Tendons are tissue cords that connect muscles to bone. The largest in the body is the Achilles tendon that connects the calf muscle to the heel bone.
Tendonitis is when the tendon becomes inflamed and is a common cause of foot or ankle pain.
Achilles tendonitis causes pain and swelling in the area. The pain and stiffness may be worst in the morning. Pain at the back of the heel worsens with activity and may be severe the day after exercising.
Tendonitis results from overuse or an injury. Exercising without a proper warm-up and stretching can contribute to this inflammation. Individuals with tight tendons, flat feet or arthritis are prone to tendonitis.
Resting the foot or ankle as much as possible can ease tendonitis pain, as can icing the area. Apply ice three or four times a day for up to 15 minutes at a time.
If your pain is persistent and rest and icing don’t help, it’s time to visit a podiatrist. Left untreated, tendonitis may become chronic and more difficult to treat.
To treat Achilles tendonitis, we will first focus on relieving your pain. Immobilization with a soft cast can help with healing which may take a few weeks. We may prescribe oral medication to help with pain and swelling.
Custom-fitted orthotics can help control the motion of your feet to reduce your chances of recurring tendonitis. Stretches and strengthening exercises can help improve elasticity and strengthen nearby muscles.
It’s important to gradually reintroduce exercise to avoid re-injuring the tendon. Build up your walking, running or other workouts to help prevent tendonitis
The foot’s arch is formed by the tarsal and metatarsal bones and is strengthened by tendons and ligaments. Its job is to help the foot support and distribute the body’s weight.
Arch pain is usually caused by inflammation of the soft tissues in the midfoot called the plantar fascia. The plantar fascia is a thick tissue on the bottom of the foot that connects the toes to the heel bone.
Several foot problems can cause arch pain including:
Stress Fractures. Overuse can cause the midfoot bones to become damaged. A stress fracture is a tiny fracture in the bone caused by repetitive overuse and causes pain that worsens with activity. Rest is important and a walking boot or crutches can take the pressure off of the area.
Sprains. A ligament sprain causes pain and swelling immediately after the injury. Landing awkwardly or twisting the foot can cause a sprain. Rest and immobilizing the foot will help the sprain heal.
Tendonitis. Inflammation of the tendons in the foot may cause arch pain. Rest and icing the area can ease the pain and swelling.
Because there are many sources of arch pain, a careful diagnosis by a foot doctor is the best way to identify the problem. We will examine your foot carefully and make imaging tests such as X-rays, CAT scans and MRIs if necessary..
Treating Arch Pain
Generally, our goals in treating arch pain will be to relieve swelling and inflammation and to ease the pressure from the irritated area. Treatments include:
- Resting the foot to reduce inflammation. Crutches or a boot can help the foot rest as can activity modifications.
- Applying ice to ease pain and inflammation. Ice massage such as rolling the foot over a frozen bottle of water can be effective.
- Anti-inflammatory medications. Check with your doctor first before starting a new medicine.
- Changing footwear. Look for shoes with extra cushioning and more arch support.
Preventing Arch Pain
You can prevent arch pain by proper-fitting wearing shoes with good arch support. Avoid unsupportive shoes and sandals like flip-flops.
Regular stretching can help keep foot and calf muscles flexible and strong. If you stand for long periods of time at home or work, consider using an anti-fatigue mat such as at the kitchen sink.
Arthritis can cause pain in your feet as well as your knees, fingers and wrists. Arthritis is inflammation of a joint and is very common in the small joints of the ankle and foot, especially in the big toe and midfoot.
Several types of arthritis can affect the foot and ankle:
- Osteoarthritis or “wear and tear” arthritis can occur with younger individuals but most often affects those during and after middle age. When the cartilage that protects the joint bones wears away, the bones rub against each other causing pain and stiffness. Other risk factors are family history and obesity.
- Rheumatoid arthritis is a chronic autoimmune disease where the immune system attacks the tissue covering the joint causing damage to the cartilage and bone. Joint deformity and disability are often the results.
- Gout is a type of arthritis caused by a build-up of uric acid crystals in the big toe and other joints. Some risk factors include heavy alcohol intake, obesity and high blood pressure.
- Arthritis can result from trauma to the foot or ankle such as fractures and dislocations.
- Pain with motion
- Joint swelling
- Joint warmth
- Difficulty walking
There is no cure for arthritis, but once we have confirmed our diagnosis we can help you manage your arthritis to relieve your discomfort.
- Custom-fitted orthotics can ease pain and minimize pressure on the foot.
- Reduce excess weight to relieve joint stress.
- Switch to low-impact exercise like swimming or biking.
- Physical therapy can increase range of motion, flexibility and muscle strength.
- Take anti-inflammatory medication to relieve inflammation.
If these conservative measures do not help, we will discuss surgery on the joint with you.
Ball of Foot Pain
Pain in the ball of the foot, the area just behind the toes, is likely metatarsalgia, an inflammatory condition that causes pain in the mid-foot metatarsal bones.
Metatarsalgia is an overuse injury that can be caused by activities like jumping and running. Wearing shoes that are too tight – or too loose – can also bring on this painful condition, as can excess weight or foot deformities.
Metatarsalgia causes sharp, burning or aching pain at the end of one or more of the metatarsal bones. You’ll notice that the pain worsens when running or walking, or when standing on a hard surface barefoot.
The pain usually comes on over a period of weeks or months, rather than suddenly.
At-home treatments including rest and icing may relieve the symptoms. But if the pain continues or gets worse, you need professional help from a podiatrist.
Changing shoes to styles with arch supports and wide toe boxes can help relieve symptoms. A metatarsal pad can help return the arch and toes to their normal anatomical positions, encouraging more support for the metatarsal heads.
Rarely, when these conservative measures don’t resolve the pain or if there are other complications such as hammertoe, we may discuss surgery with you to realign the metatarsal bones.
Custom-fitted orthotics and metatarsal pads can help eliminate the abnormal pressure or friction that caused the metatarsalgia.
Athletes or anyone who runs or works out must wear the proper footwear for their chosen activities. New shoes must have adequate cushioning and, for those who run or repeatedly jump on hard surfaces, choose rubber heels and soles for better shock absorption.
A bunion is a bump on the base of the big toe joint. Bunions are caused when the bone at the joint moves and bends toward the other toes. The big toe may even overlap the others as this movement continues.
Bunions can cause severe pain because this big toe joint carries much of the body’s weight. Bunions run in families because of an inherited foot type that includes poor foot mechanics. Wearing tight or narrow shoes can aggravate the bunion. Those with flat feet or low arches are prone to bunions, as are people with arthritis or inflammatory joint disease.
Bunion symptoms may include:
- Callus or bump on the base of the big toe on the outside of the foot
- Pain, swelling or redness
- Callus development under the ball of the foot
- Developing hammertoes
- Irritated skin including corns where the first and second toes overlap
- Painful and restricted big toe motion
To relieve the discomfort of a bunion, apply a bunion pad around the bump. Wear wide shoes with a deep toe box. Avoid shoes with heels more than 2 inches tall. You can apply ice packs often during the day to reduce the inflammation.
However, bunions will not go away – in fact, they will get larger and more painful without treatment. The earlier that podiatric treatment begins, the greater chance that your pain may be resolved without surgery.
Our goals are to relieve the pressure on the bunion and slow its progression. Padding and taping can relieve pain and keep the foot in a normal position. Cortisone injections and anti-inflammatory medication can ease symptoms.
Custom-fitted orthotics can relieve symptoms and prevent worsening of the deformity. Physical therapy and ultrasound therapy can also relieve inflammation and pain.
For severe cases, surgery may be necessary to repair the joint and relieve pressure.
Clubfoot can be several foot abnormalities that are congenital, or present at birth. The tendons in the baby’s foot are shorter and so the foot is out of position or twisted. This common birth defect can be mild or severe, and most are successfully treated without surgery.
Boys are more likely to have clubfoot than girls and it tends to run in families. The baby may have clubfoot if there is too little amniotic fluid, and the risk of clubfoot if the mother smokes during pregnancy is greatly increased.
Clubfoot can result in complications in later life such as arthritis, poor self-image, inability to walk correctly and foot sores or calluses.
Look for one or more of these signs:
- The top of the foot is twisted inward and downward
- The foot appears to be upside down
- The foot or leg may be shorter
- The calf muscles are underdeveloped
- Don’t smoke
- Avoid smoky environments
- Don’t drink alcohol
- Don’t take drugs except those approved by your doctor
However, usually there will be no pain.
Treatment for clubfoot should begin in the first few weeks after birth when the baby’s joints, bones and tendons are flexible.
Stretching and casting is the most common treatment and is called the Ponseti method. The doctor will move the baby’s foot to the correct position and apply a cast. The cast will be changed and the baby’s foot repositioned about once a week for several months. The Achilles tendon may need to be lengthened. To maintain the new correct position, stretching exercises will be required as may braces and special shoes.
If the clubfoot abnormality does not respond to stretching, or if it is severe, surgery may be recommended to reposition or lengthen ligaments or tendons into a better position.
In pregnancy, you can take steps to reduce the risk of your baby having birth defects:
Sometimes a muscle imbalance causes a hammertoe, or a bending of the toe at the first joint. The bent toe looks like an upside-down “V”. The abnormal imbalance of muscles increases the pressure on the toe’s joints and tendons.
A flexible hammertoe is still moveable at the joint and can be treated, but a rigid hammertoe may become immobile.
Trauma such as from an injury can cause a hammertoe, as can heredity, arthritis, and wearing shoes that are too tight.
Symptoms of a hammertoe include:
- Pain at the top of the toe because of shoe pressure
- Corns on top of the bend
- Swelling and redness of the joint
- Restricted motion of the joint
- Pain extending to the ball of the foot at the base of the hammertoe
You can relieve the discomfort of a hammertoe by padding the area to reduce friction. Switch to shoes with a deep, wide toe box and avoid high heels. Icing can help with inflammation.
But a hammertoe cannot be cured without professional help from a podiatrist.
To confirm our diagnosis, we will take an X-ray of the area. Treatment options include:
- Padding and taping to minimize pain and relieve stress.
- Anti-inflammatory medications and/or cortisone injections to reduce pain and inflammation.
- Custom-fitted orthotics to reduce symptoms and prevent worsening of the deformity.
There are several surgical options if necessary.
You can prevent hammertoes from forming or getting worse. Wear supportive shoes and avoid those with pointed or narrow toe boxes. Orthotics can help prevent the development of hammertoes or slow their progression.
Heel pain may occur on the bottom of the heel, or on its front or back, and may have many causes. In general, heel pain results from walking gait abnormalities that put too much pressure on the heel bone and the surrounding area. This stress may also come from an injury, from damage during activity, being overweight or wearing poorly-constructed shoes.
Here are some conditions that can cause heel pain:
- Heel spur. A heel spur is a bony growth on the bottom of the heel bone caused by muscle or ligament strain or tearing of the membrane that covers the heel bone.
- Plantar fasciitis. The plantar fascia is a thick band of tissue that runs along the bottom of the foot. With overuse, the fascia fibers can tear resulting in inflammation and pain and the formation of a heel spur. This condition is particularly painful first thing in the morning when getting out of bed.
- Excessive pronation. Too much inward motion of the foot when walking can pull the ligaments and tendons attached to the heel bone too much.
- Achilles tendonitis. Inflammation of the Achilles tendon that connects your calf muscle to the heel bone is common among runners, walkers and those with tight tendons. Over time, the fibers of the tendon stretch or tear causing pain.
- Arthritis. Rheumatoid arthritis and gout can cause heel pain.
- Bursitis. Heel pain may be caused by inflammation of the bursa sacs.
- Haglund’s deformity. Also called “pump bump,” this bone enlargement at the back of the heel is caused by shoe pressure.
If pain and inflammation persist despite resting and icing, contact a doctor of podiatric medicine. We will examine the area and take X-rays to rule out any bone problems.
Oral or injectable anti-inflammatory medication will help reduce swelling. Taping or strapping will support the foot and help muscles and tendons rest.
Custom-fitted orthotics or shoe inserts will help relieve painful pressure. The orthotic will control pronation, correct any biomechanical imbalance and support the ligaments and tendons to relieve heel pain without the need for surgery.
Physical therapy, in conjunction with the above treatments, is very effective for heel pain.
In very few cases, surgery will be required to release the plantar fascia or remove a bone spur or bursa.
- Wear the right shoes for each activity.
- Choose well-fitting shoes with shock-absorbent soles and supportive heel counters.
- Avoid shoes that have worn excessively on the soles or heels.
- Always warm up and stretch before and after running.
- Don’t overextend yourself when enjoying athletic activities.
- Give your body plenty of rest and good nutrition.
- Stay at a healthy weight to minimize excessive stress on the feet.
Plantar fasciitis is one of the most common causes of heel pain. The plantar fascia is a band of tissue that runs along the bottom of the foot from the heel bone to the toes. This tissue helps to form the foot’s arch.
With overuse such as running or standing for long periods on hard surfaces, or from wearing shoes with little support, tiny tears can develop in the plantar fascia. These can cause inflammation and heel pain.
- Sharp, burning or throbbing heel pain
- Pain is worst when arising from bed in the morning because the plantar fascia has contracted during the night
- The pain eases during the day
- Pain returns after resting or sitting for a period
Once plantar fasciitis has been identified as the cause of your heel pain, non-invasive treatments include resting and icing the area, along with anti-inflammatory drugs to reduce inflammation. A steroid injection can also relieve inflammation and pain.
Wearing a brace to keep the plantar fascia stretched at night can be very effective.
Physical therapy will help. Strengthening and stretching exercises and massage will restore the plantar fascia’s flexibility.
There are more intense treatments available for persistent pain, and surgery may be recommended in severe cases.
PreventionSome lifestyle changes can help a return of plantar fasciitis:
- Lose excess pounds if you are overweight.
- Choose sturdy shoes with good support.
- Low-impact exercises such as biking and swimming are better for your heels than running.
- Stretch your calves regularly during the day and after a workout.
- Sleep with your bedsheet untucked at the bottom so your feet and legs can stretch out at night.
Peripheral arterial disease (PAD)
Peripheral artery or arterial disease, also known as PAD, is a circulation problem where the blood flow to your extremities is restricted. PAD is caused by narrowing of the arteries that deliver the blood to your arms and legs. Fatty deposits accumulate causing atherosclerosis and reducing this blood flow.
Some people have no symptoms of PAD, but many suffer from leg pain especially when walking. The pain or cramping starts with activity but usually eases after resting. When the leg pain, or claudication, is severe, it can be hard to walk, work or do other types of activities.
- Leg weakness or numbness
- Foot or leg coldness
- Change in color
- Sores on your feet, toes or legs that won’t heal
- Hair loss on feet and legs
Treating Peripheral Arterial Disease
If you have leg pain or weakness, visit your foot doctor right away. PAD can cause complications such as heart attack, stroke and critical limb ischemia that can lead to gangrene and amputation.
To diagnose peripheral arterial disease, we will do a physical exam to check your pulse and blood pressure. The Ankle-brachial index (ABI) test is useful as it compares the blood pressure in your arm with the blood pressure in your ankle. Other tests such as ultrasound and an angiogram can confirm our diagnosis.
Treating Peripheral Arterial Disease
The goals of PAD treatment are to manage the pain and to stop atherosclerosis from progressing. Lifestyle changes may accomplish both of these goals, with the most important change is to quit smoking.