Normal anatomy of the foot & ankle
The foot and ankle work together to provide stability and propulsion. With 26 bones, 33 joints, muscles, tendons, ligaments, nerves, soft tissue and blood vessels it has a complex anatomy.
The ankle consists of three bones attached by muscles, tendons, and ligaments that connect the foot to the leg.
Ankle injuries are one of the most common sports-related injuries.
Ankle Strain or Sprain
An ankle sprain is a common injury which occurs when you fall or suddenly twist the ankle joint, or if you land on your foot in an awkward position after a jump. A sprain is characterized by the stretching or tearing of ligaments, which stabilize adjacent bones in a joint. Conservative treatment includes rest, ice and pain relief. A strain could take 1 week to recover whereas a sprain may take 3 to 4 weeks. A severe sprain may require surgical intervention..
Ankle fractures are one of the most common fractures seen in emergency departments. They are usually related to patients slipping or twisting and rotating over the ankle. Damage can occur to the small bone on the outside (fibula) or the larger bone on the inside of the ankle (tibia) or to the ligaments which tie those bones together. Treatment depends on the stability of the ankle when it is weight-bearing, and can require x-rays, CAT scans or MRI scans to assist diagnosis. Treatment can range from fully weight bearing in a boot, to an operation inserting plates, screws or rods.
Dislocations of the ankle can happen at the same time that the bone breaks, and may lead to an injury soft tissue stripping, which could damage the actual joint lining surface. Accurate diagnosis and treatment is important.
Our foot & ankle procedures:
Arthroscopy is a keyhole surgical procedure during which the internal structure of a joint is examined for diagnosis and/or treatment. This surgical approach is most commonly used to assist in the diagnosis of:
- Synovitis, inflammation of the lining of the ankle joint;
- Osteoarthritis - arthritis caused by loss of joint cartilage; and
- Acute or chronic injury
- Talar dome lesions or loose bodies
Stress Fractures of the Foot and Ankle
Stress fractures of the foot and ankle are common particularly in military recruits who have normal bones but are subjected to walking long distances with heavy packs, thus overwhelming the bones ability to tolerate the forces being applied. These are called ‘March’ fractures as they are caused by marching. Stress fractures can also occur in relation to normal walking if people’s bones are weak.
The initial treatment is to reduce the amount of weight bearing done, and support this with either a boot or cast for somewhere between 6 and 12 weeks. It is important to also look for any secondary causes such as osteoporosis. The majority of these fractures do not require anything further than non-operative treatment.
The talus is the ankle bone, which sits between the bottom of the shinbone (tibia) and the top of the heel bone (calcaneus). Talus fractures often occur from high energy injuries such as car accidents.
The blood supply to the talus can be compromised when displacement of the bone leads to tearing of the blood vessels, and ongoing damage to the bone from a lack of blood (osteonecrosis).
Treatment is non-weight bearing for between 6 and 12 weeks, and anatomical realignment of the fracture which needs to be held with plates or screws or both. It is common for people to have long-standing stiffness after a fracture of the talus.
Achilles Tendon Rupture
The Achilles tendon is a strong fibrous cord present behind the ankle that connects the calf muscles to heel bone. It is used when you walk, run and jump.
If the Achilles tendon is ruptured you will experience severe pain in the back of your leg, swelling, stiffness, and find it difficult to stand on tiptoe or push the leg when walking. A popping or snapping sound is often heard when the injury occurs. You may also feel a gap or depression in the tendon, just above heel bone. Some people describe a feeling like someone has kicked them in the back of the leg.
Achilles tendon rupture may initially be treated non-surgically by wearing a cast or special brace which is changed after some period of time to bring the tendon back to its normal length. Combined with physiotherapy to improve the strength and flexibility of leg muscles and the Achilles tendon. Depending on the degree of injury a surgical procedure involving opening of the skin and suturing the torn tendon together may be recommended. It has been found that surgery helps decrease the recurrence of the Achilles tendon in comparison to the non-surgical treatment.
To help prevent an Achilles tendon injury, it is a good practice to perform stretching and warm-up exercises before any participating in any activities. Gradually increase the intensity and length of time of activity. Muscle conditioning may also help.
Achilles Tendon Bursitis
Achilles tendon bursitis is inflammation of the fluid-filled sac (bursa) located between the skin of the back of the heel and the Achilles tendon (called posterior Achilles tendon bursitis) or in front of the attachment of the Achilles tendon to the heel bone (called anterior Achilles tendon bursitis). Typical symptoms include swelling and warmth and a tender spot at the back of the heel.
Treatment is aimed at relieving the inflammation and, depending on the location of the Achilles tendon bursitis, eliminating the pressure on the back of the heel.
Our specialist foot & ankle surgeons are:
Dr Kulisiewicz graduated from the University of Sydney in 1998, then went on to work at The Canberra and Calvary Hospitals as an intern...