Looking after your feet and ankles

In this article, Mr Lloyd Williams provides advice on the importance of looking after your feet and ankles during the winter months, and what treatment is available to you if you’re unlucky enough to sustain an ankle injury.

The most common ankle and foot injuries that occur during the winter months include:

• Sprains occur when the ligaments that support the ankle are stretched or torn. They can happen from slips, trips, or falls on wet, icy, or snow-covered ground.
• Fractures: Bones in the foot and ankle can be broken from a fall or twisting the ankle on a slippery surface.

These common injuries can be prevented by taking precautions such as wearing practical and supportive footwear, being more careful when walking on slippery icy or snowy surfaces or avoiding them altogether!

Advice for sprained ankles

Runner with a sprained or twisted ankle

“In my professional practice, I see patients with ankle trouble which often begins following an ankle sprain, a very common injury. Classically, patients twist or invert their ankle, causing injury to the lateral ligaments found on the outside of the ankle.”

Thankfully, most ankle sprains are not too serious, and they heal uneventfully. Mr Williams says, “Most ankle sprains can be managed with simple measures including protected weight-bearing with crutches, rest, ice, elevation, and compression bandaging. Physiotherapy is also important to improve fine ankle control and balance. Most people should be feeling confident again within 6 to 12 weeks.”

Long-term pain in the foot following a sprain is another symptom that should not be ignored. Ankle impingement occurs when the ruptured ankle ligament heals with lots of thickening, sometimes folding in and getting pinched in the joint. An ultrasound-guided steroid injection into the painful area can settle the symptoms. However, for persistent impingement symptoms, an ankle arthroscopy may be necessary. Deep ankle pain following a sprain is worrying and may indicate damage to the specialised cartilage inside the ankle joint. “At the time of the ankle sprain, the specialised articular cartilage that lines the joints can be damaged. Arthroscopic surgery is a powerful tool I can use, where necessary, to perform microfracture – a process where the bone marrow is stimulated to form new cartilage.”

A sprain or a fracture?

Foot and ankle in plaster following a fracture

Not everyone, however, gets away with a simple quick-healing sprain. People should know when to seek advice to rule out a more serious injury, such as a fracture. Mr Williams points out, “If patients have severe pain, are unable to weight-bear after the injury, or have bony tenderness, it is quite possible that there is a more complicated injury rather than just an ankle sprain. For such patients, I would recommend an X-ray to rule out a fracture.”

There can be longer-term problems too. “In up to 20% of cases, patients can develop long-term instability and recurrent giving-way of the ankle. In my hands, if conservative measures have failed, surgical reconstruction of the lateral ligaments is necessary, which is known as a Brostrom-Gould procedure. This is a particularly reliable operation, with 95% of patients regaining stability and trust in their ankle, allowing a return to sport.”