Common conditions that affect the Foot and Ankle
1) Plantar Fasciitis:
The plantar aponeurosis (or plantar fascia) is a thick band of connective tissue that runs along the bottom of the foot from the heel to the base of all five toes. The plantar fascia is crucial to a normal gait by doing the following things:
➢ Helps secure the medial longitudinal arch of the foot (the main dome-like arch on the bottom of the foot)
➢ Supports the foot while weight bearing/Shock absorption
➢ Dissipates the ground reaction force
Plantar fasciitis or fasciosis is inflammation & OR degeneration of the plantar aponeurosis. Pain may be felt at its origin in the heel or anywhere along the plantar fascia.
Common causes of Plantar Faciitis:
Muscle tightness or structural problems causing HYPOmobility.
➢ Restriction in extending the first toe. The first toe is crucial to mechanisms of optimal gait. If there is restriction here, it changes the biomechanics of the foot, putting pressure on other structures.
➢ Osteoarthritis or Rheumatoid arthritis of the first toe
➢ Tightness of calf muscles (tight calves restrict dorsiflexion causing your heel to come off the ground early)
➢ A higher arched foot (causing short plantar fascia)
➢ Presence of a spur (bony overgrowth)
Muscle weakness or structural problems causing HYPERmobility
➢ Weak Tibialis Posterior. Tib post is one of the most important muscles that supports’ the medial arch of the foot. If it’s weak it can lead to flat feet.
➢ Pes Planus (flat feet) without proper arch support, feet become flat, putting excessive tension on the plantar fascia
➢ Weak Glute Med, Glute Min, TFL and Quadriceps. These muscles are key in holding the lower extremity together during weight bearing
2) Pes Planus: Flat Feet.
There are two types of pes planus: structural and functional. Structural simply means there is no arch. The heel bone is turned inwards and the bones of the midfoot are turned inwards causing the foot to flatten. There is no restoring the arch in this scenario.
Functional pes planus occurs when there is no arch while the person is standing, but resumes once the person is off their feet.
Common problems with functional pes planus:
➢ Tightness in and shortening of muscles of the lower leg (gastrocs, soleus and peronials especially).
➢ Laxity: previous sprains (lengthened ligaments in the foot/ankle)
➢ Weakness in tibialis posterior, tibialis anterior, abductor hallusis
3) Pes Cavus: High Arch.
Mostly due to the foot being fixed in a plantarflexion position (pointing the toes towards the floor).
Decreased shock absorption leads to increased tension where the plantar fascia inserts at the Achilles tendon.
The foot lacks the mobility needed to absorb ground forces and go through the proper phases of gait. There is also decreased flexibility at the Achilles tendon.
➢ Tightness of the calves (especially muscles of the deep posterior compartment of the leg)
4) Morton’s Metatarsalgia (interdigital neuroma):
This condition is where a nerve serving the toes (usually between the 3rd and 4th) causes pain, especially when walking. This condition is often marked by pain and inflammation at the ball of the forefoot. Pain is increased by squeezing the toes together, increasing pressure on the digital nerve.
5) Tarsal Tunnel Syndrome:
The tarsal tunnel is a long space that runs along the inner leg just behind the medial malleolus (the large round bone that protrudes on the inside of your ankle).
This tunnel contains nerves and arteries that supply the foot. Tarsal tunnel occurs when the posterior tibial nerve is compressed within the tunnel. Often the associated symptoms are numbness on the bottom of the foot, possibly with burning and tingling.
Jogger’s Foot/Medial Plantar Nerve Entrapment:
This condition is associated with compression of the inner most branch of the posterior tibial nerve at the inside of the heel. It is often associated with pain in the heel and altered sensation on the bottom of the foot, especially near the big toe.
This condition is usually associated with fractures, muscle impingements, bone spurs or ganglia.
Sinus Tarsi Syndrome:
The sinus tarsi is a depression on the top of the foot, adjacent to the lateral maleolus (the large bone on the outside of your ankle). Inside the sinus tarsi lies the interosseous talocalcaneal ligament. Sinus tarsi syndrome is inflammation of this ligament.
Hallux Valgus (bunion):
The first toe (hallux) is out of alignment so that the base of the toe sticks out causing a large bump on the outside of the foot. The bump itself is partly due to a swollen bursa as well as bony overgrowth.
This condition presents as limited flexion and extension of the first toe because of osteoarthritis or other bony changes.
Calcaneal Fat Pad Contusion/Policeman’s Heel:
Bruising to the fat pad that covers the heel. It is often caused by excessive pounding, weight gain, improper footwear.
Exositosis (bony spur):
A spur is an abnormal overgrowth of bone that often occurs as a result of trauma, excessive pressure or overuse of the joint in question.
Ankle Sprains and Strains:
A sprain is injury to a ligament while a strain is injury to a muscle.
Inversion Sprain (rolling inward) is the most common ankle sprain. It results in injury of the Anterior Talofibular Ligament (ATFL), a ligament on the outside of the foot.
Eversion Sprain (rolling outward) is a less common ankle sprain resulting in damage to the deltoid ligament that lies on the inside of the foot.
There are three kinds of fractures seen in foot injuries.
Jones’ Fracture: fracture of the base of the 5th toe
Potts Fracture (bimalleolar): fracture of the lateral maleolus, followed immediately by a rebound fracture of the medial maleolus.
Stress Fracture: a fracture that occurs after repeated (rather than sudden) stress to a bone.
Catherine Taman is a Registered Massage Therapist practicing in Toronto, Canada. She has a special interest in treating chronic pain, headaches, sports injuries and pregnancy related pain. To book an appointment with Catherine, visit rmtmassagetherapytoronto