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WILDERMAN MEDICAL CLINIC
Anatomy of the ankle and foot
The ankle and foot are highly complex structures that carry the weight of your body with every step. When working properly, we take thousands, or even tens of thousands, of steps every day without a thought.
In an article titled Ankle Anatomy, it is noted that “the unique design of the ankle makes it a very stable joint.
This joint has to be stable in order to withstand 1.5 times your body weight when you walk and up to eight times your body weight when you run” (Complete Care Physiotherapy Chiropractic).
The ankle is formed where the distal (lower) ends of the tibia and fibula bones of the lower leg meet the talus bone and the calcaneus (heel bone) of the foot.
The joint allows for hinge-like movement: the upward, or dorsiflexion, movement of the foot and the downward, or plantarflexion, movement.
A smooth connective tissue called articular cartilage covers the ends of the bones in the ankle joint, cushioning the force of impact from movements like walking, running, and jumping, and allowing for smooth movement in the joint.
This sturdy joint is further supported by ligaments that surround the joint and, in conjunction with other soft tissues, form the joint capsule of the ankle.
The foot is made up of 26 bones that form 33 joints; the foot also contains over 100 muscles, tendons, and ligaments. An article in SportsMed online notes that “approximately 25% of the bones in the body are found in our feet” (https://sportsmedalabama.com/contents/patient-education/foot-and-ankle/).
The bones of the foot can be grouped into 3 categories: the 7 irregularly shaped tarsal bones, the 5 long metatarsal bones, and the 14 bones called phalanges, which form the toes. Joints are formed at any point where two or more of these bones meet.
Cartilage covered the ends of the bones at each joint, allowing for smooth, protected movement. Muscles, tendons, and ligaments in the foot provide support and allow for movement.
How does osteoarthritis develop in the Foot and Ankle joints?
When the foot and ankle are working as they should, we walk throughout our days without a second thought; however, when something goes wrong every step can become a painful experience.
SportsMed online notes that “approximately 80% of people will experience a foot-related problem at some point in their life” (https://sportsmedalabama.com/contents/patient-education/foot-and-ankle/).
Wear-and-tear-related osteoarthritis of the foot and ankle are common in middle age and later in life; however, those who have experienced foot and ankle trauma or practice high-impact activities like frequent running and jumping can experience osteoarthritis of the foot or ankle early in life as well.
Damage to the cartilage in a joint can result in increased friction in the joint during movement. This friction, caused by the rubbing of unprotected bones against each other, can cause chronic inflammation in the joint, as well as the formation of bone spurs.
While initial damage to the cartilage can go unnoticed since cartilage does not contain nervous tissue, once the damage begins to cause inflammation and changes to the bone itself the condition can become quite debilitating.
What are the symptoms?
Some common symptoms of foot and ankle osteoarthritis include:
- Pain and tenderness in the foot and ankle
- Stiffness in the joints, particularly upon waking in the morning
- Swelling, heat, and deformity in the joints of the foot and ankle
- Changes in gait and pain with walking
- Cracking or grinding sounds with movement, known as crepitus
How common is osteoarthritis of the foot and ankle?
An article published in the journal Foot in 2012 noted that “there are an estimated 29,000 cases of symptomatic ankle osteoarthritis being referred to specialists in the UK, representing a demand incidence of 47.7 per 100,000” (Goldberg et al. 2012). A 2021 journal article reported that “ankle OA is very debilitating in advanced stages and can have similar repercussions on the quality of life as severe hip osteoarthritis, advanced kidney failure, or congestive heart failure.”
The authors note that 75-80% of ankle OA is secondary to trauma, such as previous ankle fractures (Herrera-Perez et al. 2021). Osteoarthritis of the foot is significantly more common than ankle OA.
An article published in 2018 reported that “symptomatic radiographic foot OA affects 17% of adults aged 50 years and over.” The authors of this article report that foot pain is a common cause of healthcare consultation in older people, with foot OA being one of the leading causes of this pain; they note that “foot pain affects one in four people aged over 75 years, two-thirds of whom have related locomotor disability.
One in 10 people aged over 70 years will develop new disabling foot pain over a 3-year period” (Roddy et al. 2018).
What are the risk factors associated with osteoarthritis of the foot and ankle?
Some common risk factors for osteoarthritis of the ankle and foot include:
- Age
- Activity level – repetitive movements like frequent running or jumping increase the risk
- Excess weight/obesity
- Family history of osteoarthritis
- Previous injury to the foot or ankle
- Other inflammatory conditions, such as rheumatoid arthritis
How is the condition diagnosed?
Diagnosis of foot or ankle osteoarthritis will require an appointment with your physician.
Your doctor will take down a detailed medical history, including both general medical information, such as any medical conditions you have and any medications you are taking, as well as details specific to your foot and ankle pain, including when the symptoms first began, what types of movements or activities provoke or improve the pain, and whether you have had any previous injuries to those areas.
A physical exam will help your physician to test for pain or tenderness in the joints with specific movements, limitations in your range of motion in those areas, changes in your gait as a result of your discomfort, and whether there is any swelling or deformity in the joints.
Once this is done, you may also be recommended to have diagnostic testing done. An X-ray will show if there is any narrowing of the joint spaces or any bone spur formation; an MRI or ultrasound can show if there is damage to the tissues of these joints; other tests, such as a bone scan or CT scan may be recommended to gather pertinent information about the affected area; finally, a blood test can help to determine if your joint pain is being caused by another condition, such as rheumatoid, gout, or psoriatic arthritis.
How is the condition treated?
If you have been diagnosed with osteoarthritis of the ankle or foot, the approach best suited to your particular situation will depend on numerous factors, including age, activity level, the severity of your pain, the extent of limitation you experience as a result of the foot or ankle pain, and any other health concerns that you have. Damage caused by osteoarthritis is, unfortunately, not reversible; however, there are numerous treatments and strategies for slowing or even preventing further degeneration in the joint. Some of these options include:
- Acetaminophen to reduce pain
- NSAIDs (non-steroidal anti-inflammatory drugs) to reduce pain and inflammation
- Other oral medications specific to treating arthritis and inflammation
- Physiotherapy
- Aquatics or pool therapy program
- Acupuncture and Acupressure
- Massage therapy
- Occupational therapy (including improving the ergonomics of your workstation, if applicable)
- Exercise to improve posture and gait, to reduce weight, and exercise adaptation to avoid aggravating foot and ankle pain
- Assistive devices, including ankle braces, orthotics, and a cane
- Dietary changes to improve weight and reduce inflammation
- Smoking cessation
What do we do at WMC?
At the Wilderman Medical Clinic, we offer a variety of interventional and non-interventional treatment options, including:
Interventional pain management for osteoarthritis of the ankle and foot joints:
- Cortisone injections for ankle and foot joint osteoarthritis
- Hyaluronic acid (viscous supplementation) injections for ankle and foot joint osteoarthritis
- Dextrose (prolotherapy) injections for foot and ankle joint osteoarthritis
- PRP (plasma-rich protein) injections for foot and ankle joint osteoarthritis
- nStride injections for foot and ankle joint osteoarthritis
Non-interventional pain management for osteoarthritis of the foot and ankle joints:
- Psychotherapy
- Kinesiology education sessions
When is surgery required?
If your pain is severe and unresponsive to non-surgical treatments, your doctor may recommend that you consider surgery. Several surgical alternatives are available.
Arthroscopic debridement involves the removal of loose or damaged tissue in the joint, which can help to reduce pain and inflammation caused by friction. Arthrodesis is a more invasive option, and involves the fusion of bones in a joint; this procedure can reduce pain by removing the ability of a joint to move, but results in significant limitation in range of motion.
An ankle replacement, or arthroplasty, is an option reserved for those with very advanced ankle OA that severely limits day-to-day activity. It involves the removal of the damaged joint, which is then replaced with an artificial joint.
It is important to keep in mind that all of these procedures have associated risks, and you should consider your options carefully, with the support of your physician, to decide what is best for you.
Works Cited
Ankle Anatomy. Complete Care Physiotherapy Chiropractic. Retrieved from https://completecarephysio.com/ankle-injury/anatomy/.
Foot and Ankle. SportsMed. Retrieved from https://sportsmedalabama.com/contents/patient-education/foot-and-ankle/.
Goldberg AJ, MacGregor A, Dawson J, Singh D, Cullen N, Sharp RJ, Cooke PH. The demand incidence of symptomatic ankle osteoarthritis presenting to foot & ankle surgeons in the United Kingdom. Foot (Edinb). 2012 Sep;22(3):163-6. doi: 10.1016/j.foot.2012.02.005. Epub 2012 Mar 20. PMID: 22436838.
Herrera-Pérez M, González-Martín D, Vallejo-Márquez M, Godoy-Santos AL, Valderrabano V, Tejero S. Ankle Osteoarthritis Aetiology. Journal of Clinical Medicine. 2021; 10(19):4489. https://doi.org/10.3390/jcm10194489
Roddy E, Menz HB. Foot osteoarthritis: latest evidence and developments. Therapeutic Advances in Musculoskeletal Disease. 2018;10(4):91-103. doi:10.1177/1759720X17753337
