Anatomy, Pathology and Treatment of the Foot & Ankle

Anatomy

The foot & ankle is made up of multiple joints and the foot alone consists of 26 bones and 30 major joints. Over a quarter of all the bones in the body are found in the feet. Each foot takes approximately 1.5 times your body weight when walking and up to five times body weight when running.

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What causes Foot and Ankle pain?

Injuries in this region are common, especially with popular activities such as walking and a wide variety of sports. Soft tissue injuries can affect the tendons (achilles), ligaments (sprain) and muscles. With the complex anatomy in this region, bony and joint injuries are common too. Pain can be a result of degenerative problems such as osteoarthritis, or overuse injuries such as stress fractures.

Common Pathology of the Foot & Ankle

Achilles tendinopathy

Achilles tendinopathy is an overloading problem of your achilles tendon. This is the thick band at the back of your leg connecting your calf to your heel. Its main job is to help you push off onto your toes when walking and running. Unfortunately, it is a very common running injury and is quite well known.

See our in-depth article about this condition here.

Exercises that address biomechanics, tendon loading and flexibility can be extremely helpful in recovery. The White House physiotherapists often use shockwave as an effective evidence based treatment option as well.

Ankle ligament sprain

A ligament injury is often acute in nature, with a specific and known incident which causes it. They are most common in the ATFL (anterior talo fibular ligament) and CFL (calcaneofibular ligament), on the outside of the ankle. They often occur when you roll your ankle, especially on an uneven surface, and more so when you are not used to it. Wearing inappropriate footwear can increase the risk of this injury. This type of injury is graded according to how severely the ligament has been damaged from Grade 1 (mild) to Grade 3 (total rupture). It is often accompanied by pain, swelling and bruising in the injured area.

If you are unfortunate enough to suffer a sprained ankle it is advisable to get it assessed and treated as soon as possible. If there is significant pain and you are struggling to walk on the leg, you may require an x-ray, to help rule out any damage to the bone. Repeated strains to the same ligament may lead to a chronic loss of stability. Professional medical advice is recommended to discuss management and a rehabilitation plan.

Plantarfascitis

Platarfascitis is the most common condition to affect the heel and sole of the foot. The structure itself is he thick band of fibrous tissue that extends from the heel to the toes. It plays an important part in the biomechanics of the foot, especially as a shock absorber to protect the foot and support the arch.

In the early stages you may feel a sharp pain on the inside of the heel, have a feeling of standing on a stone in the morning and feel that the pain wears off after a few steps and improves in the day. The problem can persist and gradually worsen, in which case it won’t ease up after a few steps and it will become more painful throughout the course of the day. It can then have a more significant impact on daily function and participation in activity.

Injury is usually a result of overuse, especially in walking and sports involving a lot of running. The average length of time this condition lasts for is 6-months, therefore early intervention is critical in order to help manage it effectively.

Stress fracture

A stress fracture in the foot can occur in a number of different bones – the calcaneus (heel bone), fibula (thin bone on the outside of the leg), talus, navicular or metatarsals (the smaller bones in the foot). The most common sign of a stress fracture is pain in the local area that occurs with exercise and activity and eases with rest. Stress fractures are difficult to diagnose in the early stages, as there may be minimal findings on X-ray. A bone scan or MRI may be necessary.

OA

Osteoarthritis of the ankle is less common than in the hip or knees, but it can still become a debilitating condition. Osteoarthritis is a progressive degeneration of the joint as the cartilage surfaces wear away as we age. If this occurs at a significant rate, pain and stiffness can be the result. This can greatly affect a patient’s lifestyle. A degenerative condition such as this can still be treated ti improve movement and function and reduce pain. Physiotherapy treatment can include manual therapy, exercise, lifestyle advice and acupuncture.

Bunions

Bunions occur in the big toe when it moves in towards the other toes and becomes more prominent. The altered position of the joint forms a lump. You are at a higher risk of injury if you regularly wear high heels or tight shoes, your parents or older siblings have the issue, or when you look at your feet you notice that one big toe is slightly more rotated than the other one.

Bunions are known medically as hallux valgus and can affect your biomechanics and lead to pain. If they become severe enough they may require surgical intervention to help realign. If treated early enough with exercises to improve biomechanics and orthotics, the progression can be significantly slowed. Early identification and management is therefore highly important.

Treatment

The White House Clinic is much more than just a regular physiotherapy clinic. We have the ability to facilitate any intervention that is needed to help manage and rehabilitate any type of foot or ankle injury. The information below outlines all of the services available at the clinic.

Physiotherapy assessment and treatment

We have a group of highly experienced physiotherapists who will be able to provide a thorough assessment and diagnosis of your foot or ankle issue. Following this they will be able to provide you with the most evidence-based treatment to ensure improvement and hopefully resolution of your symptoms. We have a foot and ankle specialist physiotherapist who is able to assess, advise and treat more complex issues as well.

In the case where further investigations or treatment is required, they have the knowledge base and contacts to make sure the appropriate onward referrals are made with minimal waiting times.

Gym and rehabilitation facilities

Several of our clinics are equipped with both a gym and a studio. These have modern equipment enabling our physiotherapists to have the best facilities to provide your rehabilitation. We have access to cross trainers, which can help in the graded return to running, as well as weights, gym steps, wobbleboards and gym balls, which may all play an important part in rehabilitation of a foot and ankle injury.

Rapid access to investigative and scanning facilities

If you require further investigation such as an x-ray or MRI scan, we have the clinical pathways to refer you quickly. Many foot and ankle issues can be assessed with an ultrasound scan which we are able to perform in house with no waiting list.

Further information can be found here.

Corticosteroid injections

In certain situations, an anti-inflammatory, pain relieving injection known as a corticosteroid injection is used in the management of foot and ankle pain. We are able to provide these injections on site.

Direct referral links to the top orthopaedic specialists in the area

We have long-standing professional relationships with the top orthopaedic specialists in the area so in the scenario where an orthopaedic referral, possibly leading to surgery, is required we are able to refer swiftly and directly.

Pre-operative and Post-operative rehabilitation

We have a vast amount of experience in dealing with patients before and after foot and ankle surgery with many of the local hospitals referring a large variety of surgical cases to us.

Prior to surgery it is best practice to optimise the range of movement and strength of the local joints and lower limb, which will allow for a quicker recovery after surgery

After surgery there is a surgical protocol that is followed. Our physiotherapists will be able to guide you through this protocol to ensure optimal recovery is achieved.

Summary

At the White House Clinic we are able to help you with any form of foot or ankle issue at any stage of the process to recovery.

The foot and ankle area can be a source of pain and decreased function for many people however there is almost never a situation where you ‘just have to live with it’.

If you have any questions about your foot or ankle, or any of the services that we provide then get it contact with us today and we will be happy to help.

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