Achilles tendon problems
The Achilles tendon becomes prone to injury & pain in middle-aged people due to reduced tissue quality and blood supply. This can come on as a result of a specific injury or more chronic overuse, and often presents with a painful swelling. This can be located near the insertion into the heel bone (insertional) or some distance away (non-insertional tendinopathy) but invariably causes difficulty with mobility and participating in sports. Most patients respond to anti-inflammatory medication, splinting & stretching exercises, but occasionally surgery to remove abnormal tissue from the tendon is required.
Degenerative arthritis of the ankle joint normally develops as a result of a traumatic injury, but can also present after inflammatory joint disease such as rheumatoid arthritis and other rare conditions. Common symptoms are pain, swelling & stiffness interfering with activities. When conservative measures such as activity modification, painkillers & orthotic supports are no longer adequate, surgery may become necessary. An ankle stiffening operation (fusion or arthrodesis) has been the surgery of choice and can be performed both as an open and as a keyhole procedure. More recently results from modern ankle replacing prostheses have been improving offering this as a suitable alternative for selected patients.
Twisting injuries of the ankle are very common affecting most people in their lifetime. These lead to partial tearing usually of the outside ligaments of the ankle and cause pain, swelling & difficulty in walking for a few days to weeks depending on the severity of the injury. Many cases settle down with a period of rest, icing & splintage, but occasionally pain & giving way continues beyond 1-2 months. Symptoms can often be improved with physiotherapy & ankle supports, but occasionally problems persist interfering with the return to normal activities. This can be explained by unrecognized injuries to tendons or the ankle joint surfaces, which may require further investigations with modern imaging techniques such as ultrasound and magnetic resonance scanning (MRI). Arthroscopic (keyhole) surgery may be helpful to remove scar tissue, spurs and loose bodies and deal with localized damage to the ankle joint surface. Ligament repair procedures are useful to stabilize the ankle & improve instability & giving way episodes.