Common disorders of the foot and ankle

Ankle osteoarthritis is often a result of an injury, and severe degeneration is treated by arthrodesis or arthroplasty. Osteochondral lesions of the talus may be traumatic or atraumatic, and arthroscopic assessment and treatment may be needed. Ankle impingement can often be treated arthroscopically by removal of impingement lesions. Instability of the ankle sometimes responds to physiotherapy, but may require ligament reconstruction surgery. Hindfoot and midfoot osteoarthritis can be idiopathic, post-traumatic, or due to an inflammatory arthropathy. Arthrodesis is considered for severe symptoms. Heel pain due to Achilles tendon problems or plantar fasciitis is common, but many settle with physiotherapy. Common deformities of the foot are planovalgus (flat foot) and cavovarus (high arches). Some require investigation to determine the cause; surgery can help if deformity is severe. Hallux valgus, hallux rigidus and lesser toe deformities are common, particularly in older women. Shoe modifications often help, but surgical correction ‘makes the foot fit the shoe’. Rheumatoid arthritis commonly affects the forefoot, causing metatarsophalangeal subluxation or dislocation. Surgery provides effective relief of severe plantar callosities. Morton’s neuroma is a pseudoneuroma of the interdigital nerve that usually settles with corticosteroid injection but can be excised if troublesome. Ingrowing toenails are due to poor nail-cutting technique and nail deformity, and may require nailbed surgery. Patients with diabetes mellitus are at high risk of foot problems that can occasionally threaten limbs if neglected. A ganglion is the most common lump on the foot, but other lumps need proper investigation and possibly surgery.