- Acute Achilles Tendon Rupture. Rupture, or tearing, of the Achilles tendon is a common condition. This typically occurs in the unconditioned individual who sustains the rupture while playing sports, or perhaps, from tripping. There is a vigorous contraction of the muscle and the tendon tears. The patient will often describe the sensation that someone or something has hit the back of the calf muscle. Pain is suddenly present, and although it is possible to walk, it is usually painful. More importantly however, the leg is weak. This is particularly noticeable when trying to push off while walking, and there is not sufficient strength to do so.1
- Ankle Injuries. When an ankle is injured from twisting in towards the other foot, called an inversion injury, most commonly the anterior talofibular ligament is stretched or torn. If the two other primary ligaments on the outside of the ankle (the posterior talofibular ligament and the calcaneofibular ligament) are also injured the primary bone of the ankle, the talus, can be displaced from beneath the tibia, and the ankle "shucks" out of joint. A physician or trainer examining the ankle soon after injury can compare the amount of "shuck" to the opposite ankle and develop a grade for the amount of injury suffered. Usually, if the injury is limited to one ligament, the instability is less. If all three are involved , the ankle is more unstable. The nerve supply to injured ligaments can also be injured. The nerves provide "proprioception" or position sense, in effect telling the brain where the foot is in space. In the healing process, it is critical to re-train the healing ligaments to regain the neural connections required for a stable ankle. Specific exercises can effectively do this.2
- Arthritic Conditions. There are certain types of arthritis which cause more deformity and pain. Rheumatoid arthritis often causes moderate to severe bone changes in the feet, especially in the toes and the ball of the foot. The feet can become very painful and difficult to walk on.3
- Athlete's Foot. Athlete's foot is the most common term to describe a fungus condition involving the skin of the feet and toes. Another term is Tinea Pedis. However, that means a ringworm type infection and the term is misleading, since the organisms that cause it are not worms, but are fungus spores technically known as dermatophytes. A more appropriate name is Dermatophytosis. The three names above really mean the same thing. --
The patient first notices an itching sensation, usually between the toes. The skin in that area may have small blisters and be peeling. A less itchy form of Athlete's Foot can appear as a dry, red peeling condition on the bottom of the foot.4
- Bone Spur. A bone spur is a prominence of the bone that can often cause irritation to the overlying skin. This "spur" can be an irregularity of the shape of the bone or can be a small outgrowth of bone or cartilage. If this prominence or "spur" is in an area that is prone to pressure from shoes or from the ground during walking, it can become symptomatic and begin to cause discomfort. A bone "spur" can exist and cause no discomfort, if it is not in an area that is irritated by pressure from walking, shoes, etc. Often, the skin overlying the bony prominence can be irritated from shoe pressure or from walking and can result in a build up of skin commonly known as a corn or callus, depending upon the location.4
- Bunions. A bunion is a protuberance of bone or tissue around the joint. The enlargement occurs either at the base of the great toe or on the outside of the foot, at the base of the little toe where it is called a "bunionette" or "tailor's bunion."5
Learn about products that provide immediate pain relief for Bunions Definition Bunions, referred to in the medical community as Hallux Valgus, are one of the most common forefoot problems. A bunion is a prominent bump on the inside of the foot around the big toe joint. This bump is actually a bone protruding towards the inside of the foot. With the continued movement of the big toe towards the smaller toes, it is common to find the big toe resting under or over the second toe. This causes a common forefoot condition called overlapping toes. Some of the symptoms of bunions include inflammation, swelling, and soreness on the side surface of the big toe. The discomfort commonly causes a patient to walk improperly.
Another type of bunion which some individuals experience is called a Tailor's Bunion, also known as a Bunionette. This forms on the outside of the foot towards the joint at the little toe. It is a smaller bump that forms due to the little toe moving inwards, towards the big toe.
Bunions are a common problem experienced mostly by women. The deformity can develop from an abnormality in foot function, or arthritis, but is more commonly caused by wearing improper fitting footwear. Tight, narrow dress shoes with a constrictive toe box (toe area) can cause the foot to begin to take the shape of the shoe, leading to the formation of a bunion. Women who have bunions normally wear dress shoes that are too small for their feet. Their toes are squeezed together in their shoes causing the first metatarsal bone to protrude on the side of the foot.
It is important for men and women to realize that wearing dress shoes and boots, which are tapered in the toe area, can cause the bunion to worsen to the point where surgery is necessary.
Treatment and Prevention
In the early stages of the formation of a bunion, soaking feet in warm water can provide temporary relief. The best way to alleviate the pain associated with bunions is to wear properly fitting shoes. Shoes designed with a high, wide toe box (toe area) are recommended for people suffering from forefoot disorders, such as bunions. Shoes with rocker soles will unload pressure to the bunion area. Orthotics are also recommended for this condition to provide extra comfort, support, and protection.
Other conservative treatments include using forefoot products designed to accommodate and relieve bunions such as bunion shields, bunion night splints, and bunion bandages. These conservative treatments can limit the progression of the bunion formation, relieve pain and provide a healthy environment for the foot.
- Corns and Calluses. A corn is simply an area of hard, thickened skin that can occur on the top, between, or on the tip of the toes. A callus is similar in nature, but is larger and usually occurs across the ball of the foot, on the heel, or on the outer side of the great toe. Corns and calluses are often mistakenly considered a "skin" condition. They are actually the visible sign of an underlying "bone" problem.4
- Flat Feet. About 20 percent of adults have flat feet. Flat feet don't cause disabilities or other problems as long as the foot is supple and the heel cord, or Achilles tendon, isn't tight. This is called flexible flat foot. A supple foot looks flat when the child stands on the whole foot -- referred to as the "loaded" position -- but an arch develops when the person gets off the foot (in the "unloaded" position) and when he or she stands on the toes. If the heel cord can be bent up at the ankle more than 15 degrees from the perpendicular to the leg, it is not considered tight. Rigid Flat Foot -- This is when the foot is flat in all positions, regardless of whether it is loaded, unloaded or the child stands on his or her toes. Flat Foot With a Tight Heel Cord -- This is when the foot is unable to be bent back at the angle more than 15 degrees due to the calf muscles, which form the Achilles tendon, being contracted. Symptoms include pain, calluses, or redness.6
- Foot Pain
What are the general causes of foot pain?
Nearly all causes of foot pain can be categorized under one or more of the following conditions.
- Shoes: The causes of most foot pain are poorly fitting shoes. High-heeled shoes concentrate pressure on the toes and are major culprits for aggravating, if not causing, problems with the toes.
- Temporary Changes in Foot Size and Shape: Temperature, and therefore weather, affects the feet: they contract with cold and expand with heat. Feet can change shape and increase in size by as much as 5% depending on whether a person is walking, sitting, or standing.
- Poor Posture: Improper walking due to poor posture can cause foot pain.
- Medical Conditions: Any medical condition that causes imbalance or poor circulation can contribute to foot pain.
- Inherited Conditions: Inherited abnormalities in the back, legs, or feet can cause pain. For example, commonly one leg is shorter than the other, causing an imbalance.
- High-Impact Exercising: High-impact exercising, such as jogging or strenuous aerobics, can injure the feet. Common injuries include corns, calluses, blisters, muscle cramps, acute knee and ankle injuries, plantar fasciitis, and metatarsalgia.
- Industrial Cumulative Stress: Because of the effects of work-related repetitive stress on the hand, there has been considerable interest in the effect of work-stress on foot pain. According to one 2000 analysis, there is very little evidence for any significant impact of work on various foot disorders, including hallux valgus, neuroma, tarsal tunnel syndrome, toe deformity, heel pain, adult acquired flatfoot, or foot and ankle osteoarthritis. In general, the foot is designed for repetitive stress and few jobs pose the same stress on the feet as many do on the hands. Nevertheless, certain professions, such as police work, are associated with significant foot pain. More research is needed.
Medical Conditions Causing Foot Pain
- Arthritic Conditions: Arthritic conditions, particularly osteoarthritis and gout, can cause foot pain. Although rheumatoid arthritis almost always develops in the hand, the ball of the foot can also be affected.
- Diabetes: Diabetes is an important cause of serious foot disorders.
- Diseases that affect muscle and motor control: Diseases that affect muscle and motor control, such as Parkinson's disease, can cause foot problems.
- High Blood Pressure: High blood pressure can cause fluid build-up and swollen feet. The effects of high blood pressure on the nervous and circulatory systems can cause pain, loss of sensation, and tingling in the feet, and can increase the susceptibility for infection and foot ulcers.
- Osteoporosis: Osteoporosis, in which bone loss occurs, can cause foot pain.
- Pregnancy: Pregnancy can cause fluid build-up and swollen feet. The increased weight and imbalance of pregnancy contributes to foot stress.
- Other Diseases: Diseases that affect the nervous and circulatory systems, such as anorexia, can cause pain, loss of sensation, and tingling in the feet, as well as increase the susceptibility for infection and foot ulcers. A number of conditions, including heart failure, kidney disease, and hypothyroidism, can cause fluid build-up and swollen feet.
- Medications: Some medications, such as calcitonin and drugs used for high blood pressure, can cause foot swelling.
- Hammertoes. People of all ages can have toe problems, from infants born with deformities, to older adults with acquired deformities. The major culprit of toe deformities in adults is tendon imbalance. The tendons may stretch or tighten to compensate for imbalance of the foot leading to deformity of the toe(s). Thus, people with abnormally long toes, flat feet or high arches have a greater tendency to develop toe deformities. Over time, the toe may become permanently deformed and arthritic changes may develop. The most common digital deformities are hammertoes, claw toes, mallet toes, bone spurs, overlapping and underlapping toes, and curled toes. These deformities may lead to corns or calluses and imflammation of the small protective pouches over the deformed joints leading to pain and swelling. Pain may or may not be present.5
Hammertoe is a condition in which the toe is bent in a claw-like position. It can be present in more than one toe but is most common in the second toe.
Hammertoe is described as a deformity in which the toes bend downward with the toe joint usually enlarged. Over time, the joint enlarges and stiffens as it rubs against shoes. Other foot structures involved include the overlying skin and blood vessels and nerves connected to the involved toes.
Causes and symptoms
The shortening of tendons responsible for the control and movement of the affected toe or toes cause hammertoe. Top portions of the toes become callused from the friction produced against the inside of shoes. This common foot problem often results from improper fit of footwear. This is especially the case with high-heeled shoes placing pressure on the front part of the foot that compresses the smaller toes tightly together. The condition frequently stems from muscle imbalance, and usually leaves the affected individual with impaired balance.
A thorough medical history and physical exam by a physician is always necessary for the proper diagnosis of hammertoe and other foot conditions. Because the condition involves bony deformity, x rays can help to confirm the diagnosis.
- Conservative: Wearing proper footwear and stockings with plenty of room in the toe region can provide treatment for hammertoe. Stretching exercises may be helpful in lengthening the excessively tight tendons.
- Surgery: In advanced cases, where conservative treatment is unsuccessful, surgery may be recommended. The tendons that attach to the involved toes are located and an incision is made to free the connective tissue to the foot bones. Additional incisions are made so the toes no longer bend in a downward fashion. The middle joints of the affected toes are connected together permanently with surgical hardware such as pins and wire sutures. The incision is then closed with fine sutures. These sutures are removed approximately seven to ten days after surgery.
Alternative treatment: Various soft tissue and joint treatments offered by chiropractic and massage therapy may be useful to decrease the tightness of the affected structures.
- Prognosis: If detected early, hammertoe can be treated non-surgically. If surgery becomes necessary, surgical risks are minimal with the overall outcome providing good results.
- Prevention: Wearing comfortable shoes that fit well can prevent many foot ailments. Foot width may increase with age. Feet should always be measured before buying shoes. The upper part of the shoes should be made of a soft, flexible material to match the shape of the foot. Shoes made of leather can reduce the possibility of skin irritations. Soles should provide solid footing and not be slippery. Thick soles lessen pressure when walking on hard surfaces. Low-heeled shoes are more comfortable, safer, and less damaging than high-heeled shoes.
- Heel Disorders and Treatments. Plantar fasciitis and heel spur syndrome result from inflammation of the ligament like tissue (the fascia) that stretches from the base of the toes, across the arch of the foot, to a point on the bottom of the heel bone. It is sometimes associated with a heel spur, in which case it is called "heel spur syndrome." The condition can usually be successfully treated with conservative measures such as use of anti-inflammatory mediations and ice packs, stretching exercises, orthotic devices, and physical therapy. If the condition does not clear up after six months of these treatments, Extracorporeal Shock Wave Therapy may be considered. Sharp pain, aching or stiffness on the bottom of one or both heels is a very common ailment. The pain is often at its worst upon awakening in the morning (or after sitting down for an extended period and then resuming activity), causing hobbling or limping for a few minutes before a comfortable stride can be resumed. As weight continues to be applied during walking or standing, mild or severe pain may persist.5
When your first few steps out of bed in the morning cause severe pain in the heel of your foot, you may have plantar fasciitis (fashee-EYE-tiss). It's an overuse injury affecting the sole or flexor surface (plantar) of the foot. A diagnosis of plantar fasciitis means you have inflamed the tough, fibrous band of tissue (fascia) connecting your heel bone to the base of your toes.
You're more likely to get the condition if you're a woman, if you're overweight, or if you have a job that requires a lot of walking or standing on hard surfaces. You're also at risk if you walk or run for exercise, especially if you have tight calf muscles that limit how far you can flex your ankles. People with very flat feet or very high arches are also more prone to plantar fasciitis.
The condition starts gradually with mild pain at the heel bone often referred to as a stone bruise. You're more likely to feel it after (not during) exercise. The pain classically occurs again after arising from a midday lunch break.
If you don't treat plantar fasciitis, it may become a chronic condition. You may not be able to keep up your level of activity and you may also develop symptoms of foot, knee, hip and back problems because of the way plantar fasciitis changes the way you walk.
Rest is the first treatment for plantar fasciitis. Try to keep weight off your foot until the inflammation goes away. You can also apply ice to the sore area for 20 minutes three or four times a day to relieve your symptoms. Often a doctor will prescribe nonsteroidal anti-inflammatory medication such as ibuprofen. A program of home exercises to stretch your Achilles tendon and plantar fascia are the mainstay of treating the condition and lessening the chance of recurrence.
In one exercise, you lean forward against a wall with one knee straight and heel on the ground. Your other knee is bent. Your heel cord and foot arch stretch as you lean. Hold for 10 seconds, relax and straighten up. Repeat 20 times for each sore heel.
In the second exercise, you lean forward onto a countertop, spreading your feet apart with one foot in front of the other. Flex your knees and squat down, keeping your heels on the ground as long as possible. Your heel cords and foot arches will stretch as the heels come up in the stretch. Hold for 10 seconds, relax and straighten up. Repeat 20 times.
About 90 percent of people with plantar fasciitis improve significantly after two months of initial treatment. You may be advised to use shoes with shock-absorbing soles or fitted with a standard orthotic device like a rubber heel pad. Your foot may be taped into a specific position.
If your plantar fasciitis continues after a few months of conservative treatment, your doctor may inject your heel with steroidal anti-inflammatory medications (corticosteroid). If you still have symptoms, you may need to wear a walking cast for 2-3 weeks or positional splint when you sleep. In a few cases, you might need surgery to release your ligament.
- Ingrown Toe Nail. An ingrown nail occurs when a portion of a toenail on either side of the toe turns downward and presses into the skin. Nails normally are nearly flat, with just a slight arcing downward at the borders. When the border of the nail is turned downward, it begins to injure the skin.4
- Shin Splints. Shin splints are pains in the front of the lower legs caused by exercise, usually after a period of relative inactivity. Shin splints can be caused by any of four types of problems, none of which is serious. All types of shin splints can be treated with rest. Tibial shin splints are very common and affect both recreational and trained athletes. Runners are often affected. Tibial periostitis occurs further toward the front of the leg than posterior tibial shin splints, and the bone itself is tender. Anterior compartment syndrome affects the outer side of the front of the leg. Stress fractures usually produce localized, sharp pain with tenderness 1 or 2 inches below the knee. A stress fracture is likely to occur 2 or 3 weeks into a new training program or after beginning a more strenuous training regimen.8
- Tendonitis. A tendon is a tough yet flexible band of fibrous tissue. The tendon is the structure in your body that connects your muscles to the bones. The skeletal muscles in your body are responsible for moving your bones, thus enabling you to walk, jump, lift, and move in many ways. When a muscle contracts it pulls on a bone to cause movements. The structure that transmits the force of the muscle contraction to the bone is called a tendon. Tendons come in many shapes and sizes. Some are very small, like the ones that cause movements of your fingers, and some are much larger, such as your Achilles tendon in your heel. When functioning normally, these tendons glide easily and smoothly as the muscle contracts.7
, 2 www.stoneclinic.com
, 3 www.footankle.com
, 4 www.podiatryonline.com
, 7 orthopedics.about.com
, 8 medlineplus medical encyclopedia