Ankle surgery: conditions treated, operations offered and what recovery involves

The ankle joint links the shin bones to the foot bone beneath them, and a network of ligaments, tendons and nerves holds and moves it. Arthritis UK points out that the foot and ankle together contain 26 bones and 33 small joints, which helps explain why problems here can be complicated to pin down. Ankle surgeons treat the joint itself, the ligaments that stabilise it, the Achilles and other tendons, and the cartilage that lines it.

The specialist is typically a consultant orthopaedic surgeon who has completed general surgical training and then a fellowship in foot and ankle surgery. In some services podiatric surgeons carry out selected procedures, particularly on the forefoot. Before any operation, much of the care is non-surgical and delivered by physiotherapists, podiatrists and orthotists, who make insoles, braces and supports.

The commonest reasons for an ankle operation are fracture, long-standing instability after sprains, arthritis, cartilage damage, tendon rupture or chronic tendon pain, and complications that follow earlier injury.

• Ankle fracture: the NHS advises getting medical advice as soon as possible for a suspected break. An X-ray shows how bad it is; a minor break may need no treatment, while more serious ones may need a boot, a plaster cast, the bones moved back into place or surgery to fix them.

• Sprains and ligament injuries: most sprains settle with PRICE therapy (protection, rest, ice, compression, elevation); the NHS says that after 2 weeks most sprains feel better and strenuous exercise such as running should be avoided for up to 8 weeks. Repeated giving way can point to ligament insufficiency, which sometimes needs reconstruction.

• Ankle arthritis: loss of cartilage causing pain and stiffness. The NHS says osteoarthritis surgery to repair, strengthen or replace a damaged joint is done in a small number of cases where other treatments have not helped or damage is severe.

• Cartilage and bone lesions: small areas of damaged cartilage and the bone beneath, often after injury, which can cause catching, swelling and deep ache and are often assessed with MRI.

• Achilles tendon problems: Arthritis UK describes Achilles tendinopathy as damage or inflammation of the tendon running from calf to heel bone, with pain that worsens after activity, and says recovery can take from a few weeks to several months. A full tear is a different, sudden injury.

• Heel and forefoot conditions: plantar fasciitis, which the NHS says should be seen by a GP if not improving within 2 weeks, and bunions, where the NHS notes surgery is the only way to get rid of them.

The first appointment is mostly conversation and examination. The surgeon asks about the injury, what the ankle does when you walk on uneven ground, night pain, swelling and previous treatment, then examines alignment, range of movement and ligament stability, and watches you stand and walk. You may be asked to bring the shoes you wear most.

Weight-bearing X-rays are the usual first test because they show the ankle under load. Ultrasound can assess tendons and fluid, and MRI shows cartilage, ligaments, bone bruising and tendon tears in detail. CT is used to plan complex fractures or arthritis surgery. Nerve conduction tests are occasionally used when numbness or burning suggests a nerve problem.

Complications of any ankle operation include infection, blood clots, nerve irritation, stiffness and, with arthroscopy, a reaction to the anaesthetic. The NHS lists numbness or tingling, severe or increasing pain, a high temperature and smelly liquid leaking from the wound as reasons to call 111 or the hospital after arthroscopy.

Recovery is shaped as much by rehabilitation as by the operation. Typical phases are protection in a boot or cast with weight restrictions, gradual loading, and then strengthening, balance training and return to activity. Elevation in the first days reduces swelling, and crutches or a walking frame are common. Driving is not allowed after a general anaesthetic, and driving with a right ankle in a boot is a separate question to ask your insurer and surgeon.

Return to work depends on the job. A desk worker may return within weeks, whereas a job on your feet or on ladders may need much longer. Stopping smoking and managing diabetes before surgery reduces wound and bone-healing problems. Physiotherapy is free on the NHS but, as the NHS notes, waiting times can sometimes be long.

In England, many areas allow you to access community musculoskeletal services, including physiotherapy, without a GP referral, according to the NHS. A GP can then refer you to an orthopaedic foot and ankle clinic through the e-Referral Service. The maximum waiting time for non-urgent consultant-led treatment is 18 weeks from referral, and you generally have the legal right to choose your hospital and team.

Privately you can book directly, or be referred by a GP, physiotherapist or podiatrist. Insurers usually require a pre-authorisation code and may cover fusion or replacement only under particular conditions, so check wording on implants and rehabilitation. Costs vary with the operation, implant, length of stay and whether physiotherapy is included; ask for an itemised estimate. The Private Healthcare Information Network publishes independent information on hospitals and consultants.

Go to A&E or call 999 if your ankle is at an odd angle, a bone is sticking out, there is a bad cut, severe pain, or toes that are blue, white or numb. Call NHS 111 if after an injury the pain is very bad or worsening, swelling or bruising is increasing, it hurts to put weight on it, or you have a high temperature. If you have already had surgery and notice a high temperature, wound leakage, spreading redness or increasing pain, contact the hospital.