Bones of the Foot and Ankle: Everything You Need to Know

Have you ever looked at your feet and wondered how they hold you up all day?

Well, that's a more interesting question than it seems. I'm Dr. Luigi Manzi, and here on SmartHallux I often talk about foot surgery, but today I want to take you on a sort of "guided journey" through the anatomy of the foot and ankle. Because knowing how we are made helps tremendously in understanding what can go wrong and, more importantly, how to fix it.

The bones of the foot and ankle are a masterpiece of engineering. Think about it: 26 bones in the foot, plus three in the ankle, working together to let you walk, run, and jump. It's incredible, right?

The Foot: 26 Small Miracles of Architecture

Here's something I often tell my patients: the foot is divided into three main parts. Like a three-story house, so to speak.

The tarsus is the posterior part, closest to the ankle. It contains seven bones, including the famous calcaneus (heel bone) and the talus, which acts as a hinge for the ankle. These bones are strong. They have to be—imagine all the weight they must bear every time you walk!

Then there's the metatarsal : five long bones that run from the tarsus to the toes. The first metatarsal, the one on the big toe, is the most important for us orthopedists. Why? Simple: it's where hallux valgus, the so-called "bunion," forms. I've seen it thousands of times in my office.

The phalanges are the bones of the fingers: 14 in total, 3 for each toe except the big toe which has only 2. Small, but essential for balance.

Now, this is interesting because each group of bones has a specific role. The tarsus absorbs impact, the metatarsus distributes weight, and the phalanges help you push off when walking. A perfect system, when it works well.

The ankle: three bones that make the difference

The ankle appears simple from the outside, but it's a complex joint. The tibia and fibula (the two bones of the leg) meet the talus in the foot, forming what we call the "tibio-fibular-talar mortise."

A complicated name to describe what a perfect hinge it is. It allows for flexion, extension, and those small lateral movements you need when walking on uneven terrain.

The other day a patient asked me, "Doctor, why does my ankle hurt so much when it rains?" The answer has to do with this very anatomy: the ankle joint is very sensitive to humidity, especially if there's already some arthritis.

The Achilles tendon: the gentle giant

I can't talk about the ankle without mentioning it: the Achilles tendon. It's the strongest tendon in the human body, connecting the calf muscles to the heel.

Imagine, it can withstand loads up to 12 times its body weight while running! But precisely because of this, it's also vulnerable. Tendinitis, partial tears, complete tears: I see them all, especially in weekend athletes who overdo it without preparation.

One thing I always say: "The Achilles tendon is like a rubber band. If you pull it too hard, too often, without warming it up... sooner or later it will break."

What can go wrong?

The most common ailments I see? Hallux valgus, of course—it's my daily bread. Metatarsalgia, when the ball of the foot hurts under the toes. Plantar fasciitis, that terrible pain under the heel in the morning. And then ankle sprains, fractures, and arthritis.

Every problem has its own story. The lady who comes in with bunions often says, "Doctor, it's the heels!" It's not always that simple. Sometimes it's genetics, sometimes it's the type of foot, sometimes it's actually the wrong shoes.

I see fractures often in the winter. Ice, slips, and cracks. The fifth metatarsal is the most easily broken—a simple sprain and you're done, six weeks in a cast.

How do we understand what you have?

When you come to my office, the first thing I do is listen. "Tell me what happened?" It's amazing how much useful information you give me just by telling me how the pain started.

Then I look at how you walk, how you place your foot. I palpate, move the joint, and check exactly where it hurts. I often make the diagnosis that way, even before the X-ray.

X-rays are essential for seeing the bones of the foot and ankle, but sometimes more is needed. MRI for soft tissue, CT for complex fractures. Every case is different.

Treatments: from simple treatments to surgery

The good news is that not everything ends in the operating room. Many problems can be resolved with conservative treatments: rest, ice, anti-inflammatory drugs, and physical therapy.

Orthotics work great for many problems. Not the ones from the supermarket, mind you—the custom-made ones, designed for your specific foot.

When is surgery necessary? It depends. Severe bunions, compound fractures, severe ankle arthritis. In these cases, surgery can truly transform the quality of life.

I've seen patients who were no longer able to walk without pain return to hiking after successful surgery. This is the greatest satisfaction of my work.

Prevention is better than cure

A couple of tips I always give: the right shoes, keeping your weight under control, and regular but not excessive physical activity. Your feet are made for movement, not for sitting still in tight shoes all day.

And if you feel pain, don't wait for it to go away on its own. The sooner you intervene, the better. Always.

SmartHallux: Where we can help you

Here at SmartHallux, we specialize in foot and ankle surgery. I have extensive experience in this field, and I provide each patient with a personalized treatment plan using the most modern and least invasive techniques possible.

The SmartHallux team treats conditions such as hallux valgus , Morton's neuroma , and other deformities that cause foot pain. Providing comprehensive support throughout the treatment process, SmartHallux can be a winning choice for effective treatment tailored to your needs. Book your specialist consultation with the SmartHallux team now (opens in a new tab).

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