The ankle joint is formed where the foot and the leg meet. The ankle, or talocrural
joint, is a hinge joint where 3 bones are connected to each other. They are the tibia
and fibula of the leg and talus bone of the foot. The articulation between the tibia and
talus bears more weight than between the smaller fibula and the talus.
Tibia
Fibula
Calcaneus
Navicular Talus
Cuboid
Cuneiforms Metatarsals
Phalanges
The ankle joint is responsible for moving the toes up as when standing only on the
heels (dorsiflexion) and moving the toes down, as when standing on the toes
(plantarflexion), and allows for the greatest movement of all the joints in the foot. The
ankle does not allow rotation.
In plantarflexion, the anterior ligaments of the joint become longer while the posterior
ligaments become shorter. The reverse is true for dorsiflexion. The anterior talus is
wider than the posterior talus. When the foot is dorsiflexed, the wider part of the
superior talus moves into the articulating surfaces of the tibia and fibula, creating a
more stable joint than when the foot is plantar flexed.
The ankle joint is bound by the strong deltoid ligament and three lateral ligaments: the
anterior talofibular ligament, the posterior talofibular ligament, and the
calcaneofibular ligament. The deltoid ligament supports the medial side (inner) of the
joint, and the anterior and posterior talofibular ligaments and calcaneofibular
ligament support the lateral side (outer) of the joint.
The joint is most stable in dorsiflexion and a sprained ankle is more likely to occur
when the foot is plantar flexed. This type of injury more frequently occurs at the
anterior talofibular ligament.
The anatomy of the foot can be seemed quite complex. If the foot is considered in it's
three distinct regions, the forefoot, midfoot and the rear foot, the bony anatomy is
greatly simplified.
The forefoot includes the five metatarsal bones, and the phalanges (the toes). The first
metatarsal bone bears the most weight and plays the most important role in
propulsion. It is the shortest and thickest. It also provides attachment for several
tendons. The second, third, and fourth metatarsal bones are the most stable of the
metatarsals. They are well protected and have only minor tendon attachments and are
not subjected to strong pulling forces.
Near the head of the first metatarsal, on the plantar surface of the foot, are two
sesamoid bones (a small, oval-shaped bone which develops inside a tendon, where the
tendon passes over a bony prominence). They are held in place by their tendons, and
are also supported by ligaments.
The midfoot includes five of the seven tarsal bones (the navicular, cuboid, and three
cuneiform). The distal row contains the three cuneiforms and the cuboid. The midfoot
meets the forefoot at the five tarsalmetatarsal (TMT) joints. There are multiple joints
within the midfoot itself. Proximally, the three cuneiforms articulate with the
navicular bone.
The talus and the calcaneus make up the rear foot. The calcaneus is the largest tarsal
bone, and forms the heel. The talus rests on top of it, and forms the pivot of the ankle.
The toes are responsible for 4 movements, flexion, extension, abduction and
adduction. The foot as a whole (excluding the toes) has two movements: inversion
and eversion. All the joints of the rear foot and midfoot from the subtalar contribute to
these movements, which are complex and consist of several components. In addition,
foot movements ordinarily are combined with ankle movements.
The foot has two important functions: weight bearing and propulsion. These functions
require a high degree of stability. In addition, the foot must be flexible, so it can adapt
to uneven surfaces. The multiple bones and joints of the foot give it flexibility, but
these multiple bones must form an arch to support any weight.
The foot has three arches. The medial longitudinal arch is the highest and most
important of the three arches. It is composed of the calcaneus, talus, navicular,
cuneiforms, and the first three metatarsals. The lateral longitudinal arch is lower and
flatter than the medial arch. It is composed of the calcaneus, cuboid, and the fourth
and fifth metatarsals. The transverse arch is composed of the cuneiforms, the cuboid,
and the five metatarsal bases.
The arches of the foot are maintained not only by the shapes of the bones as well as
by ligaments. In addition, muscles and tendons play an important role in supporting
the arches.
Common sources of ankle pain
• Plantar fasciitis
• Fat pad contusion
• Navicular stress fracture
• Midtarsal joint sprain
• Extensor tendinopathy
• Fracture of 5th metatarsal
• Stress fracture of metatarsal
Lateral ankle sprain is the most common injury to the ankle and the long term
consequences of an ankle sprain is a common cause of chronic ankle pain. The most
common type is the inversion ankle sprain, in which the ankle rolls over on the
outside.
An ankle sprain is the stretching and tearing of ligaments - in the sprained ankle the
most common damage is done to the talo-fibula ligament (if the ankle sprain is worse,
the calcaneo-fibula ligament can also be damaged) - sometimes the tendons also get
damaged.
The sooner treatment starts for a sprained ankle, the greater chance to prevent chronic
pain and long term instability.
For all grades of ankle sprain follow the R.I.C.E. principles as soon as possible:
Exercises after the first 48 hours play a major role in the in the rehabilitation of the
sprained ankle and to prevent of ankle sprains.
ROM exercises:
Start by using a towel to gently pull the foot towards you. Repeat this
several times a day. Later use calf muscle stretches against the wall.
Balance exercises:
Start by balancing on one foot - hold for as long as possible - repeat
several times a day. Later, a wobble board can be used to make it harder
for balancing on one foot.
Strengthening:
Start by pushing the foot outward against a wall, hold for 3 seconds -
repeat 20 times, several times a day. Later, use an elastic band that is tied
to a heavy object and move the foot outward against this.
Plantar fasciitis is an overuse condition of the plantar fascia at it's attachment to the
calcaneus. It commonly results from activities that require maximal plantarflexion of
the ankle and dorsiflexion of the metatarsophalangeal joints e.g. running. It is usually
painful in the heel and the arch of the foot. Stretching the plantar fascia may
reproduce pain. There may be some underlying leg or foot abnormal biomechanic
problems.