The ankle is an assembly of seven bones collective referred to as the tarsus. Each joint surface is covered by a layer of cartilage called articular cartilage. There are two bones in the lower leg that contribute to the ankle joint. The thicker tibia (shin bone) is the major weight bearing bone and thinner fibula is important for tendon and ligament attachments. The end on the tibia forms the bump (medial malleolus) on the inside of the ankle and the end of the fibula forms the bump (lateral malleolus) on the outside of the ankle. Ligaments connect bone to bone and the medial and lateral malleoli serve as important points of origin for the ligaments that stabilize the ankle. There are also numerous ligaments crisscrossing between all of the tarsal bones, which are important in maintaining the foot’s arch. Ligaments connect the tarsus to the lower leg bones on one end (proximal) and the tarsus to the five metatarsal bones on the other end (distal). Toes connect to the ends of the five metatarsal bones. Each toe is comprised of individual phalangeal bones. The big toe only has two phalangeal bones and the four smaller toes each have three phalangeal bones. The foot has a very intricate system of tendons connecting specific phalangeal bones and tarsal bones to designated muscles to allow standing, walking, running and jumping. The Achilles tendon, which is the largest tendon in the body, connects two large and powerful calf muscles to the heel bone (calcaneus). Fascia, a broad flat connective tissue, is located in the bottom (plantar) aspect of the foot and this plantar fascia helps support the arch of the foot as well.
Ankle sprains are very common injuries. Ligaments connect bone to bone so when a ligament gets stretched (sprained) it does not always return to its preinjury length. This can cause the ankle joint to be less stable and become more susceptible to repeat ankle sprains. This process can lead to damage of the articular cartilage and result in arthritis of the ankle joint. Ligament problems in the tarsus can also cause arch problems in the foot which eventually provoke plantar fasciitis (shown in video) pain symptoms in the bottom of the heel, especially felt during the first several steps after getting out of bed. Changes in the foot arch can also provoke alterations in the angle of the Achilles tendon and result in Achilles tendinitis (shown in video below). Another compensation following arch problems can be pain in the bottom of the foot where the metatarsals and toes join resulting in metatarsalgia.
Commonly Treated Foot & Ankle Pain Conditions: Plantar Fasciitis, Achilles Tendinitis, ligament Sprain, Metatarsalgia, Ankle Osteoarthritis, Joint Instability or Subluxation
Treatment of any ankle or foot problem should start with ensuring proper alignment by seeking a reputable opinion regarding the potential need for orthotics to optimize arch support, etc. Thereafter, depending on the magnitude of degenerative change; the extent of tendon, ligament, or fascia injury; and of course the degree to which a person prioritizes avoiding a surgical intervention, Regenerative Medicine treatments can be considered for any of the ankle and foot injuries listed above. Call the Regenerative Spine & Joint Center today to find out if you are a candidate for Regenerative Medicine interventions for your pain. After discussing your ankle and foot history with you, performing a detailed physical examination and reviewing available imaging studies (x-ray, MRI, etc.) Dr. Terebuh will be able to give you his specific recommendations regarding whether or not Bone Marrow Cell Therapy or Platelet Rich Plasma (PRP) Therapy will help you accomplish the goals you have for your ankle or foot.