The Structure of the Foot
The foot contains a total of 26 bones. The foot can be divided into three sections. The three sections consist of the forefoot (toe area), the midfoot (arch of foot) and the hindfoot (heel and ankle). Each section contains a different number of bones and varied bone shapes.
Forefoot: 19 total bones with 14 phalanges and 5 metatarsals;Midfoot: 5 total bones with 3 cuneiform bones, 1 cuboid bone and 1 navicular bone;Hindfoot: 2 total bones with 1 talus bone and 1 calcaneus bone.
The hindfoot contains the talus that sits on top of the calcaneus. The talus connects the foot to the ankle by creating a joint with the tibia and fibula bones of the lower legs.
Twenty muscles provide the foot with shape by holding the bones in position and imparting movement. The main muscles of the foot include the anterior tibial (moves foot forward), posterior tibial (supports the arch), peroneal tibial (outside ankle movement), extensors (helps raise the toes), and flexors (stabilize toes near the ground).
Many elastic tendons connect the muscles to the many bones. The achilles tendon extends from the calf muscle to the heel and is the most prominent and powerful tendon in the foot.
The numerous ligaments connect bone to bone throughout the bones in the foot. The plantar fascia represents the longest and most conspicuous ligament in the foot. It runs from the heel to the toes and forms the arch on the bottom of the foot. It stretches and contracts to provide balance and foot strength to the act of walking. Medial ligaments on the inside and lateral ligaments on the outside of the foot allow the foot to move up and down.
Ankle cartilage, a spongy tissue, covers the end of the tibia and fibula bones where the joint meets the talus bone. The cartilage absorbs shock and allows the bones to easily slide over each other. Cartilage also exists in all the bone to bone joints present in the foot.
Injury to the Foot/Ankle
Achilles tendon injury occurs frequently, because the tendon stretches from the bones of the heel to the calf muscles in the legs. Common reasons for injury to the Achilles tendon include overuse, increasing physical activity too rapidly, wearing extremely high heels (like 3 inch heels or stiletto high heels), problems with flat feet, tight muscles or tendons in the lower leg and strenuous sports activities (like running, gymnastics, dancing, football, or tennis). If the tendon ruptures, you might hear a snapping or ripping noise during the injury and the pain may be sudden and terrible. Symptoms of an Achilles tendon injury consist of pain at the back of the foot, tenderness, swelling, stiffness, and difficulty flexing the foot or pointing the toes. By reviewing your history, your symptoms and your walking ability, your provider can diagnose your condition. Your surgeon will advise basic treatment of resting your leg, placing an ice pack on your leg, compressing the leg and ankle with an elastic bandage, elevate your leg, consume anti-inflammatory medication like ibuprofen or Celebrix, use a heel lift in your shoe and following your providers directions on stretching and strengthening exercises. Only in severe cases of Achilles tendon injury, will the surgeon recommend a cast for immobilization or surgery to repair the tendon.
Chronic Conditions of the Foot/Ankle
Osteoarthritis of the feet occurs from damage to the cartilage. The mechanism causing the osteoarthritis may appear differently than other locations of this arthritis. Faulty foot mechanics, foot injury, maligned joints and genetics contribute to foot osteoarthritis. In the foot, bone spurs may also arise in the surrounding joint area in osteoarthritis. The osteoarthritis may be localized or widespread in the foot. The condition causes symptoms of pain, swelling and deformity of the joints. The most significant treatments in foot osteoarthritis consist of controlling abnormal motion in the foot and protecting the movement of the joint. Abnormal motion of the foot and protection can be supplied with orthotics. Other treatments entail the wearing of a rigid shoe to decrease stress on the midfoot and the great toe and consumption of anti-inflammatory medication (like ibuprofen or celebrix) to reduce inflammation and minimize pain. Surgery remains the last resort.
Plantar fasciitis refers to pain in the plantar fascia ligament that runs along the bottom of the foot. Athletes in sports involving running, dancing or jumping appear at higher risk for developing plantar fasciitis. Other risk factors include tight calf muscles, situations where the feet roll inward or flatten too much, a very low or very high arch, and excessive walking in shoes without adequate arch support. Symptoms arise from pain in the heel and arch region with worse symptoms in the morning hours. Originally, it was thought to be due to inflammation, but research showed no inflammatory cells present. Now, the pain is believed to come from degeneration of the collagen fibers near the heel bone. Many treatments may be used to relieve the pain, but any underlying issues (like arch problems or appropriate shoes) need to be corrected. Resting the feet is ideal, but people work during the day so ask your physician to explain a method of plantar fasciitis taping to reduce the pain while on your feet. Use ice packs to relieve immediate pain and swelling. Use anti-inflammatory medication like ibuprofen or celebrix to help control the pain. Use a plantar fasciitis night splint to gradually stretch the calf muscles. Once pain is controlled, plantar fasciitis exercises can be initiated. If symptoms fail to resolve with conservative treatment, then surgery might be considered.