What hurts? - foot and ankle
Our feet and ankles bear the brunt of every step we take. Women in particular wear uncomfortable, jarring yet fashionable shoes that can do damage to the structure of the foot over time.
Athletes are at risk of foot problems from traumatic injury, joint, tendon, or ligament problems.
University Orthopedics has physicians who specialize in foot and treat a variety of surgical and nonsurgical problems, a team of therapists, and a prosthetic center for foot orthotics.
The most common foot problems are:
- Foot and ankle trauma/fractures
- Ligament sprains/tendonitis
- Achilles tendon problems
- Heel pain/plantar fasciitis
- Bunions, hammertoes or claw toes
- Ankle or foot arthritis
- Flat feet deformities
What causes foot pain?
The causes of foot pain can relate to traumatic injury, problems with shoes, weight, or other disease processes. The fact is, the feet take a lot of abuse. Here are some of the common causes of foot problems:
Corns are hardened, painful and raised calluses, most often on the side of the little toe, usually caused by shoes that cramp the toes. A foot specialist can remove them if necessary.
Ingrown toenails can be extremely painful. These may need the attention of a foot specialist.
Plantar warts are caused by a virus and can make walking painful when they appear on the bottom of the foot. The foot specialist can remove these by freezing them off.
Achilles tendon can be a source of pain behind the ankle. A foot specialist can help correct the strain.
When walking, the heel absorbs the brunt of our body weight in each step. That is 60 tons for every mile walked! It should come as no surprise then that it is the most common type of foot injury. Those who experience heel pain should stop the offending activity immediately and schedule and appointment with a physician since when left untreated, heel pain can become chronic.
Pain on the back of the foot
When pain surfaces behind the heel, it is usually caused by shoes that fit too snuggly in the back. Sometimes it is from running in shoes that are too tight in the heel and can also develop from walking around in everyday shoes that are too tight. The best thing to do to treat this type of injury is to use anti-inflammatory medication such as Advil, to ice the heel and to do exercises prescribed by your doctor to stretch out the muscles and ligaments that are in pain.
Pain on bottom of the foot
The three most common heel injuries at the bottom of the foot are stone bruises, plantar fasciitis, and heel spurs.
A stone bruise usually develops from stepping on a hard object and is literally a bruise just like you would find anywhere else on the body. However, unlike a bruise on the arm where it is easier to keep it protected, unless you are planning on riding around in a wheelchair, the foot will be irritated with each step. The best treatment for a stone bruise is to curtail as much walking as possible until the injury heals.
Planter fasciitis is usually the result of overuse, either from running too long without rest or jumping on the heel too much. Again, the best treatment for planter fasciitis is rest. Also, your physician may be able to show you some stretches and exercises for the injury as well as prescribe heel pads to wear while walking.
If planter fasciitis is left untreated for too long, a calcium deposit called a heel spur may grow on the heel. These very painful growths are treated the same way planter fasciitis is treated.
Hammer toe and Claw Toe
Unfortunately, all those years of wearing high-heeled, fashionable shoes can catch up with you. Hammer toe or claw toe can develop in people for a variety of reasons, but generally, hammer toe stems from years of wearing confining shoes and a muscle imbalance while claw toe can be caused by confining foot wear, alcoholism, or diabetes. Hammertoes are when a toe bends up permanently at the middle joint.
So, what then qualifies as a confining shoe? Shoes that provide a narrow space for the toes to squeeze into. A shoe that fits this description could be a high heel shoe that allows the toe to slide to close to the front of the shoe, a shoe that is a size too small or too narrow at the toe.
In its early stages, hammer toe can be treated nonsurgically. Usually by only wearing shoes that provide plenty of space in the toes and by doing certain toe stretches symptoms can be alleviated. In more severe cases, surgery may be necessary.
For claw toe, similar stretches will be prescribed. In more severe cases, those with claw toe will need to find a shoe repair place to add more room in the toe or buy shoes that are made with toe pockets. Also, sometimes pads for feet are placed in the shoe to help alleviate pressure on the toe.
Bunions are tender lumps near joints around the toes, especially the big toe. A bunion or osteophyte can be removed surgically to relieve pain and restore joint motion. They are caused by improper foot wear and heredity, are quite common and it is estimated that more than 50 percent of women have them. Adolescents can also suffer from bunions. A bunion occurs when the bones that comprise the big toe of the foot begin to bend outwards. If left untreated, it can be very painful and can lead to arthritis. There are several ways to treat a bunion nonsurgically including through the use of special padding and shoe inserts to alleviate pain. Loose fitting shoes may also help for comfort and anti-inflammatory medication can cause swelling to go down. Also, soaking the foot in warm water can temporarily lessen the pain. Sometimes surgery is necessary and following surgery, the foot will be able to fit into any size shoe comfortably.
Preventive care for the feet: It starts with shoes
The fashion-savvy will find it disheartening to hear that when it comes to foot health, function, not fashion, is key.
Looks can be deceiving, and what may seem like an attractive shoe could in the long run cause an array of musculoskeletal problems including foot, ankle, knee, hip, and spine injuries.
One of the best ways to evade a foot injury is by wearing proper foot gear designed specifically for whatever activity you participate in with regularity. Runners should buy running shoes, basketball players (even weekend warriors) should buy basketball shoes, and the employee who constantly walks around for work should wear proper walking shoes. There is a shoe for virtually any activity.
Once you have decided it is time for a new shoe, there are several things to take into consideration to make sure you get the proper fit. For one thing, buy shoes at the end of the day. This is because the feet get larger the longer we stand on them, so at the end of the day, our feet will be larger than when we wake up in the morning. For athletes, the best thing to have the sales person watch you walk and run in several shoes to see which provides proper support. A proper athletic shoe should leave enough room that there is a half-inch gap between the longest toe and the edge of the shoe. When in doubt, go up half a size. Shoes should NEVER feel too tight when you try them on. A proper shoe should not stretch out with wear.
Ankle surgery options
Whether someone injures their ankle in a single accident, or a long lifetime of ankle problems making it painful to walk, there are treatment options available.
One of the standard treatments for people with a great amount of pain from walking is an operation to fuse the ankle, holding the leg and ankle-bones together with screws and plates. New bone then grows across the fused joint. Some of the negatives of ankle fusion surgery is it can lead to arthritis in the foot and limits ankle movement.
Around 5,000 people in the United States had ankle replacement surgeries in 2011, which is more than double from the 2010. Some MDs argue the increased amounts of ankle surgeries are due to major design changes from the manufacturers of the implants, which previously had high failure rates. At the beginning of ankle fusion surgery 40 years ago, surgeons would remove more bone and the devices frequently failed. Since all bodyweight is carried over the ankles, it is a more complex joint than the hip.
Some alternative surgeries for ankle replacements replace the worn-out joint with a metal and plastic replacement. However, not everyone needing ankle replacement is a candidate. Someone with poor circulation or a deformity should not have this surgery.
Recent ankle implant designs removes cartilage and some bone from both the shinbone and the talus before attaching the new joint made up of two metal parts linked by a plastic attachment that moves. Ankle implant devices usually last at least 10 years and longer. Some of the new FDA approved devices most often used by surgeons are:
INBONE made by Wright Medical Technology, Inc.
Agility made by DePuy Orthopaedics
S.T.A.R. made by Small Bone Innovations Inc.
Salto-Talaris made by Tornier Inc.
It is important to discuss all treatment options and devices, current ankle condition, and future activity level to determine which treatment plan is best suited for your individual needs.
Quick navigation links:
About University Orthopedics in Rhode Island | Spine | Sports Medicine | Joint Replacement | Hand & Wrist | Shoulder & Elbow | Pediatric Orthopedics | Foot & Ankle | Trauma & Fracture | Physician Bios | What Hurts? | Treatment | Education | Patient Center | Contact Information for Orthopedic Specialty Offices | Driving directions to offices in: Newport | Providence (Butler Drive) | Providence (Dudley St.) | East Greenwich
Where pictures of patients are displayed, the patients of University Orthopedics have consented to have their picture in this website for the purpose of patient education.