Foot and ankle care: conditions treated, tests and what to expect from a specialist

The foot and ankle packs many bones, joints, tendons and ligaments into a small area, and carries your whole body weight with every step. Problems range from irritating overuse conditions to fractures and joint wear. Care is shared between several professions rather than belonging to one clinic.

Podiatrists assess the foot, advise on footwear, prescribe or make insoles and splints, and manage skin and nail problems. Physiotherapists build loading and stretching programmes. Orthopaedic consultants with a foot and ankle interest, trained through the general orthopaedic route and then a subspecialty fellowship, assess surgical options. Radiologists perform imaging, and in some units a specialist podiatric surgeon operates on the forefoot. Diabetes foot protection teams and rheumatology services join in when systemic disease is behind the symptoms.

Plantar fasciitis is described by the NHS as strain of the band of tissue connecting the heel bone to the toes. It is more likely if the pain is much worse with the first steps after resting, eases as you move about, then returns after long periods standing or walking. The NHS lists age 40 to 60, a recent switch to exercising on hard surfaces, a tight calf, poor cushioning in shoes, lots of standing and being overweight as risk factors.

First-line care is rest, cushioned shoes with arch support, insoles or heel pads, gentle stretches of the sole and calf, and simple painkillers. If this does not work the NHS says you may see a physiotherapist or podiatrist, who may suggest night splints. Steroid injections and extracorporeal shock-wave therapy can follow, while surgery is described as less common. Heel pain that is not plantar fasciitis, such as a stress fracture, nerve irritation or inflammatory arthritis, is why a proper examination matters.

NICE CKS describes Achilles tendinopathy as a painful overuse problem with pain, stiffness and swelling, most often 2 to 6 cm above the heel (non-insertional) or at the heel attachment (insertional). Symptoms are typically worse at night, at rest or when restarting activity. Risk factors include changes in running or jumping training, unsuitable footwear, increasing age and fluoroquinolone antibiotics. Management centres on activity changes and tendon-loading exercises, with imaging by heel X-ray or ultrasound if symptoms persist beyond six weeks and specialist referral considered if they last six months. CKS advises emergency or orthopaedic assessment if an Achilles tendon rupture is suspected, so a sudden injury should not be left to settle.

Ankle sprains are ligament injuries, and the NHS describes PRICE care for the first two or three days (protection, rest, ice, compression, elevation), with most sprains feeling better after 2 weeks and running avoided for up to 8 weeks. Repeated sprains or a giving-way ankle may mean chronic instability, which may lead to MRI and sometimes keyhole or ligament surgery.

Bunions are bony lumps at the base of the big toe, with the toe often angled towards the others. The NHS says you cannot get rid of them yourself, but wide, low-heeled, soft-soled shoes, pads, orthotics, toe spacers and painkillers can ease pain. Surgery is the only way to remove them, and the most common operation is an osteotomy, in which the toe bone is cut and straightened and held with screws or staples. The NHS says most people go home the same day, that you should keep the foot raised for at least 2 weeks, avoid driving for 6 to 8 weeks, and avoid sport for 3 to 6 months. Bunions can come back.

Big toe stiffness (hallux rigidus), hammer and claw toes, Morton neuroma and gout in the big toe joint can all be mistaken for a bunion, which is why examination and sometimes a weight-bearing X-ray matter. The NHS lists gout (hot, red, swollen skin that comes and goes) and arthritis (aching, stiff joints worse in the morning) as alternative explanations.

The NHS says a broken ankle usually takes 6 to 8 weeks to heal, though it can take longer. Treatment ranges from a boot or plaster cast to manipulation of the bones to surgery, and physiotherapy may follow. Osteoarthritis of the ankle and midfoot is a progressive loss of cartilage; the NHS describes osteoarthritis as long term and not curable, but not always getting worse, with exercise, weight loss, suitable footwear, painkillers and physiotherapy tried first. Where these fail, surgery may repair, fuse or replace the joint, such as ankle fusion or ankle replacement, which a surgeon will weigh against age, activity and bone quality.

Most diagnoses begin with a history and examination, including how you stand and walk. Imaging is then chosen to answer a specific question.

The NHS says that in many areas you can refer yourself to community musculoskeletal (MSK) services for physiotherapy without a GP referral, and that podiatry may not be free everywhere and waiting times can be long. A GP can refer to an orthopaedic foot and ankle clinic; the national standard is treatment starting within 18 weeks of referral, and in England you may be able to choose a provider through the Right to Choose for consultant-led care.

Privately, you can see a podiatrist, physiotherapist or consultant directly, or via GP referral, with insurers usually wanting the GP or a physiotherapist to refer first and approving procedures beforehand. Cost depends on the consultation, imaging, implants, whether the surgery is day case, and rehabilitation. Ask for an itemised quote and what follow-up is included.

Go to A&E or call 999 for a deformed ankle, exposed bone, a deep wound, severe pain, or toes that are blue, white or numb. Use NHS 111 for an injured ankle that is very painful and getting worse, with a lot of swelling, inability to bear weight, or fever or chills. See a GP promptly for any foot pain with tingling, loss of feeling, or diabetes.