Treatment for Foot and Ankle Pain
Foot and ankle pain can greatly affect your everyday life, limiting your mobility and diminishing your quality of life. Our goal is to educate and empower you by providing insights into a variety of conditions that can be effectively managed with foot orthoses. Scroll down and expand each section for more information.
Accessory Navicular Syndrome
Sesamoiditis is inflammation of the sesamoid bones, two small bones beneath the big toe joint. Think of them like tiny shock absorbers for your foot, helping it move smoothly. When these bones get irritated from activities like running or dancing, they can become inflamed, causing pain and discomfort, especially when pushing off with the big toe or bending the foot.
Seasmoiditis is common among athletes and those who put repetitive stress on their feet. It’s essential to address it early to prevent worsening pain and potential complications. With proper care and management, most people can recover and return to their normal activities without significant issues.
Symptoms include tenderness, swelling, and difficulty bearing weight on the affected foot. Treatment typically involves rest, icing, and wearing supportive footwear to alleviate pressure. The aim of management is to offload the sesamoids and reduce the pressure to allow healing to occur if the bones have become stressed or to allow the inflammation to settle down. Conservative treatment can take a long time to take full effect and it is a combined approach with the right orthotics, physiotherapy input and cushioned footwear. In severe cases, corticosteroid injections or, rarely, surgery might be necessary.
Achilles Tendon Disorders
The Achilles tendon is a strong band of tissue that connects the calf muscles to the heel bone. It helps you push off the ground when you walk or run. Problems with this tendon include Achilles tendonitis, para-tendonitis, and tendinosis.
Achilles tendon disorders can be split into two types:
Type I: This happens when there’s inflammation and tears in the middle of the Achilles tendon.
Type II: This occurs when there’s inflammation and tears near the heel bone.
These issues are usually caused by overuse or putting too much stress on the Achilles tendon. This can lead to tiny tears in the tissue that don’t heal properly, especially if the tendon is overused.
Symptoms of these disorders include:
- Tendinitis: Inflammation of the Achilles tendon, causing pain during physical activity or daily tasks.
- Para-tendonitis: Swelling and inflammation of the tendon, with pain starting during activities and worsening over time.
- Tendinosis: Pain and thickening of the tendon, along with weakness and reduced ability to move the foot.
To diagnose these disorders, a doctor will examine the foot and check for pain, swelling, and weakness in the Achilles tendon area. X-rays, MRIs, or ultrasound scans may also be done to see the extent of the damage.
Treatment usually starts with rest, ice, pain medication, and stretches. Orthotic intervention or physiotherapy may also compliment the rehabilitation process. In severe cases, surgery might be an option after a few months of little improvement.
Ankle & Foot Arthritis
Arthritis is a broad term referring to a group of conditions that affect joint function. Commonly seen in the elderly, nearly 50% of individuals in their 60s and 70s experience foot and ankle arthritis, though not all show symptoms. The most prevalent form is osteoarthritis, characterised by pain, stiffness, swelling, and potentially bone spurs at the joint. It worsens with active movement and shows signs of repetitive strain. Rheumatoid arthritis, though less common, includes symptoms such as pain, swelling, arch collapse in the midfoot, bunions, claw toes, misalignment, and inflammation of the joint lining, with pain increasing during active movement.
Factors contributing to arthritis include previous injuries like broken bones, torn ligaments, and sprains. Other specific forms include gout and hallux rigidus. Autoimmune disorders can also lead to arthritis.
Diagnosis involves examining foot biomechanics, symptom history, and potentially ordering X-rays to check for cartilage loss and joint changes. Treatment options include non-steroidal anti-inflammatory drugs (NSAIDs) to reduce inflammation and slow cartilage damage, physical therapy, and orthotics to relieve joint strain. More invasive treatments, like steroid injections or surgery, may be considered for advanced cases unresponsive to non-surgical management.
Ankle & Foot Related Neuropathy
Nerves function as the body’s internal electrical wiring, facilitating communication between the body and the brain. Injuries to these nerves can lead to muscle issues such as excessive stiffness, weakness, or lack of control, particularly noted in conditions like ankle and foot neuropathy often associated with diabetes or congenital disorders.
Symptoms of nerve damage include an inability to control the affected limb, weakness, numbness, tingling, and either extreme flaccidity or rigidity of the muscles. Additionally, patients may experience uneven wear on the foot due to altered pressure distribution due to altered movements.
For diagnosis, medical professionals will review the patient’s history and conduct examinations focusing on sensory sensitivity, reflexes, pain, and balance.
Orthotic prescriptions are regularly recommended to maintain flexibility and muscle strength and both before and after surgery and can support other treatments such as physiotherapy.
Ankle Sprains
Ankle sprains happen when the ankle’s supporting ligaments stretch too much or even tear. This usually occurs when someone twists their ankle. These injuries can be mild or severe, affecting how stable the ankle feels afterward. The most common ankle sprains involve the ligaments on the side of the ankle. Depending on how badly the ligament is damaged, sprains are categorized as:
Grade 1: The ligament is stretched with tiny tears
Grade 2: The ligament is partially torn, making the ankle a bit loose
Grade 3: The ligament is completely torn, leading to a lot of ankle instability
Another type, called high ankle sprains, affects different ligaments higher up near where the leg bones meet. These can also involve a ligament tear that might even break the smaller leg bone.
Symptoms include:
- Pain
- Swelling
- Bruising
- Feeling like the ankle might give way
Health professionals check the ankle by looking at it and moving it to see how badly it’s hurt. They might also use X-rays or other scans to make sure there’s no bone damage.
Treatment usually doesn’t involve surgery. For milder sprains, resting the ankle, applying ice, wrapping it, and keeping it raised helps. Pain relievers can reduce pain and swelling. Severe sprains might need a brace or physiotherapy to support the healing process. High ankle sprains take longer to heal and also benefit from physiotherapy input.
Foot Drop
Foot drop is a condition where you can’t lift the front part of your foot, making it difficult to walk without dragging your toes. This issue can be caused by weakness or paralysis in the muscles that normally lift the foot. A common reason for this problem is damage to the peroneal nerve, which helps control foot movement.
Foot drop can be a sign of various underlying issues, sometimes temporary, such as nerve compression, or long-term due to more serious conditions. People with foot drop might lift their knees higher than usual to walk, increasing the risk of tripping.
This condition can be due to several factors, including:
- Nerve Damage: This can happen in your back (lumbar radiculopathy) or specifically affect the peroneal nerve at the knee. Damage might occur from injuries, prolonged pressure on the nerve, or conditions like diabetes.
- Brain or Spinal Disorders: Diseases like multiple sclerosis, cerebral palsy, or stroke can lead to foot drop.
- Muscle or Nerve Conditions: Including muscular dystrophy or motor neuron diseases like ALS.
Diagnosing foot drop involves a physical exam, possibly alongside imaging tests like X-rays or MRI scans, blood tests for conditions like diabetes, and nerve function tests.
Treatment varies depending on the cause. It might include:
- Physiotherapy: To strengthen muscles and improve walking.
- Orthotics: Such as braces or shoe inserts to help keep the foot in position and aid safe walking ad improved balance
- Surgery: In some cases, to relieve nerve pressure or repair damage.
Some people might improve with treatment, especially if the cause is temporary. However, for those with chronic underlying conditions, foot drop might be permanent.
Home care can also help manage foot drop, such as using walking aids, making your home safer to prevent falls, and doing exercises to strengthen your foot and leg muscles.
If you can’t lift your foot as usual, it’s important to see a doctor to identify the cause and discuss treatment options. Early intervention can help manage the condition effectively.
Hallux Rigidus
Hallux rigidus is a form of arthritis that affects the big toe, causing pain, stiffness, and swelling in the joint where the big toe meets the foot. This condition means “stiff big toe” and is essentially a type of wear-and-tear arthritis. It’s important to see a healthcare professional if you notice these symptoms as they can help manage the condition.
This issue is quite common, particularly among adults over 50, and is the most frequently occurring type of arthritis in the foot. It is second only to bunions in terms of common conditions affecting the big toe’s joint.
Symptoms include pain and stiffness in the big toe, swelling around the joint, and reduced movement. This can be worse when standing, moving, or in cold, damp weather. The biomechanical forces running through the joint are important when actively moving around so the limited motion can make physical activity difficult. Tight or poorly fitting shoes can also exacerbate the problem.
The exact cause of hallux rigidus is often unclear, but it generally results from the joint’s wear and tear over time. Each step puts significant stress on this joint, which can lead to the condition. Other contributing factors might include injuries to the toe, overuse from sports or work, and having longer foot bones.
Diagnosis typically involves a physical exam and possibly X-rays to look for bone spurs and assess the joint’s condition. The severity of hallux rigidus can be graded based on how much movement is lost in the big toe.
Treatments aim to relieve symptoms and improve joint function. These may include changing to shoes with more room for the toes and stiff soles, orthotic insoles with local stiffness can be relieve pain by limiting toe movement, taking pain relievers, and applying ice to reduce swelling. In some cases, cortisone injections or foot soaks might be recommended. Surgery is not usually necessary but could be considered if other treatments do not help.
Recovery from hallux rigidus varies depending on the treatment. Simple changes like wearing different shoes may offer immediate relief, while recovery from surgery depends on the type of procedure performed, ranging from a few weeks to several months.
Hallux Valgus or Bunions
Hallux valgus, commonly known as a bunion, is a deformity at the joint where the big toe connects to the foot. This condition is marked by a noticeable bump on the side and base of the big toe, which starts to lean towards the second toe, causing misalignment. Bunions are prevalent, affecting one in three women in the UK, and are more common in women, with nine out of ten sufferers being female.
The development of bunions is often linked to wearing ill-fitting shoes, though genetic factors and the natural shape of the foot also play significant roles. Bunions tend to worsen over time, making early detection and management crucial.
Symptoms of bunions include:
- A visible enlargement at the base of the big toe.
- Pain or discomfort when walking.
- Redness and soreness around the joint.
- The big toe gradually misaligning further towards the second toe.
- Inflammation of the fluid-filled pads (bursae) that cushion the bones, tendons, and muscles near joints, known as bursitis.
For diagnosis, a healthcare professional will typically look for the characteristic bump in a physical exam and might request imaging tests like X-rays to determine the extent of the bunion’s progression.
Treatment options vary depending on the severity of the bunion. In milder cases, monitoring the bunion’s progression may suffice. For more significant discomfort, changes in footwear, reducing certain activities, applying ice, using anti-inflammatory drugs, and employing padded inserts or custom orthotics can help alleviate symptoms. If these measures are ineffective and the bunion hampers daily activities or athletic performance, surgery might be considered to correct the alignment and provide relief.
Metatarsalgia
Metatarsalgia is a broad spectrum term to describe pain under the balls of your feet. It does not however, explain the reasons why you have pain in this area and so it is important to first understand the reasons why the pain exists to treat it correctly.
Pain to the forefoot can occur for a number of reasons such as:
Rheumatoid arthritis, causing thinning of the natural protective fat pad
Stiffness within the big toe joint, causing an altered ay of walking and more pressure being taken underneath the other metatarsal heads
Something wrong with the natural mechanics of the foot, causing abnormal pressure in areas, not designed to take the pressure
High heeled footwear increasing the amount of time spent on the front of the foot
The correct treatment can be achieved when the cause is properly understood.
In many cases simply changes to footwear and exercises can be of great value. Having orthotics designed to increase the cushioning and offload the painful areas is a very successful method of management. In some cases, when conservative treatment methods have failed, surgical intervention is considered.
Morton`s Neuroma
Morton’s neuroma is a painful condition affecting the nerves between the toes in the ball of your foot. It’s more common in people aged 35 to 60, with women being more affected than men, although it can occur at any age. It arises from irritation and thickening of the nerves that supply sensation to your toes, leading to pain and numbness. Treatment typically starts with self-care measures and in extreme measures, surgery. It is important to note that surgery does not make the foot like it was before symptoms and the decision to undertake this is take very seriously by the surgeon.
The thickening occurs in one of the plantar digital nerves, which run between the long bones of the foot and provide sensation to the toes. While the nerves supplying the third and fourth toes are often involved, any of the plantar digital nerves can be affected. As the nerve thickens, the pressure around it increases, causing pain and numbness in the forefoot and toes.
Morton’s neuromas are quite common, with about one in three people experiencing it at some point. Symptoms include pain between the toes, especially when standing or walking, swelling between the toes, and tingling or numbness in the foot. The pain is often sharp, stinging, or burning, and can feel like you’re stepping on something or like your sock is bunched up.
Treatment involves easing symptoms and reducing inflammation. Guided injections are a very powerful method of reducing symptoms as well as other conservative measures which can include footwear changes, calf stretches and orthotics.
Peroneal Tendon Injuries
Peroneal tendons help stabilize the ankle and run along the outside of the calf muscle. The injuries relate to the two peroneal tendons which are peroneus brevis and peroneus longus. The injuries generally relate to those people who tend to either bear most of their weight on the outside of their foot or where the muscle has been over – loaded either due to incorrect footwear, altered running technique or running on uneven ground. Peroneal tendon injuries can occur suddenly or develop gradually over time,
It is accepted that prompt treatment is crucial for peroneal tendon injuries, especially when the tendon has experienced subluxation, to prevent further complications such as tendon tears or ruptures. Diagnosis involves a thorough examination by a healthcare professional, including assessment of pain, swelling, weakness, and instability in the ankle. Dependant on the symptoms, imaging can be very helpful to help determine the exact level of damage, predict prognosis and therefore the return to activities and in more serious cases, aid a surgeons surgical decision making.
Conservative management includes strengthening, strapping, footwear alterations and rest. Orthotics are considered when there is a need to change the way in which the muscles are utilized during walking or running, especially when the symptoms have occurred without any specific trauma.
Pes Cavus or High-Arched Foot
Pes cavus, commonly known as a high-arched foot, is a condition where the foot has an unusually high arch. This causes more pressure on the heel and ball of the foot, especially during activities like walking or running. The condition can be congenital (present from birth) or develop as part of a progressive neurological disorder.
Symptoms of Pes Cavus Include:
- Toes that curl downwards (hammertoes) or clench (claw toes)
- Increased pain during physical activities
- Calluses developing on the ball or heel of the foot due to the extra pressure
- General instability when walking or standing
Diagnosing Pes Cavus:
To diagnose this condition, a healthcare professional will review the patient’s family medical history and conduct a thorough physical examination of the foot. They’ll assess the foot’s stability and look for any signs of underlying problems. The examination may extend to other limbs and include neurological tests and imaging studies to identify any related issues.
Treatment Options:
Treatment for pes cavus primarily aims to manage the abnormal biomechanics caused by the high arch. Options include:
- Orthotics: These are custom-designed insoles placed inside the shoe to help distribute pressure more evenly
- Shoe modifications: Shoes can be adapted to provide better support and cushioning for the high arch
- Braces: These may be used to stabilise the foot and align the foot’s tissues properly
These treatments help in alleviating pain, improving stability, and promoting healing. If these conservative methods do not effectively increase functionality and reduce discomfort, surgery might be considered.
Plantar Fasciitis
Plantar fasciitis is a common foot condition that causes pain in the heel and bottom of the foot. It occurs when the plantar fascia, a thick band of tissue supporting the foot arch, becomes irritated and inflamed. Think of the plantar fascia as a sturdy elastic band stretching from the heel to the toes, aiding in shock absorption and body weight support.
Recent research suggests that plantar fasciitis can result from various factors. One major factor is overuse or repetitive strain on the plantar fascia, which can arise from activities like running, walking, or standing for extended periods. Additionally, tight calf muscles or Achilles tendons can exert pressure on the plantar fascia, leading to inflammation. Other factors contributing to plantar fasciitis include foot mechanics and footwear. For instance, having high arches or flat feet can increase stress on the plantar fascia, heightening injury risk. Wearing shoes lacking proper arch support or cushioning can strain the plantar fascia, particularly during high-impact activities.
The primary symptom of plantar fasciitis is heel pain, especially when taking the first steps in the morning or after prolonged rest. Pain may gradually diminish as the foot loosens up during the day but can intensify with extended activity. Some individuals may also experience pain along the foot’s bottom or arch stiffness.
Rest and activity modification: Allowing the foot time to rest and avoiding activities exacerbating the condition can alleviate inflammation and facilitate healing.
Stretching exercises: Stretching the calf muscles and Achilles tendon can relieve tension on the plantar fascia and enhance flexibility.
Orthotics: Using supportive shoe inserts or orthotic devices can furnish additional cushioning and arch support, reducing strain on the plantar fascia.
Physiotherapy: Collaborating with a physical therapist can bolster foot and ankle muscle strength, enhance biomechanics, and mitigate pain.
For severe cases, treatments like corticosteroid injections or extracorporeal shock wave therapy may be considered, typically for individuals unresponsive to conservative treatments.
Sesamoiditis
Seasmoiditis is inflammation of the sesamoid bones, two small bones beneath the big toe joint. Think of them like tiny shock absorbers for your foot, helping it move smoothly. When these bones get irritated from activities like running or dancing, they can become inflamed, causing pain and discomfort, especially when pushing off with the big toe or bending the foot.
Seasmoiditis is common among athletes and those who put repetitive stress on their feet. It’s essential to address it early to prevent worsening pain and potential complications. With proper care and management, most people can recover and return to their normal activities without significant issues.
Symptoms include tenderness, swelling, and difficulty bearing weight on the affected foot. Treatment typically involves rest, icing, and wearing supportive footwear to alleviate pressure. The aim of management is to offload the sesamoids and reduce the pressure to allow healing to occur if the bones have become stressed or to allow the inflammation to settle down. Conservative treatment can take a long time to take full effect and it is a combined approach with the right orthotics, physiotherapy input and cushioned footwear. In severe cases, corticosteroid injections or, rarely, surgery might be necessary.
Diabetic Ulcers
Diabetic ulcers are open sores that commonly develop on the feet of people with diabetes, typically due to nerve damage (neuropathy) or poor circulation. They often occur at pressure points on the foot, like the bottom of the big toe or the ball of the foot, and can be caused by something as simple as an unnoticed blister or callus.
Because diabetes can affect blood flow and the ability to feel pain, these ulcers may go unnoticed and untreated, leading to complications such as infection or even tissue damage that requires amputation.
Treatment involves careful wound care, which may include cleaning the ulcer, removing dead tissue, and applying dressings to promote healing. Offloading pressure from the affected area is crucial to prevent further damage. In some cases, antibiotics or other medications may be necessary to treat or prevent infection.
Prevention is key, and people with diabetes should inspect their feet regularly, wear properly fitting shoes, and manage their blood sugar levels to reduce the risk of developing ulcers. Prompt treatment and proper foot care can help prevent complications and promote healing.
Tarsal Tunnel Syndrome
Tarsal tunnel syndrome occurs when the posterior tibial nerve, which runs through a space on the inner side of the ankle called the tarsal tunnel, becomes compressed. This tunnel, protected by a thick ligament known as the flexor retinaculum, also contains arteries, veins, and tendons. Compression in this tunnel can be caused by repetitive strain, flat feet, unusual anatomical structures, injuries, arthritis, diabetes, and other health conditions. If not addressed, the syndrome can worsen over time.
Symptoms include:
- Tingling, burning, or similar sensations around the ankle.
- Numbness
- Shooting pains that can extend from the ankle to the bottom of the foot
Diagnosing Tarsal Tunnel Syndrome:
A healthcare professional will typically start with a physical examination to look for signs of nerve damage and poor foot mechanics. If they suspect complications or need to investigate further, imaging studies like X-rays or MRIs may be used to check for any abnormal growths affecting the nerve.
Treatment Options:
The initial approach to managing tarsal tunnel syndrome involves conservative methods such as:
- Resting the affected area to reduce strain
- Applying ice to minimise swelling
- Taking non-steroidal anti-inflammatory drugs (NSAIDs) to relieve pain and reduce inflammation
If these measures do not alleviate the symptoms, more specific interventions might be recommended, including:
- Orthotics custom-designed to correct foot alignment and reduce pressure on the nerve
- Physical therapy to strengthen and stretch the foot and ankle
- Braces or modified footwear to support and protect the foot
Should these conservative treatments fail to provide sufficient relief, surgery may be considered to relieve the pressure on the nerve by decompressing the tarsal tunnel. This option is typically pursued only when other treatments have not effectively addressed the symptoms.
Tibialis Posterior Tendon Dysfunction
Posterior tibial tendon dysfunction (PTTD) is a condition that causes pain in the foot and ankle. This tendon links the calf muscle to the bones on the inner side of the foot and is crucial for supporting the foot’s arch. When the tendon is damaged or deteriorates, it can lead to difficulties in supporting the arch, causing significant pain and impacting activities like walking and running. PTTD is a common cause of adult-acquired flatfoot, where the arch of the foot collapses.
Stages of PTTD:
Stage I: The tendon is injured but still intact
Stage II: The tendon is partially torn or not functioning correctly, leading to foot deformity
Stage III: There is severe foot deformity and degenerative changes in the foot’s connective tissue
Stage IV: The degeneration extends to the ankle joint
Symptoms of PTTD include:
- Pain and swelling along the inner side of the ankle and foot
- Increased pain during activities like standing, walking, or rising on toes
- The ankle rolling inward
- Difficulty navigating uneven surfaces or stairs
- Progressive worsening of a limp
- Unusual wear patterns on shoes
Causes:
PTTD can result from repetitive strain or ageing, which leads to the tendon’s breakdown. Obesity can accelerate this process due to increased stress on the tendon. Previous injuries to the ankle, foot, or joint also contribute to quicker deterioration.
Diagnosis:
Healthcare providers diagnose PTTD by examining swelling and movement in the ankle and foot. They check for changes in foot structure and perform a single-limb heel rise test to assess the tendon’s function.
Treatment:
Early-stage PTTD can often be managed non-surgically through:
- Rest and avoidance of aggravating activities.
- Low-impact exercises like cycling or swimming.
- Ice applications to reduce pain and swelling.
- NSAIDs for pain and inflammation relief.
- Physical therapy to strengthen the tendon.
- Orthotics or braces to support the arch and reduce strain on the tendon.
Persistent or severe cases might require surgical intervention after at least six months of non-surgical treatment, depending on the pain and damage extent. Surgery aims to repair the tendon and correct foot deformities.
