Foot and ankle pain are a common complaint and can be debilitating. Foot and ankle pain can be evaluated based on the location of the pain:
Forefoot – the front part of the foot that includes the toes
Midfoot – the middle part of the foot between the toes and the heel/ankle
Hindfoot – the back part of the foot including the heel and ankle
Normal anatomy of the various areas of the foot can vary widely. Some people have short wide feet, while others have long thin feet. The position of bones and degree of longitudinal arch also vary greatly from flat arches (pes planus) to very high arches (pes cavus).
There are many joints in the foot and ankle, as well as many ligaments and tendons, that allow many movement patterns as well as individual movement of toes. This varied movement requires assistance from a variety of other structures near the foot and ankle:
Muscles attach via tendons between the bones of the foot and ankle, allowing them flex, extend and rotate the foot and toes
Strong connective tissue provides flexibility and stability in the joints
Blood vessels in the region ensure there is always an adequate blood supply for movement
Nerves communicate signals that allow for your desired movement to occur
With so many complex structures working together to ensure proper function for your foot and ankle, there are many ways in which an injury can occur. If any of these structures wear out or sustain damage, you may experience pain.
Common Causes of Foot and Ankle Pain
There are many potential causes of foot and ankle pain. A proper diagnosis is crucial to ensuring you receive the most effective treatment for your condition.
Forefoot Injuries
Fractures – A sudden blow to the toes may cause one of the many bones to break. This most commonly occurs in sports injuries, but it can also be due to dropping a heavy object on the toes or foot.
Dislocations – Usually occurs with a stubbed toe, the bone of the toe gets knocked out of place.
Hallux Rigidus – Stiffness in the joint between the big toe and the associated foot bone. Extension of the big toe is limited, and can be painful. This is seen in seen in up to 6% of middle age and older adults, usually due to osteoarthritis.
Malformations –
Hallux valgus (bunions) – malformation of the big toe. The cause is unknown, and can occur at any age, although tends to increase in incidence with age. The big toe becomes angled inward, causing pain at the base of the toe.
Metatarsalgia – pain on the bottom of the foot and base of the toes. This is caused by poor gait biomechanics, abnormal foot anatomy, or congenital abnormalities.
Morton Neuroma – abnormal neural tissue growth in between the toes, usually the 3rd and 4th toes. It is a poorly understood phenomenon causing burning pain between the toes. It is common across all populations.
Gout – A complicated form of arthritis, this induces a painful joint, usually at the big toe, that becomes red, swollen, and extremely tender even to the lightest touch.
Midfoot Injuries
The midfoot is critical to arch stabilization via bones and ligaments. Injury to this area can cause instability in the foot.
Lisfranc Injury – Occurs when the bones of the midfoot are broken, or when the ligaments that provide support to the midfoot are torn. This varies from simple (one bone affected) to complicated (multiple bones involved), and is seen with falls landing directly on the foot, especially if the foot is flexed downward.
Charcot Foot – Occurs in those with peripheral neuropathy. The bones in the midfoot become weak and can break, and the arch collapses. The foot becomes deformed this affects gait.
Tendonitis – The tendons in your foot can become damaged from overuse. The most common is:
Peroneal tendinitis – Usually seen in runners, these patients experience pain on the outer side of the foot.
Hindfoot Injuries
The hindfoot includes the talus and calcaneus bones, which allow your foot to rotate. Common types of injuries include:
Plantar fasciitis – Inflammation to the thick band of connective tissue between your forefoot and your heel causes stabbing pain in the heel and along the bottom of the foot. Pain is usually worse first thing in the morning.
Tarsal tunnel syndrome – The posterior tibial tendon becomes compressed as it traverses between the leg bone and the associated band of connective tissue. This can cause pain or numbness and tingling in your foot.
Sprains and strains – Stretched or torn ligaments result in a sprain. Stretched or torn muscles result in a strain. These injuries occur when you place too much pressure on your muscles and ligaments, which is common in the ankle when participating in sports.
Arthritis
Arthritis can develop from inflammation of the foot or ankle joint, causing pain and stiffness which gets worse over time. The most common types of arthritis include:
Rheumatoid arthritis – This occurs when your immune system attacks your joint, causing swelling and pain.
Osteoarthritis – This develops when the cartilage in your joint breaks down, causing the bones to rub together. Osteoarthritis results in pain and stiffness.
Treatment for Foot and Ankle Pain
At the Denver Spine and Pain Institute, we recommend conservative treatments whenever possible. Our goal is to reduce pain, increase function, and improve quality of life. If necessary, we will order imaging of the foot and ankle which could include X-rays. Depending on the specific cause of your pain, your treatment may include:
Physical therapy – The goals of physical therapy are to improve mobility, decrease pain and address any mechanical or muscular conditions that may be contributing to your pain.
Medication – Anti-inflammatory medications and muscle relaxants can help provide short-term relief of symptoms, making it easier for you to participate in physical therapy.
Injections – If the combination of physical therapy and medications don’t provide enough relief, injections may deliver the long-term relief of symptoms you desire.
Percutaneous needle fasciotomy – This treatment is delivered using the Tenex device and is often effective when treating tendonitis.
If these conservative treatments fail to provide adequate relief, surgery may be necessary. Our team will perform all appropriate diagnostic testing prior to your surgical consultation to determine the precise cause and location of your pain. These diagnostic tests will provide your surgeon with the information necessary to plan your procedure.
Chronic foot and ankle pain can significantly impact the quality of your life, making it hard to perform routine daily tasks and participate in your favorite activities. Fortunately, you don’t have to live with this pain any longer. At the Denver Spine and Pain Institute, we offer the most advanced treatments to alleviate your foot and ankle pain, helping you enjoy life again.
We’re the only sports, back and pain specialists in the country providing a Connected Care Approach™ specifically designed to get you back to enjoying life faster. This approach involves:
A full spectrum of care, including physicians, physical therapy, massage, diet and lifestyle coaching, behavioral health, research, and cutting edge treatment options
Developing caring and therapeutic relationships that address your unique needs
Discussing options and providing the guidance you need from a dedicated healthcare partner
Mobilizing an experienced team who coordinates your care program
Schedule an Appointment
Please contact us today to schedule an appointment. The Denver Spine and Pain Institute serves patients in Denver and the surrounding areas of Colorado.
