Foot & Ankle
The average person walks more than 100,000 miles in a lifetime. To walk this distance over the course of a lifetime a person’s feet must be strong and stable. With the constant impact of walking and running, it's not surprising that the feet and ankles are some of the most frequently injured areas of the human body. Ankle and foot pain are very common.
Why the Rothman Institute Foot & Ankle Team?
At some time in your life, you may experience heel, ankle or foot pain. Fortunately, over 95% of all ankle and foot pain will heal itself over time. This section provides information to help understand the basic anatomy of the foot and ankle and the fastest and most effective methods of reducing ankle and foot pain.
The center of the ankle is the bone called the talus. The talus bone has a large cartilage covering which allows the ankle to glide effortlessly across the cartilage of the large leg bone called the tibia. When these two bones meet they form the ankle joint. On the outside of the ankle is a smaller, thinner bone called the fibula. This bone helps prevent the tibia from shifting outward.
The stability of the ankle joint is dependent upon the ability of these bones to keep the central talus bone in place while the ankle moves back and forth. The joint is more stable when the foot is flat on the floor. However, when the toes are pointed down, the ankle becomes unstable because the distance between the bony stabilizers of the ankle becomes larger. Thus, the ankle relies more and more on the ligaments to provide stability. Since the ligaments are "softer" than bones, the ankle becomes more vulnerable to a sprain when the toes are pointed.
When an ankle twists, it is usually when the toes are pointed down. However, the ankle can be twisted while in any position. There are six major soft tissue structures that hold the ankle in place. Four of these are located on the outside part of the ankle and all attach to the fibula. Thus, all four of these ligaments have the word fibula in them. The most commonly injured ligament of the ankle is called the Anterior (meaning front) Talo-Fibular Ligament, or ATFL for short. This is the ligament that is most commonly torn in ankle sprains. The second most commonly torn ligament is the ligament connecting the heel bone to the fibula called the Calcaneo-Fibular Ligament. The third ligament again attaches the fibula to the back of talus called the Posterior (meaning back) Talo-Fibular Ligament. The fourth ligament connected to the fibula is the Tibiofibular Syndesmotic Ligament, which connects the fibula to the tibia. The soft tissue just in front of the ankle is the capsule of the ankle joint and helps keep the ankle from sliding forward along with the other ligaments. The final stabilizing ligament is on the inside part of the ankle. As this ligament forms a triangle shape like the Greek letter delta, it is called the Deltoid Ligament. The deltoid ligament attaches the inner tibia to the talus.
Sometimes the bones around the ankle can break. Most commonly it is the smaller outer bone called the fibula. However, with larger forces applied to the ankle, both the fibula and tibia can break. When the bones around the ankle break, they can cause severe instability and may even result in a dislocation of the ankle joint. In some cases, the ankle moves slightly out of joint called a subluxation. If a physician diagnoses a break or fracture, they may recommend surgery based upon the actual or potential dislocation of the ankle.
- Foot and Ankle Surgery
- Treatment of Elective and Traumatic Disorders of the Foot and Ankle
- Ankle Replacement
Ankle and foot pain is the most common symptom associated with plantar fasciitis (heel pain) and ankle sprains. The foot pain occurring with plantar fasciitis is usually sharp and occurs during the first few steps after sleeping or resting. This is because foot and heel tissue (fascia) contracts when at rest. When this contraction is stretched, pain develops. However, once the tissue (fascia) is stretched, the pain diminishes. Thus, the foot pain normally disappears after a few steps. The pain of an ankle sprain is usually very sharp and almost nauseating. Ankle sprains are also associated with swelling and bruising. The most common location of ankle sprain pain is on the outside (lateral) part of the ankle. Usually, the pain is decreased with time, rest, ice compression, and elevation. However, if the pain is extreme and continues for over 48 hours, one should see a physician.
Instability (Giving way)
A feeling of instability or giving way to the foot and/or ankle after one or multiple injuries may mean that ligaments are torn. Feelings of instability may be worse when walking on uneven surfaces such as grass or stairs. Some instability is normal after a minor sprain, especially in the early phases of recovery. People with recurrent (chronic) ankle sprains complain of instability on a long-term basis. If instability and foot pain continues, this should be reported to a physician.
Stiffness can occur with ankle sprains, arthritis, and plantar fasciitis. Usually, the stiffness occurs after resting the foot and ankle. The stiffness is usually temporary and will start to diminish with exercise, proper shoe wear, weight loss, and time. However, if stiffness continues despite simple efforts to treat this symptom, one should contact a physician.
Swelling is common after an injury, such as an ankle sprain. Sometimes, swelling can be severe and last a long time. People with recurrent ankle sprains can experience swelling that is mild. Sometimes, swelling can be caused by problems not related to the ankles at all, such as heart problems or blood clots further up the legs. For this reason, your doctor should evaluate persistent swelling.
Popping of the ankle or feet without any associated ankle or foot pain is usually normal. The cracking you hear when moving around quietly in the morning is just the snapping and stretching of the tissue lining the joints. However, if a tendon is snapping over one of your ankle bones when making quick motions or descending stairs, this may indicate a condition called subluxation or dislocation of the tendons. A subluxation is when tendons jump out of their normal position and then move back. A dislocation is when these tendons move out and may have to actually be pushed back into place. A patient may also experience pain, and instability of the ankle. Some people with chronic ankle sprains complain of popping in their ankles. If these symptoms are present, please contact a physician.
A feeling of pins and needles around the foot and ankle may indicate a disease with the nerves. Such problems can be related to diabetes, vascular disease or physical compression of the nerves. The compression of nerves may be located in different areas of the body, including the spine. Numbness on the outside or top of the foot may be due to the compression of a nerve in the lower back or around the knee. Numbness on the inside or bottom of the foot can be due to a compression of the nerve around the inside of the ankle. This is due to compression of the nerve traveling through an area of fibrous tissue called the tarsal tunnel. This is very similar to carpal tunnel syndrome in the wrist. If there is severe swelling in the leg, ankle or foot, this can cause serious damage to all of the surrounding tissue including the nerves. If you are experiencing foot pain, tightness, or swelling, see an ankle doctor immediately. Also, you experience numbness that is not improving, see a physician for a proper diagnosis and treatment.
- Musculoskeletal Podiatry
- Preventative and Maintenance Foot Care in Diabetics and Elderly Patients
- Rehabilitation of the Foot and Ankle
- Sports Medicine
- Fracture Care
- Occupational Medicine
Tips for Healthy Feet
- Don’t ignore foot pain, it isn’t normal. If pain persists, see a physician.
- Inspect your feet regularly. Note changes in color and temperature, thickness or discoloration of nails, and cracks or cuts in the skin. Peeling or scaling on the soles could indicate athlete’s foot. Any growth on the foot is not considered normal.
- Wash your feet regularly, especially between the toes. Be sure to dry them completely.
- Trim toenails straight across, but not too short. Be careful not to cut nails in corners or on the sides; it can lead to ingrown toenails. People with diabetes, poor circulation, or heart problems are more prone to infection and should not treat their own feet.
- Make sure that your shoes fit properly. Replace worn-out shoes as soon as possible, and try on new shoes later in the day when feet tend to be at their largest.
- Select and wear the right shoe for your activity, in other words, running shoes for running.
- Don’t wear the same pair of shoes every day, but rather alternate them.
- Avoid walking barefoot. Your feet are more prone to injury and infection when walking barefoot. When at the beach or wearing sandals, remember to use sunscreen on your feet as well as the rest of your body.
- Use home remedies cautiously. Self-treatment often turns a minor injury into a major foot problem. If you have diabetes, it is essential that you see a musculoskeletal podiatric physician at least once a year for a thorough check-up.