Anatomy of the Foot

The ankle is a complex mechanism. What we normally think of as the ankle is actually made up of two joints: the subtalar joint, and the true ankle joint. The true ankle joint is composed of 3 bones, seen above from a front, or anterior, view: the tibia which forms the "inside”, or medial, portion of the ankle; the fibula which forms the lateral or “outside” portion of the ankle; and the talus underneath. The true ankle joint is responsible for up and down motion of the foot.

Beneath the true ankle joint is the second part of the ankle, the subtalar joint, which consists of the talus on top and calcaneus on the bottom. The subtalar joint allows side to side motion of the foot.

The ends of the bones in these joints are covered by articular cartilage (1). The major ligaments of the ankle are: the anterior tibiofibular ligament (2), which connects the tibia to the fibula; the lateral collateral ligaments (3), which attach the fibula to the calcaneus and gives the ankle lateral stability; and, on the medial side of the ankle, the deltoid ligaments (4), which connect the tibia to the talus and calcaneus and provide medial stability.

These components of your ankle, along with the muscles and tendons of your lower leg, work together to handle the stress your ankle receives as you walk, run and jump.

Plantar Fasciitis

Plantar fasciitis (inflammation of the plantar fascia) is the most common cause of heel pain seen by an orthopedist. It is common in several sub-groups of people, including runners and other athletes, people who have jobs that require a fair amount of walking or standing (especially if it is done on a hard surface), and in some cases it is seen in people who have put on weight -- either by dietary indiscretion or pregnancy.

The plantar fascia is a broad ligament-like structure that extends from the heel bone to the base of the toes, acting like a thick-rubber band on the bottom arch of the foot. With a few extra pounds on board, or with activities such as exercise, the plantar fascia can develop microtrauma at its insertion into the heel bone, or anywhere along its length. This causes pain which can be quite severe at times.

One disturbing fact about plantar fasciitis is that it sometimes takes many months to resolve. Indeed, it takes approximately 6 months for 75% of people to recover from this problem. 98% of people seem to be better at 12 months.

Treatment of plantar fasciitis consists of 3 stages:

• Stage 1 involves prescribing the patient a heel cushion to decrease shock absorption of the plantar fascia, as well as a short course of medication to decrease inflammation in the heel.
• Stage 2 may involve cortisone injections into the heel region, if Stage 1 has failed to bring significant relief. Other modalities in Stage 2 include: orthotics, taping, physical therapy, and night splinting.
• Stage 3 is for those who have had plantar fasciitis for one year or longer, whose symptoms are severe and preventing them from their job or recreation. It involves a surgical release of part of the insertion of the plantar fascia. However, this surgery is rare, as most people do have significant relief from non-surgical treatment.