The Ankle

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The ankle joint is formed where the foot and the leg meet. The ankle, or talocrural joint, is a synovial hinge joint that connects the ends of the tibia and fibula (shin bones) in the lower limb with the proximal end of the talus bone in the foot. The joint between the tibia and the talus bears the vast majority of the body's weight while the fibula keeps the talus under the tibia.
The term "ankle" is used to describe structures in the region of the ankle joint proper. The joint under the ankle allows side to side movement while the ankle joint proper allows the foot to hinge up and down. Together they allow the foot to move as it were connected to the leg with a ball joint. Listed on the left are some of the most common pathologies written by our staff and local physicians.

Achilles Tendonitis


Achilles Tendonitis is an inflammation of the thin sheath-like structure around the achilles tendon. This tendon attaches to the back of our heel and allows the muscles in the calf move our foot down so that the toes can point towards the ground (plantar flexion). The Achilles Tendon is a long and thick tendon, which moves our foot down, so that the toes point to the ground (plantarflexion). The pain can be shooting, piercing, and burning pain. The first few steps in the morning many times are the worst. It is important to treat this condition as soon as possible as it may progress to the point where it causes permanent damage to the achilles tendon proper. Ruptures and the need for surgical repair may be avoided by early diagnosis and treatment of this very common condition.

Possible Factors:
1. Overuse, such as too much running, especially up or down hill.
2. Trauma, such as a kick to the tendon.
3. Shoe or boot (ski/snowboard) pressure, especially at its attachment to the heel, or just above it.

a. Ice, Anti-inflammatories, rest, 
b. Heel lifts
c. Removable Cast Boot or CAM Walker
d. Achilles Heel Guard
e. Custom Orthotics
Washington Foot & Ankle
Peter Vincent, DPM
Lake Washington Physical Therapy
Benjamin Wobker, PT, MSPT, DPT


Foot Arthritis

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Osteo Arthritis
Osteoarthritis (degenerative joint disease (DJD)) 
is the most common form of arthritis found in the foot. It is generally due to the normal wear and tear that our joints undergo during our lifetime. There is some truth in the saying: "If you live long enough, you will develop osteoarthritis."
It may also be due to a joint injury. This injury can be due to over-utilization of the joint, a fracture, or surgery on a joint.
The most commonly affected joints in the foot are the toe joints (phalangeal joints) and the metatarsophalangeal joints. These are the joints located in the balls of the feet (in the forefoot area) — the joints where the toes attach to the feet.
The most frequently affected joint in the foot is the 1st metatarsophalangeal joint (big toe). When this joint has osteoarthritis it is usually called Hallux Limitus or Hallux Rigidus, and people may experience:
*a reduction in how far the big toe can be pushed up (dorsiflexion).

common symptoms that one may experience are:
Brief period of morning stiffness (15 minutes or less).
Aching pain in one or more joints which increases with use, and is relieved by rest. Pain is not migratory. This means that symptoms are usually experienced in the same joint, rather than in one joint today, and a different joint tomorrow. The affected joint usually appears swollen, and this swelling feels "hard." However, there is no redness nor increased warmth around the joint.
The range of motion of the joint is usually limited.

Pathology of Osteoarthritis:
OA begins with an uneven wearing down of the joint cartilage, which may be due to: over utilization of the joint, an injury to the joint, etc. This produces a narrowing of the joint space, and finally bone begins to rub against bone. When bone rubs against bone we may experience pain, stiffness, decreased movement of the joint, and swelling.

Treatment of osteoarthritic (OA) joints:

The most successful treatment is to protect the joints, especially when we walk. This is the "Gold-Standard"— the treatment recognized by the majority of the medical community to be effective. Protecting the joints will ensure a reduction in joint pain
significant slow-down in the progress of the disease within the affected joints a reduction in the chances of injuring other joints when we walk.

If we have a painful joint (or joints), we subconsciously force ourselves to walk in an abnormal manner, so as to try and keep all pressure off of the painful joint. When this is done, we apply abnormal and excessive pressure on other joints in the foot. This is called compensation. This compensation leads to over-utilization of these joints, and new sites of osteoarthritis.

create depressions in this padding that the painful joint sits in, reducing the pressure applied to that joint each time we take a step, and allowing these joints to "rest" and heal.
Hallux Limitus and Hallux Rigidus are the terms usually applied to osteoarthritis of the big toe joint (1st metatarsophalangeal joint). When this joint has osteoarthritis it is treated by using a custom-made orthotic with a Morton's Extension under the first toe. This Extension protects the joint by reducing the amount of pressure we apply to the big toe when we "push off" with each step. The orthotic and Extension reduces the bending of the big toe joint, by allowing the orthotic to help the rest of the foot "push off," and allowing the big toe joint to "rest" and be painfree.
Maintain the foot in a neutral or normal position by preventing it from rolling in or out. This helps to remove excessive pressure from the big toe and the little toe joints. Our custom orthotics accomplish this with the use of comfortable balancers and posting.



A bunion is the result of a complex deformity of the big toe and the bone it connects to, the first metatarsal. The deformity occurs at the joint between the two toes. At this point, the head of the metatarsal protrudes outward, causing a bump on the inner side of the joint and toe; and the big toe moves towards the adjacent toe.

Bunions may be hereditary. They may also be related to narrow shoes, injury, or arthritis. Shoe pressure on the toe and bump will cause redness and pain. Remedies are designed to alleviate painful shoe pressure on the bump, and to keep the big toe straight (this helps to slow down the progression of the pathology. The most common remedy is the creation of a custom orthotic.



Calluses are areas of accumulated dead skin found on the bottom of the feet. The most common calluses are found on the balls of the feet. These areas of hard dead skin can be diffuse, and spread over a broad area, or they can be localized to a small area, and be very deep. Both types can be very uncomfortable.
Causes: Calluses are the result of an underlying problem which exists in the foot. The normal foot can carry our weight comfortably, without the formation of calluses and pain. When a callus occurs, it signifies a change is occurring in our metatarsals (the long bones of our feet to which our toes connect). We have five metatarsals, and they each carry a portion of our body weight as we walk. When one or more metatarsals carry more weight then they are supposed to, the skin under these bones becomes thick, hard, and painful.

To provide relief from callus pain, the abnormal weight the callused area is carrying must be reduced and re-directed to the rest of the foot. Therapists agree that the easiest and most cost effective way to accomplish this goal is with the use of Orthotics. These are comfortable, long lasting, medical devices which are made from molds of your feet. Orthotics with proper footwear can alleviate callus pain by performing the following functions:
Adjusting and accommodating for any abnormal walking patterns you have, such as pronation (a twisting of the foot outward, so that as you walk you apply more weight on the inner border of your foot). Pronation, and other biomechanical defects such as intoeing, outtoeing, high arches, etc... affect the way weight is distributed across the balls of our feet when we walk. Orthotics allow the feet to function in a normal (neutral) position when they strike the ground, rather than in a twisted (malaligned) position, thus removing the excessive weight and pressure from painful calluses. The same pair of orthotics can be used in your dress or athletic shoes (you will need only one pair to provide you with comfort in all of your activities).



A neuroma, or Morton's Neuroma, is a benign soft tissue mass which forms on the nerve which runs between the metatarsals, in the ball of the foot. When two metatarsal bones are squeezed together, they pinch the nerve that runs between them. This squeezing together of the metatarsal bones is usually a result of: narrow shoes, high heel shoes, injury, or a biomechanical defect of the foot (such as loose ligaments; pronation, a turning of the foot outward, so that you walk more on the inner border of the foot; or aches which are too flat or high).
The most common symptoms of a neuroma are the following:
pain in the ball of the foot, radiating into the webspace between the toes, and sometimes into the toes themselves;
the pain can be sharp, burning, or tingling in nature;
the pain is usually present when wearing some shoes (especially tapered dress shoes), and gradually goes away when the shoes are removed;
numbness in adjacent toes;
when the neuroma is large, patients complain that they can feel a "clicking" between the affected metatarsals;
swelling of the area.
(Depending on the size and location of the neuroma, patients may experience some, or all of these symptoms)
Custom Orthotics with a Morton's Extension not only relieves the pain, but will also correct the biomechanical defects which may be the reason the neuroma is present. Our orthotics are comfortable, and are made of lightweight materials; they gently support the arch; and will fit in most shoes.

Vestibular Treating Therapists

 Author:  Samie Seeley  PT, DPT

Author: Samie Seeley

 Mandie Majerus PT, MSPT, OCS, CSCS, SFMAc, CMPT

Mandie Majerus

  Heidi Biehl  PT, DPT, OCS, CSCS

Heidi Biehl

  Justin Ho  PT, DPT, CSCS

Justin Ho

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