Foot and Ankle Anatomy
The foot and ankle is a complex joint involved in movement and providing stability and balance to the body. The foot and ankle consists of 26 bones, 33 joints, and many muscles, tendons and ligaments.
The ankle joint connects the leg with the foot, and is composed of three bones: tibia, fibula and talus. The tibia or shin bone and fibula or calf bone are bones of the lower leg which articulate with the talus or ankle bone, enabling up and down movement of the foot.
A sprain is the stretching or tearing of ligaments, which connect adjacent bones and provide stability to a joint. An ankle sprain is a common injury that occurs when you suddenly fall or twist the joint or when you land your foot in an awkward position after a jump. Most commonly it occurs when you participate in sports or when you jump or run on a surface that is irregular. Ankle sprains can cause pain, swelling, tenderness, bruising, stiffness, and inability to walk or bear weight on the ankle.
Achilles Tendon Rupture
Achilles tendon is a strong fibrous cord present behind the ankle that connects the calf muscles to the heel bone. It is used when you walk, run and jump. The Achilles tendon ruptures most often in athletes participating in sports that involve running, pivoting and jumping. Recreational sports that may cause Achilles rupture include tennis, football, basketball and gymnastics.
Plantar fasciitis refers to inflammation of the plantar fascia, a thick band of tissue that lies at the bottom of the foot. It runs from the heel bone to the toe and forms the arch of your foot. Plantar fasciitis is one of the most common causes of heel pain. It is most often seen in middle-aged men and women, but may also occur in those who are constantly on their feet such as soldiers.
The ankle joint is composed of three bones: the tibia, fibula, and talus which are articulated together. The ends of the fibula and tibia (lower leg bones) form the inner and outer malleolus, which are the bony protrusions of the ankle joint that you can feel and see on either side of the ankle. The joint is protected by a fibrous membrane called a joint capsule, and filled with synovial fluid to enable smooth movement.
Ankle instability is a chronic condition characterized by a recurrent slipping of the outer side of the ankle. It usually results from repeated ankle sprains. It is generally noticed during movement of the ankle joint but can also occur during standing as well.
Nail Bed Injuries
The nail is composed of a nail plate, nail matrix and nail bed. The nail bed is the soft tissue that lies below the nail and is essential for the growth of the nail. Nail bed injuries such as crush and avulsion injuries are commonly associated with injuries to the hands or fingertips.
Osteochondral Injuries of the Ankle
The ankle joint is an articulation of the end of the tibia and fibula (shin bones) with the talus (heel bone). Osteochondral injuries, also called osteochondritis dissecans, are injuries to the talus bone, characterized by damage to the bone as well as the cartilage covering it. Sometimes the lower end of the tibia or shin bone may also be affected.
Stress Fracture of the Foot
A stress fracture is a small crack in the bone which occurs from overuse injury. It commonly develops in the weight-bearing bones of the lower leg and foot. When the muscles of the foot are overworked, or stressed, they are unable to absorb the stress and transfer it onto the bone, which cracks under the pressure.
Shin splints or medial tibial stress syndrome (MTSS) is pain around the tibia or shin bone due to inflammation of the tendons, muscles and bone tissue. It occurs because of vigorous physical activity such as with exercise or sports.
Common causes of shin splints are over use from repetitive sports activities or a sudden change in the level of physical activity. Flat feet or rigid foot arches and the use of inappropriate or worn-out footwear while exercising may increase your risk of developing shin splints. Runners, military recruits and dancers are at a higher risk of developing shin splints.
The calcaneus or heel bone is a large bone found at the rear of the foot. A fracture is a break in a bone from trauma or various disease conditions. The types of fracture to the calcaneus depend on the severity and include stable fractures, displaced fractures, open fractures, closed fractures and comminuted fractures.
A fracture of the calcaneus is most commonly due to a traumatic event such as falling from a height, twisting injuries, motor vehicle accidents and ankle sprains. The commonly seen signs and symptoms of calcaneal fractures include pain, swelling, bruising and inability to walk or bear weight on the foot.
Lisfranc (Midfoot) Fracture
The Lisfranc joint or tarsometatarsal joint refers to the region in the middle of the foot. It is a junction between the tarsal bones (seven bones in the foot arch) and metatarsal bones (five long bones in the foot). Lisfranc fracture scan occur due to a fall from a height or traumatic motor accidents.
The talus is a small bone at the ankle joint that connects the heel bone and the shin bones, enabling the up and down movement of the foot. Fractures in the talus bone may occur due to a fall from great heights, motor vehicle accidents or sports injuries. Symptoms include severe ankle pain, inability to walk, swelling and tenderness.
Toe and Forefoot Fractures
The forefoot is the front of the foot that includes the toes. Fractures occurring in this part of the foot are painful, but very often not disabling. There are 2 types of fractures namely, traumatic fracture and stress fracture. Traumatic fractures occur when there is a direct impact of your foot on a hard surface. Stress fractures are tiny hairline cracks in the bone, most commonly caused due to repeated stress. The common symptoms of toe and forefoot fractures include pain, bruising, swelling and inability to walk.
Turf toe is an injury to the ligament at the base of the big toe. It is a painful condition which usually results from jamming of the toe into the ground or excessive backward bending of the toe. As it is more common in athletes playing on artificial turf, especially those involved in field sports such as football, baseball and soccer, it is known as turf toe.
The hind foot is separated from the midfoot by the medio tarsal joint and the midfoot is separated from the forefoot by the lisfranc joint. Muscles, tendons and ligaments support the bones and joints of the feet enabling them to withstand the entire body’s weight while walking, running and jumping. Despite this, trauma and stress can cause fractures in the foot. Extreme force is required to fracture the bones in the hind foot. The most common type of foot fracture is a stress fracture, which occurs when repeated activities produce small cracks in the bones.
Foot and Ankle Trauma
Foot and ankle trauma refers to the injuries that most commonly occur during sports, exercise or any other physical activity. Trauma may be a result of accidents, poor training practices or use of improper gear. Injuries may also be caused when an individual is not medically fit or because of insufficient warm up and stretching exercises.
Ankle Ligament Injury
Ankle ligament injury, also known as ankle sprain, can be caused by a sudden twisting movement of the foot during any athletic event or during daily activities. It is one of the most common orthopaedic injuries and can also be caused by walking down a slope or over any uneven surface. The injury can range from mild to severe, depending on the condition of the injured ligament and the number of ligaments involved.
Osteochondral injuries are one of the most common causes of ankle pain. Though in most cases there is a history of injury or trauma to the ankle joint, a few cases may not have any previous history of ankle injury. A condition known as osteochondritis dissecans is commonly seen in the knee and ankle joint and is characterized by the damage and separation of a piece of bone and cartilage, within the joint, from the underlying bone. In the ankle joint, it mainly affects the talus bone and sometimes the lower end of the tibia or shin bone may also be affected.
Foot and Ankle Osteoarthritis
Arthritis is inflammation resulting from the degeneration of cartilage in the joint causing pain, swelling, and stiffness in the joints resulting in restricted movements. Arthritis of the foot and ankle joint can occur due to fracture, dislocation, inflammatory disease, or congenital deformity.
Achilles Tendon Bursitis
Achilles tendon bursitis or retrocalcaneal bursitis is a condition that commonly occurs in athletes. It is a painful condition caused by swelling of bursa, a fluid-filled sac which is located at the back of the heel under the Achilles tendon. This retrocalcaneal bursa contains a lubricating fluid that acts as a cushion to reduce friction between muscle and bones. Achilles tendon is the large tendon that connects the calf muscles to the heel bone (calcaneous) and is used when you walk, run, and jump.
A bunion is a bony protuberance that appears on the external surface of the big toe when it angles toward the adjacent toe. It is an extra bone and a fluid-filled sac that grows at the base of the big toe.
Bunions are common in women and tend to run in families (heredity). The major cause of bunions is prolonged wearing of ill-fitting shoes like tight, narrow, and high-heeled shoes which compress the toes and exerts excessive pressure while walking. The condition gets worsen and more painful as the bump grows bigger in size. Certain conditions such as rheumatoid arthritis and gout may also cause bunions.
Athlete's foot also known as tinea pedis, is a fungal infection on the skin of the foot. It is characterized by itchy, moist, white, scaly lesions between the toes that can spread to the sole of the foot. Athlete’s foot is contagious and spreads through contact with infected skin scales or fungi in moist areas such as swimming pools and bathrooms, or from sharing shoes of an infected person or having contact with pets carrying the fungi. It is a chronic infection that can recur after treatment.
Forefoot pain, also referred to as metatarsalgia, is a type of pain that occurs in the ball of the foot (around the tip of the metatarsal bones). Generally, forefoot pain is associated with aging. Individuals with metatarsalgia experience pain of varied intensity and discomfort and find difficulty in activities like walking, running, playing, and several others.
In toeing also called “pigeon-toed”, is an abnormal condition characterized by inward facing of the toe or feet instead of being straight. Parents may observe their children having intoeing at an early age when they start walking. But usually intoeing corrects itself without any specific treatment as the child grows up to around 8 years of age.
Morton’s neuroma refers to a nerve injury between the toes, usually the third and fourth toes, which causes pain and thickening of the nerve tissue. Compression or chronic irritation of this interdigital nerve is the main cause of Morton’s Neuroma. Excess pressure is exerted on the nerves due to narrowing of the gap between the toe bones causing thickening of the nerve tissue from scar tissue formation. This causes swelling of the nerve and the surrounding tissue.
Foot pain occurs from distress induced by certain factors in the foot. Foot pain is a common problem experienced by young athletes involved in different activities such as running and jumping.
The foot is composed of different structures including bones, ligaments, tendons, and muscles. As feet bear the weight of our body, they are more prone to injury and pain. Normally foot pain can be treated through home treatments and may take time to heal. However, in cases of severe injury, adequate evaluation and treatment is required.
Flatfoot, also known as “fallen arches” or Pes planus, is a deformity in children’s feet in which the arch that runs lengthwise along the sole of the foot has collapsed to the ground or not formed at all. Flatfoot is normal in the first few years of life as the arch of the foot usually develops between the age of 3 and 5 years. Flatfoot can be rigid or flexible. Flexible flatfoot usually resolves without any treatment needed unless pain is involved.
Foot drop also known as drop foot, is a sign of an underlying muscular, neurological or anatomical condition, where you are unable to lift the front part of your foot, resulting in foot dragging. To avoid dragging your foot, you may lift your knee higher than usual as if you were climbing stairs or swing your leg in a wide arc, causing you to slap your foot on the ground every time you step forward. Foot drop may also produce numbness. It can affect one or both feet and may be temporary or permanent.
A hammertoe is a deformity of a lesser toe (second through fifth toes), where the toe gets bent upward at the toe’s middle joint, resembling a hammer. The bent portion may rub against a shoe causing pain, irritation and development of corns. It is caused by wearing shoes that are too tight or narrow near the toes, when the second toe is larger than the first, and as a complication of arthritis and certain neuromuscular conditions.
Mallet finger is a condition where the end of the finger is bent and does not straighten. It occurs when the extensor tendon on the back of the finger is damaged. The finger joint is a hinge-joint that allows bending and straightening of the fingers. Each finger is composed of 3 phalanges bones, joined by 2 interphalangeal joints (IP joints). The joint near the base of the finger is called the proximal IP joint or PIP joint, and the joint near the tip of the finger is called the distal IP joint or DIP joint.
Limb deformities can be congenital (present at birth) or develop at a later stage because of fracture, infection, arthritis or tumor. Congenital deformities of the lower limbs are developmental disorders that cause alterations in the shape and appearance of the legs. Several factors including genetics influence the fetal growth in the womb, and exposure to teratogenic drugs and chemicals can increase the risk of congenital deformities.
An ingrown toenail is a common and painful condition of the toe. It occurs when the sides or corner of the nail grow inwards and penetrates the skin of the toe. Pain is often accompanied by swelling and redness. The big toe is affected most often.
The heel is made up of the calcaneus bone and supported by a network of muscles, tendons, ligaments and soft tissues, which together support the weight of the body and stress during movement. Heel pain is a common symptom of excessive strain placed on these structures.
Platelet Rich Plasma Therapy
Our blood consists of a liquid component known as plasma. It also consists of three main solid components which include the red blood cells (RBCs), white blood cells (WBCs), and platelets. Platelets play an important role in forming blood clots. They also consist of special proteins, known as growth factors, which help with our body’s healing process. Platelet-rich plasma or PRP is a high concentration of platelets and plasma. A normal blood specimen contains only 6% platelets, while platelet-rich plasma contains 94% of platelets and 5 to 10 times the concentration of growth factors found in normal blood, thus greater healing properties.
Feet support your body weight, help maintain proper posture and help in movement. As the feet bear the entire weight of the body and are involved in most activities, they are more prone to problems such as calluses, corns, cracks, infections and traumatic injuries. To maintain good health of your feet, you should always wear comfortable, good quality and proper fitting footwear. Specially-designed shoe inserts, called orthotics, help in alignment and stabilization of the feet and can also reduce foot pain.
Foot Activity and Exercise Guide
A foot injury or foot surgery may leave you immobile for a period. To return to your regular activities and more strenuous recreational activities, it is necessary for you to follow a well-planned activity and exercise program.
A bunion, also known as hallux valgus, is bony prominence at the base of the big toe, which often results in pain, redness and rubbing in footwear. The 1st metatarsal bone abnormally angles outward towards the other foot from its joint in the midfoot. A bunion can change the shape of your foot, make it difficult for you to find shoes that fit correctly and worsen the symptoms if left untreated.
Foot reconstruction is a surgery performed to correct the structures of the foot and restore the natural functionality of the foot that has been lost due to injury or illness. Ideally, any foot surgery for reconstruction is done to improve the appearance and function of the foot so that patients can maintain their quality of life.
Treatment of Foot and Ankle Sports Injuries
Injuries during sports are common. They can result from accidents, inadequate training, improper use of protective devices, or insufficient stretching or warm-up exercises. Injuries to the foot and ankle are common while playing sports such as football, hockey, skating and in weekend athletes. Common sports injuries include sprains and strains, ankle fractures, and Achilles tendinitis.
Ankle Ligament Reconstruction
A sprain is stretching or tearing of a ligament. Ligaments connect adjacent bones in a joint and provide stability to the joint.
An ankle sprain is a common injury and occurs when you fall or suddenly twist the ankle joint or when you land your foot in an awkward position after a jump. It most commonly occurs when you participate in sports or when you jump or run on a surface that is irregular.