CNY Orthopedic Sports Medicine, PC: Bodyzone: Foot/Ankle

Body Zone: Foot/Ankle

Overview
Unlike virtually every other creature, humans habitually walk upright, on our feet. Walking upright enables almost everything we associate with being human, including fine manipulation of objects with the hands, carrying food to the young and weak, and most of our sports. Human development theory observes that walking upright seems to be connected to our speech, as most children begin to walk very near the same time they begin to talk. While our spines, pelvis and knees deserve their share of credit for enabling us to walk upright, we certainly wouldn't get far without our feet.

We make enormous demands on these humble extremities. When we walk, our feet absorb our weight plus push energy, which adds about 30 percent to our standing weight. A typical day of walking brings a force equal to several hundred tons to bear on our feet. The average person walks about 115,000 miles in a lifetime, more than four times the circumference of the globe.

Although studies show that 75% of Americans experience foot problems of varying degrees of seriousness some time in their lives, heavy use is not the main cause. At least two-thirds of foot troubles - affecting 175 million Americans - can be attributed to improper shoes. Ankle sprains are the most common sports-related injuries, with about 23,000 ankle sprains per day in the United States.


Injuries
Ankle sprains constitute at least 25% of all injuries in sports, with some estimates ranging as high as 45%. Other common foot maladies include various kinds of tendonitis, heel spurs, bunions and turf toe.

Achilles Tendon
Bunions


Harmful Behaviors
  • Being overweight.
  • Not loosening up. Failing to stretch regularly allows muscles and connective tissues to become tight and prone to injury.
  • Cruel shoes. Wearing shoes that are too small, of the wrong shape or too worn out to provide protection is the cause of a number of foot problems.


  • Good Practices
  • Stretch. After muscles have warmed up and after your workouts, stretch and hold - don't bounce.
  • Maintain desirable body weight.
  • Shop smart. Choose shoes for their fit, not just for fashion.
  • Be equipped. Replace shoes when they are too worn to provide adequate cushioning and stability.


  • General Conditioning
    The best exercise for your feet is walking, which helps increase strength across the entire region. To build additional muscle, walking barefoot on loose sand is an especially good conditioning exercise. The extra effort needed to position and roll the foot in sand (even when casually walking on the beach during vacation) can greatly help build coordination and muscle mass.
  • Ankle stretching exercises are also effective in reducing the liklihood of injury. Streches which rotate the ankle joint around in all directions help increase flexibility and reduce stiffness in the joint
  • Calf raises, in which the entire body is raised by the the strength of the calf and foot, build solid muscle.

  • Anatomy
    Although similar to the hand in basic structure, the foot is adapted for the special task of supporting weight and for locomotion. Each foot has 26 bones, 33 joints and a network of more than 100 tendons, muscles and ligaments. Together your feet contain a quarter of all the bones in your body.

    Biomechanically the foot can be divided into three regions, based on the bones involved:
  • The rearfoot, made up of two main bones: the talus (ankle bone), the uppermost bone of the foot; and the calcaneus (heelbone), the largest bone in the foot. The talus sits in between the lower tibia and fibula bones of the leg. The ends of these two bones, the malleoli, can be felt as the protruding bones on either side of your ankle.
  • The midfoot, made up of the navicular and cuboid bones. These bones move as a unit and give the foot side-to-side flexibility.
  • The forefort, which includes the cuneiforms, metatarsals and phalanges (toes). Although your toes have little to do when you're standing, when you're walking they provide stability by maintaining ground contact until the final phase of push-off.
  • The bones of the ankle are held together by a capsule of tough ligaments. The typical inversion ankle sprain (with the foot rolling inward) injures the outer (lateral) ankle ligaments. The lateral ligaments are:
  • The anterior talofibular (ATF), which prevents the talus from moving too far forward relative to the tibia and fibula;
  • The calcaneofibular (CF), the main stabilizer of the ankle; and
  • The posterior talofibular, which keeps the talus from moving too far back relative to the tibia and fibula.
  • The inner (medial) ligament, or deltoid ligament, is extremely strong and triangle-shaped. It supports the talus and sits between the tibia, calcaneus and navicular bones. These ligaments are so strong that if injured, the often pull off a piece of bone (an injury nown as an avulsion fracture). Another portion of the ankle that can be injured is the syndesmosis, which is a ligamentous membrane that holds the tibia and fibula together. This too may be associated with a fracture.


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    Product Considerations
    Orthotics
    An orthotic insert fits inside a shoe and helps position the foot in an anatomically correct position while walking, running, or jumping. Frequently, abnormal foot motion and gait occurs as a result of over-pronation of the foot; most orthotics are used to treat this condition. Over-pronation is a tendency to roll the foot onto the inner edge, loading the inside of the foot and leaving the outer edge almost weightless. A professionally made orthotic insert will exactly contour to the bottom of the foot, and can compensate for over-pronation or other abnormal foot mechanics.

    One of two construction methods may be used to create an orthotic; one utilizes a plaster mold of the entire foot to make a moderately rigid insert, the other utilizes a foam impression of the bottom of the foot, creating a more flexible insert. In either case, the finished product must be tilted with small wedges, while other accommodations are made to protect sensitive areas of the foot. The choice of orthotics and design will vary according to the expected use, foot type, and body weight.

    Orthotics can be used to treat:

  • abnormal foot mechanics
  • patella dislocation or maltracking
  • patellar tendonitis
  • general knee pain
  • ankle instability

  • Fitting a Shoe
    Good shoes fit properly and provide cushion, support and durability that is both appropriate for your activity and for the structure of your particular feet. For example, if your feet have tendency toward pronation (turning in), then you need a firm outsole, a cushioned insole and a firm counter, the plastic cup that holds the heel in place. If you have rigid, sensitive feet, a soft midsole will feel best.

    Remember that feet expand when they bear weight; be sure the shoe isn't too short or narrow. When fitting your shoes, allow enough room in the toebox so you won't bruise your great toe while playing your sport.

    Whatever shoe you choose, try not to get too attached to any one pair. Jogging shoes lose 20 to 30 percent of their cushioning after 500 miles, and should probably be replaced long before then.

    Ankle: Braces
    Ankle braces are often prescribed for ligament instability, tears, or sprains. The brace provides increased stability and may be used by patients suffering from ankle injuries or other chronic conditions. While walking or during other daily activity, the brace allows for normal movement of the ankle and foot. During athletic activity, the brace can also be worn to provide additional stability for the ankle, and can be comfortably worn with most varieties of shoes.

    The brace is typically sized to correspond to shoe size, yet some varieties fit to small, medium, or large dimensions. The two general types of braces are slip-on, or lace-up, although there are also numerous sub-categories of braces that are prescribed depending upon the underlying condition, the amount of stability desired or the intended use of the brace.

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