Orthopedic Care for Ankle & Foot Pain

Anatomy of the Ankle and Foot

The ankle is the connecting area between your foot and lower leg that allows your foot to move up and down and side to side. It consists of two distinct joints known as the true ankle joint and the subtalar joint. The true ankle joint connects three bones:

• The tibia, also known as the shin bone
• The fibula, a weight-bearing bone located next to the tibia that runs along the outside of the lower leg
• ​​The talus, a small bone between the lower leg bones and the calcaneus (heel bone)

The subtalar joint consists of the talus and the calcaneus.

The bases of the tibia and fibula form protruding bumps that can be felt and seen on the ankle. The protrusions located on the inside and back of the ankle are formed by the tibia and are known as the medial malleolus and posterior malleolus, respectively. The protrusion on the outer part of the ankle, known as the lateral malleolus, is formed by the base of the fibula.

The foot is a highly complex structure that consists of about 26 bones and 30 joints, which provide the foot with the flexibility it needs to articulate dynamic movement. The bones of the foot are categorized into three different groups: the forefoot, the midfoot, and the hindfoot. The forefoot consists of:

• The phalanges: the bones that make up the toes; four out of five toes have three phalanges each, while the big toe consists of two, for a total of 14 phalanges in each foot
• The metatarsals: five long bones that connect the toes to the rest of the foot
• Sesamoid bones: two bones that are embedded within tendons located in the ball of the foot

The midfoot consists of five tarsal bones known as the cuneiforms (medial, intermediate, and lateral), the navicular, and the cuboid. These irregularly-shaped bones form the arch of the foot, which provides stability and weight-bearing support for bipedal movement. They also play an important role in the foot’s various movements. The navicular and cuboid bones connect directly with the hindfoot, which consists of only two large bones: the talus and the calcaneus.

Muscles of the Ankle and Foot

Muscles are tissue that allows your ankles and feet to move while also providing support. The primary muscles that control ankle and foot movement are:

• The gastrocnemius and soleus muscles: together, these muscles form the calf muscle located in the back of the lower leg that make it possible for you to flex your feet, propel forward, stand on your toes, walk, run, and jump
• The posterior tibialis muscle: a stabilizing muscle located deep in the lower leg that provides support for the foot’s arch
• The anterior tibialis muscle: a muscle that runs along the tibia and the bones of the foot; the anterior tibialis makes it possible for you to turn your ankle and foot upward
• The peroneal muscles (peroneus longus and peroneus brevis): located on the outer edge of the lower leg and connected to the foot, these muscles allow you to move your foot down and out
• Extensor muscles: these muscles control the ability to raise the toes and take a step forward
• Flexor muscles: these muscles allow you to curl and flex your toes

Ligaments and Tendons of the Ankle and Foot

The ankle and foot rely on many ligaments and tendons for support and strength. Ligaments are tough bands of tissue that connect bones or cartilage. The primary ligaments of the ankle and foot are:

• The anterior talofibular ligament, which connects the front of the talus to the fibula
• The anterior inferior tibiofibular ligament, which connects the fibula to the tibia
• The calcaneofibular ligament, which connects the heel bone to the fibula
• The posterior talofibular ligament, which connects the back of the talus to the fibula
• The posterior inferior tibiofibular ligament, which connects the tibia to the fibula along the back
• The transverse ligament, a round ligament that connects the back of the tibia to the posterior tibiofibular ligament
• The deltoid ligament, which provides support to the inner part of the ankle
• The interosseous ligament, which runs along the fibula and tibia from knee to ankle
• The plantar fascia, which runs along the entire length of the foot from the heel to the toes to create the arch of the foot
• The plantar calcaneonavicular ligament, which connects the heel bone to the navicular bone in the hindfoot to provide support for the talus
• The calcaneocuboid ligament, which connects the heel bone to the tarsal bones in the midfoot, providing support for the arch

Similar to ligaments, tendons are also tough bands of connective tissue, but they connect bones to muscle. In the ankle and foot, the main tendons are:

• The Achilles tendon, which connects the calf muscle to the heel, making it possible for you to jump, run, and more
• The posterior tibial tendon, which connects the calf muscle to the bones of the interior side of the foot
• The anterior tibial tendon, which connects the tibia to the muscles in the toes and foot

Ankle and Foot Pain FAQ

• Q: Why does my ankle and/or foot hurt if I didn’t injure it?

  A: Although injuries are a common cause of pain for ankles and feet, pain can also be caused by overuse and stress. The ankle and foot are both responsible for some of the most dynamic movements of the human body and must also bear our weight, making it all too easy for one of its many parts to experience strain or irritation. Ankle and foot pain is also commonly caused by conditions such as osteoarthritis and rheumatoid arthritis.

• Q: When should I see a doctor for ankle and/or foot pain?

  A: In many cases, ankle and foot pain may not be a cause for concern and can be cared for at home. However, if your pain is very severe or you’re experiencing swelling, you should seek medical attention from an orthopedist who specializes in ankle and foot pain. This is especially true if the swelling has lasted longer than a few days and/or the pain has lasted longer than several weeks. If you are unable to put any weight on your foot, you should schedule an appointment immediately.

• Q: Should I see an orthopedic specialist for ankle and foot pain?

  A: The two types of doctors that specialize in ankle and foot pain are known as orthopedists and podiatrists. Podiatrists focus only on the ankle and the foot, whereas orthopedic doctors provide care for musculoskeletal and structural issues for the entire body, including the ankles and feet. Because orthopedic doctors provide care for specific parts of the body as well as the body as a whole, they can provide insight into other possible orthopedic problems that may be contributing to ankle and foot pain.

• Q: How can I relieve ankle and foot pain at home?

  A: In some cases, you may be able to relieve ankle and foot pain with at-home self-care. One of the most popular and easy-to-remember forms of self-care for ankle and feet pain is RICE therapy, which stands for Rest, Ice, Compression, and Elevation. You can also use over-the-counter pain relievers such as ibuprofen, naproxen, or acetaminophen. However, if your pain doesn’t go away and gets worse, it’s important to schedule an appointment with an orthopedic ankle and foot specialist as soon as possible.

Ankle and Foot Pain: Sprains, Tears, and Fractures

Because the ankle and foot are so complex and involve many structural parts, there are a wide variety of reasons why you might be experiencing pain anywhere in the ankle and/or foot.

One of the most common causes of ankle pain is a sprain, which is a very common injury that occurs from rolling, twisting, or awkwardly turning your ankle. Sprained ankles can happen to anyone at any age, and are commonly caused by exercising, playing sports, or even taking an irregular step. Another common ankle injury is Achilles tendonitis, which occurs when the Achilles tendon is overworked, strained, and inflamed. If the Achilles tendon becomes severely overstretched, it can tear, which is known as an Achilles rupture.

The bones that comprise the foot and the ankle joint are also vulnerable to stress fractures, which is when tiny cracks form in the bones, usually caused by overuse and repetitive activity. If left untreated, these small cracks can eventually turn into complete breaks.