Introduction
Foot and ankle care hub · Dr Sean Leo
Foot and ankle problems in Singapore: assessment and treatment options
Dr Sean LeoOrthopaedic Surgeon, Singapore
Clinic enquiries · Not an emergency service
Quick linksAchilles tendonitisAchilles tendon ruptureBilling and insurance
Illustrative image
Start here
Start here
Start here
Start by understanding the foot and ankle problem, not choosing a procedure.
Foot and ankle symptoms can overlap across different problems. This page helps you describe the concern, understand how it is assessed and find relevant educational pathways without asking you to diagnose yourself.
Seeing a specialist orthopaedic surgeon about a foot and ankle problem does not mean surgery has already been decided. The purpose of assessment is to understand the problem and discuss reasonable options for your situation.
OrthoKinetics is Dr Sean Leo’s professional brand. Clinical consultations and treatment are provided through OrthoSports Orthopaedic & Sports Surgery.
What’s covered on this webpage
Follow the route in order, or jump to the stop you need. Stops you have read are marked.
When should a foot and ankle problem be assessed
When should a foot and ankle problem be assessed
When should a foot and ankle problem be assessed?
Routine assessment may help when symptoms persist or limit function
A foot or ankle concern may be worth assessing when it continues, recurs or affects ordinary movement, work, recreation or sport. Describing what happened, how the foot or ankle behaves and what you can no longer do provides useful context.
Some concerns are decided by assessment, not by feel
After an ankle injury, clinicians use a validated decision tool, the Ottawa ankle rules, to decide who needs an X-ray. It was designed to identify essentially every fracture while allowing about a third of ankle X-rays to be avoided.[1] The rules check for bony pain around the ankle or midfoot, plus any of these: tenderness at the back edge or tip of either ankle bone, tenderness at the base of the fifth metatarsal (the long bone on the outer side of the foot leading to the little toe) or the navicular bone in the midfoot, or being unable to bear weight both straight after the injury and at assessment.[5] Whether an X-ray is needed is therefore a matter for examination, not a guess.
A sudden “pop” in the back of the calf or heel may mean a torn Achilles tendon. That is a signal to be assessed without delay, rather than to wait and see.[2] A pop does not by itself confirm a tear; it is a reason to be examined.
Urgent concerns need an urgent-care route
- OrthoKinetics does not provide emergency or urgent care through this webpage or its WhatsApp contact.
The urgent-care guidance at the end of this page applies to the whole foot and ankle region.
What does a foot and ankle assessment look at
What does a foot and ankle assessment look at
What does a foot and ankle assessment look at?
Assessment brings together the history of the problem, examination of the foot or ankle and any tests that are useful for the question being considered. The exact assessment varies with the concern.
How the problem started and how it behaves
You may be asked when the problem began, whether there was a sudden injury or a gradual build-up, how symptoms change and how the foot or ankle affects daily life or activity. The difference between a sudden injury and a gradual, load-related problem matters, because it helps separate conditions that are often confused.[2]
Movement, stability and function
Examination can consider how the foot and ankle move, how stable they feel and what the problem means for function. After an ankle sprain, the severity of ligament damage is judged most reliably by a delayed examination, about 4–5 days after the injury, rather than in the first hours.[3] That concerns when the ligament grade is best judged. It is not a reason to delay being seen.
Imaging when it can answer a useful question
X-rays show bone clearly but not tendon or other soft tissue. MRI and ultrasound show soft tissue and are used selectively.[2] A scan is one part of an assessment; it does not select treatment by itself.
A simple assessment sequence
- Describe how the problem began and how it affects you.
- Examine movement, stability and function as relevant.
- Consider targeted tests only where they may add useful information.
- Discuss the working possibilities, reasonable options and uncertainty.
Use symptoms to describe the problem, not diagnose it.
Use symptoms to describe the problem, not diagnose it.
Use symptoms to describe the problem, not diagnose it.
Pain, swelling, stiffness, giving way and a sudden pop are useful descriptions. They do not confirm which structure is responsible, and more than one concern may contribute to a person’s experience.
Pain, swelling or stiffness
Describe where you feel the symptom, when it appears, what changes it and how it limits you. Where the pain sits and whether it built up gradually[4] or began suddenly[2] are useful details. This gives the assessment context without turning the description into a diagnosis.
Giving way or instability
Describe when the ankle feels unreliable and what you were doing at the time. Giving way is worth describing in full: a large proportion of people who sustain a lateral ankle sprain go on to develop chronic ankle instability, defined as persistent pain, swelling and/or giving way together with recurrent sprains, lasting at least 12 months after the first sprain.[3] Giving way does not, by itself, tell you which structure is involved.
A sudden pop
Note exactly what you were doing and what changed afterwards. A pop is a signal to be assessed; it is not a diagnosis.[2]
Is it broken or sprained?
An ankle sprain and a broken ankle (ankle fracture) can present similarly. The distinction is made by assessment, including the Ottawa ankle rules for deciding who needs an X-ray,[1] and not by how the injury feels alone. For more depth, see Is it broken or sprained?.
Foot and ankle pathways
Foot and ankle pathways
Pathways
Find the relevant foot and ankle pathway.
These links organise educational information by broad concern. Choosing a card does not confirm a diagnosis or mean that its treatment applies to you.
Achilles tendonitis (tendinopathy) and Achilles tendon rupture are different problems. Tendonitis is typically not related to a specific injury and results from repetitive stress to the tendon, while a rupture typically results from a sudden injury.[2] For that reason they have separate cards.
Achilles tendonitis (gradual, overuse heel and tendon pain)
Use this pathway for information about gradual, overuse heel and tendon pain and how it is managed. Reading it cannot confirm that your symptoms are Achilles tendonitis.
Achilles tendon rupture (sudden tear)
Use this pathway for information about a sudden Achilles tear and the assessment and management choices that follow. Reading it cannot confirm that your symptoms are a rupture.
Broken ankle (ankle fracture)
Use this pathway for information about a broken ankle and how fracture concerns are assessed and managed. Reading it cannot confirm that your injury is a fracture.
Understand broken ankle (ankle fracture) and treatment options
Ankle sprain
Use this pathway for information about a sprained ankle and the functional treatment that usually follows. Reading it cannot confirm that your injury is a sprain.
Ankle ligament tear (the severe end of the sprain spectrum)
Use this pathway for information about the more severe end of the ankle-sprain spectrum and persistent instability. Reading it cannot confirm that your injury is a ligament tear.
What tests can and cannot show
What tests can and cannot show
What tests can and cannot show
Tests can add information to a foot and ankle assessment, but no universal sequence applies to every person. Findings need to be considered alongside the history, examination and goals before treatment is discussed.
X-ray, MRI and ultrasound
X-rays give clear images of bone, which is why they answer fracture questions. They do not show tendon. MRI and ultrasound show soft tissue. For Achilles tendonitis, MRI is not necessary to make the diagnosis; it becomes important for planning surgery if non-surgical treatment is not effective. Ultrasound is quicker and less expensive than MRI, but its results depend more on the experience and skill of the person performing it.[2]
Not every ankle injury needs an X-ray
A validated rule, the Ottawa ankle rules, identifies who needs an ankle X-ray. It was found to be 100% sensitive for fractures and to allow about a third of ankle X-rays to be avoided.[1] The rule identifies who needs an X-ray; it does not mean that no ankle injury ever does.
Timing matters for sprains
For ankle sprains, the severity of ligament damage is assessed most reliably by delayed examination, 4–5 days after the injury.[3]
Video · Dr Sean Leo
What Is A Heel Spur?
- Explains why a heel spur is usually an after-effect, not the cause of pain.
- Describes how repeated load and repair lead to calcium building up in the area.
- Notes that a spur on a scan signals a problem without being the problem itself.
Treatment follows the diagnosis and the person.
Treatment follows the diagnosis and the person.
Treatment follows the diagnosis and the person.
A treatment discussion should compare reasonable non-operative and operative options where relevant. The choice depends on the problem, the person and the purpose of treatment; specialist review does not imply surgery.
Ankle sprain
For an acute lateral ankle sprain, functional treatment is clinically the treatment strategy of choice: tape or a brace combined with an exercise programme, with a short period of immobilisation only where it helps relieve pain and swelling. Surgery should be reserved for cases that do not respond to thorough, comprehensive exercise-based treatment.[3]
Achilles tendonitis
In most cases of Achilles tendonitis, non-surgical treatment gives acceptable pain relief, although it may take a few months for symptoms to improve significantly and the pain may last longer than 3 months.[2] Treatment centres on loading-based exercise rather than prolonged rest.[4]
Other problems
Treatment for a fracture or an Achilles rupture depends on the assessment. The pathway pages explain the choices for each condition.
Structure / Patient / Goal
Structure / Patient / Goal
Deciding together
Structure / Patient / Goal
S
Structure: what is affected?
Structure covers the diagnosis and the condition of the relevant bone, ligament, tendon or other tissue. It includes what the assessment shows and what a test adds when testing is useful.
P
Patient: how does it affect you?
Patient means you as a whole person. Symptoms, health, function, preferences and practical circumstances can affect which options are reasonable.
G
Goal: what are you hoping to return to?
Goal describes what matters to you, such as daily independence, work, recreation or sport. A useful plan needs a clear purpose.
Your plan
Structure / Patient / Goal helps organise benefits, burdens, limitations and uncertainty without suggesting that one scan, one symptom or motivation alone can determine the outcome.
Protection, rehabilitation and repair describe different aims.
Protection, rehabilitation and repair describe different aims.
Protection, rehabilitation and repair describe different aims.
These are not steps in a mandatory ladder, and they are not competing alternatives. They describe different treatment purposes, and not every foot or ankle concern fits neatly into one category. Protection and rehabilitation are often phases of the same plan. Repair is a separate decision, not the automatic next step.
Protection: settling the injury
Protection aims to let an injured area settle. In an acute ankle sprain, a short period of immobilisation may help relieve pain and swelling, and tape or a brace can be used.[3]
Rehabilitation: restoring function
Rehabilitation aims to restore function through exercise. For an ankle sprain, the exercise programme is combined with tape or a brace, and supervised exercise-based programmes are preferred over passive treatments because they support recovery of functional joint stability.[3] For Achilles tendonitis, treatment centres on loading-based exercise.[4] Rehabilitation is often the mainstay of treatment, not a step down from something else.
Repair: when structure needs restoring
Repair means surgery to restore a structure. It is a separate discussion, not the automatic next step after protection or rehabilitation. For an ankle sprain, surgery should be reserved for cases that do not respond to thorough, comprehensive exercise-based treatment.[3] For an Achilles rupture, the choice between repair and non-operative care is discussed on the rupture pathway page.
An ankle sprain shows how the aims fit together: a short protective phase, then an exercise-based programme, with repair considered only when that programme has not worked. Age alone does not decide which aim applies.
Technology supports a plan; it does not replace one.
Technology supports a plan; it does not replace one.
Technology supports a plan; it does not replace one.
Any technology used in foot and ankle care supports a treatment plan rather than replacing one. A scan, a brace or an instrument does not decide what happens next; the assessment and the plan do. Technology is not presented as better for every patient.
What happens next?
What happens next?
What happens next?
Prepare for a foot and ankle assessment
Bring relevant reports or images if you have them, details of previous treatment and a current medicine list. Consider noting which activities matter most and what you want to understand.
Billing and insurance questions
Ask the clinic team for current information about fees, panel status, pre-authorisation and expected payment arrangements. Insurance coverage and out-of-pocket costs depend on the individual policy and the insurer’s decision; no coverage is guaranteed.
A cost estimate for surgery can be given only after a consultation and assessment, once a surgical plan has been developed. Each individual condition is unique — implants used, time taken, and other factors contribute to the overall estimate. The estimate will be provided to you by the clinic should you decide on surgical management, and will also be used to assist in obtaining pre-authorisation from insurance where applicable.
Insurance panels. Dr Sean Leo, Orthopaedic Surgeon, is on the specialist panels of Great Eastern (GE Panel), HSBC Life (HSBC Life Shield) and Singlife (Singlife Shield), and on the Prudential Panel. AXA Insurance Singapore became part of HSBC Life in 2023, and former AXA Shield plans are now HSBC Life Shield plans.
Corporate health plans. Dr Leo is on the panels of both Alliance Medinet and iXchange, which administer medical benefits for many company health plans. If your company plan uses either panel, you can see Dr Leo as a panel doctor.
If your company uses a different panel. Some company plans still let you see a doctor of your choice outside their panel, then claim reimbursement. This varies from plan to plan, as may the co-payment, so please check your benefits with your company’s HR department.
Panel arrangements change from time to time, so please confirm with your insurer or your company’s plan administrator before your appointment.
Dr Leo is on the panels shown. If your insurer is not listed, you may ask whether co-management with an Orthosports surgeon partner on that panel is clinically and administratively appropriate. Orthosports surgeon partners are collectively on the panels of all Shield plans.
Specific benefits, pre-authorisation, reimbursement and cashless treatment depend on the individual policy and insurer approval and are not guaranteed.
OrthoSports appointment route
Arrange a consultation: the appointment section is further down this page.
With you through the seasonsMeet Dr Sean Leo
Meet Dr Sean Leo
A consultant orthopaedic surgeon whose clinical focus is the knee, sports injuries and the lower limb.
- Dr Sean Leo is a consultant orthopaedic surgeon. OrthoKinetics is his professional brand; clinical services are provided through OrthoSports Orthopaedic & Sports Surgery at Mount Elizabeth Novena Specialist Centre and Connexion, Farrer Park Hospital.
- His clinical interests include sports injuries, including those in adolescent athletes; ligament reconstruction; realignment surgery; cartilage repair and joint-preservation approaches; knee replacement; and technology-assisted hip and knee surgery.
- The consistent aim is to return people to meaningful function and activity while avoiding unnecessary downtime.
- Qualifications: MBBS, MRCS (Ed), MMed (Ortho), FRCSEd (Ortho).
More detail: Meet Dr Sean Leo
- Training and career: Dr Leo trained in medicine at the National University of Singapore and served in the Singapore Armed Forces Medical Corps from 2000 to 2012, where his work included the care of soldiers in physically demanding roles. He completed postgraduate orthopaedic training in 2009 and a one-year clinical fellowship at Royal North Shore Hospital in Sydney, Australia, before joining Changi General Hospital as an orthopaedic consultant in 2012, where he later held the positions of Senior Consultant and Director of the Hip and Knee Service. With seniority, his educational contribution has evolved towards mentorship and support for junior doctors.
OrthoKinetics Recovery Reflection
Recovery reflection
What would it mean to trust the part of you that meets the ground every day?
Most of the day, your feet and ankles do their work without asking for attention. Stairs, kerbs, a wet floor, a long walk with shopping: you rarely think about any of it. When something goes wrong here, it is often felt less as a single symptom and more as a small loss of confidence in surfaces you used to cross without thinking. That is a reasonable thing to notice, and it is worth saying out loud.
Which ordinary surface asks the most of you right now?
The honest starting point is usually not a name for the problem. It is a moment: the uneven pavement, the stairs at the end of the day, the first steps after sitting. Being specific about where the ground feels least dependable gives the conversation something concrete to work from.
A foot or ankle problem changes how you meet the ground before it changes anything else, and describing that plainly is a sound way to begin.
Illustrative image
Questions people often ask
Common foot and ankle questions
Common foot and ankle questions
What conditions does a specialist orthopaedic surgeon who cares for foot and ankle problems see?
The pathway cards on this page cover ankle sprain, ankle ligament tear, broken ankle (ankle fracture), Achilles tendonitis and Achilles tendon rupture. Each card leads to a page with more detail. Choosing a card is navigation, not a diagnosis.
When should I see a specialist orthopaedic surgeon about ankle pain?
A foot or ankle concern may be worth assessing when it continues, recurs or limits movement, work or activity. If you are concerned that a problem needs prompt attention, use the urgent-care guidance at the end of this page rather than relying on this webpage or its WhatsApp contact.
Is my ankle broken or just sprained — do I need an X-ray?
An ankle sprain and a broken ankle (ankle fracture) can present similarly, so the distinction is made by assessment, including the Ottawa ankle rules for who needs an X-ray, and not by feel alone.[1] For more depth, see Is it broken or sprained?.
How do I know if my foot or ankle injury is serious?
This page cannot judge that remotely. Assessment is how seriousness is worked out. If you are concerned that a problem needs prompt attention, use the urgent-care guidance at the end of this page.
Can ankle or foot pain heal without surgery?
Often the starting point is non-operative treatment. For an acute ankle sprain, functional treatment is the strategy of choice and surgery is reserved for cases that do not respond to exercise-based treatment.[3] In most cases of Achilles tendonitis, non-surgical treatment gives acceptable pain relief, although it may take a few months.[2] Other problems depend on the assessment.
Do I need surgery for an Achilles rupture?
Assessment comes first, and the options depend on the person. The Achilles tendon rupture page explains the choices in more detail.
How long does foot and ankle recovery take?
It depends on the problem and the person, so no single timeline applies. For Achilles tendonitis, improvement commonly takes a few months, and the pain may last longer than 3 months.[2] The condition pages give more detail for each problem.
What happens at a foot and ankle assessment?
Assessment brings together the history of the problem, examination and any tests that are useful for the question being considered. Imaging is used only when it can answer a useful question, and a scan does not select treatment by itself. The discussion covers the working possibilities, reasonable options and uncertainty.
Sources
References
References
- Stiell IG, Greenberg GH, McKnight RD, et al. Decision rules for the use of radiography in acute ankle injuries. Refinement and prospective validation. JAMA. 1993;269(9):1127-1132. PMID: 8433468.
- American Academy of Orthopaedic Surgeons. Achilles Tendinitis. OrthoInfo. https://www.orthoinfo.org/diseases–conditions/achilles-tendinitis
- Vuurberg G, Hoorntje A, Wink LM, et al. Diagnosis, treatment and prevention of ankle sprains: update of an evidence-based clinical guideline. Br J Sports Med. 2018;52(15):956. PMID: 29514819. doi:10.1136/bjsports-2017-098106.
- Martin RL, Chimenti R, Cuddeford T, et al. Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision 2018. J Orthop Sports Phys Ther. 2018;48(5):A1-A38. doi:10.2519/jospt.2018.0302.
- Bergman R, Li D, Shuman VL. Acute Ankle Sprain. [Updated 2025 Aug 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. https://www.ncbi.nlm.nih.gov/books/NBK459212/
Final next step
Final next step
Next step
Final next step
Reading about a problem is a starting point. An assessment brings together the history, an examination where needed and any useful tests, and helps you and your clinician decide what to do next. How much physical examination is needed is a matter of clinical judgement. It may be limited when pain makes an examination unreliable, or when imaging clearly shows a problem that matches the symptoms, such as a fracture seen on an X-ray or an MRI scan that clearly shows an injury consistent with the symptoms. The Singapore Medical Council and the UK General Medical Council both allow remote medical consultations, where a physical examination is not possible, with safeguards: the doctor must be clear about the limits of an opinion formed without an examination, and whether an in-person examination is needed, or referral to other services, is left to the clinical judgement of the attending doctor.
Signs that need urgent help
Some symptoms should not wait for a routine appointment. Each item below says where to go.
After an injury
- The ankle or foot sits at an odd angle, a bone is showing, there is a deep cut, you are in severe pain, or the toes look blue or white or feel numb. Go to an emergency department or call 995.
- You felt a sudden pop or sharp pain at the back of the heel or calf, and pushing off or rising onto your toes is difficult. Arrange an urgent same-day assessment.
- It is very painful or the pain is getting worse, the swelling or bruising is large or spreading, or it hurts to put weight on the ankle or foot. Arrange an urgent same-day assessment.
At any time
- A joint, such as the ankle, is suddenly very painful, hot, red and swollen, especially with a fever or feeling generally unwell. Go to an emergency department or call 995.
- One calf or thigh is newly painful and swollen. Arrange an urgent same-day assessment. If you also feel short of breath or have chest pain, go to an emergency department or call 995.
If you have diabetes
- You have a foot sore and a fever or feel very unwell, or the foot is cold, pale or blue. Or skin on the foot or toes has turned black, or a sore looks deep, or there is pus or redness spreading up the foot. Go to an emergency department or call 995.
- You have a new foot sore, or a foot that is hot, swollen, changed in colour or leaking fluid, without the signs above. Arrange an urgent assessment within 24 hours.
If you are admitted by the doctor at the urgent care centre of one of these private hospitals, the Parkway Pantai hospitals (Mount Elizabeth Orchard, Mount Elizabeth Novena, Gleneagles and Parkway East), Farrer Park Hospital and Thomson Medical Centre, you may ask for Dr Sean Leo to be your attending orthopaedic surgeon. If you are instead discharged and referred for orthopaedic follow-up, you may contact the clinic to arrange an appointment. Both are subject to the hospital’s admission processes and to Dr Leo’s availability.
Arrange a consultation
Appointments are arranged through the OrthoSports clinic team. Send your details below, or message or call the clinic.
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Message the clinic on WhatsApp
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38 Irrawaddy Road, #10-41 Mount Elizabeth Novena Specialist Centre, Singapore 329563 Map for Orthosports@Novena (opens Google Maps)
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1 Farrer Park Station Road, #15-17 Connexion, Singapore 217562 Map for Orthosports@Connexion (opens Google Maps)
WhatsApp is for clinic enquiries only. It is not an emergency service and is not monitored for urgent care. Website or messaging contact is not an emergency-response service. For a medical emergency, use your local emergency service.
- OrthoKinetics does not provide emergency or urgent care through this webpage or its WhatsApp contact.