Foot and Ankle Orthopaedic Complications
The foot and ankle bear 1.5x body weight walking and up to 8x during running. With 28 bones, 33 joints, and over 100 ligaments, small errors or complications here can severely affect gait and quality of life.
Common complications we see
Ankle Fracture Malunion / Nonunion
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Why it happens: Inadequate reduction, missed syndesmotic injury, poor compliance with weight-bearing restrictions.
Signs: Persistent pain, swelling, visible deformity, abnormal wear on shoes, post-traumatic arthritis.
Management: CT scan to assess alignment. Corrective osteotomy + fixation for malunion. Bone graft + stable fixation for nonunion. Syndesmosis reconstruction if missed.
Chronic Ankle Instability
Why it happens : Up to 40% of lateral ankle sprains develop instability if ATFL/CFL don’t heal properly.
Signs : Recurrent “giving way”, pain, swelling, difficulty on uneven ground.
Management : Proprioceptive rehab + peroneal strengthening first. Broström-Gould repair for mechanical laxity. Tendon reconstruction for severe cases or failed repair.
Achilles Tendon Rupture Complications
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Surgical: Wound breakdown, sural nerve injury, re-rupture 3–5%.
Non-surgical: Higher re-rupture rate ∼10–12%, tendon elongation causing weak push-off.
Management: Functional bracing protocols reduce re-rupture in both groups. FHL tendon transfer for chronic ruptures with >3cm gap.
Plantar Fasciitis Recalcitrance
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Why it happens: Most resolve with stretching + orthotics, but 10% become chronic due to thickened fascia, nerve entrapment, or heel spur.
Management: Night splints, shockwave therapy, PRP. Partial plantar fascia release + Baxter’s nerve release if >12 months of failed care. Caution: complete release causes lateral column pain.
Diabetic Foot Complications
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Charcot neuroarthropathy: Midfoot collapse from repetitive trauma + neuropathy. “Rocker-bottom” foot, warmth, swelling mimics infection.
Ulcers & infection: Neuropathy + vascular disease = non-healing wounds. Osteomyelitis risk.
Management: Total contact casting for acute Charcot. Offloading, wound care, vascular optimization. Limb salvage vs amputation decisions need MDT. Strict glucose control prevents progression.
Post-op Wound & Infection Issues
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Why it happens : Foot has thin soft-tissue envelope, poor vascularity, and dependent position. Diabetes, smoking, steroids increase risk.
Prevention : Minimal incisions, respect angiosomes, avoid prolonged tourniquet, careful closure.
Management : Early debridement + antibiotics. VAC for wound coverage. Avoid weight-bearing until sealed.
General principles to prevent complications
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Get the diagnosis right first time – Stress views, CT, MRI for syndesmosis, Lisfranc, and occult fractures.
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Respect soft tissues – Foot surgery is skin surgery. Plan incisions, minimize stripping, handle flaps gently.
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Restore alignment – Hindfoot varus/valgus and 1st ray position drive forefoot loading. Check Harris heel view and Meary’s line.
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Early protected motion – Ankle and subtalar stiffness develop fast. Balance stability with motion after fixation.
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Offload + educate – Diabetics need footwear checks, neuropathy screening, and ulcer prevention counseling at every visit.
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Watch the nerves – Sural, superficial peroneal, and tibial nerve branches are at risk in most approaches. Document pre-op status.
Red flags needing urgent referral
Acute Charcot with red, hot, swollen foot. Increasing pain + wound drainage post-op. Numbness or blue toes after cast/surgery. Inability to bear weight 6 weeks after “sprain” – think fracture or Lisfranc.
The Bottom Line
Foot and ankle complications are unforgiving because patients feel every degree of malalignment with each step. Meticulous initial care, early motion, and aggressive management of diabetes and edema give the best chance of a functional, pain-free foot.