The Foot & Ankle

The foot and ankle are two of the most important parts of the human body. This joint has limited movement compared to other joints but is integral in walking and the overall functional movement of the human body.

If you’re experiencing foot and/or ankle pain, call one of the offices in San Francisco or book an appointment online to get started.

Foot & Ankle Anatomy

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The ankle joint is made up of two joints called the subtalar joint and the true ankle joint. Together these allow for flexion and extension of the foot as well as inversion and eversion. Supporting structures including the Achilles tendon, peroneal tendon, deltoid ligament and the anterior talo-fibular ligament provide stability in and around the ankle joint. Above the ankle are the lower leg muscles, including, most notably, the calf muscles. Unlike the hip and shoulder joint that are composed of only a few bones there are 26 bones in the foot.

A healthy functioning ankle and foot requires each of these bones, tendons, ligaments, and muscles to work together to support the lower leg and ultimately make walking and other activities possible.

What causes foot and ankle pain?

What causes foot and ankle pain?

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There are many causes of foot and ankle pain that vary in severity. Some of the most common injuries are falls which can cause fractures to either the foot or ankle, Achilles tendon tears, and ankle sprains. More chronic injuries can be related to arthritis, Achilles or peroneal tendonitis, shin splints, or Morton’s neuroma. Pain can be mild and only activated with activity or can be more severe and likely cause difficulty with walking.

Common Conditions

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Ankle fractures involve the distal fibula or tibia of the lower leg. They often occur from a fall onto the foot and can occur at any age. Ankle fractures vary in severity based on the force that caused the injury and the resulting fracture pattern. Symptoms include immediate pain after injury, difficulty walking, swelling, and bruising of the lower leg and foot. Diagnosis is made by X-ray, and treatment is based on the extent of the fracture.

Isolated nondisplaced fractures to the distal fibula can often be treated conservatively with weight-bearing as tolerated. In more complex fractures where both bones are fractured or there is an injury that impacts the stability of the ankle, surgical fixation or immobilization with a cast may be required. Surgical treatment will often involve placing a combination of plates and screws at the site of the fracture in order to stabilize the bone and allow for good future outcomes and function.

Ankle sprains are one of the most common foot and ankle injuries. They can vary from a mild injury that is quickly recovered to something that is more severe and can take multiple months. Ankle sprains occur when someone falls on an inverted or an everted foot. This injury puts strain on the ligament and can either simply cause inflammation in the area or cause a partial or full tear to the ligament. Symptoms vary but are characterized by immediate pain after injury, swelling, bruising, and possibly difficulty weight-bearing. Diagnosis is predominantly made by physical exam and an X-ray if needed.

Treatment depends on severity. Patients with more severe injuries may be placed in a walking boot and crutches and need physical therapy to help them return to activity. Simple sprains may be treated with rest, ice, elevation, anti-inflammatories, and return to activity as tolerated. No matter the severity of the injury, the most important treatment is continuing to strengthen the ankle and lower leg to prevent a recurrence of the injury.

Achilles tendonitis is a condition characterized by posterior heel pain. Repetitive trauma or exercise such as running leads to an inflammation of the Achilles tendon. Diagnosis is primarily with a physical exam, but an X-ray can also be done to look for a calcaneal bone spur. Treatment begins with physical therapy, anti-inflammatories, and activity modification. If symptoms worsen, a walking boot or crutches may be required, as severe Achilles tendonitis can cause a risk for a rupture of the tendon.

An Achilles tendon tear is a sudden rupture of the Achilles tendon. This most commonly occurs while doing a sudden high-explosive activity such as jumping while playing a sport. Symptoms include hearing a “pop” with sudden immediate pain in the heel, swelling, bruising, and difficulty walking. Diagnosis can include a physical exam, X-ray, and MRI. Although multiple options exist for treatment, a detailed discussion of non-operative versus surgical management should occur with your provider as the recommendation may change based on age, activity level, and location of the tear.

Jones fractures are fractures to a critical area of the base of the 5th metatarsal bone in the foot. They typically occur from an inversion or twisting injury to the foot. Like all other fractures, they are diagnosed by X-ray and typically cause pain, swelling, and bruising of the outside of the foot after injury. These fractures are unique because they cross an area of the bone that does not have a vascular supply that is adequate for bony healing. Fractures in this area that are minimally displaced typically are treated with extended immobilization in a cast for 6-8 weeks and the patient is made non-weight bearing. As these fractures have high rates of poor healing, a surgical screw fixation can be done in fractures with either a high degree of displacement or that are not healing after approximately 3 months.

There are many bones in the hind- and mid-foot including the metatarsals, navicular, cuboid, talus, and calcaneus. Fractures to one of these bones in the foot can occur from a fall or a direct impact with another object. Symptoms include pain near the fracture, swelling and bruising on the foot and ankle, and difficulty weight-bearing. An X-ray or possibly a CT scan for complex cases is used to properly evaluate the fracture.

Each fracture in the foot is treated differently based on the bone that is involved and the fracture pattern. Simple metatarsal fractures are treated conservatively with weight-bearing as tolerated in a walking foot and physical therapy for about 6 weeks. More complex fractures may need immobilization in a cast for about 6 weeks or surgical treatment. Most fractures take about 6 weeks to heal whether they are treated with immobilization in a cast or weight bearing in a walking foot. Afterward, patients typically begin physical therapy to aid in return to activity and strengthening of the foot.

Phalangeal fractures are common injuries that typically occur from direct impact with the toe and another object, such as stubbing a toe. Symptoms of these involve pain at the site, swelling, and bruising. A sprain to the toe is typically less severe but can present with similar symptoms, and therefore an X-ray can be recommended. Most toe fractures can be treated with simple buddy tape for 1-2 weeks, a walking boot if needed, and a gradual return to activity. For a dislocated or displaced fracture, a reduction, either surgically or in the provider’s office, can be done to maintain proper alignment.

Tibial Stress Syndrome, also known as shin splints, occurs when the tibialis anterior muscle and periosteum of the bone are overworked. This typically occurs in runners but can happen to any athlete who is putting repetitive stress on the lower legs. Symptoms include pain in the anterior portion of the lower leg that may be noticeable during running or other activities. Diagnosis includes a physical exam and a possible MRI in refractory cases. X-rays may be taken in order to rule out a fracture. Treatment is based on physical therapy, shoe modifications, and changes in activity including decreasing running and doing low-impact exercises

Treatment

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At Pacific Crest Orthopedics we customize a treatment plan to meet your individual needs. For the foot and ankle, some of the most common treatments can include immobilization in a walking boot or cast, corticosteroid injections, the use of anti-inflammatories, and physical therapy. For some conditions, surgery is indicated as the best option. Learn more about our surgery treatments.

Ephraim Dickinson, MD at Pacific Crest Orthopedics has extensive experience treating your foot and ankle pain and providing therapies to prevent future problems and to keep you active and healthy. Don’t continue to suffer from foot or ankle pain or immobility.

If you have questions about your symptoms, call Pacific Crest Orthopedics in San Francisco or use the online booking tool to schedule an appointment today.

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If you’re in need of immediate care, please visit one of our Walk-In locations.

Real Stories, Real Recovery.

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“Dr. Dickinson has been super helpful in my recovery and truly cares about the patient in getting back to full range of motion. Great team all around – I highly recommend!”

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“Amazing from the time i walked in the door until the time i left. Everyone is so helpful and a joy to work with. I got the treatment i need fast and efficiently. This place is a must go to when to need to be seen urgently. Skip the ER if they can see you!”

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“Loved how accessible this clinic was and how easy it was to book. I looked everywhere for an ortho to see me for days and couldn’t find one available or who look at back issues, and with them I was able to book a same day appointment and got answers to my problems during that one visit. I was seen by Brianna and she was great. She talked me through everything and explained things easily to me where I felt very comfortable and trusting in her diagnosis.”

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Apr 4, 2024

Allyssa J.

“Great service: very professional, nice office and location, and excellent staff. I fractured my foot, and they took great care of me!”

Apr 2, 2024

Frank T.

“Great service: very professional, nice office and location, and excellent staff. I fractured my foot, and they took great care of me!”

Apr 2, 2024

Katherine B.

“I came to the office with a huge pain. Dr Ephraim Dickinson not only quickly assist my problem and gave me the treatment plan. He was very nice and explain everything clear and answer all my questions. I recommend Dr. Dickinson and his office!”

Mar 20, 2024

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