Foot & Ankle Specialists
Rolf R. Drinhaus, M.D.
Orthopedic Surgeon
Total Joint Fellowship Trained
Igor Jercinovich, M.D.
Orthopedic Surgeon
Hector O. Pacheco, M.D.
Orthopedic Surgeon
Spine Surgery Fellowship Trained
Andrew Erwteman, M.D.
Orthopedic Surgeon
Sports Medicine Fellowship Trained
Matthew Gargulinski, D.O.
Orthopedic Surgeon
Sports Medicine Fellowship Trained
Foot & Ankle Anatomy
The foot and ankle form complex joints essential for movement, stability, and balance. Together, they consist of 26 bones, 33 joints, and numerous muscles, tendons, and ligaments. Understanding this intricate anatomy helps patients appreciate how injuries and conditions affect function and what treatment approaches can restore mobility.
Bones of the Ankle
The ankle joint connects the leg to the foot and consists of three main bones:
- Tibia (Shinbone) - The larger weight-bearing bone of the lower leg
- Fibula (Calf Bone) - The smaller bone on the outer side of the lower leg
- Talus (Ankle Bone) - Sits between the tibia and fibula above and the calcaneus below, enabling up-and-down foot movement
Three bony prominences form key landmarks of the ankle:
- Medial Malleolus - Inner ankle bump formed by the tibia
- Lateral Malleolus - Outer ankle bump formed by the fibula
- Posterior Malleolus - Back portion of the tibia
Bones of the Foot
The foot is divided into three functional regions:
- Hindfoot - Forms the ankle and heel, consisting of the talus and calcaneus (heel bone, the largest foot bone)
- Midfoot - Connects hindfoot to forefoot, containing the navicular, cuboid, and three cuneiform bones
- Forefoot - Includes five metatarsal bones forming the arch and the phalanges (toe bones). Each toe has three phalanges except the big toe, which has two. The big toe also has two sesamoid bones beneath it
Joints of the Ankle and Foot
The 33 joints provide mobility and adaptability:
- Hinge Joints (Ankle) - Allow flexion (bending) and extension (straightening)
- Gliding Joints (Hindfoot) - Enable smooth gliding movements between tarsal bones
- Condyloid Joints (Forefoot and Toes) - Allow flexion, extension, adduction, and abduction
These joints work together to support body weight, enable walking and running, and adapt to uneven surfaces.
Articular Cartilage and Lubrication
All joint surfaces are covered with articular cartilage—a thin, smooth, flexible tissue that acts as a shock absorber and reduces friction. Synovial fluid lubricates the cartilage, ensuring smooth bone movement during activity.
Ligaments of the Ankle and Foot
Ligaments are tough, rope-like tissues connecting bones and providing stability:
- Lateral Ligaments - Located on the outer ankle, control side-to-side movement and prevent excessive inversion
- Medial Ligaments (Deltoid Ligament) - Strong ligament complex on the inner ankle providing stability
- Plantar Fascia - The largest foot ligament, extending from the heel to the forefoot along the bottom of the foot. Maintains the arch and provides shock absorption
Muscles and Tendons
Twenty muscles control foot and ankle movement:
- Anterior Tibial Muscle - Enables dorsiflexion (lifting foot upward)
- Posterior Tibial Muscle - Supports the arch
- Peroneal Muscles - Control lateral ankle movement
- Extensors - Lift toes before stepping forward
- Flexors - Stabilize toes against the floor and enable pushing off
- Intrinsic Foot Muscles - Small muscles controlling fine toe movements
The Achilles tendon is the largest and strongest tendon in the body, connecting the calf muscles to the heel bone and enabling plantarflexion (pointing foot downward).
Bursae
Fluid-filled sacs called bursae reduce friction between tendons, bones, and skin. They contain synovial cells that secrete lubricating fluid for smooth tendon gliding.
Common Foot & Ankle Conditions
Ankle Sprains
Stretching or tearing of ankle ligaments, most commonly the lateral ligaments from rolling the ankle inward. Causes pain, swelling, bruising, and instability. Severity ranges from mild to complete rupture.
Plantar Fasciitis
Inflammation of the plantar fascia ligament causing sharp heel pain, especially with first steps in the morning. Results from overuse, tight calf muscles, or biomechanical issues.
Achilles Tendinitis
Inflammation or degeneration of the Achilles tendon from overuse or sudden increase in activity. Causes pain and stiffness along the back of the heel, particularly with activity.
Bunions (Hallux Valgus)
Bony bump forming at the base of the big toe as it deviates toward the other toes. Causes pain, inflammation, and difficulty fitting into shoes. May be hereditary or result from poor footwear.
Ankle Arthritis
Degenerative joint disease affecting the ankle, causing pain, stiffness, swelling, and reduced mobility. Can result from osteoarthritis, rheumatoid arthritis, or post-traumatic changes after injury.
Ankle Fractures
Breaks in one or more of the ankle bones (malleoli, talus, or calcaneus). Results from twisting injuries, falls, or high-impact trauma. May require surgical fixation depending on stability.
Stress Fractures
Small cracks in bones from repetitive stress and overuse, commonly affecting metatarsals. Common in runners and athletes with sudden training increases. Causes localized pain and swelling.
Flat Feet (Pes Planus)
Loss or absence of the arch causing the entire foot sole to contact the ground. Can be flexible or rigid, congenital or acquired. May lead to pain, fatigue, and biomechanical issues.
Morton's Neuroma
Thickening of tissue around nerves between the toes, commonly between the third and fourth toes. Causes burning pain, numbness, and sensation of standing on a pebble.
Foot & Ankle Treatments & Procedures
Physical Therapy & Rehabilitation
Conservative treatment focusing on strengthening, flexibility, balance training, and gait correction. Essential for ankle sprains, plantar fasciitis, and post-surgical recovery.
Custom Orthotics
Prescription shoe inserts designed to support the arch, correct biomechanical abnormalities, and redistribute pressure. Effective for flat feet, plantar fasciitis, and various foot pain conditions.
Ankle Arthroscopy
Minimally invasive procedure using small incisions and a camera to diagnose and treat ankle joint problems including loose bodies, cartilage damage, and ligament issues.
Ankle Ligament Reconstruction
Surgical repair or reconstruction of torn ankle ligaments for chronic instability. May use native tissue repair or tendon graft depending on injury severity.
Bunion Correction (Bunionectomy)
Surgical realignment of the big toe joint involving bone cuts, repositioning, and fixation with screws or plates. Restores normal alignment and relieves pain.
Achilles Tendon Repair
Surgical reattachment of ruptured Achilles tendon or removal of damaged tissue in chronic tendinitis. May be performed open or minimally invasive depending on injury type.
Ankle Fracture Fixation (ORIF)
Open reduction and internal fixation of broken ankle bones using plates, screws, or rods. Restores anatomical alignment and stability for proper healing.
Ankle Fusion (Arthrodesis)
Surgical fusion of ankle bones to eliminate painful joint motion in severe arthritis. Provides pain relief by preventing bone-on-bone contact, though sacrifices ankle mobility.
Total Ankle Replacement
Replacement of damaged ankle joint with prosthetic components. Alternative to fusion that preserves motion while relieving arthritis pain in select candidates.
Cortisone Injections
Anti-inflammatory steroid injections into joints, tendons, or bursae to reduce pain and swelling. Useful for plantar fasciitis, arthritis, and tendinitis when conservative measures fail.
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