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The foot and ankle are an intricate system of 28 bones, 33 joints, 112 ligaments and numerous muscles. This complex system is capable of bearing weight and navigating uneven terrains.
Your feet and ankles are the foundation of your mobility. Pain or discomfort in them can be limiting and frustrating. At One Health, we’re dedicated to helping you regain mobility and reduce pain.
Whether you’re suffering from an injury or condition, our expert consultants have the technology and knowledge to diagnose and treat your feet and ankles.
The ankle joint is a synovial joint. It allows for inversion, eversion, plantarflexion and dorsiflexion of the foot.
In the foot, there are 28 bones and various muscles associated with it. The muscles are responsible for moving parts of your feet, such as your toes. Some muscles are outside the foot, but they cross the ankle joint and help position the foot.
The main jobs of the foot and ankle include:
The foot is an incredibly complex part of the body. The following sections will touch on the various tissues that make the whole foot.
Skeleton
The two bones tibia and fibula come together with talus to form a secure mortise joint.
The mortise and tenon construct is well known to carpenters and craftsmen who use this joint in the construction of everything from furniture to large buildings because it is so stable.
The talus and calcaneus are the two hindfoot bones that are connected at the subtalar joint. The ankle joint allows the foot to bend up and down. The subtalar joint allows the foot to rock from side to side.
The next group of bones are tarsal bones that work together. These bones are very interesting in the way they fit together. When the foot is twisted inwards by the muscles of the foot and leg, these bones lock together and form a very rigid structure. When they are twisted outwards, they become unlocked and allow the foot to conform to whatever surfaces the foot is contacting.
The 5 long bones of the foot called the metatarsals which are joined to the tarsal bones. There is a fairly rigid connection between the two groups without much movement at the joints.
Finally, the phalanges are the group of bones that make up the toes. The joints between the metatarsals and the phalanges are called the metatarsophalangeal joints. These joints form the third rocker of the foot and allow for the push off for a normal walking pattern.
The big toe or hallux is the most important toe for walking, and the first metatarsophalangeal joint is a common area for problems.
Important Soft Tissue
The important soft tissues of the foot and ankle include ligaments, tendons, nerves, and blood vessels.
The main blood supply to the foot is by posterior tibial artery that runs behind the medial malleolus and to some extent by the anterior tibial artery. The main nerve supply is through the posterior tibial nerve and anterior tibial nerve that runs alongside the arteries. Of course there are other nerves and arteries that supply rest of the foot.
The calf muscle becomes the Achilles tendon and is attached distally to the os calcis. The posterior tibial tendon is attached to the inner part of the foot and the peroneal tendons are attached to the outer part of the foot. These tendons hold the foot straight whilst the Achilles tendon provides the push-off. The tibialis anterior tendon dorsiflexes the foot. The ligaments statically control the joints whilst the tendons provide the power for propulsion.
History and Physical Examination
The important symptoms of foot pathology are pain. The doctor may ask:
This is followed by a physical examination of your feet, legs, how you walk, and the shoes you wear.
X-ray
X-rays are important in detecting bone and joint problems such as fractures and deformities.
MRI Scan
These are good at detecting soft tissue problems such as ligaments, joint surface, tendons etc. This in conjunction with clinical examination help in the overall management.
CAT Scan
These scans show slice of bones and to some extent soft tissues and are also helpful in picking up subtle fractures. They also help to define bone tumours and diseases affecting the bones.
Laboratory Tests
Blood test and other laboratory tests are done in some infective conditions and in diabetes. Common Foot and Ankle Syndromes.
Injuries in the foot and ankle are common, particularly in sports people, runners and keen walkers. Each foot will take around 1.5 times your bodyweight when walking, and up to 5 times your body weight when running. It isn't surprising that this area can be prone to injury and pain. However, impact isn't the only cause of foot and ankle pain. Foot and ankle pain can be due to inflammation in the joints caused by arthritis, a muscle or tendon injury and ligament sprains. Weight gain and posture changes can also put significant pressure on your feet and ankles.
Overuse, trauma, sprains, or changes in your biomechanics may cause foot and ankle problems. Others relate to wear and tear, such as osteoarthritis. We understand foot and ankle conditions well, and regularly treat conditions such as Achilles tendon injuries, claw toe deformities, and chronic ankle pain.
Pain relief, rest, and supportive footwear can ease some conditions, while others require surgery, physio, and treatment.
Common foot and ankle injuries and conditions:
When you suffer from foot and ankle pain, you should talk to your GP or Pharmacist about over-the-counter pain medication and anti-inflammatory drugs, such as ibuprofen.
A GP will be able to perform an assessment and refer you to a specialist if needed. They may suggest that you rest, ice, compress and elevate (RICE) to relieve symptoms. A Physiotherapist may use manual therapies and exercise prescriptions to set the foot and ankle right. Sometimes MRI, X-ray or ultrasound scans are required to find the root cause of the problem
If physiotherapy does not help, surgery may be the next cause of action. We aim to help you return to your regular activities – pain-free and more mobile. We specialise in advanced foot and ankle treatments to address various issues.
Before foot and ankle surgery, make the necessary preparations. These include some basic foot care routines, like washing your feet and toes daily, moisturising them if the skin is dry, and avoiding blisters, abrasions or ulcers. You should remove nail polish and use antifungal treatments if you have conditions such as athlete’s foot.
You may also need to stop taking certain medications before treatment, so discuss the specifics with your medical team. Please let us know if you have had recent dental work, an infection, or antibiotics within six weeks of the operation, for instance. If you smoke, you should try to quit. Smoking can delay the healing of bone and skin and increase the risk of general anaesthetic. If you are overweight, try to lose some weight before surgery to take pressure off your feet and ankles and aid your recovery. Eat a healthy diet leading up to the operation as this can aid recovery and healing.
There are also some preparations you need to make for your return home. Arrange for someone to help with shopping, cooking, and housework after the surgery. You could also move a bed downstairs, remove any clutter and obstacles to reduce the risk of falls, and make sure you have a comfortable seat ready with a place to elevate your foot.
As with all surgeries, foot and ankle surgery has risks and, in some cases, may lead to complications. You should always discuss the specific risks with your surgeon.
Risks include:
Deep vein thrombosis can occur if you get a blood clot. If you’re at risk of a blood clot, your medical team will take extra precautions
After your surgery, you are advised to rest with your foot elevated and to take the required pain medication. You must not get the dressing wet in the bath or shower. If you have a cast or surgical shoe, it’s important that you keep it on until you are told otherwise. If you have crutches or walking aids, you should use them to help you move safely after surgery.
Do I need to arrange my own physiotherapy?
How soon can I go home after my surgery?
What activities are safe after surgery?
When can I go back to work after surgery?
When can I start driving after surgery?
What activities can I do while I recover?
One Health waiting times from consultation to treatment are 2 - 12 weeks on average.
