The ankle joint is a hinge joint formed by the tibia, fibula (shinbones), and talus. As the ankle is a hinge joint, it allows an up (dorsiflexion) and down (plantarflexion) movement.
The foot is made up of 26 bones: 7 tarsal bones (rear foot); 5 metatarsals (midfoot) and 14 phalanges (toes). The main movement at the rear foot between the calcaneus (heel) and talus bones is in (inversion) and out (eversion). The phalanges (toes) are hinge joints which allows for up (extension) and down (flexion) movement.
The Ligaments
Ligaments are a structure that connects bone to bone and helps create stability and gives the foot and ankle awareness of its position in space (proprioception). There are many ligaments within the foot and ankle. The main ankle ligaments include the lateral ligaments (on the outside of the ankle) which resist over inversion and the medial ligaments (on the inside of the ankle) which resist over eversion.
The Muscles
The main muscles of the foot and ankle consists of 4 groups that work to move the foot up (dorsiflexion), down (plantarflexion), in (inversion) and out (eversion).
The muscles at the front of the ankle include the anterior tibial muscle that shorten to pull the foot up and lengthen to allow to foot to point down.
The muscles at the back of the lower leg blend into the Achilles tendon which is the largest tendon in the body and connects the calf muscles to the heel bone.
The posterior tibial muscle at the medial (inside) ankle acts to move the foot in towards the other (invert) while the peroneal muscles at the lateral (outside) ankle act to move the foot away from the other (evert).
The Fascia
The fascia is a strong band of tissue on the sole of the foot also called the plantar fascia. It is thick in the middle and thinner at the sides, fanning out in a triangle shape from the heel bone (calcaneus) to the toes.
This structure is important for maintaining the arch of the medial (inside) foot, for protection of deeper structures in the foot like blood vessels and nerves as well as a shock absorber when walking.
Foot and ankle myths
Myth: My feet are too flat
Fact: There is no such thing as perfect foot posture. Some people have high arches, some are low and others have arch heights somewhere in between. Studies have shown that arch height is not a predictor of foot health problems.
Myth: I need insoles for my flat feet
Fact: In most cases low arched feet (flat feet) do not cause any problems and pain and therefore do not need corrective insoles (also known as Orthoses). Orthoses are prescriptive devices and best prescribed by your Podiatrist after a full consultation about your presenting symptoms.
Myth: Insoles will fix my pain
Fact: Similar to above, orthoses are usually part of a treatment plan to manage your symptoms and can assist in managing your symptoms along with other treatments and life style changes.
Myth: I have bunions and therefore need corrective surgery
Fact: Most of the time, surgery is not needed. Often a mixture of footwear advice, exercises and sometimes orthoses are successful in managing your symptoms.
Myth: Surgery is the only option for my foot pain
Fact: Surgery isn’t always the answer in managing your pain. Surgery is never guaranteed to work and often it does not solve the reason you had the issue in the first place. In most cases surgery should be the last resort for those who have not responded to all other treatments.
Myth: Expensive shoes are best
Fact: Good footwear comes in all price ranges. Do not fall victim into thinking that you need to spend more to get more.
Myth: Exercise is bad for my pain
Fact: Exercise is recommended as a safe and effective treatment for everyone. There will be differences regarding the amount and intensity of exercise that an individual can tolerate. It is important that you get into a regular exercise routine.
Myth: Rest will help with my pain
Fact: Rest has often been used to tackle pain. In most instances, rest and avoidance of exercise makes pain worse – especially in the long term.
Myth: I need a scan
Fact: In most cases, a scan is not needed in the first instance and diagnosis can be by clinical assessment alone. Often scans can find incidental findings that have no relevance in explaining an individual’s pain. Furthermore structural changes found on a scan does not always correlate with the amount of pain and disability as there are other factors which also contribute to a person’s experience of pain.
Myth: Pain means I am damaging my foot / ankle
Fact: The most important thing you should know is that pain does not always mean harm. We can experience pain as a result of tissue damage, however it’s also possible to feel no pain with damage to the tissues in our body. It’s also possible to experience significant amounts of pain even when there has been no damage to our body.
We know now that pain is far more complex than solely what is going on in our bodies and can be influenced by other areas in your life. These include;
- Moods and emotion
- Beliefs about pain
- Avoidance of meaningful activities / social contact
- Lifestyle choices
This is often referred to as “The Bio-Psycho-Social model of pain”. Meaning all areas of your life can influence pain. It is important therefore to look at your life as a whole when dealing with foot and ankle pain to see if there are other contributing factors.
Further information can be found on understanding pain by clicking here.