A Good Foundation
While exercise is an important part of maintaining your overall health, it can also cause or worsen painful problems in your foot and ankle. With a quarter of your body’s bones being located in your foot, along with over 30 joints and over 100 muscles, tendons, and ligaments, there are many opportunities for injury, which can keep you from reaching your goals. These problems can occur suddenly, like a fracture or sprain, or worsen over time. Many of these conditions will improve with RICE- rest, ice, compression and elevation, but some will require the attention of a specialist. I will discuss some of the more common problems people face when they experience pain in this area.
Turf Toe and Bunions
Pain that occurs at the base of the big toe is most commonly one of two things: a bunion or “turf toe.” A bunion is when the big toe is leaning towards the second toe, and a bony bump develops on the inside of the foot at the joint. The pain can be over the bump, inside the joint, or caused by the rubbing of the big toe on the second toe. Generally, this problem does not improve on its own. Ice and anti-inflammatory medications (NSAIDs) like Aleve or Advil can help reduce the pain and swelling, and wearing a wider shoe or a shoe without a seam over the bump can decrease pain. If pain cannot be relieved through these methods, surgical correction is an option. In general, you are able to walk immediately after surgery and return to athletic activities in a few weeks.
Turf Toe can refer to any kind of inflammation around the big toe joint. Sometimes it’s a sprain caused by repeatedly bending the big toe back too far; it will improve with rest, ice, NSAIDs, and eleva-
tion. However, pain in this area can also be related to arthritis of the big toe joint, which is a very common occurrence. Orthotics can be used to either limit or improve the motion of the joint, depending on the severity of the arthritis. X-rays are usually needed to assess the joint. Arthrodesis, or fusion of the joint, is the most successful surgical treatment for this condition, but other treatments are available, including cartilage repair and joint replacement.
Toenail injuries are especially common for runners and other athletes. These can be caused by the shape of the toenail itself, trimming a nail incorrectly, a deformity like a bunion or hammertoe, or ill-fitting shoes. Ingrown toenails can quickly become infected and require medical attention. Mild cases can improve with soaking the foot in warm water with Epsom salts. A black toenail, or subungual hematoma, is especially common with runners. It is essentially a blood blister under the toenail caused by trauma; this can be caused by dropping something on the foot or kicking something, or by repetitive injury, like the thousands of steps you take during a long run. Since nails grow very slowly, these are slow to improve. If the injury is fresh, it can be drained in the doctor’s office, allowing for relief of the pressure and pain. If a large portion of the nail is involved, the nail may eventually fall off. It can also be removed in a doctor’s office without much pain or consequence.
A stress fracture is a small crack in a bone, generally resulting from overuse and frequently seen in runners and other athletes. The pain and symptoms can vary, and can include throbbing and swelling.
Symptoms usually worsen with activity and improve with rest. X-rays and occasionally other imaging are needed to diagnose a stress fracture. The first treatment is usually to stop the activity that caused the injury. Switching to a low-impact exercise like elliptical training, biking, or swimming is advised. Sometimes these fractures may require advanced treatment, like being in a cast or walking boot, and rarely, surgical correction. Stress fractures can be prevented by exercising in appropriate footwear, warming up before workouts, stretching the calf, and gradually increasing the speed and distance of runs. If pain persists for more than a week, or is bad enough that regular walking is painful, seek medical attention.
Heel pain is the most common complaint seen in a foot & ankle specialist’s office. The most common cause for this is plantar fasciitis. Plantar fasciitis typically is most painful after getting out of bed in the morning or after getting up after sitting for a while, i.e., after not using the heel for a while. Walking around generally improves the pain to a degree. Most people will improve with conservative treatments, which include stretching the calf, avoiding barefoot walking, NSAIDs, icing, using a night splint, and supportive shoes or arch supports. A physician can provide a cortisone or stem cell injection when pain is severe, and physical therapy is an option for difficult cases. Very rarely is surgery needed. Plantar fasciitis can be prevented by avoiding barefoot walking, stretching the calf regularly, and wearing supportive shoes.
Most people have endured an ankle sprain at some point in their life. Immediate treatment includes elevating the leg, icing, limiting activity, and using an ankle brace for compression and stability. Severe sprains can include rupture of an ankle ligament, cartilage damage, and occasionally a break in one of the bones of the ankle. Sometimes this will improve with the above-mentioned treatments, but long-lasting issues can occur. Ankle instability, or repeated ankle sprains, or even just a feeling that the ankle is going to give out, may require a surgical procedure to stabilize the joint. If there is damage to the cartilage, the tissue lining the bones of the joint, it can be repaired arthroscopically, which is a surgery involving very small incisions with cameras and specialized instruments.
Ignoring ankle sprains can lead to arthritis, which can require more advanced surgical treatment. If you have bruising with an ankle sprain, a sprain that does not improve within a few days, or repeat ankle sprains, you should consult a foot & ankle specialist.
Many people have a flat foot, to some degree, and are able to go on with their daily activities without pain. Occasionally, a flat foot can lead to tendon and ligament damage on the inside of the ankle, pain over the top of the foot, arch pain, arthritis, and toe deformities. If you have flat feet, you will most commonly notice that when you walk, your toes point outwards. A good, supportive shoe and sometimes a special insert is needed to control the position of the foot. If tendon or ligament damage occurs, or arthritis develops, injections, custom-made ankle braces, or surgery may be needed.
Achilles Tendon Problems
Pain in the back of the heel and leg is usually related to the Achilles tendon. This can be a long-lasting problem, like Achilles tendinitis (inflammation of the tendon) or Achilles tendinosis (hardening of the tendon). Sudden injuries can also occur, like a rupture of the Achilles tendon, which is most commonly seen after age 30 in athletic people. Most people with an Achilles tendon rupture will feel a sudden snap in the back of their heel while they are moving.
The Achilles tendon is the largest and strongest tendon in the body. This snap is usually loud enough that you can also hear it, and strong enough that it will bring you to the ground. Achilles tendon ruptures require immediate medical attention and usually surgical repair. Achilles tendinitis and tendinosis are more of a chronic problem. They can improve with NSAIDs, stretching, physical therapy, shoe modification, and icing. In the case of tendinosis, surgical repair may be needed.
If you experience any of the above issues, and they do not improve after a week of simple treatments or are so bad that you can’t participate in your normal daily activities, call a podiatrist. A podiatrist can help you understand exactly what is causing your pain, and guide you through the healing process and get you back into your normal routines.