Foot & Ankle Conditions & Injury
Foot & ankle anatomy
The foot combines mechanical complexity and structural strength. It supports and balances our body’s weight while standing, as well as raising and moving the body in a forward and backward motion when walking. The ankle serves as foundation, shock absorber, and propulsion engine.
The ankle is a hinge-type, freely moving joint that consists of a capsule containing fluid which both nourishes and lubricates the joint making motion possible between the foot and the leg.
The foot and ankle contain:
- 26 small bones (one-quarter of the bones in the human body).
- 33 joints.
- more than 100 muscles, tendons and ligaments.
- a network of blood vessels, nerves, skin, and soft tissue.
These components work together to provide the body with support, balance, and mobility.
Parts of the foot
Structurally, the foot has three main parts: the forefoot, midfoot, and hindfoot.
The forefoot is composed of the five toes (called phalanges) and their connecting long bones (metatarsals). Each toe is made up of several small bones. The big toe has two phalanges, two joints and two tiny, round sesamoid bones that enable it to move up and down. The other four toes each have three bones and two joints. The phalanges are connected to the metatarsals by five metatarsal phalangeal joints at the ball of the foot.
The midfoot has five irregularly shaped tarsal bones, forms the foot’s arch, and serves as a shock absorber. The bones of the midfoot are connected to the forefoot and the hindfoot by muscles and the plantar fascia ligament.
The hindfoot is composed of three joints and links the midfoot to the ankle. The top of the talus is connected to the two long bones of the lower leg forming a hinge that allows the foot to move up and down. The heel bone is the largest bone in the foot. It joins the talus to form the subtalar joint, which enables the foot to rotate at the ankle.
Muscles, tendons and ligaments
A network of muscles, tendons, and ligaments supports the bones and joints in the foot.
There are 20 muscles in the foot that give the foot its shape by holding the bones in position and expand and contract to impart movement. The main muscles of the foot are:
- the anterior tibia, which enables the foot to move upward.
- the posterior tibia, which supports the arch.
- the peroneal tendon, which controls movement on the outside of the ankle.
- the extensors, which help the ankle raise the toes to initiate the act of stepping forward.
- the flexors, which help stabilize the toes against the ground.
Parts of the ankle
The ankle joint consists of the connection of the talus and the lower ends of the two leg bones (tibia and fibula). Multiple ligaments provide stability to the ankle joint.
The chief motions of the ankle are flexion and extension. Like synovial joints (those joints in which fluid is present) the ankle is subject to many diseases and injuries.
The foot is a complex mechanical structure that balances the weight of the body while providing support and mobility. Pain in the foot may only be a minor nuisance, but long-lasting or intense discomfort can be a sign of a serious condition or injury that requires treatment.
Common symptoms of foot pain include swelling, tenderness, and discomfort in and around the joints, toes, or heel.
Sudden (acute) injuries – such as ligament sprains, muscle strains, and bone fractures – can occur during sports activities or simply activities like walking on uneven surfaces. Occupations that require long periods of standing or walking can also cause stress to the structures in the foot, leading to painful conditions such as stress fractures, plantar fasciitis, arthritis, and tendonitis.
Footwear can also cause foot injury. For instance, wearing shoes that fit too tightly or have high heels can cause bunions, misalignment of the toes, or other foot pain. Additionally, some conditions like diabetes, arthritis, and bursitis can cause painful symptoms in the feet.
The ankle is a hard-working joint that connects the lower leg to the foot and supports the body’s weight. Ankle pain may be felt in any part of the complex system of ligaments, muscles, tendons, or bones that make up the ankle area. People experiencing ankle pain or who have an ankle injury may have swelling, stiffness, bruising, or tenderness in and around their ankle, or have difficulty walking.
While sports injuries are a common cause of ankle pain, it is possible to incur injury or pain with simple activities, such as stepping on an uneven surface. Pain in the ankle may be acute, or sudden, as in the case of an Achilles tendon rupture, that frequently occurs during sports activity like running, gymnastics, football, basketball, or tennis. Ankle pain can also develop over time from repetitive motions associated with sports, work, or everyday life, causing conditions like tendonitis or tarsal tunnel syndrome.
Common causes of foot & ankle pain treated at MOS:
Arthritis is painful inflammation and stiffness of the joints, which can be caused by many types of degenerative joint conditions. There are over 100 types of arthritis, including osteoarthritis, rheumatoid, gout, psoriatic, septic, post-traumatic, and lupus. Arthritis symptoms can include swelling, tenderness, sharp pain, stiffness, and sometimes fever and chills.
Achilles tendon injury or rupture
Achilles tendon injuries occur when the tendon that connects the calf muscle to the heel bone is overstretched, torn, or completely ruptured. Symptoms include pain above the heel and along the back of the foot (especially when pointing or flexing the foot), tenderness, swelling, bruising and stiffness.
Bone spurs (also known as osteophytes) are bony projections that develop on the surface of the bone, often at joints or on the spine. Bone spurs are often the result osteoarthritis. Bone spurs often do no cause symptoms, but can cause swelling, pain, and tearing to the surrounding tissue or tendon. Corns or calluses may also build up over time to provide padding in the area of the bone spur.
A bunion is an abnormal enlargement of the joint at the base of the big toe, characterized by a painful, bony bump. The affected toe is often curved outward, moving the bones of the feet out of alignment. Bunions are often caused by improper footwear, inherited foot structure, and foot injuries.
Bursitis is painful inflammation of the bursae, the fluid-filled sacs that reduce friction between bones, tendons, and muscles, caused by an injury, infection or other condition. Pain may be accompanied by swelling, tenderness or loss of movement.
Flat feet (also known as pes planus or fallen arches) is a condition in which the arch of the foot collapses, causing the entire sole of the foot to make contact with the ground.
A fracture is a break in a bone. Broken bone symptoms include pain (intensified when the area is moved or pressure is applied), swelling, bruising, and loss of function. Fractures may also cause the area around the bone to appear distorted or deformed, especially in open fractures where the bone protrudes from the skin.
A stress fracture is a hairline crack in a bone that can worsen during activity over time. Stress fracture symptoms include pain, which increases with activity and decreases after rest, in addition to swelling and tenderness.
A fractured heel bone (calcaneus) is a break in the heel bone, ranging from a crack to a shattered bone. Symptoms include inability to walk, bruising and/or swelling, and severe heel pain.
Ganglion cysts are fluid-filled, noncancerous tumors (cysts) that develop on the outside of a foot joint or tendon, as well as other parts of the body like the hands or knees. These cysts develop under the skin as small sacs filled with a clear, jelly-like substance that may feel spongy or firm to the touch, depending on size.
Hammertoe/mallet toe/claw toe
Hammertoe, claw toe, and mallet toe are deformity conditions that cause the shape of the toes to curve. Hammertoe affects the toe’s middle joint; claw toe affects the toe’s middle and end joints; mallet toe affects the toe’s end joint. These conditions are often caused by improper footwear, but can also be inherited or caused by diseases.
Heel pain & heel spurs
Heel pain is marked by discomfort when the heel bears weight, and is often caused by conditions associated with foot pain. Heel spurs – small, bony growths on the heel bone resulting from severe cases of plantar fasciitis (inflammation of foot tissue) – can also cause pain in the heel.
Metatarsalgia is inflammation in the ball of the foot, just behind the toes. Symptoms include sharp, burning, or aching pain in the ball of the foot and in the toes that gets worse with activity and better with rest. Metatarsalgia is also marked by the feeling of having a rock in your shoe, and can be caused by a shift in normal weight distribution, such as with heavy exercise or the development of another foot condition.
Morton’s neuroma is the thickening of the tissue around the nerve between the bases of the toes (usually between the third and fourth toes). Symptoms can include the feeling of a rock in your shoe, burning pain, or numbness. The exact cause of Morton’s neuroma is unclear, but may result from irritation or injury to foot nerves connecting to the toes.
Neuropathy (diabetic foot)
Diabetic neuropathy is damage to the nerves of the feet and legs, which significantly dulls or eliminates the ability to feel pain, heat, or cold. This is caused by complications from diabetes, particularly for people who have had diabetes for more than 25 years.
Osteochondral lesions are tears or fractures in the cartilage that covers the bones in a joint, commonly seen in the ankle or knee. In the ankle, osteochondral lesions usually occur over the bone connecting the leg to the foot (the talus). Lesions occur when the cartilage is torn, crushed or damaged, and a cyst may form within the damaged cartilage.
Plantar fasciitis is inflammation of the thick tissue on the bottom of the foot (called the plantar fascia), which is the tissue that connects the heel bone to the toes and creates the arch of the foot. The exact cause of plantar fasciitis is unknown, but may develop from repeated tears in the foot tissue, a result of repetitive activities, aging, or stress to the tissue.
Sesamoiditis (also known as turf toe) is inflammation of the tendons around the big toe. This often causes pain underneath the toe in the ball of the foot, and may also present swelling, bruising, and difficulty bending or straightening the big toe.
Sprains & strains
Sprains are stretched or torn ligaments – the fibrous bands of tissue in joints that connect bones. Sprains cause pain and swelling and are ranked by three degrees of severity: a slight ligament tear or stretch (first-degree), a partial or incomplete ligament tear (second-degree), or a complete ligament tear or rupture (third-degree).
A strain is a stretched or torn muscle or tendon. Strains cause pain and swelling and are ranked by three degrees of severity: a slight muscle or tendon tear/stretch (first-degree), a partial or incomplete muscle or tendon tear (second-degree), or a complete muscle or tendon tear/rupture (third-degree).
Tarsal tunnel syndrome
Tarsal tunnel syndrome is the loss of movement or sensation in the ankle and foot. This is caused by the tibial nerve, which stretches down the back of the leg to the inner ankle, becoming pinched.
Tendonitis (also known as tendinitis) is inflammation of the tendons – the thick, rope-like cords of tissue that connect muscle to bone. Tendonitis is caused by overuse (repetitive motion) or sudden injury. Tendonitis symptoms include pain in the tendon area, and sometimes loss of motion.