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The human foot has 26 bones, 39 joints, and over a hundred muscles, tendons and ligaments that keep it working properly.
Dr. Don Stewart, Orthopaedic surgeon, will show us what those bones look like:
But why should you care?
Looking at the foot as just bones, ligaments, muscles, tendons, nerves and blood supply doesn’t really tell us anything apart from that it is a complex system. So let’s look how even seemingly simple tasks affect the bones of the feet (some foot facts courtesy of Ontario Society of Chiropodists):
- Standing in one spot is more tiring that walking. This is because, when standing only, a lot of pressure is applied to only a few muscles and bones over a long time. Normally specific areas of the foot only achieve high pressures quickly for shorter periods.
- When you run, 3 times your bodyweight is applied to the foot. That’s a lot of weight to absorb!
- When you lift your heel when walking, your toes get one half of your body weight applied to them. That’s a lot for such a tiny structure to take on.
As you can see, your feet have instant demands placed upon them every single day, and sometimes those demands can be a huge burden. Specific areas can hurt, one of those being the bones of the feet.
It is also worthy to note that many muscles outside the foot are attached to bones within the foot. And muscles within the foot attach to other bones in the foot. Bones also anchor ligaments. Therefore, if one bone is off it can affect a complex system that can be sore even outside of the foot.
Bones themselves can also be fragile or be affected by what’s going on within our body. This is what bone actually looks like. It is a living structure:
- Bone can be traumatized – especially as a child, bone trauma can stunt growth.
- Bone can bruise
- They can bend or break
- They can become thin or thick
- In some conditions bone infection can be common
- In rare instances you can also get bone tumours
And these points can apply to the bones of the foot.
So let’s learn more about the different regions of the foot. This will also give the Chiropodist a good idea where to assess if you do have foot pain.
Understanding the Bones of the Foot
As we saw in the video, the foot ca be split up into different regions. Each region can play a very large part in foot health. The 4 regions that we will go through today are:
- Tarsal Bones
- Metatarsal Bones
- Phalanges
- Treatment Options for Bone-Related Foot Pain Causes
Tarsal Bones
Mount Sinai notes the tarsal bones in the foot are responsible for ankle movement and make up the rear of the foot. There are seven tarsal bones in total (as shown by the picture above kindly used from TheSkeletalSystem.com)
- The Talus Bone: This is a bone that forms the ankle complex (with the Tibia and Fibular) and therefore sometimes called the ankle bone. The talus is integral in helping you stand, foot shape and keeps your ankle moving smoothly.
- The Calcaneus Bone: Also called the heel bone, this is a large, strong bone at the back of the foot that transfers body weight to the ground.
- The Tarsals: Five bones that work together to form the midfoot arch.
The Tibia, Talus and Calcaneous form a tiny tunnel called the Tasrus Tunnel. It is very important because through it runs many tendons, blood vessels and nerves.
The formation of these bones working together may pronounce your arch (high arches) or flatten it (flat feet).
The height of your arch determines the level of arch support you need from your shoes or custom orthotics.
Metatarsal Bones
These are the 5 “long” sections of your toes. Image from TheSkeletalSystem.com
Five tubular bones in the middle and the top of the foot (the forefoot) connect the tarsal bones to the phalanges. Metatarsal bones look similar to each other and are numbered one to five, or from medial to lateral, by healthcare professionals. Lateral would be the outside- where the 5th toe would be. Each bone contains the following parts:
- Proximal base: Connects to the tarsal bones
- Slender shaft: Extends along the forefoot.
- Distal head: Connects to the phalanges in the toes
Metatarsal bones are the most vulnerable to blunt-force foot injuries. Their main function is to support body weight, help with balance and walking, and they play a role in forming foot arches.
Phalanges
The phalanges are 14 bones that make up the toes. The big toes and other toes consist of different phalanges: (picture courtesy of The Skeletal System.)
- Big toe: Consists of the technically 2 joints. The proximal and the distal
- Other toes: Consist of 3 segments. Proximal, Middle and Distal
- Sometimes left out are the sesamoids which are on the big toe and look like 2 circular pea sized bones. They help with big toe movement, efficiency and help to focus tendons. If constantly pressured they can fracture.
Phalanges bend your toes properly and help with lateral movements, navigating strange surfaces, and balance.
Treatment Options for Bone-Related Foot Pain Causes
Foot pain often correlates with the bones of the foot, namely blunt force trauma (stubbing your toes, dropping an object on your foot, etc.) and stress fractures. Here are some additional common issues:
- Osteoarthritis: Causes inflammation and pain via degradation of the cartilage in the joints
- Bunions: Associated with arthritic changes in the bones of the foot
- Sesamoiditis: Pain and inflammation in sesamoid bones in the big toe
- Hallux Rigidus/Limitus: Decreased range of motion and stiffness in the big toe joint
- Hammertoes: Bent and contracted toes caused by arthritic changes
There are many treatment options for bone related trauma. However, as Chiropodists we need to figure out first if it is a bone-related issue, and not a ligament, muscle, nerve or even circulation issue. It could even be a combination of these. So an assessment to pinpoint the root cause of the pain is a really good start.
From there, the clinician will decide what treatments would be suitable for you depending on multiple factors;
- Your job: If you are on the go all the time, then your treatment plan should accommodate this.
- Your medical conditions: Some conditions, like diabetes and rheumatoid arthritis, require more oversight and management because they can quickly progress and become worse.
- Ability: Sometimes, due to mobility restrictions or other factors beyond our control, we simply cannot do everything that is asked. If that is the case, then your treatment plan can be be modified to accommodate you.
Practicing foot care by performing stretches and exercises before and after your activities can help prevent or at least reduce the risk of developing bone problems in your feet. Gentle exercises could also be a part of the rehabilitation process for healing fractures and trauma.
Other treatment options include wearing proper footwear and inserts, medications, splinting, bracing and taping methods, aligners, and potentially shockwave therapy. In some cases surgery is an option.
