Many patients have similar questions when they’re dealing with foot and ankle pain, injuries or treatment decisions. This FAQ hub brings together clear, expert answers to the topics I’m most frequently asked about in clinic — from ankle sprains and ligament injuries to cartilage problems, bunions, arthritis and reconstructive surgery. I hope you find it helpful.
FOOT & ANKLE GENERAL
1. When should I see a specialist for ankle pain?
If pain lasts more than 6 weeks, affects walking, causes swelling, or follows repeated sprains, specialist assessment is recommended.
2. Why choose the Royal National Orthopaedic Hospital (RNOH)?
It is the UK’s leading centre for complex foot and ankle conditions, receiving tertiary referrals from across the country for difficult cases, advanced cartilage repair and joint-preserving surgery.
ANKLE SPRAINS & LIGAMENT INJURIES
1. How long does it take to recover from a severe ankle sprain?
Recovery varies from 2–6 weeks for mild sprains to 3–6 months for high-grade ligament injuries. Persistent swelling, stiffness or instability often means deeper structural damage that may require specialist assessment.
2. Why does my ankle still hurt months after a sprain?
Ongoing pain may come from ligament insufficiency, cartilage injury, or an undiagnosed osteochondral lesion of the talus. Chronic instability is also common after repeated sprains.
3. When should an ankle sprain be investigated with an MRI?
Consider MRI if:
Pain or swelling persists beyond 6–8 weeks
You're unable to trust the ankle
There was a “pop” at injury
You experience catching, locking or instability
4. What is a syndesmotic injury (“high ankle sprain”)?
It is a sprain of the ligaments between the tibia and fibula. These take longer to heal and may need surgical stabilisation if unstable.
ANKLE REPLACEMENT & ANKLE ARTHRITIS
1. What is the difference between ankle replacement and ankle fusion?
Ankle replacement maintains movement and is often chosen for patients wanting preserved mobility.
Ankle fusion removes the painful joint movement and is extremely reliable but sacrifices ankle flexibility. Both procedures relieve pain but suit different patient profiles.
2. How long does an ankle replacement last?
Modern implants typically last 10–15+ years, with improving survivorship in active patients due to better alignment techniques such as PROPHECY-guided implantation.
3. Who is a good candidate for ankle replacement surgery?
Ideal candidates have:
Over the age of 55.
End-stage ankle arthritis
Preserved surrounding tendons
Good bone quality
Reasonable activity levels (walking, cycling, golf)
Patients with severe deformity or instability may still be suitable after corrective procedures.
4. What activities can I do after an ankle replacement?
Most patients return to:
Walking
Golf
Cycling
Swimming
High-impact activities like running are generally avoided.
ANKLE ARTHRODESIS (FUSION)
1. Why choose ankle fusion over ankle replacement?
Fusion is preferred when:
younger than 50
The deformity is severe
Bone quality is poor
Ligament support is insufficient
There has been a prior infection
It provides excellent pain relief and stability.
2. Will I walk normally after my ankle is fused?
Yes — most patients walk very well and compensate with the midfoot and subtalar joints. Some experience stiffness on inclined ground.
ACHILLES TENDON RUPTURE
1. How do I know if I have ruptured my Achilles tendon?
A sudden “snap” or “pop”, difficulty pushing off, and weakness are classic. Most patients cannot perform a single-leg heel raise, there is a gap in the tendon.
2. Should an Achilles rupture always be repaired?
Both operative and non-operative treatments are effective. Surgery may suit younger athletic individuals; non-operative treatment avoids surgical risks and is effective with modern rehab (functional bracing).
3. How long does Achilles rupture recovery take?
Typically 6–12 months to return to full activity, although walking is usually comfortable by 12 weeks.
ANKLE ARTHROSCOPY & CARTILAGE INJURY (OCL)
1. What is ankle arthroscopy used for?
It treats impingement, removes scar tissue, repairs cartilage, stabilises ligaments and manages early arthritis.
2. What is an osteochondral lesion of the talus (OCL)?
A combined cartilage and bone injury inside the ankle that can follow sprains or trauma. Symptoms include deep pain, swelling, and catching.
3. What is AMIC and when is it used?
Autologous Matrix-Induced Chondrogenesis combines microfracture with a collagen membrane to regenerate cartilage. It is used for medium-to-large OCLs to preserve the ankle and delay arthritis.
SPORTS INJURIES & LIGAMENT REPAIR
1. When is surgery needed for ankle ligament injuries?
When instability persists after rehab, or when ligament rupture is severe. Procedures include Broström repair and Gould augmentation.
2. Can athletes return to sport after ligament repair?
Yes — most return to full activity within 3-4 months, depending on the type of repair and sport.
FLAT FOOT (ADULT ACQUIRED FLATFOOT)
1. What causes adult flat foot deformity?
Most cases of adult flat foot are due to posterior tibial tendon dysfunction, which leads to collapse of the arch, pain, and difficulty walking.
2. Can flat foot deformity be corrected?
Yes. Early treatment involves orthotics and physiotherapy. Advanced cases may require reconstructive surgery such as calcaneal osteotomy, FDL tendon transfer, spring ligament repair, or Achilles lengthening and arthroereisis screw.
3. What happens if posterior tibial tendon dysfunction is not treated?
It can progress to rigid flat foot, ankle arthritis, and severe deformity that is more difficult to correct.
PES CAVUS (HIGH-ARCH FOOT / NEUROLOGICAL CAVUS)
1. What causes a high-arched (cavus) foot?
Often neurological in origin (Charcot-Marie-Tooth being the most common), or due to muscle imbalance. It leads to ankle instability, pain and hard skin on the outer foot and claw toes and pain.
2. How is pes cavus treated?
Treatment ranges from insoles and bracing to reconstructive surgery such as calcaneal osteotomy, tendon transfers, and sometimes fusion procedures for severe deformity.
