Ankle, Foot & Tendon Injuries
Avoid missed unstable foot injuries and distinguish tendon disruption from uncomplicated sprain.
Quick revision ↓ Medical Dictionary
01Ankle assessment
Assess bony tenderness, deformity, skin and ability to bear weight. Validated decision rules can guide radiography in suitable patients but do not replace judgement or apply to every presentation. Document distal neurovascular findings and consider proximal fibular injury when the mechanism or examination suggests it.
02Stability matters
An ankle fracture is assessed for alignment, joint congruity and associated syndesmotic or ligament injury. Apparent isolated injury may be unstable. Dislocation with skin or vascular threat requires urgent trained management; reassess after reduction and splinting and follow the definitive treatment plan.
03Midfoot injury
Midfoot pain, swelling, plantar bruising or inability to bear weight after a twisting or crush mechanism raises concern for Lisfranc injury. Initial non-weight-bearing radiographs can miss instability. Protect the foot and arrange specialist imaging or review when suspicion persists rather than calling every case a simple sprain.
04Achilles and other tendons
A sudden posterior ankle snap with weakness can indicate Achilles rupture. Some plantarflexion may remain through other muscles, so preserved movement does not exclude rupture. Use the appropriate clinical tests and imaging when needed, then arrange a treatment and rehabilitation plan through trained services.
05Follow-up and footwear
Soft-tissue injuries benefit from appropriate protection, progressive loading and rehabilitation according to severity. Give warnings about worsening pain, numbness, swelling or skin pressure. Persistent inability to progress should trigger reassessment for occult fracture, instability or tendon injury rather than repeated generic sprain advice.
High-Yield Revision
- An ankle film does not assess every proximal associated injury.
- Plantar bruising can signal a significant midfoot injury.
- Preserved plantarflexion does not exclude Achilles rupture.
Common Pitfalls
- Applying a radiography rule outside its intended population.
- Dismissing persistent midfoot pain after normal initial films.
References & Further Reading
Read the relevant guideline sections alongside these original clinical teaching cases. Local pathways, available services and individual patient factors determine care.
Reference review: 28 September 2026. Consult current local protocols for prescribing, procedures and escalation.