Assessment of pain in the foot and ankle

Plymouth Orthopaedic and Sports Injury Clinic

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.

Investigations may be indicated following clinical evaluation.  Plain X-rays remain the most useful and important investigation, and usually these can be performed as part of your consultation, with images immediately available so that your Consultant can discuss them with you.  Further investigations may include Ultrasound, CT or MRI scans. 

Ultrasound Scan

Ultrasound scans are useful for investigating soft tissue problems such as suspected mortons neuroma. The ultrasound scan is performed by a Consultant Radiologist who has  specialist training and skills in musculo-skeletal radiology. 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. Ultrasound is a painless non-invasive investigation.  Sometimes it is appropriate to perform an injection under ultrasound guidance.

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.

Computerised Tomography(CT) Scanning

This is a special scan using X-rays. The patient is placed into a short tunnel.

Diagnostic and therapeutic injections

Injections of local anaesthetic and steroid are used to help in 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.

A Radiologist can 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 appropriate to produce a more long lasting pain relief.