1. Ankle and Foot Pain
Enas Mohamed Shahine; MD
Ass. Prof. Physical Medicine, Rheumatology & Rehabilitation
Faculty of Medicine,
Alexandria University,
Egypt

2. Ankle joint
The ankle joint is made up of three bones: the lower end of the tibia, the
fibula and the talus.

3. Foot Anatomy

4. Foot Anatomy
Arches of the Foot
3 Arches, to absorb shock, on the Plantar Aspect
• Transverse Front of calcaneus to 5th metatarsal
• Metatarsal Runs along metatarsal heads
• Longitudinal Calcaneus to metatarsal heads

5. Foot and Ankle Anatomy
Ligaments of the Lateral Ankle
• Anterior TaloFibular (ATF) Most often sprained
• Posterior TaloFibular (PTF) 2nd most often
• CalcaneoFibular (CFL)

6. Deltoid Ligament
Very strong, stronger than all lateral ligaments combined .
3 bands to deltoid Anterior, Middle, Posterior
Foot and Ankle Anatomy
Ligaments of the Medial Ankle
• Deltoid Ligament
• Posterior Talocalcaneal (PTC)
• Posterior Talotibial (PTT)

7. Muscles

8. Nerves

9. Painful foot and ankle

10. ANKLE TENOSYNOVITIS
Inflammation of any ankle tendon and its lining synovial sheath.
Causes
oStrain from unusual use or overuse of muscles and tendons in
the ankle.
oDirect blow or injury to the ankle.
oRepeated ankle injury.
oDegenerative changes or inflammatory arthritis.

11. ANKLE TENOSYNOVITIS
•Symptoms and signs
oConstant pain or pain with motion.
oLimited motion of the ankle.
oCrepitation (a "crackling" sound when the tendon moves or
is touched).
oHeat and redness over the inflamed tendon.
•Treatment
oRest
oPain medications
oHeat applications

12. Lateral ligament sprain/ complete tear
Ligament is stretched and torn. The ligaments can tear
partially or completely.

13. Achilles paratendinitis
Rest: the tendon by keeping off their feet as much as possible;
Ice: packs for 20 minutes at a time every hour for a day or two to reduce
swelling;
Compress: the ankle and foot with a firmly (not tightly) wrapped elastic
bandage; and
Elevate: the foot whenever possible to minimize swelling.
tissues immediately surrounding the Achilles Tendon become inflamed.
Inflammation of these structures leads to swelling. The tendon feels painful
to squeezing and thickened.

14. Rupture Achilles tendon
Insidious or abrupt onset with pain and swelling 2-3 cm
proximal to the insertion of the Achilles tendon (partial). Pop or
snap in the back of the ankle (complete). After chronic Achilles
tendonitis.

15. Retrocalcaneal bursitis
A bursa acts as a cushion and lubricant between tendons and
muscles sliding over bone.
Excessive walking, running, or jumping.
Is commonly associated with
Achilles tendinitis
Pain may get worse when rising on the toes
(standing on tiptoes)
Red, warm skin over the back of the heel.

16. SEVER'S DISEASE OR CALCANEAL
APOPHYSITIS
A painful inflammation of the growth plate (apophysis) of the
calcaneus at the Achilles tendon insertion.
In early teenagers, the blood supply to the growing plate is not
keeping up with the demands of growing. Pain is a deep ache or
soreness to the corner of the heel and tends to be aggravated
with running activities.
Decreasing activities for two weeks and the use of custom made
foot orthotics to help improve foot biomechanics.

17. Tender heel pad
Pain beneath the hind part of heel (weight bearing part of
calcaneus) on standing or walking. Local tenderness over the
heel pad.
Contusion (trauma), mild inflammation, uncertain.
Spontaneous recovery.
Corticosteroid injection.
Heel cushion insole

18. CAUSES OF HEEL PAIN
1. Disease of the calcaneus.
2. Arthritis of the subtalar
joint.
3. Ruptured calcaneal
tendon.
4. Calcaneal paratendinitis.
5. Post-calcaneal bursitis.
6. Calcaneal apophysitis.
7. Tender heel pad.
8. Plantar fascitis.

19. Osteochondritis of the talus
Injury to the talus cartilage.
Trauma to the ankle or spontaneously.
The blood supply to the injured cartilage
is poor, giving it little potential to heal.
This area of cartilage and underlying
bone can become detached from the
surrounding bone, which can become
loose in the joint. With time, as the
cartilage injury progresses, arthritis can
develop in the ankle.
Pain and swelling around the ankle.

20. Arthritis
Degenerative (Osteoarthritis)
Inflammatory (Rheumatoid arthritis)
Seronegative arthropathies (psoriatic )
Infective (septic arthritis)
Crystal induced (Gouty arthritis)

21. Plantar fasciitis and heel spur syndrome
Plantar Fascia is a strong inelastic band of fibers which begins
at the heel and extend into the toes.
The usual cause of is excessive pulling on the Plantar Fascia
from excessive exercise. heel spur formation occurs at the site
of where the Plantar Fascia is connected to the heel.
cause pain at the bottom of the foot which is greatly exacerbated
with stepping down the first thing in the morning.

22. Pain in the forefoot (metatarsalgia)
a common overuse injury. It is associated with
increased stress over the heads of metatarsal
bones (the ball of foot).
Poorly fitting footwear such as narrow, high
heeled shoes which force the foot into a small
space can cause the condition. Running or
jumping.
A burning or aching sensation.
Cushioning silicone gel insoles may provide
relief. Advice regarding appropriate footwear with
good shock absorption is important.

23. Morton's metatarsalgia (interdigital neuroma)
Affects the proximal part of the plantar digital
nerve and accompanying plantar digital artery.
Trauma to these structures leads to inflammatory
oedema, fibrosis, and degeneration of the nerve.
Gradual onset with sudden attacks of neuralgic
pain or paraesthesia during walking, often in the
third and fourth toe.
often occur in women.
Treatment—Patients should be advised about
suitable footwear. Injections of local anaesthetic
and hydrocortisone around the nerve or surgical
excision can be helpful.

24. Stress (march) fracture of metatarsal bones
Occurs as the result of applied load to the bone in an
amount, or at a rate, that is greater than the ability of
the bone to repair and heal itself (overuse). commonly
seen in the second and third metatarsals, less
common in the 4th and 5th metatarsals. Rare in the
1st metatarsal.
Pain on walking
Local tenderness&
Swelling.
Spontaneous healing.
Below knee plaster
fixation for 3-4 weeks

25. Callosities
Hard (localized thickening) skin is a sign of
over work in that particular area of the foot
(prominent bone). The body responds to a
greater stress on a skin area by increasing
production of skin cells at the basal layer of the
epidermis.
Shoes can cause skin stresses. Occupation;
leisure activities and foot deformities.
If painful can be removed.
Salicylic Acid application.

26. Planter wart (verruca plantaris)
Growths that develop on the plantar aspect due to a
contagious virus called Human Papillomavirus. Warts can
be flesh colored or dark, rough or smooth, can grow
singly or in groups, often termed as "mosaic warts".
Painful walking on warts.
On walking the warts begin to flatten making them more
difficult to treat because the majority of the wart has been
pushed deeper under the skin.
Keep feet dry as warts thrive in moist conditions.
Wear comfortable shoes to lessen pressure on the wart.
Salicylic acid plasters.
Laser or Electro surgery.
Cutting. Freezing methods.

27. Flat foot

28. Hallux valgus

29. Hammer toe

30. Ingrowing toe nail