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    James Metcalfe

    Consultant Orthopaedic Surgeon

    James Metcalfe

    James Metcalfe

    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.


    After the clinical evaluation it is common to order some investigations. X-rays are often a useful start

    may include Ultrasound, CT or MRI scans. These unfortunately need to be booked on a separate day.

    Ultrasound Scan

    and can usually be ordered and assessed on the same day as the consultation. Further investigations

    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

    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

    skills in this area. The ultrasound scan involves the placement of a probe and jelly across the foot /

    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

    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

    up to 24 hours. The steroid can provide some long lasting pain relief. If the pain is relieved even for a

    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.