How many bones do you think there are in the foot and ankle? Ten? Fifteen? Twenty-five?
Try 38. And those bones are all connected by a series of joints and held together by an intricate array of ligaments, tendons and muscles.
Our feet have two basic jobs: to hold us up and to move us around. No matter our size or how much weight we are carrying, it all comes down to our feet. And to get from one place to another without mechanical assistance, we generally rely on our feet.
The architecture of the foot includes three arches that give it stability, supports its weight-bearing function, and allows it to be flexible and mobile. The arches are created by the shape of the bones in the foot and the ligaments that hold the bones in place.
The best-known ligament—because it is the largest and the most susceptible to inflammation—is the plantar fascia, a long, flat ligament that stretches along the bottom of the foot and attaches to the heel. T here are 13 tendons in the ankle—each one attaching a muscle to a bone—that enable the ankle, foot and toes to move the way we want them to.
The largest of the tendons is the Achilles tendon at the back of the ankle, which attaches the calf muscles to the heel bone.
Bunions are the most common problem that people have with their feet. They are so common, in fact, that David Strom, M.D., an orthopaedic surgeon at Pinehurst Surgical, sees several bunion patients every day.
Dr. Strom, who specializes in foot and
ankle problems, performs orthopaedic
procedures as FirstHealth Moore
Regional Hospital and FirstHealth
Richmond Memorial Hospital.
“When the big toe deviates from its
normal position toward the other toes,
that creates a bony prominence on the
inside of the foot at the base of the toe
joint that we call a bunion,” he says. “It
may not be painful, but it usually is. It may
not be progressive, but it usually is.”
Bunions are a hereditary trait in some
people. Wearing narrow or high-heeled
shoes that put pressure on the big toe
also can cause bunions.
Surgery to correct the problem usually
involves removing or realigning bone and
soft tissue around the big toe joint. But
less than half of the people who come to
Dr. Strom with bunions require surgery.
Most can get relief by wearing wider
shoes or putting inserts or pads in their
shoes to cushion the painful area.
In some cases, injections of antiinflammatory
drugs can relieve the pain
and swelling of bunions.
“If everything else has been tried and it
is still very painful, that’s when we think
about surgery,” Dr. Strom says.
Next to bunions, the most common
cause of foot pain is plantar fasciitis. The
long, flat ligament on the bottom of the
foot that attaches to the heel bone—the
plantar fascia—can develop small tears
that cause inflammation. This can result
in sharp heel pain that typically is worse
when a person first gets out of bed in the
“It hurts,” Dr. Strom says. “People
often think they have heel spurs, but
actually those rarely cause pain.”
Activities that stretch the plantar
ligament, such as running or jumping,
can cause plantar fasciitis. Having a
tight Achilles tendon or tight heel cord
also can be contributing factors. The
condition rarely requires surgery.
|David Strom, M.D.
“We have a whole list of conservative
measures we use including stretching
exercises, physical therapy, heel cups and
corticosteroid injections,” says Dr. Strom.
Tendonitis—inflammation of a
tendon—in the ankle and lower leg
are relatively common conditions. The
Achilles tendon at the back of the ankle
is particularly susceptible. The posterior
tibial tendon, which is on the inside of
the ankle, also can become inflamed.
Usually caused by overuse, tendonitis
can involve inflammation alone or small
tears in the tendon and surrounding
tissue that become inflamed.
“There are many different stages
of tendonitis,” says Dr. Strom, who is
recognized internationally as an expert
on the posterior tibial tendon. “Some
are easily treated with a little brace or an
insert in the shoe, some can be treated
with a cortisone injection, and some
People with advanced, poorly
controlled diabetes are particularly
susceptible to foot problems. Diabetes
reduces blood flow to the extremities and
affects the ability of nerves to feel pain.
“The nerves that lead to the joints
don’t work as well as they used to, so
you can have a loss of sensation in the
foot that can lead to all kinds of trouble,”
Dr. Strom says. “You can have a blister
that you don’t feel, and it can turn into a
diabetic ulcer. And with the lack of blood
supply to the foot, it is hard for anything
|Karen Fox now stands comfortably while she paints since she had bunion surgery late last year.
The bunion on the side of Karen Fox’s foot
started giving her trouble about five years ago. She
tried to ignore it, but it gradually got worse and
“One day I was on the golf course, and I thought,
‘I’ve got to get this fixed, because it hurts too much
every time I take a step,’” she recalls.
Fox went to David Strom, M.D., an orthopaedic
surgeon with Pinehurst Surgical, to have the bunion
Dr. Strom typically advises bunion patients to try
other remedies first. He often recommends that
they wear wider or specially designed shoes or that
they put inserts in their shoes to take pressure off
the bunion. But Fox had done all that a few years
earlier when she had a bunion on her other foot.
She was living in Connecticut at the time.
“I had tried the special shoes and the inserts, and
they didn’t work,” she says. “So, rather than going
through all that again, I decided to go ahead and
deal with the source of the problem,” she says. “I
knew I was going to end up having surgery anyway.”
Fox had the operation as an outpatient procedure
this past December. She never felt much pain from
the surgery, and she had a quick recovery.
“I was wearing regular shoes within six weeks and
playing 18 holes of golf at week seven,” she says. “I
usually play about three times a week.”
Fox also is an artist, and she stands while she
paints. Now 61, she took up oil painting when she
retired and moved to Pinehurst in 2002. She had
her first single-artist show at the Artist League of
the Sandhills in Aberdeen last summer.