Ankle and Foot Pain
Ankle Sprain
Ankle sprains are one of the most common injuries seen in orthopedics. This injury usually occurs after a traumatic injury with the turning or rolling of your ankle inward. This is also known as an inversion injury. It often happens on an uneven surface or it is caused by instability of the ankle.
Common Symptoms:
- Pain and swelling typically in the lateral ankle
- Possible bruising
- Difficulty walking without a limp
- Reduced range of motion
- Hearing or feeling a "pop"
Common Treatments:
- Rest, ice, and elevation
- Anti-Inflammatories (Ibuprofen / Aleve) and/or Tylenol
- Crutches
- Ankle brace or a walking boot
- Physical therapy / Home exercises
- Sometimes surgery if chronic instability develops
Risk Factors:
- Previous sprain resulting in joint laxity
- Chronic issues can lead to degenerative arthritis in the ankle and increased risk for fracture
Please use the following link to learn more about ankle sprains.
https://orthoinfo.aaos.org/en/diseases--conditions/sprained-ankle/
Please use the following link to learn more about ankle exercises. Consult your physician before beginning any exercise program.
https://orthoinfo.aaos.org/en/diseases--conditions/ortho-pinion-ankle-sprains/
Achilles Tendonitis
The Achilles tendon is the largest tendon in the body. It connects your calf muscles to your heel bone. It is used when you walk, run, climb stairs, jump, and stand on your tip toes. Typically Achilles tendonitis is caused by an over-use injury or it can be caused by a sudden increase in the amount or intensity of physical activity. Chronic inflammation and irritation of the tissue and tendon can lead to some degeneration of the tendon.
Common Symptoms:
- Pain in the back of the ankle at the Achilles tendon or into back of the heel
- Pain increases typically with activity and throughout the day
- Swelling or enlargement may be seen along the tendon
- Chronic irritation possibly can lead to "pump bump"
Common Treatments:
- Rest
- Limit aggravating activities
- Ice
- Anti-Inflammatories (Ibuprofen / Aleve) and/or Tylenol
- Small heel lift/gel heel cup
- Walking boot
- Physical therapy/stretching program
- Sometimes surgery if conservative treatment fails
Risk Factors:
- Chronic overuse or sudden increase in intensity/amount of physical activity
- Abnormal bone shape/contour
- Tight calf muscles
- Chronic issues can lead to Achilles tendon tears
- Use of fluroquinolone antibiotics (ex: Cipro) can increase your risk of a tendon rupture.
Please use the following link to learn more about Achilles tendonitis.
https://orthoinfo.aaos.org/en/diseases--conditions/achilles-tendinitis/
Ankle Osteoarthritis
Arthritis of the ankle is when the hard cartilage covering of the bones wears away and the bones are no longer protected. There are many different kinds and causes of arthritis, which include osteoarthritis, rheumatoid arthritis, and arthritis caused by an old injury (post-traumatic). Risk Factors for developing arthritis include previous injury, ankle instability, obesity, and personal/family history of rheumatoid arthritis or other rheumatologic diseases.Common Symptoms:
- Pain/stiffness with motion
- Joint swelling
- Difficulty with walking and physical activity
- Ankle instability
- Psoriasis
Common Treatments:
- Rest and minimizing activities that increase pain
- Ice/heat
- Anti-inflammatories (aleve, ibuprofen) and/or Tylenol
- Rheumatologic evaluation and medications
- Bracing including ankle-foot orthoses (AFOs)
- Physical therapy
- Steroid joint injections
- Weight loss
- If all this fails, surgery including joint replacement or fusion
Posterior Tibial Tendonitis
The posterior tibial tendon is a tendon that runs down the back of your calf, along the inside part of the ankle, and under your foot. This tendon is important in keeping your ankle straight and holding up the arch of your foot. This common condition can be seen from an acute injury or from chronic inflammation/microtearing from overuse. It is very common in women, especially those over 40 years of age, and patients with risk factors such as diabetes, obesity, and hypertension.Common Symptoms:
- Pain in the inside of the ankle into the arch of the foot
- Swelling of the ankle and foot
- Limited range of motion of ankle
- Difficulty walking (especially when pushing off)
- When you are dealing with this for a long time, it can cause
- lateral ankle pain due to overloading
- Flattening of the arch
Common Treatments:
- Rest
- Anti-inflammatories (ibuprofen and aleve) and/or Tylenol
- Ice
- Bracing/orthopedic boot
- Physical therapy
- More supportive shoes/inserts to support arch
- Unsuccessful conservative treatment can lead to surgery for
-
- Tendon debridement
- Tendon repair
- Joint fusion
- Re-aligning the bones of your foot/ankle to take pressure off (osteotomy)
Plantar Fasciitis
This is a very common condition that causes a lot of pain and can be very debilitating. Most of the time, the pain starts at the heel but can hurt through the entire bottom of your foot. The pain is usually worst in the morning and can be causes by a sudden increase in daily activities, wearing shoes with poor support, obesity, and tight calf muscles. If the problem goes on for a long time, it can lead to tissue rupture and increased pain.Common Symptoms:
- Pain in the arch or heel that is worst with the first few steps in the morning
- Often pain is not bad during physical activity but intensifies once it is completed
- Pain may increase as the day progresses
Common Treatments:
- Rest
- Ice
- Anti-inflammatories (ibuprofen and aleve) and/or Tylenol
- Physical therapy for calf stretching and ankle strengthening
- Night splints or orthopedic boot
- Orthotics/arch supports
- Steroid or PRP (platelet rich plasma) injections
- If the above treatment does not help, the last option is surgery for plantar fascia debridement or release
Midfoot Arthritis
Just like other joints in the body, it is possible to have arthritis in the bones of your foot when the protective covering wears away and the bones rub on each other. There are many different kinds/causes of arthritis that affect the foot including osteoarthritis, rheumatoid arthritis, and post-traumatic arthritis. Risk factors for developing arthritis in your feet include old injuries, obesity, unsupportive shoes, female gender, family or personal history of osteoarthritis or rheumatoid arthritis.Common Symptoms:
- Pain/stiffness with motion
- Foot swelling
- Difficulty with walking and physical activity
- History of psoriasis
- High/low arch
- This condition is also associated with bunions, hammertoes, claw-toes, and cross-over toes
Common Treatments:
- Rest and minimizing activities that increase pain
- Ice/heat
- Anti-inflammatories (ibuprofen and aleve) and/or Tylenol
- Rheumatologic evaluation and medications
- Foot orthotics
- Supportive shoes
- Physical therapy
- Steroid injections in the foot (this is often done with the help of xray and sedation in the operating room because of how small the joints are)
- Weight loss
- If the above treatments are unsuccessful, we consider surgery including joint replacement or fusion
“Bunions” also known as 1st MTP Arthritis and Hallux Valgus
This is a very common condition that affects most of us as we get older. Bunions are a painful bump can be seen in the inside part of the big toe and as they progress it can appear like your big toe angles in toward the other toes. These often develop very slowly over a period of time, but can be seen congenitally. Risk factors for developing bunions include female gender, wearing toes with a small toe box for years, injuries to the big toe, and history of rheumatoid arthritis.Common Symptoms:
- A hard bump that forms over the inside part of the big toe (1st MTP joint)
- Pain with pressure and walking
- Callus formation over bottom of foot
- Swelling
- Limited motion of the big toe
- Crossover toe with the second toe
- Ulcer formation due to rubbing on shoes
Common Treatments:
- Rest
- Ice
- Anti-inflammatories (ibuprofen and aleve) and/or Tylenol
- Changing shoewear to have a higher toe box
- Padding areas that are rubbing on shoes
- Toe spacers
- A stiffer sole shoe or a hard plate (usually made out of carbon fiber) that limits bend and takes pressure off the toes
- Steroid injections
- If the above treatments are unsuccessful, we consider surgery, including bunionectomy to remove the bump, "chilectomy" to clean out the joint and remove excess bone spurs, and lastly joint replacement or fusion
Gout
This is a common problem, usually in the big toe but can happen in any joint, that can cause sudden increase in extreme pain/swelling. It is caused by high levels of uric acid in the joint which is usually related to how our bodies process food and drinks. This usually happens in younger men, those with histories of diabetes or hypertension, and patient who have problems with their kidneys. It is also related to diet and people who eat a lot of red meats and cheese or drink a lot of alcohol can be at higher risk to develop gout.Common Symptoms:
- Sudden increase in extreme pain/swelling
- Redness or heat around the toe
- Inability to walk/move joint without pain
- As the disease progresses, flares can be more frequent and increase in severity/duration and can attack other joints
- Over time, the toe may become distorted from bumps called "tophi" which are lumps of material that resembles toothpaste
- Symptoms are seen for about 3-10 days and often resolves even without treatment
Common Treatments:
- Rest
- Ice
- Anti-inflammatories (ibuprofen and aleve) and/or tylenol
- Repetitive flares may require specific gout medication to prevent flares
- Increase hydration
- Lower alcohol/red meat intake
- If the above treatments are unsuccessful, we may consider surgery, including debridement of the tophi or joint replacement/fusion