The feet and ankles are an extremely complex structure and many common problems can occur in this area. Around 1 in 5 of all people will suffer from foot and ankle injuries in their lifetime. As feet and ankles bear the full body weight and cushion all impact when walking, running, and jumping, it is not surprising that foot and ankle injuries arise with such frequency.
The feet and ankles are more complicated than we think.
The feet are made up of 26 different bones and more than 33 joints, arranged in columns and arches that vary in both stiffness and flexibility
There are 3 different parts to the structure
The back of the foot (hind foot) which is made up of the heel bone and the ankle (talus). They are joined together by joints which allow the foot to move from side to side. The ankle bone is joined to leg bones at the ankle joint which acts like a hinge allowing the foot to bend up and down.
The middle of the foot (midfoot) is made up of 5 tarsal bones which form the arch of the foot. Tarsal bones are connected to the front and back of the foot by muscles and the arch ligament (the plantar fascia). They act as shock absorbers when walking and running.
The front of the foot (forefoot) is made up of toe bones which are connected to 5 long bones by joints. The forefoot takes on half of the body’s weight. Muscles in the lower leg are attached to bones in the feet by tendons which control movement. The heel bone is connected to the calf muscles by the Achilles’ tendon, which is the most important tendon for movement and where injury can often occur.
Both foot and ankle injuries are especially common in people who lead active lifestyles and people who carry around excess weight, however there are other causes that can lead to pain and damage. Pain can occur in the ankle joint itself, the heels, toe, sole and ball of the foot. Symptoms can include swelling, bruising, sharp pain between the heel and the arch of the foot, and pain when standing on tip-toes. One of the main issues in any ankle/foot injury is that if left untreated it can have a knock on effect in other parts of the foot. For example if an ankle is sprained and damage is caused to the ligaments which hold the bones of the joint together, other stressors are put through other joints in the foot as the walking gait is forced to change.
Pain can mean that weight cannot be put through the foot and the shape and mechanics of the joint can actually change.
There are several causes of foot and ankle injuries. One of the most common is arthritis.
Arthritis damages the joints and causes pain and significant inflammation. In the US, more than 56 million people have arthritis or suffer from similar conditions that affect the joints.
Arthritis in the ankle doesn’t gain as much attention as other joints in the body, but it can take a significant toll on mobility and quality of life. Arthritis in the ankle can lead to pain, swelling, deformity, and instability in the ankle joint. Arthritis here affects the tibiotalar joint, which forms between the shin bone and ankle bone. 70% of arthritis in feet and ankles are caused by previous injury.
Differing kinds of arthritis that affect the foot and ankle
Osteoarthritis is a degenerative joint disease where the cartilage that cushions the ends of the joint wears away gradually due to wear and tear. 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 injury e.g a sprain, fracture, or dislocation that can lead to premature deterioration of the joint.
Rheumatoid arthritis is a chronic inflammatory disease where the bodies immune system attacks itself. Standing and basic walking becomes uncomfortable.
Achilles tendinopathy and tendonitis is a common overuse injury resulting in repetitive injury to the Achilles’ tendon, the band of tissue at the back of the lower leg which connects the calf to the heel bone. It causes pain and stiffness to the back of the heel and means there is an inability to move freely or play sports. This is a common injury for those who play racquet sports, football, and run. Age can also be a factor as the tendon becomes less flexible over time and less able to cope with movement. Other causes include weight, genetics, and existing medical conditions such as high blood pressure and cholesterol.
Peroneal tendinopathy is common in athletes and runners and causes pain and swelling to the back of the foot and the outside of the lower leg. It can also be caused if you have a muscular imbalance or a high foot arch.
Other causes of foot and ankle pain include:
Plantar fasciitis, bursitis, bunions, tarsal tunnel syndrome, fracture, hammer toes, tendon/ligament injury, toenail malformations and ankle instability.
When surgery is an option
When a foot or ankle injury interferes with its function and causes pain which cannot be controlled by traditional medication, surgery is an option.
Fracture repair is the most common reason for ankle surgery. A fracture can range from a clean break to a break that means the bone is left in small pieces. The exact procedure will depend on which bone is broken and how severely. Surgery may include the placement of metal plates and screws to hold the bones in place as they heal.
Ankle arthroscopy is a minimally invasive surgery performed by inserting a lighted scope and narrow instruments through small incisions in the skin of the ankles. Surgeons may use this procedure to remove pieces of cartilage or bone debris from the joint space or to evaluate and repair a damaged ligament. Ankle arthroscopic repair is helpful in the early stages of arthritis in the ankle and for those with limited ankle arthritis but it is often ineffective in advanced ankle arthritis as because when a significant amount of cartilage has worn away, the procedure will not help the joint.
An Achilles tendon rupture is usually treated with surgery or with a cast, splint, brace, or other device that will keep your lower leg and ankle from moving (immobilization). Compared to immobilization, surgery provides a shorter recovery period and a reduced risk that the tendon will rupture again. There is greater risk for wound complications in surgery, though.
In cases of severe bunion discomfort, a surgical procedure known as a bunionectomy may be performed. The amount of the deformity will determine the surgical technique prescribed. In the case of small bunions, the bothersome bump may only require shaving to repair the soft tissue in the big toe joint. In more severe cases, the technique most often recommended is a procedure that involves breaking and then realigning the metatarsal bone to decrease the toe’s angle of deviation. In both procedures, the bones are correctly repositioned and then stabilized with screws, pins, plates, or wires.
Hammer toe surgery can be highly effective in people for whom the primary or only issue is hammer toe. But when an underlying condition such as rheumatoid arthritis causes a hammer toe, doctors may recommend treating that condition first. Surgical options for hammer toe include tendon transfer, joint resection and fusion.
Ingrown toe nail surgery can help relieve the enormous pain caused by chronic ingrown toe nails. Your surgeon will remove the offending part of your toe nail and kill the root portion of the nail bed to prevent regrowth.
Alternatives to surgery
Ankle arthritis doesn’t have a cure but there are many alternative treatments that can help which can help relieve pain and improve function.
Medications are important parts of treatment. They can help slow bone loss and relieve inflammation. Steroid injections into the ankle joint can help relieve inflammation. Analgesics and topical creams can help with pain relief. Lifestyle changes can also help such as exercise and healthy eating, RICE therapy, physical therapy and supportive devices.
Many foot and ankle injuries can be treated with stem cell therapy and PRP therapy.
PRP is an effective and well researched procedure which provides a great alternative to ankle surgery. Treatment is administered via a course of injections performed at weekly intervals. Patients see improvements within 4- 6 weeks. It is a safe treatment option which uses a concentrated dosage of platelets prepared from the patient’s own blood to repair the damaged cartilage, tendons, ligaments, muscles and bones in the ankle.
Stem Cell therapy procedures take an hour with a minimal recovery time. This is a minimally invasive procedure and can also be used after surgery to help aid in healing. Early results show an improvement for 75% of all patients undergoing treatment. Stem cell therapy offers a much shorter recovery time and proposes less risks than conventional surgery and also means that the patient is often up and walking the same day.