Often times, people do not seek help for foot and ankle pain because it is viewed as a minor injury, when in reality it could be something much more severe. Approximately 5% of the adult population is affected by a disabling foot disorder. There are a multitude of different foot and ankle problems. Systemic diseases such as diabetes can manifest through the feet because of poor blood flow. Neuropathy often times occurs in diabetic patients. This can change the shape of the feet, often resulting in increased pressure to specific areas of the foot. Any joint pain in the lower extremity can also cause an individual to alter their walking gait. This makes it very difficult to do many activities of daily living. In the worst-case scenario, foot and ankle pain can often lead to surgery. With proper prevention and treatment, one can potentially avoid surgery for a foot or ankle problem. In the long run, it is essential to seek proper medical care for any foot and ankle pain. It is often much easier to treat a minor injury than a chronic problem in the future.
Millions of people across the United States suffer from foot and ankle pain, whether it be sudden or chronic. The reasons behind the pain in this area can be due to many different factors such as foot arch problems, obesity, ankle sprains, and often get pain from just being on your feet all day. The body works as a system where all parts are integrated together. Slight damage to one area can cause problems in another. Lower extremity pain often leads to altered gait mechanics. This then changes the forces that go through both the foot and the rest of the lower extremity, which can lead to damage in other areas. Because of this domino effect, it is important to pay close attention to foot and ankle pain as it can cause issues in other areas of the body.
Understanding Foot Pain
Finally, a skin infection or toenail infection can also cause foot pain.
A cyst is when a sac filled with a jelly-like fluid develops abnormally in the body. It can occur anywhere, and a cyst in the foot can cause pain and irritation, particularly on the soles of the feet.
A neuroma is a benign tumor of a nerve, and in the case of a foot neuroma, it is a growth of nerve tissue between the third and fourth toes. It is a result of compression and irritation of the nerve and usually causes burning pain in the ball of the foot that radiates into the toes.
Bone spurs are bony projections that develop along the edges of bones. They are a result of wear and tear damage on the bone and are common in the joints of the shoulder, hands, hips, and knees but also on the feet. The spurs cause pain when they press on other bones or soft tissues.
A fracture, or break, in any of the bones in the foot or ankle will cause sudden pain. Often, it is hard to tell if a bone is broken or if the injury is a severe sprain, so it is advisable to see a doctor in these cases.
A rip or tear in a ligament or the inflammation of a ligament is known as a sprain. Ligaments are tough, non-elastic fibers that hold bones together. A tear in a ligament may be painful and can result in instability of the joint.
Inflammation of a fascia, the connective tissue running along the bottom of the foot, usually provokes a sharp, stabbing pain with your first steps in the morning. This is a condition called plantar fasciitis.
Muscle or tendon strain is a common cause of foot pain. Most strains are a result of overusing a particular muscle or group of muscles, and while they can be quite painful, most strains are not serious.
There are many causes of foot pain, and each can have different symptoms. A more detailed article on the general topic of pain is available. Here is a brief overview of various causes.
Causes of Foot Pain
When people complain of foot pain, it can be a symptom of many conditions. Some of the major causes of foot pain can include: obesity, ill-fitting shoes, high-impact exercise, stress fractures, or any direct injury. Obesity can contribute to a number of medical conditions in the feet including gout, tendonitis, or osteoarthritis. Wearing shoes that are too tight can cause a condition known as “plantar fasciitis”. This is when the bottom of your foot becomes inflamed, producing heel or arch pain. Often the only cure for this is buying more appropriate footwear with better support, and often patients of this condition will need to buy shoes with a built-in arch support or an orthotic. High-impact exercise can often lead to bruising to the fat pad on the heel. This can be very painful, and in order to treat it, you should ice the foot after exercising. More severe cases may require the use of crutches. Stress fractures can be caused by a sudden increase in activity, such as running. They can also occur in osteoporosis sufferers. The best way to treat a stress fracture is with rest and immobilization. Using a surgical shoe and crutches can help to reduce pressure on the foot and promote healing. Any direct injury to the foot can cause a number of tears or breaks in the various tissues, which will be painful. Usually, the R.I.C.E method (rest, ice, compression, elevation) can be applied to treat the pain and its symptoms.
Common Foot Conditions
Plantar fasciitis is often linked with tightness of the calf musculature and a heel spur, which is usually an incidental finding. Treatment should be aimed at reducing tension in the plantar fascia and associated structures. A flat shoe (or heel raise) will relax the complex of muscles at the back of the leg and reduce traction on the calcaneus via the Achilles tendon. Anti-inflammatory measures may be helpful initially. A corticosteroid injection could be considered in more severe cases. Long-term relief is usually achieved through the use of a custom-made orthotic device in order to optimize foot posture and reduce stress through the plantar fascia. A night splint might be used to maintain the length of the calf musculature and reduce symptoms experienced in the morning. It can also be useful for the splint user to release tension in the plantar fascia by using a massage ball.
Plantar fasciitis is a common cause of heel pain. The plantar fascia is a thick, broad, inelastic ligament originating on the calcaneus and extending along the sole of the foot towards the toes. Its purpose is to help maintain the longitudinal arch of the foot. It is thought that the pain usually experienced with the first few steps in the morning is due to micro-tearing of the plantar fascia from its insertion into the calcaneus. Usually, the body’s attempt at repair causes an increase in symptoms.
If we consider that foot pain differs enormously from individual to individual in cause, seriousness, and defining characteristics, it can be understood why accurate diagnosis is crucial in determining the most effective management strategy. The following are some of the more common conditions, often presenting as a chronic ache or pain.
Tips for Preventing Foot Pain
Recommended footwear includes a firm sole, added support to the midfoot, sufficient padding, lightweight, and flexibility at the forefoot. The sole should be patterned to prevent slipping. This is an attractive list and many people may believe that their favorite footwear can match this description, however there are a few additional points that should be made. Athletic shoes can lose their shock absorption after 250-500 miles of wear, or around 1 year. This may vary based on the intensity of use, the body weight of the individual, and the running style of the athlete. Trails may cause the upper of the shoe to become torn without affecting the sole of the shoe. Often times this can go unnoticed. Failure to address this can also result in a loss of effectiveness of the shoe in shock absorption and foot control. This is important to keep in mind as direct correlation has been found between the increased use of athletic footwear and a decreased incidence of foot pain. Be sure to remember that cushioning crosses all types of footwear. This is especially important with dress shoes. In this case, the less cushioning the shoe provides, the more force concentrated directly beneath the foot. This can result in discomfort surrounding the ball of the foot and the development of conditions such as calluses or metatarsalgia. A study conducted by the American Orthopaedic Foot and Ankle Society showed that 77% of women aged 18-55 years had one or more foot problems, mainly stemming from the use of narrow, pointed-toe, and/or high heeled dress shoes. These findings suggest that it may be best for both men and women to avoid these types of shoes, however it is understandable that this is not always possible. In this case it is best to use such footwear in moderation and avoid any activities that may put excess force on the foot.
Proper Footwear Selection
Wearing shoes that are too tight, too loose, or without enough support can cause long-term foot problems. The size of your feet changes as you grow older, so always try your shoe size before you buy. Make sure the ball of your foot fits comfortably into the widest part of the shoe. Don’t buy shoes that feel too tight and hope they will stretch. They should be comfortable from the start. Opt for shoes with lace, Velcro, or a buckle fastening. They can be adjusted and provide greater support. High heels tilt your body forward and squash your toes together, increasing the pressure on them. Try to opt for soft leather or canvas shoes, which allow your feet to breathe and also give to the shape of your feet. Finally, when it comes to completing home DIY, take off your shoes and don’t go barefoot. Wearing thick-soled shoes will give you support and protection.
Maintaining Healthy Foot Hygiene
Caring for your feet means more than just treating them to a pedicure. Healthy hygiene of the feet is essential in preventing infection and illness. Daily washing of the feet with soap and water and completely drying the feet, especially between the toes, is important in stopping bacterial and fungal infections. Allowing feet to remain damp encourages the development of athlete’s foot, a common and stubborn fungal infection. This can also be prevented by changing shoes, socks, and hosiery daily to decrease moisture around the foot. And because foot odor often accompanies bacterial growth, it is important to wash feet with soap and water daily, dry them thoroughly, and change into clean shoes and socks. In the shower, wear shower shoes to avoid infection from ringworm or athlete’s foot. Trimming toenails on a regular basis is important to prevent ingrown toenails. Using a mild antiseptic when cutting the nails can aid in preventing fungal and bacterial toenail infections. If you do develop any cuts or abrasions, it is important to clean the area well with soap and water, apply an antiseptic, and cover the area to prevent infection. If an infection occurs, even if minor, seek medical attention. An infection can turn into a serious issue for those with diabetes or other conditions that cause poor circulation to the feet. And finally, for at least a few minutes a day, prop your feet up. This helps to prevent swelling in the feet and ankles.
Stretching and Strengthening Exercises
Toe-curl exercises can help to keep the tendons along the top of your foot and ankle in the best shaped length-tension relationship. This exercise also helps to strengthen the muscles on the underneath side of the toes. Sit in a chair with feet flat on the floor. Attempt to curl toes under the chair. This can be made more difficult by pressing some form of weight across the tops of the toes. Hold for 3-5 seconds and perform 2-3 sets of 10 repetitions. This can be done every other day. Another good exercise which works the hallux (great toe) in an attempt to maintain strength and function is the solar intrinsic exercise. This exercise is designed to isolate the muscles controlling the movement of the big toe. Failure of these muscles is thought to be a major contributor to various pathological foot conditions. Stand next to a wall for balance and support. Using the foot without shoes, attempt to grab and pull the floor towards you by curling the toes. Imagine the motion used to bring a rug, held by the toes, from the floor. Only the toes should curl and the motion should not be coming from the rest of the leg. With a conservative resistance, perform 2-3 sets of 10 repetitions and again, this should be done every other day.
Treatment Options for Foot and Ankle Pain
In many instances, foot and ankle pain can be resolved by the sufferer. This is especially true if the pain is due to the mechanical breakdown of the structure of the foot and/or ankle. As an example, stress fractures have been shown to have very successful outcomes when treated with a period of non-weight bearing followed by a progressive weight bearing program. The length of time to restrict the weight over the fracture line is dependent on the type and location of the stress fracture and can be anywhere from 2-6 weeks. Progressive weight bearing would be initiated once pain-free x-rays indicated sufficient healing of the fracture. This same type of treatment can be beneficial for many different foot and ankle injuries. By allowing the structures to rest and repair, followed by a gradual increase in stress applied to the structures, pain levels can be reduced and a normal level of function can be restored. Rest is a very general idea and can be accomplished through many different forms of immobilization depending on the injury. This can range from the use of a couple of days of decreased activities and using a soft or hard cast to offload stress on certain foot and ankle structures, to the use of a walking boot which may completely offload the foot and ankle. Crutches or a wheelchair may also be necessary to completely offload and rest certain injuries. Any questions on the type of immobilization to use should be directed towards a medical professional who can guide you into the best form of treatment.
Rest and Ice Therapy
A more convenient way is to use ice packs that can be kept in the freezer and will remain flexible, cold, and easy to use. This is important as using a bag of frozen peas is often too cold and can be too painful to apply to the skin and can result in the ice being applied for too long.
Ice is normally applied to a painful area and can be a useful treatment to reduce inflammation and swelling. This can be in the form of ice wrapped in a tea towel and applied to the area for 15-20 minutes every hour for the first two days. After this, it is less important but still beneficial to do before and after activity.
Rest is needed to reduce excessive loading and stress on the painful area to enable the body to protect and start the healing process. If this is not done and activity continues, then this can prevent proper healing and a chronic problem can occur. This is often the case in people who ignore pain or have too much of a “no pain, no gain” attitude.
Rest and ice are essential aspects of the treatment of acute soft tissue injuries. This is useful for any sudden onset pain or persistent pain in a joint or specific area. This could be anything from scalding yourself to persistent pain in the same area happening on a daily basis.
Over-the-Counter Pain Relief
Non-steroidal Anti-inflammatory Drugs (NSAIDs) are commonly used to reduce pain and inflammation, and to decrease symptoms of arthritis. There are many different types and brands of over the counter NSAIDs including ibuprofen (Advil, Motrin), naproxen (Aleve), and aspirin. Each prescription and over the counter NSAID is at least somewhat effective at relieving pain and inflammation from osteoarthritis, and some are also effective for other forms of arthritis. Treatment typically is given 3-4 times per day. It is important to be mindful of the potential side effects of NSAIDs, which may include gastric irritation, peptic ulcer formation, fluid retention, high blood pressure, and kidney damage. Duration of treatment must be weighed against potential risks and benefits, especially in patients with other conditions that may increase drug sensitivity or risk of adverse events. Slightly selective COX-2 inhibitors are a type of NSAID that was designed to have fewer gastrointestinal side effects. Two COX-2 inhibitors that are still available with prescription are celecoxib (Celebrex) and meloxicam (Mobic).
Acetaminophen (Tylenol) is a widely used oral medication for relieving pain and fever, and is sold over the counter. It is effective for mild pain, but has been shown to be no more effective than a placebo for pain and disability from osteoarthritis of the hip or knee. Dosage is generally one or two 500mg tablets every 4 to 6 hours, with a maximum of 4g per 24 hours. It is important to be mindful of the potential for liver toxicity, especially if using acetaminophen in the setting of a chronic condition, in the elderly, or when using multiple medications that also contain acetaminophen. An overdose can result in liver failure or death.
Physical Therapy and Rehabilitation
An often neglected form of therapy for foot and ankle pain is an orthotic. An orthotic is any device that is inserted into a shoe. It can range from simple felt pads to custom made shoe inserts. They are designed to correct alignment and function of the foot to help eliminate pain. If designed properly, an orthotic will help to redistribute weight on the bottom of the foot which can help to alleviate pressure on a certain area. They can also help to properly align the joints in order to prevent further mechanical damage. Studies have shown that the use of an orthotic can be as effective as surgery for certain conditions. An individual should consult their doctor or a podiatrist to see if an orthotic is a viable option for their condition.
Rehabilitation is an often misunderstood term in the medical community. People often associate rehab with professional athletes and think that the goal is to get back to an exceptionally high level of competition. In reality, anyone with a physical impairment can benefit from rehabilitation. In terms of foot and ankle pain, rehabilitation is designed to decrease pain, swelling and inflammation, increase mobility and strength, and ultimately get back to the activities of daily living. So, rehabilitation can range from a competitive athlete trying to get back to his/her sport, to an elderly patient just trying to walk without pain. The bottom line is that if you have pain anywhere in the lower extremity, a good rehabilitation program can be very beneficial.
Physical therapy is a highly effective treatment for foot and ankle pain. Proper therapy can help align muscles and joints, take pressure off of the nerves that cause irritation, and increase stability and strength. The patient’s program usually lasts from four to six weeks, however it could be shorter or longer depending on the nature of the condition. The goal is to first identify the cause of the pain, then to take stress off of the affected area. This is often done using crutches or a brace. Range of motion exercises are done to help increase flexibility, particularly useful when a joint has been immobilized for a long period of time. A strengthening program is then implemented in order to increase stability of the affected area. This is key in preventing future occurrences. The program should then progress to more functional activities. This could be anything from a runner trying to get back to light jogging, to a factory worker trying to return to his/her job. The program should create a smooth transition to these activities in order to decrease the likelihood of re-injury.
Medical Interventions
Medical interventions include a variety of options, some more conservative than others. When considering medical intervention, it is important to consult your physician to discuss the risks and benefits of each option relevant to your particular case. The most conservative medical intervention is injection therapy. Injections of corticosteroids can be useful in alleviating pain and reducing inflammation in a painful region. However, this is not always effective, and there is some evidence to suggest that corticosteroid injections can be detrimental to the tissues in the long term. Injections of local anesthetic and/or corticosteroid can also be useful to anesthetize a painful region to allow a more effective course of physiotherapy. Any form of injection should always be carried out using ultrasound guidance to ensure accuracy and safety. Injections of platelet-rich plasma, a concentrated form of the patient’s own blood, are becoming more popular, but the evidence regarding its effectiveness is limited at present. It is also common for a physician to refer a patient to a podiatrist to discuss the possibility of manufacturing custom foot orthoses.
