Common Foot & Ankle Conditions Debunked

Foot and ankle conditions can be acute injuries or chronic issues that significantly affect your ability to walk, work, and play. Learning about common causes of foot and ankle pain, how they present, and treatment options can help you identify problems early, make informed treatment decisions with your clinician, and prevent long-term disability.

Your foot supports your weight with just 26 bones and 33 joints! Joints and stabilizing ligaments provide stability to resist inversion (rolling of the ankle) and forward motion while allowing the ankle joint to move up and down. The joints in the subtalar region and midfoot help your foot adapt to uneven surfaces.

Tendons attach muscles to bones and help transfer force from the muscles to the foot. They also help control your foot’s position as you walk or run. Major tendons in the foot and ankle include the Achilles, posterior tibial tendon, and peroneal tendons.

Your foot also contains numerous ligaments, which help support and stabilize joints. These structures allow normal motion while preventing excessive movement. Ligaments include the

ATFL, calcaneofibular ligament, and deltoid ligament on the sides of the ankle. The ligaments on the top of the foot and inside joints help support your arch and allow you to twist your foot.

Whenever alignment changes, tendon strength decreases, or ligaments are injured, forces throughout your foot will shift. When load shifts, increased stress is placed on certain structures causing them to become overworked or injured. This is why foot anatomy and biomechanics play such a big role in the conditions people develop as well as their treatment.

Foot & Ankle Bunions, Achilles Pain, Morton’s Neuroma

Forefoot Conditions

Bunions (Hallux Valgus)

A bunion forms when the big toe begins to angle toward the second toe as you walk, causing a prominent bump on the inside of the foot at the first MTP joint.

Symptoms can include pain, redness, irritation from shoes, or callus formation.

Treatment: Shoes with a wide toe-box, orthotics, activity modification, changing times of day you are active, and footwear alleviate symptoms. Surgery is considered when these measures fail to improve pain that limits daily activities.

Hammertoes

Hammertoes occur when there is abnormal bending of the toe joints. They can affect any toe but usually involve the second or third toe. Flexible hammertoes can bend back to a straight position while rigid deformities cannot.

Treatment: Treatment for flexible deformities include toe splints, stretching exercises, or footwear modifications. Surgical tendon transfers or joint removal can correct fixed deformities.

Metatarsalgia

A vague term that describes pain in the ball of your foot, typically underneath the second or third metatarsal head. Can be made worse with activities that load the foot, like standing or running.

Treatment: Shoes with good cushioning, metatarsal pad/os, orthotics, activity modification, and load management. Localized problems may require procedure if there is a correctable cause that doesn’t improve with conservative treatment.

Morton’s Neuroma

Compression of an interdigital nerve, usually between the third and fourth toes causing burning or tingling pain, numbness, and feeling like there is a “pebble in your shoe.”

Treatment: Proper shoe modification, pads, injections, and procedures for persistent pain.

Heel and Midfoot Conditions

Plantar Fasciitis

This is the most common cause of heel pain. Patients often experience pain with the first few steps when getting out of bed in the morning.

Treatment: Calf and plantar fascia stretching, supportive shoes, orthotics, night splints, massage, and physical therapy. It can take months for this to resolve without surgery.

Midfoot Arthritis

Joint arthritis of the midfoot often occurs after a prior injury like a Lisfranc injury and can cause vague achiness when standing or walking on the foot.

Treatment: Stiff-soled shoes, bracing, steroid injections, and surgical fusion of painful joints in advanced cases.

Tarsal Tunnel Syndrome

Dorsal foot numbness or tingling due to posterior tibial nerve compression within the tarsal tunnel on the inside of the ankle.

Treatment: Foot orthotics, activity modification, night splints, targeted injections, and surgery to relieve pressure on the nerve if indicated.

Ankle Injuries and Tendon Disorders

Ankle Sprains and Chronic Instability

Lateral ankle sprains are by far the most common sports medicine injury. Pain occurs on the outside of the ankle. Repeated ankle sprains can lead to ankle instability and feelings of your ankle “giving out.”

Treatment: Early physical therapy emphasizing balance and ankle strengthening exercises is important. Surgery may be necessary to correct remaining instability.

Achilles Tendinopathy

Patients present with pain and stiffness along the back of the heel that is often worse with activity.

Treatment: Eccentric strengthening, loading modifications, heel lifts, physical therapy, and activity modification. If you hear a sudden “pop” and notice painless swelling with inability to push-off, you may have ruptured your Achilles and should seek immediate care.

Peroneal Tendon Disorders

Cause pain on the outside of the ankle and can occur after an ankle sprain.

Treatment: Bracing, therapy, activity modifications, and surgery to repair tears or correct subluxation.

Nerve, Vascular, and Systemic Causes of Foot Pain

Peripheral Neuropathy/Diabetic Foot Syndrome

Peripheral neuropathy occurs when nerves are damaged causing numbness, burning pain, and weakness. Loss of sensation in the feet is called loss of protective sensation and can increase your chances of developing foot ulcers and infection.

Management: Daily inspection of feet, avoid going barefoot, wear proper fitting shoes, controlling your glucose levels, and seeking early care for cuts or breaks in the skin.

Inflammatory and Vascular Causes of Foot Pain

Rheumatoid arthritis, gout, and peripheral arterial disease often present in the foot and ankle. These conditions can cause joint swelling, deformity, ulcers, pain with walking, or claudication.

Management: These conditions are best treated by a multidisciplinary team to address both the foot problem as well as the underlying disease.

Diagnosis of Foot & Ankle Conditions

Your provider will start with a history and physical examination. X-rays are often needed to confirm a suspected condition, and advanced imaging with MRI or ultrasound may be required.

The majority of foot and ankle conditions are treated successfully with conservative management first. This includes activity modification, supportive shoes or orthotics, physical therapy/exercises to strengthen the muscles around your foot and ankle, and medications or injections for pain and swelling.

Surgical intervention is required when conservative treatment fails to control your pain or instability persists despite physical therapy. Surgical procedures are designed to correct deformity or flatten instability to prevent recurrence of your symptoms.

Learn more about How We Approach Foot & Ankle Treatment

Remember…

Although there are many causes of foot pain, most conditions follow fairly predictable patterns. With early recognition and appropriate care, most foot problems can be successfully treated without surgery. If you have pain that bothers you during walking, work, or recreation it is important to get checked by a professional. Nobody should have to live with foot pain and our providers can help protect your mobility.

Frequently Asked Questions

Q1: When should I seek evaluation for foot pain or ankle pain?

A: If your foot or ankle pain is not improving after two weeks, it becomes worse, causing limping, numbness, swelling, or instability. Or if you injured your foot or ankle and cannot bear weight.

Q2: Will I need surgery for my foot problem?

A: No, most foot conditions can be treated without surgery. Footwear modifications, therapy, and orthotics are often very helpful.

Q3: Can biomechanics cause foot pain?

A: Absolutely! The type of arch you have, how your foot and ankle are aligned, and how you walk play a huge role in what injuries you are at risk for developing.

Q4: How long will it take to recover from?

A: It depends on what condition you have. Minor ankle sprains and mild tendonitis can improve in a matter of weeks. More chronic conditions or ones that involve a structural problem may take months and require several procedures/stages of rehabilitation.

Q5: How can I prevent my condition from coming back?

A: Wear shoes that support your feet, strengthen your feet and calf muscles, and gradually progress your activity levels. If you begin to feel pain, seek care early to avoid chronic problems.