Bones & joints in the foot

Anatomy: bones and joints of the foot at a glance

The foot consists of 26 bones, numerous joint connections and a complex ligament and tendon system. It has to be stable and mobile at the same time – a biomechanical masterpiece.

• Ankle joint complex: upper ankle joint (OSG) between the tibia/fibula and talus; Lower ankle joint (USG) between the ankle bone and the heel/scaphoid bone
• Metatarsal joints: Chopart joint line (heel bone – scaphoid bone/cube bone) and Lisfranc joint line (scaphoid bone/cube bone to the metatarsal bones)
• Forefoot: base, middle and end joints of the toes; on the big toe the sesamoid bones under the joint head
• Ligament apparatus: strong ligaments stabilize OSG/USG; Lisfranc band secures the metatarsal connection
• Longitudinal and transverse arches: are held in place by bone form, ligaments and muscle tendons (e.g. tibialis posterior, peroneal tendons).

Disturbances in one section often affect the entire statics - which is why we always view the foot as a functional unit.

Typical complaints and possible causes

• Stress-related pain (stairs, prolonged walking, sports) or start-up pain
• Swelling, warmth, tenderness, occasionally redness
• Stiffness or feeling of locking in joints
• Feeling of instability, repeated twisting
• Misalignments, shape changes, axial deviations
• Pain at rest/night pain (warning signs, e.g. in the case of inflammation or bone edema)

• Overload and microtrauma (new training volumes, hard surfaces, unsuitable shoes)
• Misalignments (arch arches, hollow feet) with overloading of certain joint sections
• Osteoarthritis (age- or stress-related cartilage wear)
• Inflammatory rheumatic diseases or gout
• Bone metabolism disorders (e.g. osteoporosis) and circulatory disorders (osteonecrosis)
• Post-traumatic consequences after ligament tears, fractures or dislocations

Common diseases of bones and joints in the foot

Some clinical pictures primarily affect the bony and joint structures. You can find selected topics in more detail on our subpages.

• Lisfranc dislocation fracture/instability: Injury to the metatarsal union with pain in the instep and stress-dependent swelling
• Stress fractures of the foot bones: gradual onset, increasing pain under strain, often as training increases
• Osteonecrosis of the foot: localized bone pain due to reduced blood circulation
• Osteoarthritis: e.g. B. in the upper/lower ankle joint or metatarsal joints
• Post-traumatic joint problems and instability after ligament or bone injuries

Complaints about the toe or forefoot joints (e.g. hallux rigidus) as well as problems near the rear of the foot are also explained in the linked areas.

Diagnostics in our practice

We choose the diagnostics in a targeted manner and weighing up benefits, radiation exposure and significance.

Conservative therapy: exhaust it first

As a rule, noticeable improvement can be achieved without surgery. The building blocks are combined individually.

• Load control: temporary reduction of sudden loads, gradual reconstruction (e.g. 10% rule).
• Orthopedic technology: insoles (longitudinal arch/metatarsal support, rigidus spring), shoe modification (roll aid, cushioning), taping or functional orthoses.
• Physiotherapy: mobilization of overloaded/shortened structures, strengthening and sensorimotor skills/proprioception, axis and gait training.
• Medication options: anti-inflammatory painkillers short-term and as needed; local, topical preparations as an alternative with fewer side effects.
• Cryo/heat therapy depending on findings; Lymphatic drainage for swelling.
• Infiltrations: in cases of activated osteoarthritis or irritation in carefully selected cases, e.g. B. low-dose corticosteroid injection short-term; Hyaluronic acid possible for certain joints, benefits individually.
• Regenerative procedures (e.g. PRP): can be considered for degenerative joint problems; The evidence is limited depending on the joint - we provide advice based on the indication and transparently.
• Optimize bone metabolism: check vitamin D and calcium balance and treat deficiencies; Osteoporosis therapy according to guidelines.
• Lifestyle: weight management, adequate footwear, avoiding smoking (blood circulation), controlling blood sugar/uric acid well.

The goal is a less painful, resilient function in everyday life and sport - without any promise of cure.

Operational options – when do they make sense?

Surgery is considered when conservative measures have been exhausted, persistent functional deficits exist, or structural damage requires it.

• Clearly unstable injuries (e.g. pronounced Lisfranc instability) and displaced fractures
• Advanced osteoarthritis with rest/night and exertion pain despite conservative therapy
• Imminent collapse of osteonecrosis
• Axis or static-relevant misalignments with subsequent problems

• Arthroscopic procedures (OSG/USG) for the diagnosis/therapy of selected pathologies
• Stabilizing osteosynthesis in the midfoot (e.g. screws/plates for Lisfranc lesions)
• Corrective osteotomies to optimize the axis and load distribution
• Joint stiffening (arthrodesis) for painful, advanced osteoarthritis
• Bone marrow stimulating techniques for localized bone lesions

Rehabilitation includes individually controlled partial weight-bearing, physiotherapy and thrombosis prophylaxis. Return to everyday life and sport occurs gradually as healing progresses.

Self-help and prevention

• Make the training structure moderate; Do not increase the volume or intensity abruptly.
• Adapt shoes to the activity: enough space in the forefoot, good cushioning/roll, stabilizing heel support.
• use deposits consistently; Have the fit checked regularly.
• Foot gymnastics: toe gripping, short foot exercises, calf and plantar fascia stretching.
• Changing types of exercise (e.g. adding cycling/swimming).
• Weight control supports joint relief.
• Avoid smoking, regulate blood sugar/uric acid – important for blood circulation and joint health.
• Take early warning signs seriously (persistent pain, swelling, pain at rest) and get them checked out.

When should you come to us in Hamburg?

Seek medical advice – promptly in urgent cases – if any of the following signs are present:

• Acute severe pain or swelling after twisting an ankle/trauma, inability to exercise
• Visible misalignment or instability
• Pain at rest/night pain, fever, pronounced redness/overheating
• Feelings of numbness, increasing weakness or problems with wound healing
• Foot problems > 2–6 weeks despite rest and basic measures
• Repeated buckling or recurring joint blockages

Our practice is located at Dorotheenstraße 48, 22301 Hamburg. We plan diagnostics and therapy tailored to your everyday life and your goals.

What we offer in practice

• Structured anamnesis, foot and gait analysis, standing x-ray, sonography; reliable indication for MRI/CT
• Conservative focus: insoles and shoe advice, physio prescription with clear treatment goals, infiltrations with a sense of proportion
• Therapy pathways for overload, osteoarthritis, instability and bone edema
• Network for foot surgery procedures if necessary; Follow-up treatment and rehabilitation management in our practice

Topics and subpages in the area of ​​bones & joints

You can find more in-depth information in the following areas - depending on the focus of the complaint:

• Lisfranc dislocation fracture/instability
• Stress fractures of the foot bones
• Osteonecrosis of the foot
• Toes & forefoot
• Foot deformities
• Hindfoot diseases
• Sole of foot (Plantar)
• Blood circulation/metabolism
• Foot injuries
• Rare foot diseases

Assess the course and prognosis realistically

Most bony and joint foot problems improve within weeks to a few months with consistent conservative measures. In the case of structural instability, severe osteoarthritis or complex injuries, the course can be longer.

• Early diagnosis and adjusted loading often shorten the healing time.
• Rehabilitation is an active process: training, technology, footwear and everyday life must fit together.
• Patience is required after surgical procedures; full resilience occurs gradually.
• There is no promise of cure – we focus on your goals and clinical evidence.