Foot & Ankle


 

FOOT
The feet are flexible structures of bones, joints, muscles, and soft tissues that let us stand upright and perform activities like walking, running, and jumping. The feet are divided into three sections:

  • The forefoot contains the five toes (phalanges) and the five longer bones (metatarsals).
  • The midfoot is a pyramid-like collection of bones that form the arches of the feet. These include the three cuneiform bones, the cuboid bone, and the navicular bone.
  • The hindfoot forms the heel and ankle. The talus bone supports the leg bones (tibia and fibula), forming the ankle. The calcaneus (heel bone) is the largest bone in the foot.


Muscles, tendons, and ligaments run along the surfaces of the feet, allowing the complex movements needed for motion and balance. The Achilles tendon connects the heel to the calf muscle and is essential for running, jumping, and standing on the toes.

Due to its position and function on the body the foot is often under a great deal of pressure, literally. Even in daily activities such as walking and climbing stairs the foot is under regular light impact with objects on a routine basis. When engaged in sports, this regularity of impact is significantly increased. The use of the foot also opens it up to unexpected collisions with objects outside the typical line of sight. This is another common cause of injuries to the feet. Below we’ll outline some typical foot conditions.

Plantar fasciitis
Plantar fasciitis (fashee-EYE-tiss) is the most common cause of pain on the bottom of the heel. Plantar fasciitis occurs when the strong band of tissue that supports the arch of your foot becomes irritated and inflamed. The plantar fascia is designed to absorb the high stresses and strains we place on our feet. But, sometimes, too much pressure damages or tears the tissues. The body’s natural response to injury is inflammation, which results in the heel pain and stiffness of plantar fasciitis.

Osteoarthritis
Arthritis is inflammation of one or more of your joints. It can cause pain and stiffness in any joint in the body, and is common in the small joints of the foot and ankle. Age and wear and tear cause the cartilage in the feet to wear out, causing pain, swelling, and deformity in the feet.

Rheumatoid Arthritis
Rheumatoid arthritis is a chronic disease that attacks multiple joints throughout the body. It most often starts in the small joints of the hands and feet, and usually affects the same joints on both sides of the body. Most people with rheumatoid arthritis (RA) develop symptoms in the foot and ankle over the course of the disease.

Bunions (hallux valgus)
A bunion is a bony bump that forms on the joint at the base of your big toe. It forms when your big toe pushes against your next toe, forcing the joint of your big toe to get bigger and stick out. The skin over the bunion might be red and sore. Wearing tight, narrow shoes might cause bunions or make them worse. Bunions also can develop as a result of an inherited structural defect, stress on your foot or a medical condition, such as arthritis.

Achilles Tendon Injury
Pain in the back of the heel may suggest a problem with the Achilles tendon. The injury can be sudden or a nagging daily pain (tendinitis).

Heel Spurs
This is an abnormal growth of bone in the heel, which may cause severe pain during walking or standing. People with plantar fasciitis, flat feet, or high arches are more likely to develop heel spurs.

Mallet Toes
The joint in the middle of a toe may become unable to straighten, causing the toe to point down. Irritation and other feet problems may develop without special footwear to accommodate the mallet toe.

Metatarsalgia
This is a condition in which the ball of your foot becomes painful and inflamed. You might develop it if you participate in activities that involve running and jumping. There are other causes as well, including foot deformities and shoes that are too tight or too loose.

Fracture
Fractures of the toes and forefoot are quite common. Fractures can result from a direct blow to the foot—such as accidentally kicking something hard or dropping a heavy object on your toes. The metatarsal bones in the forefoot are the most frequently broken bones in the feet, either from injury or repetitive use. Stress fractures are an overuse injury resulting from increasing the amount or intensity of activity.

ANKLE
The ankle is often injured in sports or activities that require running and rapid shifts in direction. The most common injuries to the ankle are not usually serious, consisting primarily of twists, strains, and sprains. However, some are afflicted with more serious ailments. Due to the complexity of the structure of this joint, more serious ankle injuries often need longer and more involved treatments. The sections below offer summaries of common ankle problems.

Strains
One of the assets and vulnerabilities of the ankle joint is its wide range of motion. While this provides undeniable benefits to the body, it also exposes the joint to injury. A strain affects tendons and can occur from trauma or overuse in approximately equal measure. Runners, soccer players, and basketball players frequently strain an ankle. Strains can involve pain and swelling as well as limited use of the ankle. The strain can be treated, in most cases, by rest and immobilization of the ankle. Chronic strains can become an issue if not treated properly. Severe strains may warrant surgery to rectify completely.

Sprains
The ligament is the area of the ankle injured in a sprain and, in some cases, may tear partially or completely. Sprains most often occur with the “rolling” of an ankle, a “pop” sound is sometimes reported. The sprain will cause swelling, pain, lack of mobility, and—in more severe cases—inability to bear weight on the joint. More benign sprains can be healed at home by simple ice and rest. However, in the case of a severe sprain, especially in athletes, it’s important to consult a doctor to assess the extent of the damage.

Fractures
The ankle can fracture in any of the three main bones that compose the joint. This can be the result of impact or pressure on the weight-bearing areas of the joint. Minor ankle fractures can simply be casted and heal in a few weeks. Severe or complex fractures may require surgery to secure bones in their proper position with pins and plates to heal.

Achilles Tendinitis & Achilles Tendon Rupture (Tear)
The Achilles tendon is the largest tendon in the body. It connects your calf muscles to your heel bone and is used when you walk, run and jump. Although the Achilles tendon can withstand great stresses from running and jumping, it is also vulnerable to injury.

Achilles tendinitis is a common condition that occurs when the tendon becomes irritated and inflamed due to overuse or degeneration.

Achilles tendon rupture is more common in those with preexisting tendinitis of the Achilles tendon. A sudden and severe pain may be felt at the back of the ankle or calf — often described as “being hit by a rock or shot” or “like someone stepped onto the back of my ankle.” A sound of a loud pop or snap may be reported. A gap may be felt and seen in the tendon about 2 inches above the heel bone. Initial pain, swelling and stiffness may be followed by bruising and weakness. Standing on your tiptoes or pushing off when walking may be impossible. Interestingly, a complete tear is more common than a partial tear.

Athletes and people with a highly active lifestyle should be mindful of proper treatment. Repeated injuries to the ankle that are not properly treated can lead to a chronic issue over time. If serious ankle injury is suspected, it’s best to see a practitioner of sports medicine or an ankle specialist as soon as possible.