Dr. Mark S. Cantieri • Doctor of Osteopathic Medicine
Foot & Ankle Pain
Foot and Ankle Pain
During standing, walking, and running, the foot and ankle provide support, shock absorption, balance, and several other functions that are essential for motion. Three bones make up the ankle joint, primarily enabling up and down movement. There are 28 bones in the foot, and more than 30 joints that allow for a wide range of movement.
In many of these joints the ends of the bones are covered with articular cartilage - a slippery substance that helps the bones glide smoothly over each other during movement. Joints are surrounded by a thin lining called the synovium. The synovium produces a fluid that lubricates the cartilage and reduces friction.
Tough bands of tissue, called ligaments, connect the bones and keep the joints in place. Muscles and tendons also support the joints and provide the strength to make them move.
It is important to differentiate ankle pain from foot pain when evaluating an injured patient. The patient with a sprained ankle complains of vague, diffuse pain, often localized to the lateral or anterolateral aspects of the ankle. One may experience the feeling of the ankle giving away or instability of the joint when walking on uneven surfaces or of swelling and stiffness sometimes accompanied by locking, popping and snapping of the ankle. Fractures can occur in the ankle and the Ottawa rules provide a proven screening tool for ankle fractures.
A high ankle sprain results from forced supination, forced internal or external foot rotation and forced foot flexion. Patients will complain of pain with weightbearing, a general feeling of ankle instability during exercise and an inability to do single-foot toe stands. An inversion sprain is the most frequent type of ankle injury. It occurs after forceful plantar flexion and supination of the foot. This will result in sprains to multiple ligaments of the ankle joint and chronic instability. It can cause injury to not only the ligaments but to tendons and nerves by overstretching them. Edema is frequently noted in the lateral or outside aspect of the ankle and becomes more obvious as the day progresses. Stabilizing the ankle requires manipulation, taping and prolotherapy to create lasting results.
Foot pain may be caused by sprains to the deep ligaments supporting the bottom of the foot. These include the spring ligament, the long and short plantar ligaments and the plantar fascia. Many people diagnosed with plantar fascitis have sprains and instability of these deeper ligaments. These patients will complain of pain in the heel. A careful history will reveal that over the last several years her shoe size has increased by 1 or 2 sizes. This increase in foot length results from overstretching and lengthening of the ligaments leading to increased stress on the plantar fascia. Successful treatment requires repairing the deep plantar ligaments with prolotherapy. The use of orthotics can complement this.
Pain in the forefoot can be referred from these deep plantar ligaments. It can also be the result of sprains to the metatarsals or to the tendons between the metatarsals, such as a sprained anterior arch, or the deep transverse metatarsal ligaments. When this sprain occurs the muscles between the metatarsals will go into spasm causing contracture and hammering of the toes.
Treating Foot and Ankle Pain
Treatment options for foot and ankle pain are tailored to the needs of each individual patient. Dr. Cantieri will diagnose the source of your pain and provide recommendations for treatment.