Assessment of Foot and Ankle Pain

Clinical Assessment

The first step in the diagnosis of any foot and ankle problem is taking a comprehensive history and making a detailed clinical examination.  James has received expert training at Oswetry in the assessment of foot and ankle problems and has used these skills to good effect as a Consultant for the last 5 years.

Investigations

After the clinical evaluation it is common to order some investigations. X-rays are often a useful start and can usually be ordered and assessed on the same day as the consultation. Further investigations may include Ultrasound, CT or MRI scans. These unfortunately need to be booked on a separate day.

Ultrasound Scan

Ultrasound scans are useful for investigating soft tissue problems such as suspected Morton's neuroma. The ultrasound scan is performed by a consultant radiologist with specialist interest and skills in this area. The ultrasound scan involves the placement of a probe and jelly across the foot / ankle.  This is the same test as a pregnant mother has to look at her baby. The test can take up to 20 minutes to perform. The test is usually not painful. This test needs to be booked and is usually performed on a separate day.

Magnetic Resonance Imaging  (MRI) Scan

This scan is useful for assessing soft tissue, bone and joint problems. This scan uses magnetic fields to assess the tissues. The patient is placed into a tunnel for about 20 to 30 minutes. The tunnel is quite narrow.  You may not be able to have an MRI scan if you have metal or electronic implants. You will be asked before hand if you are suitable for this scan and will be required to fill out a safety questionnaire. Once the scan is performed James will receive the report within a few days. James will then either write, phone or see you in clinic with the results.

Computerised Tomography(CT) Scanning

This is a special scan using X-rays. The patient is placed into a short tunnel. Once the scan is performed James will receive the report within a few days. James will then either write, phone or see you in clinic with the results.

Diagnostic and Therapeutic Injections

Injections of local anaesthetic and steroid are used to help the diagnosis of foot and ankle problems.  There are many joints and tendons around the foot. One or many of these may be a source of pain. It can be difficult to identify which of these may be causing the pain.
An X-ray doctor (consultant radiologist) will locate a specific area to inject with an ultrasound probe or using a special X-ray machine. The local anaesthetic acts to numb the affected area for a time lasting up to 24 hours. The steroid can provide some long lasting pain relief. If the pain is relieved even for a few hours then the area injected is the source of that pain. This is the diagnostic part of the injection.
The steroid injection may relieve the pain for a longer period of time. The pain relief may last for a few days, weeks, months or even longer. The length of pain relief is unpredictable.
If the pain relief lasts for a few hours or days then returns the injection has still been useful. If the pain has not been totally relieved then the source of the pain may be somewhere else. In this situation than further injections may be necessary to locate the source of the pain.
If the injection has produced pain relief but the pain has returned then a surgical intervention may be necessary to produce a more long lasting pain relief. I will assess you in this situation and be able to advise on an individual basis.