Sports Medicine and Wellness
Foot & Ankle
Structures of the foot comprise a highly integrated group of 26 bones, with numerous muscles, tendons, and ligaments holding the bony structures together in proper alignment and providing support for balance and movement.
The ankle is formed by the juncture of three bones – the lower ends of the tibia and fibula (the lower leg) and the uppermost bone of the foot, called the talus. The uniquely curved dome of the talus bone permits the hinge-like movement of the foot.
Beneath the ankle joint are additional tarsal bones, which form the lower portion of the heel and its connection to the metatarsal bones of the foot. The Achilles’ tendon joins the heel to the muscles of the calf.
The metatarsal bones form a portion of the arch, or instep, of the foot and connect to the phalanges, or toe bones, at the “ball” of the foot. A broad sheath of tendons called the plantar fascia supports and cushions the foot and heel. A thick layer of fatty tissue between the skin and the underside of the foot and ankle provides additional cushioning from the stresses of weight bearing and joint movement.
Common Problems of the Foot and Ankle
- Hammer Toe
- Flat Foot
- Sprains, Strains, Dislocations and Fractures
- Heel Spurs
- Morton’s Neuroma
- Foot Ganglion
A bunion is a deformity of the big toe in which a firm pad filled with fluid forms on the side of the foot at the base of the toe. The big toe bends toward the second toe, sometimes overlapping it, causing the base of the big toe to protrude beyond the normal alignment of the foot. The resulting bump at the base of the big toe is called a bunion. Because the bunion is constantly being rubbed, the skin becomes thick. Wearing tight shoes with pointed toes and high heels is most often the cause of bunions, however heredity may also be a factor.
Treatment for bunions is basically focused on finding shoes that fit right with plenty of room in the toes. These are called wide toe box shoes. Surgery is generally not necessary, but may be considered when the bunion causes pain or disability.
Hammer toe is a condition in which the toe bends upward like a claw and becomes rigidly fixed in the bent position. It often affects the second toe, but may affect several toes. Additionally, a small area of thickened skin may develop on the top of the affected toe due to pressure placed on it from the shoe. Hammer toe may be caused by wearing shoes that do not fit properly. The condition also occurs in people with muscle and nerve damage.
Often, if pain is not a problem, there is no treatment necessary to correct hammer toe. A felt pad may be used to protect the joint from the shoe and can help ease some of the discomfort. However, surgical treatment may be considered to correct the toe by straightening it out and causing it to become rigid in the new, straightened position.
A flat foot, where the arch of the foot is dropped, is usually considered a variation of normal. Sometimes in children, there may be an abnormality in the separation of the bones as they form in the foot. There may be a connection between some of the bones of the foot that should not be there. This often causes a stiff flat foot. In general, children have flat feet until they are approximately five years old. If the foot remains flat into adulthood and it is not very stiff, this is probably the result of genetics. Older adults may experience “fallen arch syndrome,” a situation where muscles and tendons that support the arch stop working and cause the arch to collapse.
Treatment for flat foot may involve special shoes, arch supports, and exercises to strengthen ligaments and muscles. There are surgical treatments that can be accomplished if foot support is unsuccessful in alleviating the pain associated with acquired flat foot or fallen arch. Surgeries are quite extensive and require prolonged casting, but can be quite successful in helping the pain. Most people will respond to a non-operative treatment program.
Sprains, strains, dislocations, and fractures are all common injuries to the ankle and foot. Sprains involve injury to one or more of the ligaments in the foot or ankle, and strains involve injury to muscles or tendons. A fracture means the bone in the foot or ankle has been broken. Dislocations of the ankle and foot indicate one of the joints is out of place and no longer fits together properly. It may also involve an associated fracture.
It is important to seek appropriate medical care as soon as possible following any serious injury to the ankle and foot. Treatment may range from ice packing to local injections, splinting, casting, or other measures depending on the nature and extent of the injury. In some instances, surgery may be required to repair the damage, followed by a period of rehabilitation.
Arthritis is a group of conditions that cause inflammation of the joints, often resulting in pain and stiffness. There are two major forms of arthritis: rheumatoid arthritis and osteoarthritis. Problems can range from mild pain and stiffness, to deformities of the joint and internal organs. Because the feet and ankles bear much of the body’s weight, arthritis in the joints of the ankles and feet can be particularly painful and disabling in some cases.
Treatment such as nonsteroidal anti-inflammatory medicines, steroid injections, ice packing, exercise and physical therapy can be very effective in reducing symptoms and improving mobility. Surgery may be considered after careful evaluation by an orthopedic surgeon. Common types of surgery include bone fusion, removal of the synovium, tendon surgery, or joint replacement.
Heel pain when weight is placed on the foot is quite common. The pain may be felt below and behind the heel, resulting from inflammation or irritation of the heel pad, which is fibrous tissue that cushions the foot. X-rays of the foot may reveal a bony protrusion or heel spur.
Many people get relief from changing shoes or adding heel cups, as well as modifying their activities. However, treatment may include resting the feet and applying ice, massage, and stretching. Most often the condition will improve with these measures. Persistent pain may require prescription medication and shoe modification. Steroid injections and walking casts may also be used if the problem continues.
Bursitis is the inflammation of one of the fluid filled sacs, or bursa, which facilitate movement in the foot. Particularly problematic is inflammation of the bursas of the heel bone, Achilles’ Tendon, and the lower joint of the big toe.
Treatment may consist of local injections, aspiration, application of heat to the affected area, and protection against further irritation. A doctor may also prescribe nonsteroidal anti-inflammatory drugs and resting the foot.
A neuroma, which is a benign tumor or buildup of nerve tissue, can occur anywhere in the body. Morton’s Neuroma, caused by a nerve being pinched at the base of the toes, is quite common, usually causing burning and sore feet.
Treatment often involves simply taking off the shoes occasionally and massaging the painful area. If the condition is particularly bothersome, it may be necessary to inject the area or surgically remove the tissue causing the problem.
A foot ganglion (synovial hernia) is a small, hard nodule associated with a tendon sheath usually on the top of the foot. The nodule fills with synovial fluid which causes it to enlarge, sometimes to a large size.
A foot ganglion may subside without treatment, and then reappear later. Aspiration, which involves extracting the jelly-like fluid with a needle,is most effective. In some instances, surgery may be necessary.
CSO surgeons who specialize in Foot disorders
CSO surgeons who specialize in Ankle disorders
- R. Clio Robertson, M.D.
- Michael W. Tanner, M.D.
- David E. Nonweiler, M.D.
- Bryan J. Hawkins, M.D.*
- Jeffrey R. Morris, D.O.
- Ronald S. LaButti, D.O.
- Jeff A. Fox, M.D.
- Brian C. Howard, M.D.
*Fellowship focus in area