Common Causes of Foot and Ankle Pain

Identifying the area of pain can give you some insight into the cause of your foot or ankle pain. Below are some common diagnoses for foot and ankle pain. While this information is useful, it is not a substitute for a visit to the doctor. If you have Foot or Ankle Pain, visit a specialist like a Chiropractor who can help find the cause and proper treatment for your condition.  

Ankle Sprain: Rolled Ankle

The majority of ankle problems I see at my clinic are usually related to a strain/sprain from “rolling” the ankle. Either the initial trauma or the lasting effects of that injury alters the mechanics of the joint. The resulting dysfunction leads to years of maladaptation and repetitive microtrauma with the most common outcome as osteoarthritis of varying degrees. As such an important foundation and weight-bearing structure, these injuries need to be resolved as soon as possible to avoid such damage accumulating over time.

Anatomy

The tibia and fibula are the two bones of the lower leg. These two bones sit on the talus which is the topmost foot bone. The junction between these three bones is the talocrural joint, commonly known as the ankle joint. The majority of the movement at this joint is a forwards and backwards motion (dorsiflexion and plantar flexion), but there are also components of side to side motion and minor amounts of rotation.

Mechanism of Injury

Typical strains/sprains occur as the ankle encounters a motion that causes the foot to roll inwards or outwards and overwhelms both the muscular force and the ligamentous barrier along both sides of the joint. This damage can range from being minor to severe and requiring surgery. It is very common for a patient to allow the ligament to heal by itself and simply protect the ankle for several weeks or months not realizing that the injury has resulted in altered joint mechanics. The truth is often that the ligaments have been damaged and stretched and can no longer hold the bones in the correct place during movement and weight-bearing. With the muscles strained, these too cannot manage to correctly stabilize the joint and the result is a chronically stressed structure. One of the tell-tale signs that this is occurring is clicking and popping or a sense of the joint feeling different.

Implications for Osteoarthritis

As you might imagine, re-injury is also quite common rolling the joint a second time or more. Over time, the condition results in repetitive damage of the cartilage in the joint and degenerative/arthritic changes set in. Correction involves not just realigning and re-balancing the joint with manipulation, but also strengthening the surrounding musculature to protect and restrict the motion in the joint. This gives the ligaments a chance to heal and shrink back up. This is in fact the nature of ligaments… they shrink and tighten over time. This is beneficial in most cases of healing, but can also result in dysfunction in other cases.

Getting Help

It takes the right kind of physician to know whether ligaments need to be lengthened or shortened to correctly balance a joint. If you suffer from ankle pain, see a Chiropractor or other qualified physician that specializes in biomechanical injury. The longer you let the problem ride, the worse it is likely to become.

Foot and Ankle Pain: The Foot

There are many areas of the foot that can generate lower extremity pain. Check out these culprits.

 

Plantar Fasciitis

The plantar fascia is the connective tissue of the foot that runs from the heel to the toes. Think of the plantar fascia as a fibrous web that connects one end of the foot to the other. The plantar fascia is actually more of an aponeurosis (connective structure) than a fascia. It helps to check the motion of the foot and ties structures together. It is paramount shaping the arch of the foot. In turn, this arch adds a shock absorbing spring to the foot.

Mechanism of Injury

Every time you stand, the weight of your entire body is loading on the arches of your feet. The plantar fascia helps to maintain that arch during such times of loading. It acts like an ultimate barrier. The muscles in the foot are supposed to be powerful enough to maintain that arch. In the case that the foot muscles become weak, the stress passes onto the plantar fascia. If the stress occurs for long enough it begins to repetitively damage the plantar fascia. Then fibers will become irritated, inflamed, and painful. Plantar fasciitis is inflammation in the plantar fascia. However, recent studies show that plantar fasciitis is less inflammatory and more degenerative in nature. This idea is reinforced by development of bone spurs in the heel. A spur does not cause plantar fasciitis, but rather is a result of tension forces. The body attempts to reinforce the tissue by laying down calcium. Keep in mind, plantar fasciitis is the result of mechanical overload. Any factor that increases stress to the plantar fascia can cause damage resulting in microtrauma and inflammation.

Risk Factors Include

• Obesity or weight gain
• Change in foot wear
• Change in exercise habits
• Tight calves
• Leg length inequality
• Sedentary life style that weakens foot muscles
• Standing on hard surfaces for long periods

Treatment of Plantar Fascia

Treating plantar fasciitis usually involves ultrasound to promote healing, manipulation by our Chiropractor to correct bony alignment, stretching the calf muscles, and strengthening the intrinsic foot muscles. In more serious cases, I may refer out for shockwave therapy (originally designed to break up kidney stones). In some cases, certain injections may be warranted. Personally, I do not recommend any release surgery because this alters the length of the plantar fascia and usually does not have a good long-term outcome.  

 

Pes Planus

Pes Planus is commonly referred to as flat foot/feet. This is a condition where the arch of the foot is lost under weight-bearing conditions. The top of the foot typically rolls inward during gait. Pes planus usually leads to altered mechanics and stress in joints. This causes arthritis, plantar fasciitis, corns, calluses and general foot pain. The solution usually involves foot orthotics, manipulation of the foot, and strengthening exercises to retrain the arch of the foot.

 

Pes Cavus

Just like flattening of the foot, a high arch causes altered dynamics of the foot leading to excessive stress. There is a propensity to develop hammer toes with pes cavus which can lead to arthritis and tendinopathy. Manipulation and stretches is warranted for this condition. Shoe inserts can help. In severe cases, surgery may be necessary.

 

Morton’s Neuroma

Morton’s Neuroma is a kind of benign tumor (not malignant). Neuromas can grow on the nerves that pass between the metatarsal bones in the foot causing compression of the nerves. Symptoms include pain and numbness or altered sensation in the foot/toes. Avoiding compressive footwear is important. I refer out for this condition, and only do minimal treatments myself. For more information on nerve pain, click here.

 

Bunions

Bunions are a bony outgrowth at the base of toe with accompanying inward bend of the toe. This condition actually begins in the midfoot at the base of the metatarsal bone at the tarsal-metatarsal joint. The angle of the metatarsal is altered causing the bone to travel outward while the toe compensates by leaning inward. Manipulation, ultrasound, and rehab are the mainstay of conservative therapy. Altered footwear and/or inserts are warranted. However, there is a misconception about footwear’s role in this condition. Because even people who have never worn shoes in their lives have develope bunions. In severe cases, surgery is necessary.

 

Gout

Gout is a systemic arthritis. It is one of the metabolic arthritides associated with increases in uric acid levels. In high concentrations, uric acid can aggregate and form crystals in the joints that irritate and cause damage. The first place this shows up is usually the base of the big toe. Changes in diet and exercise are very important to treat this condition. Ultrasound and gentle manipulation are a good conservative approach. In addition, I refer out for this condition to the patient’s family doctor or a rheumatologist. Gout is a team approach.

 

Tarsal Tunnel Syndrome

The tarsal tunnel is a space along the inside of the ankle. This is where the tibial nerve and artery pass from the lower leg into the foot. Irritation, trauma, or misalignment can all cause compression of the nerve and/or artery in this space. Symptoms are typically heel and foot pain with numbness. If the entrapment occurs high enough the entire foot can become involved. It is more common for pain to radiate into the big toe and the or first three toes. Manipulation and retraining the arches of the foot are key here.

 

Osteoarthritis

Also called the wear and tear disease of the joints, OA can happen anywhere in the body. However, osteoarthritis prefers to develop in weight bearing joints. Manipulation and ultrasound can work wonders in the foot and ankle. See the section on arthritis for more detail.

 

Metatarsalgia

Matatarsalgia is essentially stress on the balls of your foot. There are bones in your feet called the metatarsals. These are long bones that connect to your toes also called the forefoot. People who have mechanical changes that result in shifting more weight to their forefoot are at risk for developing this. For example, during pregnancy, changing shoe ware, change in activities, tight calves, or lax plantar fascia change can occur. As a result there is overloading of the heads of the metatarsals. Patients then experience pain and inflammation in the balls of their feet. Manipulation and foot taping along with ultrasound are great care combos for metatarsalgia.