissue not built to take it. Injury changes it suddenly, and an ankle that was sprained badly and never regained its strength stays vulnerable to the next twist.

Diabetes changes the whole picture. When sensation in the foot is reduced, the warning system that normally makes you shift your weight or take off a tight shoe stops working, and a small problem can grow unnoticed. Anyone with diabetes is assessed differently from the first minute of the consultation.

Your doctor watches you walk before touching the foot. Gait shows which part of the step hurts, whether the arch collapses under load, and whether you are avoiding weight on one side. You will then be examined standing, because a foot changes shape once it takes your weight, and lying down, where the joints and tendons can be moved individually.

Most of the diagnosis comes from finding the exact point that hurts. Your doctor presses over specific landmarks to localise it to one tendon, one ligament, one joint or one bone, then tests the range of each joint and asks you to push, pull and raise onto your toes to see which tendons are working.

Circulation and sensation are checked in every foot examination: pulses at the ankle and the top of the foot, and light touch across the sole. Skin is inspected between the toes and under the heel for pressure areas. X-rays of the foot are taken standing where the shape of the arch is part of the question, since a picture taken lying down does not show what your foot does under load.

Soft-tissue problems in the foot are slow, and knowing that in advance saves a great deal of frustration. Pain under the heel commonly takes three to six months of stretching, footwear changes and load management to settle, with improvement arriving in small steps. A moderate ankle sprain takes two to six weeks to walk on comfortably and around three months to regain full confidence on uneven ground.

Fractures in the foot are usually protected in a boot or cast for six to eight weeks, often with a period of limited weight-bearing, followed by several weeks of building back up.

After foot surgery, expect a boot or a special shoe for around six weeks, desk work at two to six weeks depending on whether you can keep the foot elevated, and driving once you can brake without hesitation. Swelling is the long tail: a foot that has been operated on often swells by the end of the day for three to six months, and shoes fit properly again somewhere around the third month.