Ankle and Foot Injuries

Injuries to the foot and ankle are among the most frequently occurring musculoskeletal injuries.  Ankle injuries commonly occur when the ankle joint is twisted out of position. Although it is more likely to occur during sports, the ankle can be injured doing fairly simple tasks such as walking on uneven surfaces.  Most commonly seen injuries occurring in the ankle are sprains and fractures.

The foot is a complex structure that is designed to withstand considerable forces placed on it by walking, running, and jumping.  Athletes involved in sports requiring jumping and running are at higher risk for foot injury as there is a high demand placed on the feet. 

The Primary Function and Anatomy of the Ankle

The ankle joint is a hinge type joint that allows for two distinct types of movement called dorsiflexion and plantarflexion.  Eversion and inversion are produced at the subtalar joint of the foot. 

The ankle joint is made up of muscles, bones, cartilage, ligaments and tendons.

• Bones:  The ankle joint is between the foot and leg.  It is made up of three separate bones: the tibia (shinbone), the fibula, and the talus.
• Cartilage:  The ends of bones are covered in cartilage.  This is a smooth substance that allows the bones to glide against each other during ankle movement.
• Ligaments:  These are fibrous tissues that connect bones to other bones.  The deltoid ligament is located along the medial aspect of the ankle.  This ligament resists over-eversion of the foot. There is a lateral ligament comprised of three separate ligaments that resist over-inversion. This help provide stability to the joint.

The Primary Function and Anatomy of the Foot

The foot is complex as it is both a rigid structure used for weight-bearing, as well as a flexible structure used to conform to uneven surfaces.  It provides balance and shock absorption while also transferring ground reaction forces. The feet allow us to stand upright and perform activities such as walking, running, and jumping.

The foot is divided into three sections:

• The forefoot is the front of the foot and contains the phalanges (toes) and the metatarsals, which are the long bones connecting to the toes.
• The midfoot is the middle of the foot.  It is a pyramid-like formation of bones that creates the arches of the foot.  The midfoot is composed of the navicular bone, the cuboid bone, and the cuneiform bones.  
• The hindfoot is the back of the foot that forms the heel and ankle.  The talus bone combines with the tibia and fibula to form the ankle. The calcaneus, or heel bone, is the largest bone in the foot. 

There are many muscles, tendons, and ligaments that combine with the bones of the foot and allow for the complex movements needed for balance and motion.

Common Types of Ankle and Foot Injuries Seen in Our Practice

• Sprains and strains:  A strain is a muscle injury where the muscle is overstretched or torn.  A sprain is a tearing or stretching of a ligament, which is a fibrous tissue connecting two bones.  Ankle sprains are one of the most common musculoskeletal injuries in people of all ages, regardless of athletes or non-athletes alike.   This occurs when one or more of the ligaments in the ankle are stretched or torn. Sprains of the foot are rarer but can occur in people who participate in certain sports or occupations that subject the feet to abnormal twisting motions or bends.
• Growth Plate Injuries:  For adolescents who have not reached skeletal maturity, injury to the ankle growth plate in the ankle is a common occurrence.  The developing growth plate in the ankle is weaker than the surrounding ligaments. Therefore, the same sprain suffered in an adult may lead to an injured or fractured growth plate.
• Tendonitis:  Tendonitis is inflammation of the tendon.  In the ankle, this usually involves the Achilles tendon, posterior tibial tendon, or peroneal tendon.  It is often the result of overuse such as from running activities but can also be due to trauma.
• Plantar Fasciitis:  The plantar fascia is a thick band of tissue that runs across the bottom of the foot and connects your heel bone to your toes.  Plantar fasciitis is inflammation of this tissue, which can cause a stabbing pain usually felt at the heel.
• Sever’s Disease (Calcaneal Apophysitis):  This is a common cause of heel pain in growing children and adolescents due to inflammation of the growth plate in the calcaneus (heel bone).  It is usually caused by repetitive stress to the heel and usually occurs during periods of growth spurts. 
• Stress Fractures:  Stress fractures are commonly seen in the weight-bearing bones of the foot and lower leg.  Stress fractures are areas of small cracks or bruising in the bone that is caused by overuse and repetitive activity.  It is often seen in runners due to the repetitive forces they must absorb during running. The most common areas for stress fractures in the foot are the 2nd and 3rd metatarsals in the foot because this is the area of greatest impact on your foot as you push off. It is not uncommon to see stress fractures in other bones in the foot as well.

How are the Causes of Ankle and Foot Pain Diagnosed?

First and most important is a good thorough medical history intake and a physical exam. 

Imaging tests can also help with the diagnosis.

• X-Ray:  X-rays use radiation in the form of electromagnetic waves of high energy to pass to create pictures of the inside of your body.  X-rays show bones well and can help us identify things such as fractures. It is also very helpful in identifying things such as dislocations.  It can also help us identify signs of osteoarthritis.

• MRI Scan:  MRI scans use large magnets and radio waves to look at structures inside your body with great detail. It is a helpful imaging study to visualize soft tissues such as muscles and ligaments, as well as give an additional evaluation of bones. 
• CT Scan:  A CT scan is an imaging tool that combines x-rays with computer technology to produce a detailed cross-sectional image of your body.  In our field, it is helpful sometimes for further evaluation of bony structures.
• Ultrasound:  Ultrasound uses high-frequency sound waves that echo off the body.  It is a non-invasive study that does not use any radiation. It is used in-office to help with the diagnosis of some musculoskeletal conditions.

Treatment for Ankle and Foot Injuries

There are many treatment options for ankle and foot pain. However, the treatment option varies depending on multiple factors such as age, injury, medical history, etc.

• RICE therapy: RICE is a form of self-treatment or can be done under the guidance of trained physiotherapists. RICE stands for Rest, Ice, Compression, and Elevation. This therapy can help improve pain and swelling of many ankle and foot injuries.

• Heat therapy:  Heat can help relax tense muscles and soothe a stiff ankle or foot.  You can use a heated pad or hot water bottle.
• Physical therapy: Manual therapy and a special exercise routine planned by a physiotherapist, keeping the condition of the patient in mind, can help strengthen the ankle and foot muscles and improve their flexibility.
• Medication:  Over the counter medications such as acetaminophen or ibuprofen can help ease the pain.  Stronger pain medications and muscle relaxers can also be of help temporarily.
• Steroid injections: Steroid injections, usually in conjunction with physical therapy, can be helpful to reduce inflammation and overall pain. 
• Surgery: If conservative treatment does not work, surgery may be needed.  Sometimes surgery needs to be considered sooner depending on the injury itself.

Stephen S. Chen, MD- Sports Medicine Doctor can help you evaluate and treat your ankle and foot pain.  Contact us using our phone number 925-934-3536 or email at stephen.chen@eastbaysportsdoc.com to book an appointment.