Foot & Ankle

Foot & Ankle Anatomy

The foot and ankle is a complex joint involved in movement and providing stability and balance to the body. The foot and ankle consists of 26 bones, 33 joints, and many muscles, tendons and ligaments.

Bones of the Ankle

The ankle joint connects the leg with the foot, and is composed of three bones: tibia, fibula and talus. The tibia or shin bone and fibula or calf bone are bones of the lower leg which articulate with the talus or ankle bone, enabling up anddown movement of the foot.

Three bony bumps present on the ends of the tibia and fibula form parts of the ankle joint:

  • The Medial malleolus, formed by the tibia, is found on the inside of the ankle;
  • Posterior malleolus, also formed by the tibia, is found at the back of the ankle and the
  • Lateral malleolus, formed by the fibula, is found on the outer aspect of the ankle

Bones of the Feet

The foot acts as a single functional unit, but can be divided into three parts: the hindfoot, midfoot and forefoot.

The hindfoot forms the ankle and heel and is made up of the talus bone and calcaneous or heel bone. The heel bone is the largest bone in the foot.

The midfoot connects the hindfoot to the forefoot, and consists of one navicular bone, one cuboid bone, and three cuneiform bones. The navicular bone is found in front of the heel bone, and the cuneiform and cuboid bones are arranged in front ofthe navicular bone.

These bones are connected to five metatarsal bones of the forefoot, which form the arch of the foot for shock absorption while walking or running. The forefoot is also made up of the toes or digits, formed by phalanges, three in each toe, exceptthe big toe, which has only two phalanges. The big two has two additional tiny round sesamoid bones in the ball of the foot, which help in upward and downward movement of the toe.

Ankle and Foot Joints

There are 33 joints in the ankle and foot. They include the

  • Hinge joints in the ankle, which allow flexion (bending) and extension
  • Gliding joints found in the hindfoot, which allow gliding movements
  • Condyloid joints found in the forefoot and toes, which allow the flexion (bending) and extension, adduction and abduction (sideward movement).

The joints of the foot and ankle provide stability and support the weight of the body, helping you to walk or run, and to adapt to uneven ground.

The joint surface of all bones of the ankle and foot are lined by a thin, tough, flexible, and slippery surface called articular cartilage, which acts as a shock absorber and cushion to reduce friction between the bones. The cartilage islubricated by synovial fluid, which further enables smooth movement of the bones.

Soft Tissues of the Ankle and Foot

Our feet and ankle bones are held in place and supported by various soft tissues such as cartilage, ligaments, muscles, tendons and bursae.

Cartilage is the flexible, shiny, smooth tissue on the ends of bones that meet to form a joint. Cartilage provides cushioning between the bones allowing smooth movement.

Ligaments are tough rope-like tissue that connect bones to other bones, and holds them in place providing stability to the joints. The Plantar fascia is the largest ligament in the foot, originating from the heel bone to the forefoot, it extendsalong the bottom surface of the foot and is involved in maintaining the arch of the foot. The plantar fascia ligament stretches and contracts to provide balance and strength to the foot. Lateral ligaments on the outside of the foot and medialligaments on the inside of the foot provide stability and allow up and down movement of the foot.

The foot is made up of 20 muscles, which help in movement. The main muscles include:

  • Anterior tibial muscle: allows up and down movement of the foot
  • Posterior tibial muscle: supports the arch
  • Peroneal tibial muscle: controls movement on the outside of the ankle
  • Extensors: enable the ankle to raise the toes just before stepping forward
  • Flexors: stabilize the toes against the floor

Smaller muscles are also present to help the toes lift and curl.

Tendons are soft tissues that connect muscles to bones. The largest and strongest tendon in the foot is the Achilles tendon, present at the back of the lower leg around the heel bone. Other tendons include peroneals and anterior and posteriortibialis.

Bursae

Bursae are small fluid filled sacs that decrease friction between tendons and bone or skin. Bursae contain special cells called synovial cells that secrete a lubricating fluid.

Conditions

  • Broken Bones & Injuries

    Broken Bones & InjuriesComing soon

  • Ankle Fractures

    Ankle FracturesThe ankle joint is composed of three bones: the tibia, fibula, and talus which are articulated together. The ends of the fibula and tibia (lower leg bones) form the inner and outer malleolus, which are the bony protrusions of the ankle jointthat you can feel and see on either side of the ankle.

  • Lisfranc (Midfoot) Fracture

    Lisfranc (Midfoot) FractureThe Lisfranc joint or tarsometatarsal joint refers to the region in the middle of the foot. It is a junction between the tarsal bones (seven bones in the foot arch) and metatarsal bones (five long bones in the foot). Lisfranc fracture scan occurdue to a fall from a height or traumatic motor accidents.

  • Ankle Sprain

    Ankle SprainA sprain is the stretching or tearing of ligaments, which connect adjacent bones and provide stability to a joint. An ankle sprain is a common injury that occurs when you suddenly fall or twist the joint or when you land your foot in an awkwardposition after a jump. Most commonly it occurs when you participate in sports or when you jump or run on a surface that is irregular.

  • Fracture of the Calcaneus

    Fracture of the CalcaneusThe calcaneus or heel bone is a large bone found on the rear part of the foot. The calcaneus connects with the talus and cuboid bones to form the subtalar joint of the foot. A fracture is a break in a bone from trauma or various diseaseconditions.

  • Stress Fracture of the Foot

    Stress Fracture of the FootA stress fracture is a small crack in the bone which occurs from overuse injury. It commonly develops in the weight-bearing bones of the lower leg and foot. When the muscles of the foot are overworked, or stressed, they are unable to absorb thestress and transfer it onto the bone, which cracks under the pressure.

  • Talus Fractures

    Talus FracturesThe talus is a small bone at the ankle joint that connects the heel bone and the shin bones, enabling the up and down movement of the foot. Fractures in the talus bone may occur due to a fall from great heights, motor vehicle accidents or sportsinjuries. Symptoms include severe ankle pain, inability to walk, swelling and tenderness.

  • Toe and Forefoot Fractures

    Toe and Forefoot FracturesThe forefoot is the front of the foot that includes the toes. Fractures occurring in this part of the foot are painful, but very often not disabling. There are 2 types of fractures namely, traumatic fracture and stress fracture. Traumaticfractures occur when there is a direct impact of your foot on a hard surface.

  • Turf Toe

    Turf ToeTurf toe is an injury to the ligament at the base of the big toe. It is a painful condition which usually results from jamming of the toe into the ground or excessive backward bending of the toe. As it is more common in athletes playing onartificial turf, especially those involved in field sports such as football, baseball and soccer, it is known as turf toe.

  • Achilles Tendinitis

    Achilles TendinitisThe Achilles tendon is one of the longer tendons in your body which stretches from the heel bone to your calf muscles. It appears as a band of tissue at the back of your ankle and above your heel. The Achilles tendon attaches to the heel boneover a broad area.

  • Adult Flatfoot

    Adult FlatfootFlatfoot, also known as "fallen arches" or Pes planus, is a deformity in children's feet in which the arch that runs lengthwise along the sole of the foot has collapsed to the ground or not formed at all. Flatfoot is normal in the first fewyears of life as the arch of the foot usually develops between the age of 3 and 5 years.

  • Foot & Ankle Osteoarthritis

    Foot & Ankle OsteoarthritisArthritis is inflammation resulting from the degeneration of cartilage in the joint causing pain, swelling, and stiffness in the joints resulting in restricted movements. Arthritis of the foot and ankle joint can occur due to fracture, dislocation, inflammatory disease, or congenital deformity.

  • Bunion

    BunionA bunion is a bony protuberance that appears on the external surface of the big toe when it angles toward the adjacent toe. It is an extra bone and a fluid-filled sac that grows at the base of the big toe.

  • Bunionette

    BunionetteComing soon

  • Claw Toe

    Claw ToeClaw toe is a deformity, where a toe bends and appears like a bird's claw. The affected toe is bent upward from the joint at the ball of foot, and downward at the joints in the middle and tip of the toe to curl under the foot. Hard thick skincalled corns may develop under the ball of the foot or on the top of the affected toe, causing pain while walking.

  • Hammertoe

    HammertoeA hammertoe is a deformity of a lesser toe (second through fifth toes), where the toe gets bent upward at the toe's middle joint, resembling a hammer. The bent portion may rub against a shoe causing pain, irritation and development of corns.

  • Heel Pain

    Heel PainThe heel is made up of the calcaneus bone and supported by a network of muscles, tendons, ligaments and soft tissues, which together support the weight of the body and stress during movement. Heel pain is a common symptom of excessive strainplaced on these structures.

  • Metatarsalgia

    MetatarsalgiaComing soon

  • Common toe Deformities

    Common toe DeformitiesAnatomically the foot is divided into the forefoot, mid foot and hind foot. The Forefoot has 4 small toes called phalanges and 1 large toe called the hallux or big toe. Phalanges have 3 bones and 3 joints, while the big toe has 2 bones and 2 joints.

  • Morton's Neuroma

    Morton's NeuromaMorton's neuroma refers to a nerve injury between the toes, usually the third and fourth toes, which causes pain and thickening of the nerve tissue. Compression or chronic irritation of this interdigital nerve is the main cause of Morton'sNeuroma.

  • Plantar Fasciitis

    Plantar FasciitisPlantar fasciitis refers to inflammation of the plantar fascia, a thick band of tissue that lies at the bottom of the foot. It runs from the heel bone to the toe and forms the arch of your foot. Plantar fasciitis is one of the most common causesof heel pain.

  • Posterior Tibial Tendon Dysfunction

    Posterior Tibial Tendon DysfunctionThe posterior tibial tendon passes through the ankle to attach the calf muscle with the bones of the mid foot. It provides stability to the arch and supports the foot while walking. Inflammation or a tear of this tendon as a result of injury maycause dysfunction, leading to pain and the development of flatfoot.

  • Rheumatoid Arthritis of the Foot and Ankle

    Rheumatoid Arthritis of the Foot and AnkleComing soon

  • Sesamoiditis

    SesamoiditisSesamoiditis is an inflammation of the sesamoid bone and the associated tendons. It is commonly seen in ballet dancers, sprinters and basketball players. It is an overuse injury caused by an increased pressure over the sesamoid bones resultingin a chronic inflammation.

  • Hallux Rigidus

    Hallux RigidusHallux rigidus is an arthritic condition characterized by stiffness and rigidity of the big toe. Arthritis of the foot commonly occurs at the big toe base. The condition can be quite painful as the big toe has to bend with every step you take.

  • Tarsal Tunnel Syndrome

    Tarsal Tunnel SyndromeTarsal tunnel is the gap that is formed between the underlying bones of the foot and the overlying tough fibrous tissue. Tarsal tunnel syndrome refers to a condition where the posterior tibial nerve that lies within the tarsal tunnel iscompressed. The condition occurs when the tibial nerve is pinched.

  • Ankle Instability

    Ankle InstabilityAnkle instability is a chronic condition characterized by a recurrent slipping of the outer side of the ankle. It usually results from repeated ankle sprains. It is generally noticed during movement of the ankle joint but can also occur duringstanding as well.

  • Cavus Foot Deformity

    Cavus Foot DeformityComing soon

Procedures

  • Bunion Surgery

    Bunion SurgeryA bunion, also known as hallux valgus, is bony prominence at the base of the big toe, which often results in pain, redness and rubbing in footwear. The 1 st metatarsal bone abnormally angles outward towards the other foot from its joint in the midfoot.

  • Achilles Tendon Tear Repair

    Achilles Tendon Tear RepairAchilles tendon is a strong fibrous cord present behind the ankle that connects the calf muscles to the heel bone. It is used when you walk, run and jump. The Achilles tendon ruptures most often in athletes participating in sports that involverunning, pivoting and jumping.

  • Cheilectomy

    CheilectomyMetatarsophalangeal joint (MTPJ) is a junction between the metatarsal bones (long bone in the foot) and proximal bones (bone in toes). 1 st MTPJ refers to the joint in the big toe of the foot. Cheilectomy is a surgery to remove excessive bone from the 1 st MTPJ.

  • Ankle Ligament Reconstruction

    Ankle Ligament ReconstructionAn ankle sprain is a common injury and occurs when you fall or suddenly twist the ankle joint or when you land your foot in an awkward position after a jump. It most commonly occurs when you participate in sports or when you jump or run on asurface that is irregular.

  • Ankle Arthroscopy

    Ankle ArthroscopyAnkle arthroscopy is a minimally invasive surgical procedure in which an arthroscope, a small, soft, flexible tube with a light and video camera at the end, is inserted into the ankle joint to evaluate and treat a variety of conditions.

  • Ankle Fusion

    Ankle FusionAnkle arthrodesis is the surgical fusion of bones that form the ankle joint. The ankle joint is formed by the tibia, talus, and the fibula bones.