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Health Library : Orthopaedic Surgery

 

Foot Pain and Problems

Anatomy of the foot
Click Image to Enlarge

Anatomy of the foot

The foot is one of the most complex parts of the body, consisting of 26 bones connected by numerous joints, muscles, tendons, and ligaments. The foot is susceptible to many stresses. Foot problems can cause pain, inflammation, or injury, resulting in limited movement and mobility.

What are the different types of foot problems?

Foot pain is often caused by improper foot function. Improperly fitted shoes can worsen and, in some cases, cause foot problems. Shoes that fit properly and give good support can prevent irritation to the foot joints and skin. There are many types of foot problems that affect the heels, toes, nerves, tendons, ligaments, and joints of the foot.

The symptoms of foot problems may resemble other medical conditions and problems. Always consult your doctor for a diagnosis.

What are heel spurs?

A heel spur is a bone growth on the heel bone. It is usually located on the underside of the heel bone where it attaches to the plantar fascia, a long band of connective tissue running from the heel to the ball of the foot. This connective tissue holds the arch together and acts as a shock absorber during activity. If the plantar fascia is overstretched from running, wearing poor-fitting shoes, or being overweight, pain can result from the stress and inflammation of the tissue pulling on the bone. Over time, the body builds extra bone in response to this stress resulting in heel spurs. Treatment options may include:

  • Rest
  • Cold packs
  • Anti-inflammatory medication, such as ibuprofen
  • Proper stretching prior to activity
  • Proper footwear or shoe inserts
  • Corticosteroid injections
  • Surgery (for more severe, prolonged conditions)

What is a corn?

Corns are yellowish, callus growths that develop on top of the toes. Corns develop because of abuse or stress. Often, a corn develops where a toe rubs against a shoe or another toe. Corns can cause extreme discomfort and pain. Treatment may include:

  • Trimming the corn by shaving the layers of dead skin
  • Applying pads around the corn area
  • Wearing larger shoes to comfortably fit your foot without rubbing
  • Surgery

To avoid corn development, always purchase footwear that fits properly.

What is a bunion?

A bunion is a protrusion of bone or tissue around a joint. Bunions may occur at the base of the great toe or at the base of the little toe, and often occur when the joint is stressed over a period of time. Women are more frequently affected because they may wear tight, pointed, and confining shoes. Bunions can also be a result of arthritis which often affects the big toe joint.

Treatment of bunions may vary depending on the pain and deformity. Treatment may include:

  • Wearing comfortable, well-fitting footwear (particularly shoes that conform to the shape of the foot and do not cause pressure areas)
  • Surgery (for pain, not for cosmetic purposes)
  • Applying pads to the affected area
  • Medication, such as ibuprofen

What is Morton's neuroma?

Morton's neuroma is a buildup of benign (noncancerous) tissue in the nerves running between the long bones of the foot. Morton's neuroma occurs when two bones rub together and squeeze the nerve between them. Most often, neuromas develop between the bones leading to the third and fourth toes. Morton's neuroma often causes swelling, tenderness, and pain. If the pain becomes severe, it may cause tingling, numbness, and burning in the toes. It usually occurs after standing or walking for a long period of time. Treatment for this condition may involve rest and/or a change in footwear that does not restrict the foot. If the problem persists, cortisone injections and/or surgery may be considered.

What are hammertoes?

A hammertoe is a condition in which the toe buckles, causing the middle joint of the affected toe to poke out. This condition is often aggravated by tight-fitting shoes that put pressure on the hammertoe. Often a corn develops at this site. Treatment for hammertoes may include:

  • Applying a toe pad specially positioned over the bony protrusion
  • Changing your footwear to accommodate the deformed toe
  • Surgical removal
Illustration demonstrating the three ligaments involved in ankle sprains/strains
Click Image to Enlarge

What is an ankle sprain?

An ankle sprain is an injury to the ligaments in the ankle. Ligaments are tough bands of elastic tissue that connect bones to each other. Ankle sprains may occur if the ankle rolls, turns, or twists beyond its normal range of motion. Ankle sprains may be caused by awkward foot placement, irregular surfaces, weak muscles, loose ligaments, or wearing shoes with spiked heels. The symptoms of a sprain will depend on how severely the ligaments are stretched or torn but usually include swelling, pain, or bruising. Treatment will depend on the severity of the sprain and may include:

  • Resting the ankle
  • Wrapping the ankle with elastic bandage or tape
  • Ice pack application (to reduce inflammation)
  • Elevating the ankle
  • Gradual return to walking and exercise
  • A walking cast (for moderate sprains)
  • Surgery (for severe sprains)
  • Physical therapy

What is a foot fracture?

With 26 bones in a single foot, almost any of them can be broken. Many fractures do not require surgery, or even a cast, as they will heal on their own with some support. When a foot is fractured, the site of the fracture usually is painful and swollen. The site of the fracture will determine the course of treatment, if necessary, including the following:

  • Ankle joint fractures. These fractures may be serious and require immediate medical attention. Ankle fractures usually require a cast, and some may require surgery if the bones are too separated or misaligned.
  • Metatarsal bone fractures. Fractures of the metatarsal bones, located in the middle of the foot, often do not require a cast. A stiff-soled shoe may be all that is needed for support as the foot heals. Sometimes, surgery is needed to correct misaligned bones or fractured segments.
  • Sesamoid bone fractures. The sesamoid bones are two small, round bones at the end of the metatarsal bone of the big toe. Usually, padded soles can help relieve pain. However, sometimes, the sesamoid bone may have to be surgically removed.
  • Toe fractures. Fractures of the toes normally can heal with or without a cast.

What is foot pain?

Foot pain can be debilitating to an active lifestyle. Foot pain can have many sources, from fractures and sprains to nerve damage. Listed below are three common areas of pain in the foot and their causes:

  • Pain in the ball of the foot. Pain in the ball of the foot, located on the bottom of the foot behind the toes, may be caused by nerve or joint damage in that area. In addition, a benign (noncancerous) growth, such as Morton's neuroma, may cause the pain. Corticosteroid injections and wearing supportive shoe inserts may help relieve the pain. Sometimes, surgery is necessary.
  • Plantar fasciitis. Plantar fasciitis is characterized by severe pain in the heel of the foot, especially when standing up after resting. The condition is due to an overuse injury of the sole surface (plantar) of the foot and results in inflammation of the fascia, a tough, fibrous band of tissue that connects the heel bone to the base of the toes.

    Plantar fasciitis is more common in women, people who are overweight, people with occupations that require a lot of walking or standing on hard surfaces, people with flat feet, and people with high arches. Walking or running, especially with tight calf muscles, may also cause the condition.

    Treatment may include:

    • Rest
    • Ice pack applications
    • Nonsteroidal anti-inflammatory medications
    • Stretching exercises of the Achilles tendons and plantar fascia
  • Achilles tendon injury. The Achilles tendon is the largest tendon in the human body. It connects the calf muscle to the heel bone. However, this tendon is also the most common site of rupture or tendonitis, an inflammation of the tendon due to overuse.

    Achilles tendonitis is caused by overuse of the tendon and calf muscles. Symptoms may include mild pain after exercise that worsens gradually, stiffness that disappears after the tendon warms up, and swelling. Treatment may include:

    • Rest
    • Nonsteroidal anti-inflammatory medications
    • Supportive devices and/or bandages for the muscle and tendon
    • Stretching
    • Massage
    • Ultrasound
    • Strengthening exercises
    • Surgery

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