Combined, the human foot and ankle contains more than 26 bones and 40 joints, and the average person takes 10,000 steps per day. The ankle is a highly intricate structure that works in unison with the foot to help support our body weight, allow us to stand, walk or run, and move and flex in a variety of ways. To read more about foot & ankle conditions, click here.
At OrthoNorcal Orthopedic Specialists, our expert ankle surgeons have extensive training in performing specialized techniques for treating foot & ankle conditions. Common ankle procedures our orthopedic surgeon often performs include achilles tendon surgery, tendon transfer of the foot and ankle, tendon repair, implant surgery, lateral and medial ligament reconstruction and ankle joint replacement. From operative to nonoperative ankle care, the OrthoNorcal Orthopedic Specialists ankle doctor provides a unique treatment plan focused on restoring your function.
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Arthritis of the Foot and Ankle
The ankle joint is a commonly injured joint in the body. While ankle fractures and ankle sprains heal pretty well, they can lead to problems much later in life. This is due to the wear and tear that occurs for years after the injury.
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Rheumatoid arthritis
Rheumatoid arthritis is the most common form of inflammatory arthritis, affecting about two to three million Americans. Rheumatoid arthritis is a symmetric disease, meaning that it will usually involve the same joints on both sides of the body.
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Ankle Instability
The joints of the ankle are held in place and stabilized by strong bands of tissue called ligaments. Ankle instability is a chronic condition characterized by a recurrent slipping of the outer side of the ankle.
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Ankle Ligament Injury
An ankle ligament injury, also known as an ankle sprain, can be caused by a sudden twisting movement of the foot during any athletic event or during daily activities.
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Plantar Fasciitis
Plantar fasciitis, sometimes called a heel spur, is a condition that causes pain on the bottom of the heel when putting weight on the foot.
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Ankle Fractures
Ankle injuries are very common in athletes and individuals performing physical work; often resulting in severe pain and impaired mobility.
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Foot Fracture
Trauma and repeated stress can cause fractures in the foot. Extreme force is required to fracture the bones in the hindfoot.
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Heel Fractures
The calcaneus or heel bone is a large bone found at the rear of the foot. A heel fracture is a break in the heel bone due to trauma or various disease conditions.
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Foot Infections
Foot infections may occur after trauma to the foot or loss of tissue because of contamination from foreign material and/or bacteria or fungus. Infections can occur in healthy individuals as well as in those whose health is compromised.
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Heel Cracks
Heel cracks or fissures are the splitting or cracking of the skin on the outer edge of the heel due to excessive drying and pressure that causes the skin to expand sideways.
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Athlete's Foot
Athlete's foot, also known as tinea pedis, is a fungal infection that forms on the skin of the foot. It is characterized by itchy, moist, white, scaly lesions between the toes that can spread to the sole of the foot.
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Forefoot Pain
Forefoot pain, also referred to as metatarsalgia, is a type of pain that occurs in the ball of the foot (along the ends of the metatarsal bones).
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Foot and Ankle Trauma
Foot and ankle trauma refers to injuries that most commonly occur during sports, exercise or any other physical activity. Trauma may be a result of accidents, poor training practices or use of improper gear.
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Lisfranc (Midfoot) Fracture
The Lisfranc joint or tarsometatarsal joint refers to the region in the middle of the foot. It is a junction between the tarsal bones (bones in the foot arch) and metatarsal bones (five long bones in the foot).
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Midfoot Arthritis
Midfoot Arthritis is the most common form of inflammatory arthritis, affecting about two to three million Americans. Midfoot Arthritis is a symmetric disease, meaning that it will usually involve the same joints on both sides of the body.
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Achilles Tendonitis and Achilles Tendon Rupture
A major strain can cause injury to the calf muscles or the Achilles tendon. This can happen during a strong contraction of the muscle, as when running or sprinting.
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Talus Fractures
The talus is a small bone at the ankle joint that connects the heel bone and the shinbones, enabling up and down movement of the foot.
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Diabetic Foot Conditions
Diabetes is a chronic condition that is characterized by high blood glucose (sugar) levels. Diabetic patients are at high risk for developing chronic wounds, especially in the feet.
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Osteochondral Injuries of the Ankle
The ankle joint is formed by the articulation of the end of the tibia and fibula (shinbones) with the talus (heel bone). Osteochondral injuries, also called osteochondritis dissecans.
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Morton's Neuroma
Morton’s neuroma refers to a nerve injury that occurs between the toes, usually the third and fourth toes. This causes pain and thickening of the nerve tissue.
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Hallux Rigidus
Hallux rigidus is a degenerative arthritis that affects the large joint at the base of the big toe. Degenerative arthritis results from wear and tear on the joint surface over time.
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Congenital Deformity and Clubfoot
Congenital deformities of the lower limbs are developmental disorders that are present at birth, causing alterations in the shape and appearance of the legs. Several factors such as genetics, teratogenic drugs, and chemicals can cause congenital deformities.
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Shin Splints
Shin splints or medial tibial stress syndrome (MTSS) is pain around the tibia or shinbone due to inflammation of the tendons, muscles and bone tissue. It occurs because of vigorous exercises and sports activities.
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Achilles Tendon Bursitis
Achilles tendon bursitis or retrocalcaneal bursitis is a condition that commonly occurs in athletes. It is a painful condition caused by the swelling of the bursa, a fluid-filled sac that is located at the back of the heel under the Achilles tendon.
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Ingrown toenail
An ingrown toenail is a common and painful condition of the toe. It occurs when the side or corner of the nail grows inwards and penetrates the skin of the toe.
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Stress Fractures of Foot and Ankle
A stress fracture is described as a small crack in the bone which occurs from an overuse injury of a bone. It commonly develops in the weight-bearing bones of the lower leg and foot.
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Foot Inflammation
Foot inflammation is the result of a person’s immune response towards various irritants or injuries to the foot. Based on the type of response, the inflammation can be classified as acute when it occurs suddenly, or chronic, occurring gradually as a result of a long-term disorder.
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Cavus Foot Deformity
Cavus foot also referred to as a high arch, is a condition in which the arch on the bottom of the foot that runs from the toes to the heel is arched more than normal.
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Foot Lesions
A foot lesion is an abnormal change in an area of skin on the foot. It may be caused by infection, injury or abnormal growth of tissue. Foot lesions are commonly seen in diabetic patients due to nerve damage and poor circulation.
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Nerve Conditions of the Foot
The foot is composed of bones, ligaments, nerves, muscles, and tendons. Nerve conditions of the foot can range from minor nerve injuries to serious conditions like nerve entrapment and damage.
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Lesser Toe Deformities
Lesser toe deformity is an abnormality in the anatomy of your toe that occurs as a result of imbalance between the intrinsic and extrinsic muscles.
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Sesamoiditis
Sesamoids are two small, pea-shaped bones located in the ball beneath the big toe joint at the bottom of the foot. Sesamoid bones are connected to muscles and other bones by tendons that envelop these bones.
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Congenital Limb Deformities
Limb deformities can be congenital (present at birth) or develop at a later stage because of a fracture, infection, arthritis or tumor.
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Foot Spasms
oot spasms, also known as foot cramps, occur due to the involuntary contraction of the foot muscles. These cramps are usually harmless and will get better on their own; however, sometimes they may need medical attention.
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Sever's Disease
Sever’s disease is a painful inflammation of the growth plate in the heel. Growth plates are areas at the end of children’s bones that undergo changes so bone growth can occur.
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Bunionette (Tailor's Bunion)
Bunionette, also called Tailor’s bunion, is a bony lump formed along the outside of the little toe at the base. It occurs when the very bottom bone (fifth metatarsal bone) of the little toe enlarges or shifts outward.
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Mallet Toe
Mallet toe is a deformity where the toe abnormally bends downward, resembling a hammer or mallet. The bones at the tip of the toe are connected by the distal interphalangeal joint (DIP).
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Sesamoid Fracture
A sesamoid fracture is a break in the sesamoid bone. Sesamoids are two small, pea-shaped bones located in the ball beneath the big toe joint at the bottom of the foot.
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Haglund’s Deformity
Sometimes the shape of a bone can cause problems in the foot. One example of this is Haglund’s deformity, a condition caused by a prominent bump on the back of the heel.
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Ankle Sprain
An ankle sprain is a common injury and usually results when the ankle is twisted, or turned in (inverted). The term sprain signifies an injury to the soft tissues, usually the ligaments, of the ankle.
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Accessory Navicular Problems
The accessory navicular is a congenital anomaly, meaning you are born with an extra bone in your foot. If there is an accessory navicular, it is located in the instep where the posterior tibial tendon attaches to the real navicular bone.
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Posterior Tibial Tendon Dysfunction
The posterior tibial tendon passes through the ankle to attach the calf muscle with the bones of the midfoot. It provides stability to the arch and supports the foot while walking.
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Metatarsalgia
Metatarsalgia is a condition in which pain and inflammation are caused due to overuse or injury to the ball of the foot - the area between the toes and the arch.
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Osteochondral Lesions of the Ankle
The tibia and the fibula bones of the lower leg join with the talus bone to form the ankle joint. The talus bone is an important bone located between the tibia and fibula and the heel bone (calcaneus).
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Tarsal Tunnel Syndrome
The tarsal tunnel is a narrow passageway that lies on the inside of your ankle and runs into the foot. It encloses arteries, veins, tendons and nerves that supply the foot.
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Vertical Talus
Talus is a small bone in your ankle joint. It sits between the heel bone (calcaneus) and the confluence of two bones of the lower leg (tibia and fibula).
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Joint Replacement Surgery
Your foot and ankle surgeon will work closely with your regular medical doctor before and after your joint replacement surgery.
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Minimally Invasive Bunion Surgery
Minimally invasive bunion surgery, also known as keyhole bunion surgery, is a procedure to treat a foot condition called a bunion or hallux valgus.
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Minimally Invasive Foot Surgery
Minimally invasive foot surgery (MIFS) uses the latest advanced technology to treat foot and ankle pain caused by a variety of conditions.
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Achilles Tendon Repair
Tendons are the soft tissues connecting muscle to bone. The Achilles tendon is the longest tendon in the body and is present behind the ankle, joining the calf muscles with the heel bone.
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Flatfoot Reconstruction
Foot reconstruction is a surgery performed to correct the structures of the foot and restore the natural functionality of the foot that has been lost due to injury or illness.
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Foot Reconstruction
Foot reconstruction is a surgery performed to correct the structures of the foot and restore the natural functionality of the foot that has been lost due to injury or illness.
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Ankle Ligament Reconstruction
A sprain is the stretching or tearing of a ligament. Ligaments connect adjacent bones in a joint and provide stability to the joint.
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Ankle Instability Surgery
Ankle instability is a chronic condition characterized by the recurrent slipping of the outer side of the ankle.
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Treatment of Foot and Ankle Sports Injuries
Injuries during sports are common. They can result from accidents, inadequate training, improper use of protective devices, or insufficient stretching or warm-up exercises.
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Complex Foot and Ankle Surgeries
Complex foot and ankle surgeries are procedures employed to treat foot and ankle structures with deformities, injuries, structural issues, and damage from diseases like diabetes or arthritis.
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Foot & Ankle Deformity Correction
Foot and ankle deformity is the structural abnormality caused by misalignment of the bones of the foot and ankle.
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Cavovarus Foot Correction
To support the entire body’s weight on your two feet, the inner middle portion of each foot (midfoot) is raised off the ground to form an arch. A cavovarus foot deformity is characterized by a higher-than-normal arch of the inner midfoot.
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Internal and External Fixation of Foot and Ankle Fractures
Foot and ankle fractures are breaks or cracks in any bone of your foot and ankle joint. Fixation of fractures is a surgical method of reconnecting the broken or cracked bones and fixing them in the correct place using orthopedic hardware.
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Lesser Toe Surgery
Lesser toe surgery is an operation to correct deformities of the lesser toes other than the big toe. Some of the common lesser toe deformities include hammer toe, claw toe, and mallet toe.
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Metatarsal Surgery
Metatarsal surgery is a surgical procedure performed on the metatarsal bones, the long bones in the feet that connect to the toe bones.
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Fifth Metatarsal Fractures
The metatarsal bones are the long bones in your feet. There are five metatarsal bones in each foot. The fifth metatarsal is the long bone that is located on the outside of the foot and connects to the small toe.
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Subtalar Arthrodesis
The subtalar joint is a complex joint located below the ankle joint and is formed by the union of the heel (calcaneus) and the talus (ankle) bone. The subtalar joint allows side-to-side movement of the foot.
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Ankle Tenotomy
Ankle tenotomy is a surgical procedure to lengthen the Achilles tendon, enabling the ankle to flex upward and allowing the heel to be placed flat on the floor.
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Neurolysis
Neurolysis is a procedure that involves injecting chemical agents into nerve fibers to reduce nerve pain by destroying the damaged nerves. These agents degenerate the nerve fibers blocking the transmission of pain signals.
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Bunionectomy
A bunionectomy is a surgical procedure to remove a bunion. A bunion, also called a hallux valgus, is an enlargement of bone or soft tissues around the joint at the base of the big toe that results in the formation of a bump.
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Osteochondral Allograft Transplantation System (OATS) of the Ankle
OATS of the ankle is a surgical procedure to treat Osteochondral Lesions of the Talus (OCL) or Osteochondritis Dissecans (OCD). It involves the transfer of healthy cartilage to replace the damaged cartilage and restore the normal function of the foot.
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Tendon Transfer
In a tendon transfer procedure, a healthy tendon is transferred to replace the damaged tendon and restore the normal movement of the foot.
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Foot and Ankle Examination
Examination of the foot and ankle is necessary for an accurate diagnosis of injury or disorder.
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Foot Injections
Foot injections are steroids that are injected into your foot to relieve pain and inflammation. Cortisol is a hormone that is produced in the human body and functions to reduce stress and inflammation.
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Foot Rehabilitation Following Surgery
A foot injury or foot surgery may leave you immobile for a period of time. To return to your regular activities and more strenuous recreational activities, it is necessary for you to follow a well-planned activity and exercise program.
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Ankle Fusion Surgery
An ankle fusion surgery (or arthrodesis) is commonly suggested for a degenerative (worn out, painful) ankle joint. For many years, surgeons have considered an ankle fusion to be the permanent solution for advanced degenerative arthritis of the ankle joint.
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Osteochondritis Dissecans of the Ankle
Osteochondritis dissecans is a condition that causes ankle pain and stiffness. Osteochondritis dissecans can affect all age groups and usually follows a twisting injury to the ankle such as an ankle sprain.
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Remedial Massage
Massage therapy is a form of treatment that involves the manipulation of the muscles and soft tissues of the body.
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Non-Surgical Treatment for Foot and Ankle Pain
The foot and ankle is a complex joint involved in movement and providing stability and balance to the body.
What is the Normal Anatomy of the Foot and Ankle?
The foot and ankle form complex joints that are involved in movement and providing stability and balance to the body. The foot and ankle consist of 26 bones, 33 joints, and many muscles, tendons, and ligaments.
Bones of the Ankle
The ankle joint connects the leg with the foot and is composed of three bones: the tibia, fibula, and talus. The tibia or shinbone and fibula or calf bone are bones of the lower leg, which articulate with the talus or ankle bone, enabling up and down movement of the foot.
Three bony bumps present on the ends of the tibia and fibula form parts of the ankle joint:
- The medial malleolus, formed by the tibia, is found on the inside of the ankle.
- The posterior malleolus, also formed by the tibia, is found at the back of the ankle.
- The lateral malleolus, formed by the fibula, is found on the outer aspect of the ankle.
Bones of the Feet
The foot acts as a single functional unit, but can be divided into three parts: the hindfoot, midfoot and forefoot.
The hindfoot forms the ankle and heel, and is made up of the talus bone and calcaneus or heel bone. The heel bone is the largest bone in the foot.
The midfoot connects the hindfoot to the forefoot, and consists of one navicular bone, one cuboid bone, and three cuneiform bones. The navicular bone is found in front of the heel bone, and the cuneiform and cuboid bones are arranged in front of the navicular bone.
These bones are connected to five metatarsal bones of the forefoot that form the arch of the foot for shock absorption while walking or running. The forefoot is also made up of the toes or digits, formed by bones called phalanges - three in each toe, except the big toe, which has only two phalanges. The big toe has two additional tiny round sesamoid bones in the ball of the foot, which helps in upward and downward movements of the toe.
Ankle and Foot Joints
There are 33 joints in the ankle and foot. They include:
- Hinge joints in the ankle, which allow flexion (bending) and extension
- Gliding joints found in the hindfoot, which allow gliding movements
- Condyloid joints found in the forefoot and toes, which allow the flexion (bending) and extension, adduction, and abduction (sideward movement).
The joints of the foot and ankle provide stability and support the weight of your body, helping you to walk or run, and adapt to uneven grounds.
Soft Tissues of the Ankle and Foot
Our feet and ankle bones are held in place and supported by various soft tissues such as cartilage, ligaments, muscles, tendons, and bursae.
The joint surface of all the bones of the ankle and foot are lined by a thin, tough, flexible, and slippery surface called the articular cartilage, which acts as a shock absorber and cushion to reduce friction between the bones. The cartilage is lubricated by synovial fluid, which further enables smooth movement of the bones.
Ligaments are tough rope-like tissue that connect bones to other bones, and hold them in place, providing stability to the joints. The plantar fascia is the largest ligament in the foot, originating from the heel bone to the forefoot, it extends along the lower side of the foot and is involved in maintaining the arch of the foot. The plantar fascia ligament stretches and contracts to provide balance and strength to the foot. Lateral ligaments on the outside of the foot and medial ligaments on the inside of the foot provide stability and allow up and down movement of the foot.
The foot is made up of 20 muscles that help in movement. The main muscles include:
- Anterior tibial muscle, which allows up and down movement of the foot
- Posterior tibial muscle, which supports the arch
- Peroneal tibial muscle, which controls movement on the outside of the ankle
- Extensors, which enable the ankle to raise the toes just before stepping forward
- Flexors, which stabilize the toes against the floor
- Smaller muscles that help the toes to lift and curl
Tendons are soft tissues that connect muscles to bones. The largest and strongest tendon in the foot is the Achilles tendon, present at the back of the lower leg around the heel bone. Other tendons include peroneal and anterior and posterior tibialis.
Bursae are small fluid-filled sacs that decrease friction between tendons and bone or skin. They contain special cells called synovial cells that secrete a lubricating fluid.
