Feet & ankles

The human foot is divided into longitudinal and transverse arches and consists of 26 bones and over 30 joints. When pressure is placed on the foot, the longitudinal and transverse arches act like a suspension.

The ankle connects the foot to the lower leg. Together, the upper and lower ankle joints facilitate the mobility of the foot and consequently our upright gait. Due to its exposed position and the incredible load it has to bear, the ankle is prone to injuries such as twists and sprains.

Here are some of the common problems and diseases that can affect the feet and ankles.

It is not a comprehensive list.

• Heel spur
• Bunions (hallux valgus)
• Osteoarthritis of the ankle

Heel spur

A heel spur is a thorn-like bony protrusion on the bottom of the heel bone. The associated pain is much more likely to be the result of excess strain on the very strong layers of tendons that connect to the heel bone. To heal the small tendons, the body deposits calcium on the injuries.

Various things can cause excess strain on the tendons. Certain shoes or walking on hard surfaces for several hours can certainly lead to inflammation. Shortened calf muscles or excess body weight can have the same effect. This disorder can also become chronic.

The most common symptom of a heel spur is pain in the heel of the foot. The greater the strain, the more intense the pain – and it can even continue when the foot is not in use. Surgical treatment is only considered necessary if medication and physiotherapy have failed to resolve the problem.

For more information, see the clinical picture of heel spurs, fasciitis plantaris.

Bunions (hallux valgus)

Women in particular will be familiar with this problem: those fabulous shoes suddenly feel tighter and the joints in your toes hurt, even if you have not walked very far. Then if your big toe also starts protruding at an unnatural angle, the diagnosis is soon clear: hallux valgus, otherwise known as a bunion. The joint of the big toe presses outwards towards the edge of the foot and the first metatarsal is increasingly pushed inwards. The head of the first metatarsal bone becomes a painful bulge. The deformity prevents the big toe from properly supporting the foot and the neighbouring second metatarsal bone becomes chronically overworked as a result. This can lead to irritations such as an inflamed bursa, horny skin or calluses.

People with genetically inherited weak ligaments and connective tissue are more predisposed towards developing bunions. Women are affected more frequently than men and narrow shoes with high heels can also increase the risk.

Various surgical procedures are available for correcting and relieving the pain of a deformed metatarsal bone. Hallux valgus is usually only treated conservatively (without surgery) in the early stages of very mild cases, or if the patient is elderly and cannot or does not want to undergo an operation.

You can find more information in the clinical picture Hallux valgus.

Osteoarthritis of the ankle

The thin layer of cartilage on the small joint surfaces in the ankle can absorb huge amounts of pressure, for example during sporting activities. Nevertheless the joint is susceptible to wear and tear, which can lead to damaged cartilage (osteoarthritis). Unlike the hip and knee joints, osteoarthritis of the ankle is often the result of an injury. For instance, a broken bone or ligament injury can lead to osteoarthritis two or three decades later.

Common symptoms of ankle osteoarthritis are pain when the joint initially starts moving, as well as swelling on the upper ankle joint. Depending on the severity of the osteoarthritis, the pain may continue as the person walks or it may improve with movement. Resting the joint can relieve the pain, however, after lots of physical activity the pain may even linger when the joint is not in use. Over time the joint can become stiff, which can have a major impact on quality of life.

In general, there are two treatments available:

• Therapy without surgery: this is usually the main approach, although it only treats the symptoms and not the cause.
• Operations on the ball of the joint either involve fusing the joint or replacing it with an artificial joint. However, there is also a relatively new surgical technique that retains the joint by means of ankle arthrodiastasis.

For more information, see the clinical picture of osteoarthritis and rheumatoid arthritis, chronic polyarthritis

Click on the links below for more information.

Our medical specialists regularly answer readers’ questions in newspapers, magazines and online. We have put together a few of these questions and answers for you here. Please note that the Q&A is purely informative. The advice provided is not comprehensive and does not substitute a consultation with a medical professional. 

• Twisted ankle while hiking
• Foot falling asleep while jogging
• Pain in the metatarsophalangeal joint in the big toe

Twisted ankle while hiking

«I’m 26 years old and four years ago I twisted my ankle while hiking in high-cut boots. I didn’t go to the doctor, because it was only slightly swollen and there was a minor bruise. It continued to hurt, so one year later I went to an orthopaedic specialist for an x-ray examination. The x-ray didn’t show anything, so then I had an MRI, which revealed scarring on two very thin ligaments. The orthopaedic specialist said it was purely a functional disorder and it should go away with time. I still have pain underneath the outer part of my foot, up to the Achilles tendon and at the front of my ankle (towards my toes). The pain was tolerable until now. But recently I’ve been experiencing severe pain, even when I’m resting the foot. And since the accident I keep twisting my ankle. Though never so badly that I have pain for long periods of time. The pain can also be triggered if I move my foot in a circle, then I can hear a clicking noise and feel a stabbing pain. What could be causing this problem?»

It appears that after the accident, the insufficiency of the outside ligaments caused your ankle to become chronically unstable. It’s also possible that the subsequent repeated twisting has caused additional injuries, such as damage to the ankle’s articular cartilage. I would recommend having another MRI examination, so that a targeted treatment plan can be developed to deal with your current problems.
Dr. Daniel Brunnschweiler, Sport Clinic Zurich, Klinik Hirslanden, Zurich

Foot falling asleep while jogging

«My boyfriend is/was preparing for the half marathon. He wanted to take part in it in April. Now unfortunately he has had to abandon his plans. Whenever he starts jogging, he begins to have problems with his right foot after about 20 minutes. It’s like his foot is going to sleep. It feels numb and really heavy. We have already done some online research, but what we found is that people often came to the conclusion that they were wearing the wrong shoes or had tied their laces too tight. But none of that applies in my boyfriend’s case. He has special shoelaces and bought his shoes in a specialist shop, where he received extensive assistance and very good advice. Now we think it could have something to do with a nerve, which might become constricted when the muscles expand as he jogs. How would you diagnose this problem?»

The problem you have described is well-known and often related to the development of excess pressure in the foot muscles, which irritates the nerves and leads to physical complaints. I recommend seeing a medical specialist (ideally a foot surgeon) and another MRT examination of the foot may also be necessary.
Dr. med. Marcel Schibli, Sport Clinic Zurich, Klinik Hirslanden, Zurich

Pain in the metatarsophalangeal joint in the big toe

«I have a question regarding the joint in my big toe. I experience a stabbing pain when I walk and while resting my foot. It is slightly swollen and also hurts when I’m wearing shoes. The movement of the joint is very restricted and it makes a clicking noise when I move it. What kind of medical specialist should I see, are there any alternative treatments available, and above all, what could the diagnosis be?” I don’t want to end up needing surgery. I’ve been experiencing the pain for about a year now.»

According to the information you have provided, the problem is most likely being caused by osteoarthritis of the metatarsophalangeal joint in your big toe. If you would like a diagnosis I recommend consulting a specialist in orthopaedic surgery, if possible someone with experience in foot surgery.
Dr. med. Marcel Schibli, Sport Clinic Zurich, Klinik Hirslanden, Zurich