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21 Mar 2014 

The Anatomy of Ankle Bones | Foot Vitals

The ankle joint, or talocrural joint is formed where the foot and leg meet, connecting the tibia, fibula, and talus. This joint allows the foot to move up and down or side to side. The calcaneus is the largest bone in the foot, and it lies under the talus, with which it forms the subtalar joint, which works in conjunction with the ankle joint to allow triplane motion of the foot.

The talus works inside a socket, acting as a director to the movements of the ankle. To see how your talus controls the movements of your ankle, try this experiment: While keeping your heel on the ground, lift your toes and hold them up. This movement is called dorsiflexion. You will also note that your foot can be moved from side to side. Now place your foot on the ground and lift your heel up while keeping your toes on the ground,. This movement is called plantarflexion. Although the foot is perfectly capable of moving numerous ways, most of its flexibility is due to the presence of other joints within the ankle region. The ankle joint acts as a hinge joint, limiting the rotation of the talus. This makes the ankle one of the most stable joints in the lower extremities.

Ankle bones

Here is a brief definition of each of the ankle bones:
The tibia forms the inside (medial) portion of the ankleThe fibula forms the outside (lateral) portion of the ankleThe talus is also known as the ankle bone and is found underneath the tibia and fibula.The calcaneus is also known as the heel bone and is found under the talus

The Ankle Joint
The parts of the bone that move against each other have articular surfaces which form the ankle joint. Each is covered in a smooth hyaline cartilage and held together by strong ligaments: the lateral side is held together by the anterior talofibular ligament, the calcaneofibular ligament, and the posterior talofibular ligament. The medial side has the anterior talotibial, calcaneotibial, and posterior talotibial ligaments. The joint and cartilage are surrounded by a synovial membrane that distributes fluid and lubricates the joint. The articular surfaces of the ankle joint consist of the following:

Inside of the lateral malleolus: This is the lower end of the fibula, and it moves against the outer side of the upper surface of the talus. This is the bone that sticks out on the outside of your ankle. You can easily see and feel it.

Undersurface of the lower end of the tibia: This surface moves against the talus and forms the roof of the socket.

Inside of the medial malleolus: This is located at the lower end of the tibia, and it moves against the inner side of the upper surface of the talus. This is the bone that sticks out on the inside of your ankle. You can easily see and feel it.

Dome of the talus: This is the upper part of the talus, and it fits into the ankle joint and moves against the lower ends of the tibia and fibula.

The stability of your ankle joint heavily depends on the ability of these ligaments to keep the talus bone (or central bone) in place while the ankle is moving back and forth. Your ankle joint is more stable while your foot is flat on the ground. It is more susceptible to injury when your foot is pointed down (plantarflexed) with the talus moving out of the ankle mortise. When it is enlarged, it becomes dependent on the soft tissues and ligaments to support, protect, and stabilize it. Ligaments and soft tissues are softer than your bones, making them vulnerable to injury when your foot and toes are pointed down.

Ankle Bone Injuries
Injuries to the ankle usually take the form of fractures, strains, or sprains. Ankle fractures are very common and can range in severity from less serious avulsion injuries to severe breaks of the tibia or fibula. In most cases only the tibia or fibula are injured. Rarely is the calcaneus or talus fractured. Most ankle injuries are caused by the ankle rolling inward or outward.

Injuries such as strains and sprains affect the muscles, tendons, and ligaments, not the bones of the ankle. These injuries are also very common and are sometimes associated with ankle fractures, but usually occur on their own. Broken ankle bones can vary in severity"sometimes they are merely a few cracks in the bone; other times pieces of the bone protrude through the skin.

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20 Mar 2014 
How To Treat Pain In The Ball Of The Foot (Foot problems)

In this video, I am going to talk to you about how to treat pain in the ball of the foot. The ball of the foot is the cushioned area behind the toes where we stand and put most of our weight on during the take-off phase of walking. One of the most common reasons for pain in the ball of the foot is known to be Morton's neuroma.

A neuroma is a swelling of a nerve that supplies the toes in-between the metatarsals. Neuroma pain appears to affect more women than men, probably due to the footwear type that women are accustomed to, and the use of high heels. The second most common problem to affect the ball of the foot is the inflammation of the joint itself, this is most commonly seen in people where there is thinning of the fat pad at the ball of the foot and prominent bones on touch.

Other common reasons of getting pain in the ball of the foot include swelling of tendons or dislocation of the toes which adds to pressure under the ball of the foot. Treatment options include using soft innersoles, or wearing a soft cushioned shoe. Should these fail to address the problem, then treatment may be sought from a specialist.

The specialist may simply make you a more custom-made innersole, or provide you treatments which include anti-inflammatory cortisone injections or surgery may be discussed. Should surgery be necessary, then removal of the painful and damaged nerve or straightening of the toes may be indicated. This is how we treat pain in the ball of the feet. .

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18 Mar 2014 

Claw Toes - Wheeless' Textbook of Orthopaedics
- See:

- Hallux Claw Toe

- Hammer Toes

- Muscles of Foot

- Polio: Claw Toes

- Anatomy and Discussion:

- claw toe consists of hyperextension at the metatarsophalangeal joint, and flexion at the proximal (and distal interphalangeal joints);

- all of the toes are usually affected, although contracture of the great toe can be the most severe;

- there is an imbalance between the extrinsic extensor tendons (which indirectly extend the MP joint and the intrinsics which flex the MP joint);

- claw toes result from simultaneous contraction of extensors & flexors with weak or insufficient intrinsic muscles;

- hyperextension deformity of the MP joint is caused by excessive relative pull of the extensor tendons;

- PIP hyperflexion is caused by excessive pull of the long flexors;

- hyperextension of the MT joints and flexion of the IP joints, are common features of a neuropathic clawfoot or pes cavus;

- dorsiflexion of the MP joint causes the metatarsal fat pad to be pulled distally through its attachments to the proximal phalanx;

- flexed IP joints are constantly irritated by shoe, & painful metatarsal callosities develop;

- deformity will become permanent;

- diff dx:

- hammer toes

- characteristics include: MPT joints extended, flexed at the PIP joint, and hyperextended at the distal interphalangeal joint;

- in contrast to hammer toes which may or may not have MPT joint hyper-extension, a claw toe is always associated w/ MTP hyperextension;

- inciting conditions:

- rheumatoid arthritis

- advanced age (decreased muscle tone and reliance of toe gripping for balance)

- diabetes

- compartment syndrome involving deep posterior compartment;

- polio: claw toes:

- Charcot Marie Tooth

- stroke

- cavus foot

- when the claw toe deformities are associated with a cavus deformity, tarsal deformity should be corrected first, since clawing of toes may correct spontaneously;

- Exam:

- note presence of pes cavus deformity;

- determine degree of MTP hyperextension and PIP flexion;

- note presence of metatarsalgia w/ associated skin changes (plantar keratosis);

- determine whether claw toes are flexible or fixed;

- assess flexibility of toes w/ ankle in plantar flexion and dorsiflexion;

- if the claw toe deformity disappears w/ plantar flexion then the deformity is considered flexible;

- apply pressure underneath the metatarsal heads and note degree of correction;

- assessment during gait:

- note whether the clawing becomes worse during gait (stance phase vs swing phase);

- clawing during swing phase: may indicate weak ankle dorsiflexors and over-compensation of toe extensors;

- clawing during stance phase: may indicate weak triceps surae and over-compensation of long toe flexors;

- Radiographs:

- subluxation is indicated on AP radiographs by narrowing of the apparent joint space (which occurs from the overlap of the proximal phalanx over the metatarsal;

- Non Operative Treatment:

- includes corn padding, soft metatarsal pads (when metatarsalgia is present), & shoe w/ high, wide toe box, often succeeds;

- Flexible Claw Toes:

- implies that there is no contraction of MTP or PIP joints;

- Girdlestone-Taylor Procedure:

- indicated for flexible claw toes w/ dorsally subluxated MP joints;

- transfers long flexor to extensor hood over proximal phalanx) is performed along with extensor tenotomies and dorsal capsulodesis of MTP;

- clawed hallux:

- authors carried out a cross-sectional study in 51 patients (81 feet) with a clawed hallux in association with a cavus foot after a modified Robert Jones tendon transfer;

- in all feet, concomitant procedures had been undertaken, such as extension osteotomy of the first metatarsal and transfer of the tendon of the peroneus longus to peroneus brevis, to correct the underlying foot deformity;

- overall rate of patient satisfaction was 86%, and the deformity of the hallux was corrected in 80 feet;

- catching of the big toe when walking barefoot, transfer lesions and metatarsalgia, hallux flexus, hallux limitus and asymptomatic nonunion of the interphalangeal joint were the most frequent complications;

- hallux limitus was more likely when elevation of the first ray occurred (p = 0.012);

- additional transfer of the tendon of peroneus longus to peroneus brevis was a significant risk factor for elevation of the first metatarsal (p < 0.0001);

- deforming force of extensor hallucis longus is effectively eliminated by the Jones transfer, but the mechanics of the first metatarsophalangeal joint are altered;

- ref: Function after correction of a clawed great toe by a modified Robert Jones transfer.

- Fixed Claw Toe Deformity:

- inform pt that toe ischemia sometimes follows correction of severe deformity;

- w/ neurologic disorder such as Charcot Marie Tooth disease, consider transfer of the long extensors to the neck of metatarsals along with fusion of the PIP joints;

- MTP Joint Subluxation:

- often associated with metatarsalgia;

- once MP joint is dislocated, result is never entirely satisfactory, & joint is always slightly stiff;

- contracted extensor tendons (which are the main deforming force) may have to be tenotomized to allow correction of dorsal subluxation of MP joints;

- first extend EDL, then EDB;

- if MP joint is still extended, then release collateral ligaments;

- note that reduction of MP joint, may cause ischemia of the digit, due to stretching of the N/V bundle across contracted soft tissues;

- hence, toe cannot be relocated w/o bone resection;

- shortening at base of proximal phalanx;

- resection of base of proximal phalanx may lead to instability, which is may require syndactylization to an adjacent toe;

- shortening at metatarsal head;

- resect bone from or distal metatarsal head shaving or partial resection of distal portion of metatarsal head alone;

- joint should immobilized for three to four weeks postoperatively;

- PIP Deformity:

- deformity at PIP joint is best treated w/ resection arthroplasty, removing distal one third of proximal phalanx;

- arthrodesis is indicated only in the presence of severe or recurrent deformity, or when associated w/ neurologic disturbance of forefoot;

- when performing arthrodesis of the interphalangeal joint, toe should be slightly plantarflexed, because this position is better tolerated than a stiff straight toe

The pathological anatomy of claw and hammer toes

The treatment of clawtoes by multiple transfers of flexor into extensor tendons.

Subluxation and dislocation of the second metatarsophalangeal joint.

Modified Resection Arthroplasty for Infected Non-healing Ulcers with Toe Deformity in Diabetic Patients

Flexor Hallucis Longus Tendon Transfer for Hallux Claw Toe Deformity and Vertical Instability of the Metatarsophalangeal Joint

Muscular Imbalances Resulting in a Clawed Hallux

Comparison of the Results of the Weil and Helal Osteotomies for the Treatment of Metatarsalgia Secondary to Dislocation of the Lesser Metatarsophalangeal Joints

Reversal of toe clawing in the patient with neuropathy by neurolysis of the distal tibial nerve.

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16 Mar 2014 

Bunions: Healthwise Medical Information on eMedicineHealth
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Topic Overview
Health Tools
What Happens
What Increases Your Risk
When To Call a Doctor
Exams and Tests
Treatment Overview
Home Treatment
Other Treatment
Other Places To Get Help
Related Information

Topic Overview

Picture of a bunion

What is a bunion?
A bunion is a bony bump on the joint at the base of the big toe. As the bump gets bigger, it causes the big toe to turn in toward the second toe. The tissues around the joint may be swollen and tender.

A bony bump at the base of the little toe is called a bunionette or tailor's bunion. The little toe also bends inward, and the joint swells or enlarges.

See pictures of a bunionClick here to see an illustration. and bunionetteClick here to see an illustration..

What causes a bunion?
You may get bunions if:
The way your foot is shaped puts too much pressure on your big toe joint. Because bunions can run in families, some experts believe that the inherited shape of the foot makes some people more likely to get them. Your foot rolls inward too much when you walk. A moderate amount of inward roll, or pronation, is normal. But damage and injury can happen with too much pronation. You have flat feet. You often wear shoes that are too tight.
All of these may put pressure on the big toe joint. Over time, the constant pressure forces the big toe out of alignment, bending it toward the other toes.

What are the symptoms?
Your bunion may not cause any symptoms. Or you may have pain in your big toe, red or irritated skin over the bunion, and swelling at the base of the big toe. The big toe may point toward the other toes and cause problems in other toes, such as hammer toe. A bunionette can cause similar symptoms at the base of the little toe.

How are bunions diagnosed?
Your doctor will ask questions about your past health and carefully examine your toe and joint. Some of the questions might be: When did the bunions start? What activities or shoes make your bunions worse? Do any other joints hurt? The doctor will examine your toe and joint and check their range of motion. This is done while you are sitting and while you are standing so that the doctor can see the toe and joint at rest and while bearing weight.

X-rays are often used to check for bone problems or to rule out other causes of pain and swelling. Other tests, such as blood tests or arthrocentesis (removal of fluid from a joint for testing), are sometimes done to check for other problems that can cause joint pain and swelling. These problems might include gout, rheumatoid arthritis, or joint infection.

How are they treated?
Currently, no strong evidence points to the best treatment for bunions. But in most cases, you can treat them at home. This includes taking medicine you can buy without a prescription to relieve toe pain. It also helps to wear shoes that do not hurt your feet. For example, avoid high heels or narrow shoes. You can wear pads to cushion the bunion, and in some cases, you can use custom-made shoe inserts (orthotics).

Avoid activities that put pressure on your big toe and foot. But don't give up exercise because of toe pain. Try activities that don't put a lot of pressure on your foot, such as swimming or bicycling.

Surgery to correct a bunion may be an option if other treatment does not relieve pain. There are different types of surgery for bunions. You and your doctor can decide which one is best for you.

How can you prevent bunions?
Proper footwear may prevent bunions. Wear roomy shoes that have wide and deep toe boxes (the area that surrounds the toes), low or flat heels, and good arch supports. Avoid tight, narrow, or high-heeled shoes that put pressure on the big toe joint.

Medicine will not prevent or cure bunions.

Frequently Asked Questions

Learning about bunions:
What are bunions?What causes bunions?Can I prevent bunions?What are the symptoms of bunions?What happens when I have a bunion?What increases my risk for bunions?Who is affected by bunions?
Being diagnosed:
Who can diagnose a bunion?How are bunions diagnosed?
Getting treatment:
How are bunions treated?What medicines do I need to take?Will I need surgery?Click here to view a Decision Point.Should I have surgery for bunions?What can I do to treat bunions at home?What other treatments may be recommended?
Living with bunions:
What can I do at home to relieve symptoms of bunions?When should I call my doctor?Click here to view an Actionset.What kind of shoes should I wear?Next Page:Health Tools>>
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15 Mar 2014 

Bunions | Dr. Scholl's

A bunion is an enlargement of the joint at the base of the big toe which appears to stick out. The outside of the foot at the base of the little toe can also be affected and is called a tailor's bunion. A bunion involves enlargement and repositioning of joints at the ball of the foot and most commonly affects women. Tight-fitting shoes, especially high-heeled and narrow-toed shoes, might increase the risk for bunion formation. It also has been suggested that inherited factors may predispose to the development of bunions.

A condition that is often part of the bunion is an abnormal position of the big toe or the bone to which it connects. One such condition is a malformation in which the joint at the base of the big toe bulges outward (medically termed hallux valgus deformity) from the inner side of the foot and the big toe points inward (toward the smaller toes). Excessive turning in of the ankles and injury may also be factors causing bunions. Osteoarthritis may develop and cause joint scarring, limiting the foot's range of movement.

Symptoms and Diagnosis

Symptoms may or may not be present when you have bunion. The first symptom may only be a painless bulge of the joint or pain at the joint when wearing certain shoes. The enlarged joint at the base of the big toe can become inflamed, causing symptoms of redness, tenderness, and pain. A small fluid-filled sac (bursa) next to the joint can also become inflamed (bursitis), leading to additional swelling, redness, and pain. Joint motion may be restricted.

Doctors usually base the diagnosis on symptoms and examination findings. Sometimes X-rays are taken to determine the integrity of the joints of the foot and to screen for arthritis or gout that may be underlying conditions.


There is currently no strong evidence pointing to the best treatment for bunions, but in most cases, you can treat them at home.
The avoidance of tight, narrow or high-heeled shoes that put pressure on the big toe joint seems appropriate. Wearing wider shoes may significantly decrease discomfort. The use of felt or foam padding on the foot may help protect the bunion from irritation. Depending on the structure of the foot, custom insoles might add further support and repositioning.Stretching exercises can sometimes reduce tension on the inner part of the joint of a bunion.Taking anti-inflammatory drugs or injecting a corticosteroid can help relieve pain and swelling.The surgical removal of the bunion for those whose bunions cause persisting pain can be considered.

The prevention consists in avoiding the compression of the toes with narrow, poor-fitting shoes.

When to consult a doctor

If the bunion:
Continues to cause pain even after self care, such as wearing wide-toed shoesPrevents you from doing your usual activitiesHas any signs of infection (like redness or swelling), especially if you have diabetes.
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