The Foot and Ankle
Your feet and ankles take a lot of abuse. They are literally at the bottom of the pile-they have to support the weight of everything else in your body. There are more bones in your feet than in your legs and back combined, and each foot has 26 joints, making very flexible movement possible. The two ankle bones (malleoli) are extensions of the two bones of the lower leg. At the ankle, these two bones meet with bones of the foot to make a hinge joint which moves primarily forward and backward, though there is also some side-to-side movement that is vital to walking safely on uneven surfaces. In fact, the foot and the ankle are dependent on each other for their safety; strong ligaments hold the two ankle bones together and also connect the ankle bones to the foot in numerous places.
In all, 15 different tendons, more than 10 different ligaments, and several bursa add together with the bones and joints to make up the structures in the feet and ankles. With so many parts, itıs easy to understand why the feet and ankles are so vulnerable to injury.
Injury Patterns
Ligament injuries The most troublesome of the ankle ligaments is the anterior talofibular ligament. This ligament, which extends from the front of your outer ankle bone into the foot, tears and develops adhesive scar tissue in 90 percent of all ankle sprains. Another important ligament, the calcaneo-fibular ligament, is also often torn; this ligament extends from the outer ankle bone straight down to the outer heel. The mass of ligaments at the inner ankle, called the deltoid ligaments, is sprained a little less frequently and mostly in the older population.
Tendinitis Other foot injuries © copyright Ben Benjamin 2001
Spraining an ankle is so common an injury that it is difficult to find a person who has not experienced it at least once. Most commonly, an outer ankle sprain occurs when your foot inverts (twists inward) under your weight during a sudden movement or fall. While certain ligaments are most commonly damaged (see below), the degree of damage and its location can vary a great deal, and many small ligaments in both the foot and ankle may be injured.
The most important tendon of the foot/ankle structure is the Achilles tendon, which attaches all the calf muscle to the back of the heel bone (or calcaneous). When you have Achilles tendinitis it is difficult to walk, run, raise onto the balls of your feet or jump without pain. There is also a group of tendons that run along the top of the foot which help extend the foot and toes, and an opposing group of tendons that run along the bottom of the foot, which facilitate flexing or pointing the toes. Some of these tendons connect to muscles in the lower leg, while others connect to small muscles within the foot. The most common injury in the small muscles of the foot occur to the interosseus muscles which lie betweent the toes. Finally, on the inside of the foot there is a tendon which helps you move the foot inward and on the outside there are two tendons which allow you to move the foot outward. When one or more of these tendons becomes strained where they pass just behind the ankle bones, the pain may be mistaken for a mildly sprained ankle ligament.
Inherited structural problems in the formation of the bones of the foot can cause a host of problems. Different types of feet make people prone to different kinds of injuries. For instance, a foot with a high arch has much less weight-bearing surface than a normal foot; consequently, having a high arch can create problems in the heel and ball of your foot. If your second toe is longer than the big toe there will often be problems with balancing on one foot and therefore injuries to the big toe joint or the the toes on the outer part of the foot.