Our feet and ankles are constantly in use from the moment we step out of bed in the morning. They’re always supporting our entire body weight, getting us from place to place, and allowing us to walk, run and jump. With all of the stress we’re consistently putting on the foot and ankle, it’s easy to see why injuries are common.
Staying informed about these injuries can help you realize if the pain you’re dealing with is more serious than you thought. Learn more about the many muscles and bones that make up the foot and ankle, symptoms to be aware of, and recommended treatment methods.
Anatomy of the Foot and Ankle
About the Foot
In order to understand the injuries you may suffer from, it’s best to get an understanding of what makes up the foot and ankle. A fun fact about the foot is that almost one-fourth of the body’s bones are in our feet. That means a lot of movement and a lot of opportunity for injury.
The bones of the feet include the talus, calcaneus, tarsals, metatarsals, phalanges, and sesamoids. Joints are formed wherever two of these bones meet. Each toe has three joints, except the big toe, which has two joints.
Twenty muscles give the foot the ability to move while also providing support and stability. These include the tibialis posterior, tibialis anterior, peroneals, extensors, and flexors.
Tendons then attach the muscles to the bones, as well as ligaments that hold the bones together. The main tendon is the Achilles tendon, which runs from the calf muscles to the heel. The main ligaments include the plantar fascia, plantar calcaneonavicular ligament, and the calcaneocuboid ligament.
About the Ankle
According to the National Institutes of Health, the ankle is the most traumatized body part in sports injuries. Ankle injuries account for 10%-30% of all sports injuries. The ankle is actually two joints, though typically referred to as a single joint. The true ankle joint is made up of three bones: the tibia, the fibula, and the talus. The subtalar joint includes the talus and the calcaneus.
The ligaments in the ankle hold the bones together and include the tibiofibular ligaments, lateral collateral ligaments, and the deltoid ligament. The major tendons are the Achilles tendon, flexor tendons, peroneal tendons, tibialis posterior tendon, tibialis anterior tendon, and extensor tendons. The ligaments and tendons provide stability and range of motion to the ankle.
Foot and Ankle Injuries
A common source of foot and ankle pain is osteoarthritis. Osteoarthritis is a degenerative joint disease where the cartilage that cushions the ends of the joint wears away due to wear and tear. While osteoarthritis occurs gradually due the consistent use of the joint, injury can damage the cartilage directly or change how the ankle joint works leading to deterioration over time.
Post-traumatic arthritis develops in the foot as a result of an injury, such as a sprain, fracture, or dislocation, and can lead to premature deterioration of the joint. Seventy percent of arthritis in the foot and ankle is caused by a previous injury.
A physician will typically prescribe medication to reduce inflammation. Steroid injections are also administered to reduce inflammation and pain. Methods such as rest, ice, physical therapy, exercise, and bracing are also typically recommended.
Surgery becomes an option when nonoperative methods are ineffective.
There are small fluid-filled sacs in the foot and ankle called bursa that help reduce friction between tendons and between tendons and bone. This bursa can become inflamed, causing pain and the inability to comfortably move. Inflammation can occur from a direct blow, a fall, overuse or repeated stress, or an infection. Rheumatoid arthritis, osteoarthritis, or gout can also lead to bursitis.
Treatment for bursitis typically includes resting the ankle, ice, non-steroidal anti-inflammatory drugs such as ibuprofen, or corticosteroid injections to help reduce inflammation and relieve pain. If nonsurgical treatments do not relieve pain, surgery may be necessary.
A hammer toe is a deformity of the second, third, or fourth toe. The toe is bent at the middle joint, resembling a hammer. This condition forms due to an imbalance in the surrounding muscles, tendons, or ligaments that normally keep the toe straight.
Initially, hammer toes are flexible and can be corrected with simple measures but, if left untreated, they can become fixed in that position and require surgery.
Tendon and Ligament Injury
Tendons are the bands that connect the foot and ankle muscles to the bone. Ligaments support the joints. Both are critical in stabilizing the foot and ankle and in providing daily function. If you’re experiencing major pain, swelling, and loss of function, it’s possible you may have a tendon or ligament tear.
You’ll be instructed to stay off of the affected foot and may have to use a brace to stabilize it. Medication can also help reduce swelling, inflammation, and pain. If the tendon or ligament is completely torn, surgery may be required to reattach it if it cannot be treated conservatively.
Ankle instability occurs when the outside part of the ankle "gives out" when putting weight on it, especially when you're running or walking on uneven surfaces. This can result in an unstable or wobbly feeling when walking or even standing.
Ankle instability is also common in people who have been dealing with an injury that didn’t properly heal. In fact, about 20% of acute ankle sprain patients develop chronic ankle instability, according to the National Library of Medicine. Those who have suffered from past ankle injuries are likely to deal with ankle instability.
Physicians typically recommend bracing the ankle to keep it from turning and injuring it further. Physical therapy can also be effective in strengthening the ankle and improving range of motion. Surgery is sometimes considered to reconstruct the lateral ankle ligaments, creating a tighter band and thus greater support.