All About the Foot and Ankle

What is the foot and ankle area and how does it work?

The foot is a complex area made up of 28 bones and more than 30 joints. The ankle joint, which connects the foot and the leg, mainly flexes and extends, or moves up and down. The hind foot, or sub-talar joint moves from side to side and helps to accommodate walking on uneven surfaces.

What kind of injuries and conditions can affect the foot and ankle?

Many conditions can involve the small joints of the foot, such as:

• Bunions
• Ankle sprains—injuries to the ligament
• Ankle fractures, which can often be treated without surgery
• Heel spurs
• Plantar fasciitis
• Arthritis

What is an ankle sprain and how is it treated?

A sprained ankle is an injury to an ankle ligament. Ankle sprains are graded on a scale from 1 to 3, with Grade 3 being the most severe—a complete tear of the ligaments that stabilize the ankle joint.

A Grade 3 ankle sprain can be more painful and take longer to heal than an ankle fracture. Treatment often involves putting the ankle in a cast to protect it while it heals.

What is plantar fasciitis?

Plantar fasciitis is an inflammation of the arch of the foot where it attaches to the back of the heel. This is simply an earlier stage of heel spurs, described below.

Who typically gets plantar fasciitis?

Anyone can get plantar fasciitis, but it tends to occur more often in people who spend a lot of time standing on a hard surface. If you're running on concrete, or not wearing good shoes when you're running, you have some risk of developing plantar fasciitis.

What is a heel spur?

A heel spur is chronic tendinitis—inflammation of the fibrous band of tissue that connects muscle to bone-on the bottom of the foot where the arch attaches to the heel bone. When this tendinitis goes on for a long time, the body's response is to calcify in that area, forming a heel spur.

A heel spur tends to cause pain when you first get up and walk in the morning or when you get up from a seated position. Most times, heel spurs are treated non-surgically with stretching exercises, physical therapy and medication. Occasionally, heel spurs require surgical removal.

What is a bunion?

A bunion is a mis-alignment of the joint where the base of the big toe meets the ball of the foot. These bones normally align in nearly a straight line. When a bunion forms, the big toe starts to turn inward toward the smaller toes. This produces a bump on the side of the foot when the joint is pushed to the side.

• A mild or moderate bunion creates a small bump on the side of the foot at the base of the big toe.
• A severe bunion forms a larger bump on the side of the foot. The big toe turns in even farther, and may even move under the second toe.

What causes bunions?

• Most bunions are caused by squeezing your feet into pointed-toe shoes—thus, they occur mainly in women.
• Bunions can also be caused by degenerative bone or joint diseases such as arthritis.
• A tendency toward bunions can run in families.

What are the symptoms of bunions?

Bunions are primarily a cosmetic problem and may cause no symptoms. If they become very advanced, bunions can cause pain and swelling at the base of the big toe. Bunions can also affect the other toes of the foot and cause secondary problems.

How are bunions treated?

Treatment for bunions involves wearing shoes that don't squeeze your toes. There are some braces for correcting bunions, but they have not been shown to be effective. In severe cases, surgery may be necessary to shave away the bunion and realign the bones in a straight line.

Preventing bunions by wearing properly fitting shoes is more important—and more effective—than treating them.

How can arthritis affect the foot and ankle?

• Osteoarthritis, also known as wear-and-tear arthritis or degenerative joint disease, can occur in the ankles, but it is less common than in other weight-bearing joints such as the knees.
• Rheumatoid arthritis or RA, can affect the ankles. This most-disabling form of arthritis is a systemic disease that may attack many parts of the body. RA is believed to be an autoimmune disease caused by a virus or a genetic component. Among patients with RA, the ankle region is commonly affected.
• Post-traumatic arthritis, similar to osteoarthritis, can develop years after a foot or ankle injury.

What are the symptoms of foot and ankle arthritis?

Foot and ankle arthritis may cause:

• Pain and swelling
• Stiffness or reduced motion in the affected joint
• Difficulty in walking

What surgical procedures can treat ankle arthritis?

In cases of severe, advanced ankle arthritis where the pain and stiffness do not improve with conservative treatment methods, surgery may be necessary. An ankle fusion or arthrodesis fuses the bones of the ankle joint completely. Ankle replacement surgery is another option.

Find out more about arthritis