Common Foot and Ankle Conditions We Treat

Foot, Ankle and Heel Pain

Arthritis, Tendinitis, Ankle Instability, Plantar Fasciitis, Heel Spurs, Gout, Flat Feet, Sport Injuries (Sprains, Tendinitis, Capsulitis, Bursitis, Shin Splints), Foot Deformities (Bunions, Hammertoes, Tailor’s Bunion), Neuroma
Foot, Ankle and Heel Pain

Foot, Ankle And Heel Pain

Plantar fasciitis is the most common cause of heel pain.  This is an inflammation of the plantar fascia, which is the band of connective tissue that runs from the heel to the ball of the foot and supports the arch of the foot.  This condition may occur from change in activity, poorly fitting or worn out shoes, excessive weight, heel injury, standing for long hours on hard surfaces or walking barefoot. 

In some cases, a heel spur is present on x ray.  A heel spur is a bony growth at the bottom of the heel bone which results from chronic pulling of the plantar fascia.  It is important to keep in mind that it is not the heel spur that is causing your heel pain, but a tight, inflamed plantar fascia.

Nine times out of ten plantar fasciitis resolves without surgery.  The condition takes time to improve, which can be a source of frustration.  It is important to be consistent with the treatment protocol which includes three main steps:  1. Management of inflammation with oral or injectable medications.  2.  Stretching. 3. Arch support.

If after 6-12 months of conservative care you are still experiencing pain, then surgical options will be discussed.

Foot, Ankle And Heel Pain

Gout is a form of inflammatory arthritis that develops when you have high levels of uric acid in the blood. People experience sudden, intense pain accompanied by joint redness, warmth and swelling.  Symptoms can be severe enough that you may not be able to put weight on your foot.

Gout occurs when urate crystals accumulate in your joint.  When you eat foods rich in purines, your body breaks down the purines into uric acid. Urate crystals can form when you have high levels of uric acid in your blood.

Risk factors include diet, obesity, certain medical conditions (high blood pressure, diabetes, heart and kidney disease), certain medications (thiazide diuretics used to treat high blood pressure and low-dose aspirin), family history, recent surgery or trauma, if you are male or a post-menopausal female.

Foods to avoid include: steak, organ meats, seafood (especially shellfish like shrimp, lobster, mussels, anchovies and sardines), certain alcoholic beverages (grain liquors and beer), and drinks sweetened with fruit sugar (fructose).  Recommended foods include low-fat or non-fat dairy products, fresh vegetables and fruits (especially cherries), nuts and grains.

Treatment includes oral medications (either NSAIDs or steroids) and/or injectable steroid.  Your primary care provider may place you on a daily maintenance medication if you suffer from chronic gout attacks.

Foot, Ankle And Heel Pain

Flat feet or low arches may be present during childhood or may develop during adulthood. 

Some people experience pain with every step.  Even flat feet that don’t hurt can cause future problems such as knee, hip & back pain, arch & heel pain, bunions and hammertoes.

Custom molded orthotics (created from a mold of your feet and prescription based on your needs) relieve pain caused by low arches.  Pre-fabricated supports may ease the pain of a mild condition.

Foot, Ankle And Heel Pain

A bunion is an abnormal, enlarged bone at the base of your big toe. Bunions form when your big toe pushes up against your other toes, forcing your big toe joint in the opposite direction, away from normal profile of your foot.  Bunion deformities can be progressive, which means they can get worse over time.

Bunions can be caused by high-heeled or poorly fitting shoes.  They can be a result of an inherited foot type (you can thank your parents of grandparents!), a foot injury, or can be present during childhood.

Depending on the severity of the bunion, there may be swelling, redness or soreness around the big toe joint.  Thick skin (callus) or corns can develop from the abnormal position of the big toe.  There can also be limited movement of the big toe, constant or intermittent pain.

Bunions and pain associated with bunions can be managed without surgery.  Common nonsurgical options include: changing to a wider shoe, padding, medications and shoe inserts.

In some cases, patient’s do not experience relief from conservative treatment and require surgical correction.  There are multiple surgical procedures depending on the type of bunion.  Surgery isn’t recommended unless a bunion causes you frequent pain or interferes with your daily activities.

Foot, Ankle And Heel Pain

A hammertoe has an abnormal bend in the middle joint of the toe.  Hammertoe deformities are most likely to occur in the toe next to your big toe, but may be present in third through the fifth toes as well.  Hammertoes usually are a result of a muscle imbalance.  Initially hammertoes may be flexible and lie flat when you’re not wearing crowded footwear.  But overtime the tendons of the toe contract and tighten, causing your toe to become permanently stiff.  Your shoes can rub against the raised portion of the toe and toes, causing painful corns and calluses.

Hammertoe deformities occur most often in women who wear high heel or shoes with a narrow toe box.  These types of footwear may force your toes against the front of the shoe, causing an unnatural bending.  Other causes include trauma and nerve injuries or disorders.  Certain factors may also increase your risk of hammertoe which include: age, sex and toe length.

Relieving the pain and pressure from hammertoes may be achieved without surgery.  Changing your footwear to a roomier and more comfortable shoe reduces pressure on the toes.   Wearing inserts or pads can reposition your toe and relieve pressure and pain.  In addition, you can perform exercises to stretch and strengthen your toe muscles.  These may include picking up marbles or a thin towel off the floor with your toes.

If you have a more severe case of hammertoe(s) you may need surgery to experience relief.  Surgery may involve releasing the tendon that’s preventing your toe from lying flat.  In some cases, you may benefit from having some pieces of bone removed to straighten your toe.

Foot, Ankle And Heel Pain

A tailor’s bunion, also called a bunionette, is a bony lump that forms along the side of the little toe. It happens when the fifth metatarsal bone enlarges or shifts outward. The fifth metatarsal is the long bone at the base of the 5th toe.   A bunion can be painful, especially if it rubs against your shoe.

The name Tailor’s bunion was derived from the fact that tailors sat in a crossed-legged fashion on the floor when performing their work putting pressure on the lateral side of the forefoot, particularly the fifth metatarsal head, causing symptoms in that area. (Source:  The Podiatry Institue)

Please refer to “Bunions” section for causes, nonsurgical and surgical treatment.

Foot, Ankle And Heel Pain

Neuroma is a painful condition that affects the ball of your foot, most commonly the area between your third and fourth toes (referred to as Morton’s Neuroma). When you have a neuroma you may feel as if you are standing on a pebble in your shoe or on a fold in your sock.

A neuroma is a benign thickening of the tissue around one of the nerves leading to your toes.  This occurs when the nerves in the foot are pinched and inflamed.  This can cause a sharp, burning pain in the ball of your foot. Your toes also may sting, burn or feel numb.

High-heeled or tight-fitting shoes have been linked to the development of neuroma.  Other causes include high-impact athletic activities such as jogging or running and those who have foot deformities such as bunions, hammertoes, high arches or flat feet.

Treatment is dependent on the severity of your symptoms.  Many people experience relief by switching to lower heeled shoes with wider toe boxes. Sometimes injections or surgery may be necessary.