For Matthew Solan & James Davis at St John & St Elizabeth Hospital and OneWelbeck

For Martin Klinke at London Bridge, Cromwell Hospital, Chiswick Outpatients, New Victoria Hospital & One Welbeck

Foot and Ankle Treatment and Recovery Guide

A guide to the right treatment and recovery from a foot injury or ankle sprain

Getting the correct advice at the right time is absolutely essential if you want to make the speediest possible recovery from your ankle sprain or other foot injury – and who wouldn’t?

As specialist surgeons, we frequently meet patients who have unnecessarily had to put life on hold, because they have not had the benefit of an expert assessment from the outset. Day to day life, work and leisure activities are all affected, which is frustrating for you, and your family on one hand, as well as your colleagues and clients on the other.

Accident and Emergency Departments provide safe care for most patients who have a foot or ankle injury, but the staff there are not trained beyond the initial management. They will usually put a fracture into a temporary plaster cast and provide crutches. The system then refers you to a fracture clinic – which can mean a wait of two weeks – while you rest and await the “final verdict”. Quite rightly, if the A and E Department are not certain how severe your foot injury is they will err on the side of caution. Safe – but slow.

Common Problems after going to A&E

What are the common problems after going to A&E following an ankle or foot injury?

Too Cautious

Imagine the frustration of finding out that you hadn’t needed all that rest or even the crutches, and that instead you could have been walking in a brace or a boot and returning to normal much more quickly. You may have cancelled a holiday or missed many days at work.

Missed Diagnosis

Less commonly, the injury severity has not been fully appreciated, and there is in fact a need to recommend further x-rays, scans or sometimes surgery. A delay in treatment will impact upon work and home life. You cannot get that time back.

In either of these scenarios the inconvenience (and cost) of being held back by an insufficiently expert assessment is far from ideal.

Use our guide to decide whether you might benefit from an expert opinion now, rather than risking frustration when the system eventually catches up with your case.

Ankle Sprain

Standard NHS Advice

The London Foot and Ankle Centre Approach

There are several ligaments to consider in the ankle. 10% of cases have a “High Ankle Sprain” which demands further investigation with a proportion requiring surgery.

Proper x-ray evaluation is the minimum required to image the injury (to rule out small fractures A and E commonly miss). On occasion, an MRI or CT scan is recommended.

If yours is actually a straightforward ankle sprain then early mobilisation, a support brace, physiotherapy and a gradual return to sport program is the way elite sportspeople are treated. Why should you be different?

Broken Ankle

Standard NHS Advice

The London Foot and Ankle Centre Approach

Broken ankles vary in severity. Sometimes there is just a “crack on the windscreen” and you have no need of a cast. Walking as soon as possible and having good physiotherapy are the keys to success.

More severe ankle injuries do mean that the foot is not properly joined to the leg and so surgery is needed. Surgery has improved in recent years, and in the vast majority of cases you need plaster for no more than two weeks after the operation. All too often patients are kept in cast and on crutches – needlessly – for 6 weeks. A stiffer ankle and a slower recovery is the result.

On occasion it is more difficult to ascertain whether the ankle is stable or unstable. A and E staff request help from the Orthopaedic Fracture Clinic. Why wait for a fracture clinic appointment? It is always possible to answer this question at the outset.

Fifth Metatarsal Fracture

Standard NHS Advice

The London Foot and Ankle Centre Approach

Most of these fractures mend by themselves – and do not need a plaster. Crutches are optional. A good solid shoe makes walking easier. Physio helps with rehabilitation.

Not all fractures are the same however, and some carry only a 50% chance of healing. Checking that you are not carrying such an injury is important. Prompt fixation of this “high risk” type of fracture can save literally months of discomfort and frustration.

Achilles or Calf Injury

Standard NHS Advice

The London Foot and Ankle Centre Approach

Achilles tendon rupture is, in a proportion of cases, not diagnosed and therefore not treated properly. Surgical repair of the tendon is not essential in every case – but a proper assessment and decision about whether surgery is required cannot be delayed. Only fresh ruptures are suitable for treatment without an operation. After just a few days the opportunity to consider treatment just in a cast or boot is lost.

If the diagnosis has been missed for a few weeks, then surgery becomes more complex, because a straightforward repair is not possible. This is because the ends of the tendon have pulled apart leaving a gap.

Toe or Metatarsal Fracture

Standard NHS Advice

The London Foot and Ankle Centre Approach

It is most unusual for a toe fracture or metatarsal fracture to need surgery. Exceptions might be cases where the fracture goes into the joint, of the big toe particularly, or involves several metatarsals.

Buddy strapping toes is awkward and not needed. A cast is unlikely to help and a removeable boot or stiff soled shoe will be easier to manage, reduce the need for crutches, allow ice to be applied and facilitate early physiotherapy.

Key Messages