Understanding Foot and Ankle Injuries: Risks and Recovery

Article written by Adrian Talia Orthopaedic Surgeon

As an orthopaedic surgeon specialising in foot and ankle surgery, I frequently encounter patients who have sustained injuries to their foot and/or ankle. Given that our feet form the foundation upon which our lives are built, it is crucial to treat and rehabilitate these injuries correctly. Herein I provide some background on common injuries, background information regarding potential issues if these are not properly addressed, and answers to frequently asked questions about foot and ankle surgery, including recovery and associated risks.

Common Acute Foot and Ankle Injuries

It is important to understand that the foot and ankle are frequently injured parts of the body, affecting people from all age groups and walks of life. The acute injuries that I commonly see in my practice include:

Common Acute Foot and Ankle Injuries

• Ankle Fractures
• Ankle Ligament Injuries
• Lisfranc (Midfoot) Injuries
• Osteochondral Lesions (OCL)
• Achilles Tendon Ruptures
• High Ankle Sprains (Syndesmosis Injuries)

The Importance of Proper Treatment for Foot and Ankle Injuries

I treat a broad spectrum of conditions in patients ranging from teenagers to the elderly. One of the challenges is that the bones, ligaments, or joints often become misaligned. This misalignment can lead to significant pain and joint instability. Sometimes an unstable joint is treated to prevent significant arthritis in the foot and ankle later in life.

We know that trauma is the most common cause of ankle arthritis, accounting for 85 to 90% of cases. This trauma need not result from a major car accident; subtle ankle sprains that cause slight instability at the ankle can, over time, alter the biomechanics and cause joint wear.

In some cases, where these injuries are deemed unstable after clinical examination, X-rays, or other imaging such as CT or MRI, surgery will be recommended. The aim of most surgery is to realign the bones and joints to their normal position and provide stability, allowing patients to rehabilitate in a fast yet careful and safe manner.

Recovery Phases After Foot and Ankle Surgery

We are commonly asked about the recovery after surgery. We understand that people's social and work demands often mean they need ample planning to allow the necessary recovery for an optimal outcome after surgery. Broadly, the recovery phases from most foot and ankle surgery can be divided as follows:

0-2 Weeks: Initial Rest and Elevation

Rest and elevation are critical during this period. Keeping the foot elevated helps minimise swelling and bleeding. The risk in the first two weeks if the leg is not elevated is wound healing complications, which can lead to infection. In almost all cases, patients are recommended to stay off the foot for two weeks after surgery, using a moon boot or a plaster while keeping the foot elevated on a bolster pillow “toes as high as the nose”. Typically, stitches are removed at two weeks in most cases.

2-6 Weeks: Gentle Weight-Bearing and Rehabilitation

This period allows for some gentle weight-bearing in a moon boot or a post-operative shoe in most operations. Showering and water-based rehabilitation, such as swimming, can be beneficial. Additionally, patients can start loading the foot to facilitate bone and tendon healing. It is vital not to overdo things during this period, as rushing back to full activities can undo some of the surgical repair. Typically, gentle range of motion exercises and physiotherapy are initiated during this phase of recovery.

6 Weeks and Beyond: Transitioning to Normal Activities

This phase typically sees patients gradually weaning out CAM boots or post-operative shoes and returning to normal shoes, initially wide-fitting trainers with support, then their regular footwear. Depending on the specific surgery, strengthening work typically starts during this period. We review all our patients around three months postoperatively, provided everything has gone smoothly this is often the final review appointment. Longer follow-up may be necessary in specific cases, and this will be discussed during postoperative appointments.

During each recovery phase, repeat Xrays or scans may be necessary to monitor progress and healing.

Managing Risks Associated with Foot and Ankle Surgery

While most surgery risks can be mitigated, we cannot guarantee that there will be no complications. Thankfully most complications are short-lived and/or easily treatable, but rare and more significant complications do occur. If you are unfortunate enough to suffer a severe complication, there is a small risk that your condition may be worse post-surgery than pre-surgery. The significant risks of any surgery will be specific to your case and your operation, and these will be discussed with you ahead of time.

In general, the common risks discussed for foot and ankle surgery include:

Infection: Antibiotics are provided at the time of surgery, and surgery is performed sterile environment with antiseptic solution and sterilized instruments to minimize the risk of any infection occurring. Thankfully, in the foot and ankle, if infection does occur, this is typically superficial and clears up with some antibiotic tablets. In rare cases, there is a risk of a deep infection where further surgery to clear this may be required. Or admission to hospital with antibiotics through a drip.

Scar sensitivity: Scars around the foot and ankle tend to heal nicely, but occasionally there may be noticeable scars which can be sensitive. This is more common in patients who are smokers, who have diabetes and who have lots of swelling after surgery and have not been elevating the foot post-op. Full stop. Once the scars have healed and the sutures have been removed, moisturising and massaging healed scars can help with sensitivity and to help break up some of the scar tissue.

Blood clots: Any surgery that slows your walking and or puts you in a cast carries the risk of development of a blood clot in your leg known as a DVT, or deep vein thrombosis. In exceptionally rare circumstances, a blood clot can spread to the lungs and be fatal, full stop. Thankfully, the risk of blood clots with most surgery is very low, and patients are typically prescribed medication to help minimise the risk of this. This is typically in the form of an injection once daily, but there is also a tablet if this is not suitable.

Potential Need for Further Surgery: To achieve the best possible outcome, a further operation may be required. This can sometimes be a planned manner, for example, removing plates and screws for a Lisfranc injury. But in some cases, a second operation is not planned. If there is a complication, a second operation may be recommended. to improve the outcome. Usually implants are removed once everything is healed and they have stopped doing their job inside the body. In most cases, the removal of implants is a much smaller surgery than the initial surgery to fix the injuries.

Comprehensive Care for Your Foot and Ankle Injuries

If you’re dealing with a foot or ankle injury, the comprehensive service at The Avenue Private Hospital is here to help. Our dedicated team is ready to provide timely assistance and expert guidance for a speedy recovery.

Early intervention is key! Our healthcare professionals will offer tailored advice, treatments, and exercises to promote healing and restore your normal function. If needed, your GP or physiotherapist may refer you to our specialists for further assessments or surgical opinions.

At The Avenue Private Hospital, we pride ourselves on our multidisciplinary approach, collaborating with orthopaedic surgeons, nurses, physiotherapists, and exercise physiologists to provide comprehensive care.

Article written by Adrian Talia Orthopaedic Surgeon