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Foot & Ankle

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Conditions

Understanding the Foot and Ankle Joints

The ankle joint is made up of the talocrural joint, which is where the two shin bones (tibia and fibula) meet the talus of the foot. Below the ankle joint are the joints of the foot which are divided into three main sections.
  • Hindfoot (subtalar joint)
  • Mid-foot (mid-tarsal joints)
  • Forefoot (Metatarsal/ phalangeal joints).

The foot is made up of 26 bones, 33 joints, and 112 ligaments, all controlled by 13 extrinsic and 21 intrinsic muscles. Many of these muscles originate in the lower leg and cross over the ankle joint to insert into the foot. There are additionally four layers of muscles in the foot itself.

 

The foot and ankle are very important for:

  • Supporting body weight.
  • Providing balance.
  • Shock absorption.
  • Transferring ground reaction forces.
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The foot and ankle absorb all our on-foot daily movement and therefore are susceptible to injury. The most common is a sprain or ‘rolled ankle’ which can result in muscle, tendon, and/ or ligament damage and in severe cases, a fracture. Another common issue in the foot is tendinopathic pain which can be caused by a sudden increase in demand on the tissue, i.e. weight gain, a new sport or simply a longer walk than normal. Like all our joints in the body, the foot and ankle are prone to osteoarthritic changes as part of the normal ageing process. The smaller joints of the foot are also common sites for gout and rheumatological diseases such as psoriatic and rheumatoid arthritis.

With a good understanding of the cause and structure involved in your foot and ankle pain, you can then get the right treatment and management plan for your condition.

 

The cause of your foot or ankle pain can be diagnosed by taking a thorough history of your recent activity and lifestyle, a review of your medical history, and a thorough physical examination.


Imaging can sometimes be useful to rule out any structural damage following injury or serious pathology. It can also be useful if your symptoms are not responding to conservative management. Examples of imaging are Ultra-sound, x-ray, or MRI.

If you have acutely hurt your foot or ankle or either has suddenly become painful, sometimes short-term relief is needed such as pain medication, topical non-steroidal gels, ice or heat treatment or modification of your activity levels. If the pain persists, then seeking input from a Physiotherapist is advised.

A Physiotherapist will take a detailed case history to understand the cause and contributing factors to your foot or ankle pain.


Active tests in standing will be used combined with passive movements of either foot or ankle to assess any biomechanical factors contributing to your symptoms. This may involve a combination of simple foot and ankle movements or looking at the functional tasks you are struggling with i.e. walking.


The Physiotherapist will then explain what they see and advise on the diagnosis and factors contributing to your pain picture.


Depending on your presentation and expectations of the appointment, the Physiotherapist will advise on any relevant short-term relief options such as optimising pain relief medication, manual therapy techniques i.e. soft tissue release, joint mobilisations or taping. These hands-on techniques provide short-term relief and can sometimes help to dampen down the secondary responses to pain such as muscle tightness.


The Physio will also suggest self-management advice i.e. how to modify your activities, simple movement strategies, or an exercise program to address any movement deficits. In some cases, the Physiotherapist may feel onward referral is necessary i.e. back to GP or a specialist. This will always be a shared decision-making process and often there is a lot you can be doing in the meantime.