Foot and ankle conditions such as sprained ankles or ankle fracture are commonplace injuries - in fact, they are so common that they represent some of the most frequent injuries in the accident and emergency departments in hospitals and GPs across the country.
Most of these foot or ankle injuries that are mild will usually heal ok within 8 weeks but a percentage of injuries, especially
ones will take longer. One of the causes of this foot and ankle persistent pain to consider are the small joints of the foot, which unfortunately may get forgotten in medical or rehab care after foot and ankle injury.
Treating them can make the difference to that last bit of pain or restriction sometimes felt.
The anatomy of the foot is highly complex - so many small bones, ligaments, tendons and
joints within the foot held firm with multiple moving parts and muscles.
The main ankle joint is termed the talocrural joint. This is the joint at the end of the shin bones (tibia and fibula) where it meets the first foot bone (talus). The majority of foot movement comes from this joint and most injury is to the ligaments that support this joint.
Further into the foot, down from the talocrural (ankle) joint, you will come across the small joints of the talonavicular and calcaneocuboid. There is much less movement at these two joints in comparison to the talocrural joint. Of course, there are some movement at these joints during walking and weight-bearing on the foot to allow for normal movement.
There is a small amount of up and down movement and also some rotation in this joint when we put weight on to our foot during walking. This movement varies from person to person and even varies from left foot to right foot but an idea of the expected amount of movement can be assessed by your senior physiotherapist.
The calcaneocuboid joint is located between the calcaneum bone and the cuboid bone. It is more towards the outer side of your mid foot. This joint has very little natural movement but does have a small amount of movement during walking.
These joints have developed and collectively important as they allow a flexible platform in which we can move, walk, jog, run, correct our position/posture etc. Our foot is impressively designed with many small interacting joints, muscles and ligaments in order that we can be both flexible and strong.
Two joints, the talonavicular and calcaneocuboid are particularly important as they have particular functions which are important roles in the arches that form naturally in our foot as we weight bear.
Mr B, 31 year old male
Sprained his ankle badly playing football resulted in a small fracture of the ankle and significant swelling.
He spent some time in an air boot to help the protect the fracture and injury and allow the bone to heal and when he came out of the boot he found he had a stiff and sore ankl (this is a normal/natural outcome following injury and immobilization).
He was given some foot and ankle exercises to do and found that in general his ankle
started to loosen up nicely and as he could get back to walking and
things were improving he decided not to stop his physiotherapy sessions.
Unfortunately even 8 weeks later Mr X found that although he had improved he still had problems when he was walking up hills, slopes, stairs, uneven surfaces or had been on his feet for a long time.
He decided to go back to his physiotherapist.
Mr B was assessed by a senior physiotherapist who found that his main talocrural (ankle) joint was moving nicely but found that his talonavicular joint didn’t have as much play and movement as his un-injured foot and that the up and downwards movement was slightly restricted.
Joint mobilization was performed and Mr B was shown how to do these mobilisations at home. He worked on these for several weeks and noted an improvement in his uphill and slope walking.
In summary, these small mid foot joints do not provide a large percentage of the movement in the foot during walking but they do contribute. They also contribute to the arches that form a flexible but strong platform on which we are able to stand and move.
This allows us incredible mobility and function on two feet.
After injury it is important to pay attention not only to the
If you find that you have been having persistent foot or ankle pains or discomforts that have yet to be resolved, contact us to see one of our senior physiotherapists to assess and treat you.