Foot Injuries

About a quarter of all the bones in your entire body are located in your feet. Each human foot has 26 bones, 33 joints, and over a hundred muscles, ligaments, and tendons. Pain in any part of the feet may interfere with activities or, in severe cases, prohibit a person's ability to walk. A foot specialist, called a podiatrist, can examine and diagnose maladies of the feet. In many cases, however, an orthopedic doctor is called upon when a patient's issue involves bones, joints, muscles, ligaments, or tendons.

With 26 bones in each foot, there is high potential for foot bone fractures.

 

With 26 bones in each foot, there is high potential for foot bone fractures. A doctor will order an x-ray to determine whether a person's foot pain is caused by a fracture or other injury. Often, a "broken foot" is dressed with a compression bandage to secure the bones in proper place for healing. Patients are advised to rest, elevate the affected limb, and apply ice periodically. Crutches are generally advised to keep weight off of the foot as it heals. If a bone is irreparable, surgery may be recommended. Any foot injury that involves a joint may contribute to the development of arthritis.

 

Sprain in foot:

Another common foot injury is stressed or sprained ligaments and strained tendons or muscles. Sprains occur when a ligament is torn or over-stretched, and strains happen when a tendon or muscle is torn or over-stretched. Both injuries can result from one wrong motion or a repeated motion that weakens the tissues over time.

 In some cases, an x-ray, MRI, or CT scan is ordered to help a doctor diagnose a foot sprain or strain. Treatments often involve rest, ice, elevation, anti-inflammatory medication, and compression,.

Achilles Tendon Pain:

The Achilles tendon is a tough band of fibrous tissue that connects the calf muscles to the heel bone (calcaneus). The Achilles tendon is also called the calcaneal tendon.

The gastrocnemius and soleus muscles (calf muscles) unite into one band of tissue, which becomes the Achilles tendon at the low end of the calf. The Achilles tendon then inserts into the calcaneus. Small sacs of fluid called bursae cushion the Achilles tendon at the heel. 

The Achilles tendon is the largest and strongest tendon in the body. When the calf muscles flex, the Achilles tendon pulls on the heel. This movement allows us to stand on our toes when walking, running, or jumping. Despite its strength, the Achilles tendon is also vulnerable to injury, due to its limited blood supply and the high tensions placed on it.

Achilles Tendon Conditions(heal pain)

• Achilles tendon tear: Tears of the Achilles tendon can be tiny (microtears), or large, causing pain, swelling, and impaired movement. They may occur suddenly during activity, or gradually over time.
• Achilles tendon rupture: A complete rupture of the Achilles tendon may make a "pop" sound, followed by pain and swelling of the lower leg. Treating an Achilles tendon rupture requires surgery or long-term immobilization of the ankle.
• Achilles tendinitis (tendonitis): Frequent activity (running or walking) can gradually inflame the end of the Achilles tendon, causing pain and stiffness at the back of the heel. Rest, ice, and stretching may speed healing, which can take weeks.
• Achilles peritendonitis: Similar to Achilles tendonitis, but inflammation and pain occur in the tissue surrounding the tendon, often two or more inches above the heel. 
• Achilles tendinosis: Gradual thickening of the Achilles tendon without apparent inflammation, due to aging or overuse. Despite the thickening, the tendon is weakened and prone to further injury or rupture.
• Achilles tendinopathy: A general term for tendinitis or tendinosis affecting the Achilles tendon.
• Achilles or heel (calcaneal) bursitis: Low-riding shoes can irritate the bursa, a sac of fluid cushioning the Achilles tendon at the heel. Pain in the back of the heel, worse with shoes on, is the common symptom.

Arthritis of the Foot and Ankle

Arthritis is inflammation of one or more of your joints. It can cause pain and stiffness in any joint in the body, and is common in the small joints of the foot and ankle.

There are more than 100 forms of arthritis, many of which affect the foot and ankle. All types can make it difficult to walk and perform activities you enjoy.

Although there is no cure for arthritis, there are many treatment options available to slow the progress of the disease and relieve symptoms. With proper treatment, many people with arthritis are able to manage their pain, remain active, and lead fulfilling lives.

Description

The major types of arthritis that affect the foot and ankle are osteoarthritis, rheumatoid arthritis, and posttraumatic arthritis.

Osteoarthritis

Osteoarthritis, also known as degenerative or "wear-and-tear" arthritis, is a common problem for many people after they reach middle age, but it may occur in younger people, too.

In osteoarthritis, the cartilage in the joint gradually wears away. As the cartilage wears away, it becomes frayed and rough, and the protective space between the bones decreases. This can result in bone rubbing on bone, and produce painful osteophytes (bone spurs).

In addition to age, other risk factors for osteoarthritis include obesity and family history of the disease.

Osteoarthritis develops slowly, causing pain and stiffness that worsen over time.

Rheumatoid Arthritis

Rheumatoid arthritis is a chronic disease that can affect multiple joints throughout the body, and often starts in the foot and ankle. It is symmetrical, meaning that it usually affects the same joint on both sides of the body.

Rheumatoid arthritis is an autoimmune disease. This means that the immune system attacks its own tissues. In rheumatoid arthritis, immune cells attack the synovium covering the joint, causing it to swell. Over time, the synovium invades and damages the bone and cartilage, as well as ligaments and tendons, and may cause serious joint deformity and disability.

The exact cause of rheumatoid arthritis is not known. Although it is not an inherited disease, researchers believe that some people have genes that make them more susceptible. There is usually a "trigger," such as an infection or environmental factor, which activates the genes. When the body is exposed to this trigger, the immune system begins to produce substances that attack the joints.

Osteoarthritis of foot:

Osteoarthritis, or "wear-and-tear" arthritis, is the most common type of arthritis. Also known as degenerative joint disease or age-related arthritis, osteoarthritis is more likely to develop as people age. Inflammation and injury to the joint cause a breaking down of cartilage tissues, resulting in pain, swelling, and deformity. The changes in osteoarthritis usually occur slowly over many years, though there are occasional exceptions

What Are the Symptoms of Foot and Ankle Osteoarthritis?

Symptoms of foot and ankle osteoarthritis often include:

• Tenderness or pain
• Reduced ability to move, walk, or bear weight
• Stiffness in the joint
• Swelling in the joint

Post traumatic arthritis:

posttraumatic arthritis can develop after an injury to the foot or ankle. Dislocations and fractures—particularly those that damage the joint surface—are the most common injuries that lead to posttraumatic arthritis. Like osteoarthritis, posttraumatic arthritis causes the cartilage between the joints to wear away. It can develop many years after the initial injury.

An injured joint is about seven times more likely than an uninjured joint to become arthritic, even if the injury is properly treated. In fact, following an injury, your body may actually secrete hormones that stimulate the death of your cartilage cells.

Symptoms

The symptoms of arthritis vary depending on which joint is affected. In many cases, an arthritic joint will be painful and inflamed. Generally, the pain develops gradually over time, although sudden onset is also possible. There can be other symptoms, as well, including:

• Pain with motion
• Pain that flares up with vigorous activity
• Tenderness when pressure is applied to the joint
• Joint swelling, warmth, and redness
• Increased pain and swelling in the morning, or after sitting or resting
• Difficulty in walking due to any of the above symptoms
• Bunions, Hammer Toes, Claw Toes

What are hammer, claw, and mallet toes?

Hammer, claw, and mallet toes are toes that are bent into an odd position. They may look strange or may hurt, or both. These toe problems almost always happen in the four smaller toes, not the big toe.

• A hammer toe bends down toward the floor at the middle toe joint. This causes the middle toe joint to rise up. It usually affects the second toe. Hammer toes often occur with bunions.
• Claw toe often affects the four smaller toes at the same time. The toes bend up at the joint where the toes and the foot meet. They bend down at the middle joints and at the joints nearest the tip of the toes. This causes the toes to curl down toward the floor.
• A mallet toe bends down at the joint closest to the tip of the toe. It often affects the second toe, but it may happen in the other toes too.

 

If you notice that your toe looks odd or hurts, talk to your doctor. You may be able to fix your toe with home treatment. If you don't treat the problem right away, you are more likely to need surgery.

What causes hammer, claw, and mallet toes?

Tight shoes are the most common cause of these toe problems. Wearing tight shoes can cause the toe muscles to get out of balance. If a shoe forces a toe to stay in a bent position for too long, the muscles tighten and the tendons shorten, or contract. This makes it harder to straighten the toe. Over time, the toe muscles can't straighten the toe, even when you aren't wearing shoes.

These toe problems form over years and are common in adults. Women are affected more often than men because they are more likely to wear shoes with narrow toes or high heels.

Less often, these toe problems are linked with other conditions, such as diabetes, rheumatoid arthritis, stroke, or an injury to the foot or ankle.

What are the symptoms?

Besides looking odd, hammer, claw, and mallet toes may:

• Hurt.
• Make it hard to find shoes that fit.
• Rub against your footwear. You may get calluses or corns where a bent toe presses against another toe or your shoe or where the toe's tip touches the ground.

In more severe cases, these toe problems may affect your balance and make it hard to walk

Flat Feet Deformities

Flat feet (also called pes planus or fallen arches) is a postural deformity in which the arches of the foot collapse, with the entire sole of the foot coming into complete or near-complete contact with the ground.

Causes of flat feet include:

• Genetic factors, as flat feet can run in families.
• Weak arches, where the foot is visible for example, when sitting, but the foot flattens onto the ground when standing.
• Foot or ankle injury.
• Arthritis or rheumatoid arthritis.
• Damage, dysfunction, or rupture of the posterior tibial tendon.

Plantar Fasciitis (Heel Pain)

Your foot has thick, fibrous band of tissue (''fascia'') reaching from your heel to your toes. These tissues support the muscles and arch of the foot. When they’re overly stretched, tiny tears can occur in their surface. This can cause pain and inflammation.

Doctors once thought this type of pain was caused by bony growths called heel spurs. Now they believe that heel spurs are the result -- not the cause -- of pain from plantar fasciitis.

What Causes It?

A number of things can contribute to plantar fasciitis. While men can get plantar fasciitis, it’s more common in women. You're also more likely to suffer from this condition as you age or if you’re overweight or on your feet for several hours a day.

Your risk also increases if you:

• Wear worn-out shoes with thin soles
• Have flat feet or a very high arch
• Often wear high-heeled shoes
• Have tight Achilles tendons, or “heel cords”
• Have an unusual walk or foot position

Symptoms

Symptoms include pain in the bottom of your foot -- at the front or center of the heel bone. You might notice that it’s worse in the morning when you first wake up (“first-step pain”). And it may happen when you’re standing after having sat for a long time. You’re also more likely to feel it right after exercise.

 

Heel spur:

A heel spur is a calcium deposit causing a bony protrusion on the underside of the heel bone. On an X-ray, a heel spur can extend forward by as much as a half-inch. Without visible X-ray evidence, the condition is sometimes known as "heel spur syndrome. "though heel spurs are often painless, they can cause heel pain. They are frequently associated with plantar fasciitis, a painful inflammation of the fibrous band of connective tissue (plantar fascia) that runs along the bottom of the foot and connects the heel bone to the ball of the foot.

causes of Heel Spurs

Heel spurs occur when calcium deposits build up on the underside of the heel bone, a process that usually occurs over a period of many months. Heel spurs are often caused by strains on foot muscles and ligaments, stretching of the plantar fascia, and repeated tearing of the membrane that covers the heel bone. Heel spurs are especially common among athletes whose activities include large amounts of running and jumping.

Risk factors for heel spurs include:

• Walking gait abnormalities,which place excessive stress on the heel bone, ligaments, and nerves near the heel
• Running or jogging, especially on hard surfaces
• Poorly fitted or badly worn shoes, especially those lacking appropriate arch support
• Excess weight and obesity

Other risk factors associated with plantar fasciitis include:

• Increasing age, which decreases plantar fascia flexibility and thins the heel's protective fat pad
• Diabetes
• Spending most of the day on one's feet
• Frequent short bursts of physical activity
• Having either flat feet or high arches

Symptoms of Heel Spurs

Heel spurs often cause no symptoms. But heel spurs can be associated with intermittent or chronic pain -- especially while walking, jogging, or running -- if inflammation develops at the point of the spur formation. In general, the cause of the pain is not the heel spur itself but the soft-tissue injury associated with it.

Many people describe the pain of heel spurs and plantar fasciitis as a knife or pin sticking into the bottom of their feet when they first stand up in the morning -- a pain that later turns into a dull ache. They often complain that the sharp pain returns after they stand up after sitting for a prolonged period of time.

Burning Feet

A burning sensation in your feet may be caused by nerve damagein the legs, also called neuropathy. Although many medical conditions can cause burning feet, diabetes is the most common. Most burning feet treatments focus on preventing further nerve damage and reducing pain.

Many other conditions can cause neuropathy or a burning sensation in the feet:

• Chronic kidney disease (uremia)
• Small fiber neuropathy
• Vitamin deficiency (vitamin B12, folate, and occasionally vitamin B6)
• Alcohol abuse
• Low thyroid hormone levels (hypothyroidism)
• Lyme disease
• HIV/AIDS
• Amyloid polyneuropathy
• Drug side effects, including chemotherapy drugs, vitamin B6 overdose, HIV medicines, amiodarone, isoniazid, metformin, and others
• Erythromelalgia
• Heavy metal poisoning (lead, mercury, arsenic)
• Vasculitis (inflammation of blood vessels)
• Sarcoidosis
• Guillain-Barre syndrome (GBS)
• Chronic inflammatory demyelinating polyneuropathy (CIDP)

Besides neuropathy, infections and inflammation of the feet can also cause a burning sensation. The most common of these is athlete's foot, an infection of the skin caused by fungus.

Peripheral artery disease (PAD) also commonly causes burning feet. The poor circulation of blood to the feet may frequently cause pain, tingling, and burning feet, especially while walking.

Weeks or months after gastric bypass surgery, some people experience a burning feet sensation. Poor absorption of B vitamins after gastric bypasscan cause neuropathy in the legs and a sensation of burning feet.