Mr Bal Dhinsa discusses common foot & ankle injuries in amateur athletes

Mr Bal Dhinsa, Orthopaedic Foot and Ankle Surgeon at One Ashford Hospital addresses common foot and ankle injuries which are often seen with amateur athletes. 


Lateral Ligament Injury

This typically occurs when the foot is rolled inwards, either from a mis-step or following a tackle. The injury tends to be worse if the foot is planter-flexed at the time of impact. Often associated with a sudden change of direction. There are grades of sprain severity, up to complete rupture.


Short-term Management

If there is concern regarding a possible fracture it is important to seek attention from a medical professional to assess and arrange investigations (such as plain radiographs).

With soft tissue injuries, initial resting of the limb, application of ice, high elevation (above the heart level) and compression should be instigated. Getting the ankle moving early with a rehabilitation programme that takes into account the degree of swelling and pain present at each stage is important for ligament healing. These exercises will help prevent reoccurrence of any injuries. There are some exercises you can do yourself, but I would advocate seeking the advice of a physiotherapists prior to commencing.


When to seek medical advice

In the initial stage, if there is a concern about possible fracture or associated injuries it is sensible to seek medical advice to rule this out.

If the ankle remains unstable despite a thorough rehabilitation process, or in the case of reoccurrence of injury, a medical opinion should be sought for consideration of operative measures.


Osteochondral Lesions

The cartilage lining the ankle joint can be damaged as the joint surfaces impact on each other (after a sprain, for example). There is initially a localised bruise, followed by cartilage softening and then a small crack in the surface can develop. If this progresses a cyst may form in the bone below the cartilage surface, forming an osteochondral lesion.

Patients present with pain in the joint and becomes worse with activities. Patients may also have stiffness, locking or catching as a result of the injury and this may need addressing as well. If suspected, a magnetic resonance imaging (MRI) scan is recommended for diagnosis.



Initial management for all lesions should be protection of the joint (ankle brace or walking boot), rest (crutches), compression (sometimes a compression bandage is of help) and elevation. Analgesics and non-steroidal anti-inflammatory medication may also be used. Corticosteroid intra-articular injections may also be considered.

When to seek medical advice
With persistent pain and symptoms despite non-operative measures, arthroscopic (‘keyhole’) surgery can be considered for small lesions to stimulate the bone marrow. For the larger lesions, greater than 15 mm, than open surgery through a small incision at the front of the ankle (arthrotomy) may be required to fill the defect with graft.


Ankle Impingement

This typically occurs in the anterolateral aspect of the ankle and results from entrapment of inflamed and/or chronically damaged soft tissue. MRI can be of use, as well as a diagnostic/therapeutic injection of local anaesthetic and corticosteroid.



Initial management is physiotherapy and deep tissue massage, as well as following the RICE protocol during acute episodes. Surgical intervention may consist of arthroscopic assessment and debridement. Unfortunately, reoccurrence of impingement after surgical intervention is possible.


Bony impingement

Impingement resulting from osteophytes (bone spurs), usually in the anteromedial aspect of the ankle, lead to reduced ankle motion. Plain radiographs can be of help, and augmentation with MRI helps to look for associated injuries.

When to seek medical advice
Initial management is the same as for soft tissue impingement, however it is often less effective given the presence of a mechanical block to motion. Operative management is arthroscopic debridement to improve range of motion, however it is not uncommon to have to repeat the procedure in the future for reoccurrence.


Plantar Fasciitis

The high plantar pressures seen in training and matches, particularly on artificial surfaces, predisposes athletes to plantar fasciitis. A sudden increase in activity places the players at increased risk.



Initial steps include resting, a rehabilitation programme including plantar fascia specific stretching exercises, and the use of orthotics. Extra-corporeal shockwave therapy may also be used to complement the physiotherapy. If these measures fail to improve symptoms, dry needling and corticosteroid injections may be indicated.

When to seek medical advice
An open plantar fascia release and spur removal is not recommended, however if there is nerve entrapment associated with it, this may need decompressing.


How to avoid

Daily stretching, as well as a dedicated warm-up regime, is essential to stretch the calf and foot musculature in preparation for increased activity.


Tendoachilles Tendinopathy

This can occur at either the site of Achilles insertion into the calcaneum (insertional tendinopathy) or within its mid-substance (non-insertional Achilles tendinopathy).

Typically, there is pain around the injured area with swelling, often worse in the morning before stretching and after activity. There may be thickening seen over the area of inflammation and this can make wearing footwear uncomfortable.



Initial management includes activity modification, incorporating rest periods, modification of footwear with heel lifts and stretching exercises. Analgesics and non-steroidal anti-inflammatory medication may also be used. Early physiotherapy will help with the recovery.

Next steps in management could be an injection of high-volume fluid around the tendon under ultrasound guidance. This helps to free the paratenon sheath from the tendon, which can become inflamed and adherent to each other. An alternative is extracorporeal shock wave to help break down the scarring that is often present with inflammation and allows the stretching exercises to be carried out effectively.


When to seek medical advice

With persistent pain and swelling surgical intervention can be considered. For the non-insertional tendinopathy, the unhealthy tendon is debrided and repaired. However, for insertional tendinopathy the Achilles tendon needs to be lifted from its insertion, debrided and the Haglund’s bump (calcaneal bony prominence) resected prior to reattaching the tendon back to the calcaneum.



Metatarsal fractures can occur from trauma or as a stress fracture, especially if activity levels have suddenly increased. These fractures are often minimally displaced and can be managed with immobilisation for the initial 4-6 weeks to help with pain control, followed by physiotherapy. If the fracture is significantly displaced or has failed to heal after non-operative measures, surgical reduction and fixation maybe required.


Mr Bal DhinsaMr Bal Dhinsa, Consultant Foot and Ankle surgeon at One Ashford Hospital

Baljinder (Bal) Dhinsa is a fellowship trained Consultant Orthopaedic Surgeon, specialising in the treatment of foot and ankle conditions. On completion of Higher surgical training on the Southeast Thames rotation he completed British Orthopaedic Foot and Ankle Surgery (BOFAS) approved fellowships at Guy’s and St Thomas’ hospital and Malawi.


For more information on Mr Bal Dhinsa, please click here



Why choose One Ashford Hospital?

  • Recognised by all major private medical insurers
  • Competitive fixed-price packages available with 0% interest
  • Rapid access to treatment