Foot and Ankle pain

The foot and ankle form a complex system which consists of 28 bones, 33 joints, 112 ligaments, controlled by 34 muscles. 

The ankle joint is comprised of 3 parts: the tibia and fibula (shin bones) meeting the talus (foot). 

The foot however is a more complex series of bones that are usually separated into sections: rear foot (calcaneus and talus), midfoot (tarsal bones) and forefoot (metatarsals and phalanges (toes)). The foot and ankle joints function together as a mobile platform to help stabilise the lower limb when standing and walking, but also as a rigid lever to propel you forward while engaging in activity. 

Common causes of musculoskeletal related pains tend to originate from bones, ligaments, tendons and muscles. These symptoms tend to settle with time and good self-management.

Ankle pain

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Osteoarthritis

Coming soon.

Ankle sprain

What is an ankle sprain?

Ankle sprain is a soft tissue injury typically occurring from an inversion (inwards) or eversion (outwards) force. Most ankle sprains can be managed at home.

Typically, there will be an event which causes pain ie slip, trip or fall.

Symptoms include:

  • localised swelling
  • bruising
  • pain

The pain can be particularly strong in the first three weeks as this is the inflammatory phase of your body healing itself. Typically, these injuries last 4 to 6 weeks depending on the severity.

How to deal with an ankle sprain?

You can look after yourself by following the advice in our soft tissue injury information below.

Ankle impingement

Coming soon.

Achilles Tendon pain (tendinopathy)

What is it? 

The Achilles tendon is the largest and strongest tendon in the body and is the combined tendon of the two largest calf muscles, the gastrocnemius and soleus.  It is situated at the back of the ankle and can be felt as a cord that connects the muscles of the calf to the heel bone. 

When the tendon contracts, it has the effect of pointing the foot down which is important for running, walking, jumping and stair climbing. 

Despite being the strongest tendon in the body, it can sometimes be overloaded, causing discomfort and even pain. 

Achilles tendinopathy causes are not fully understood however there are many factors that can increase the risk of developing it: 

  • Weak or tight calf muscles 
  • Stiff ankle joints 
  • Weight gain or being overweight
  • Athletic training problems such as old or inappropriate footwear and lack of pacing i.e.:  increasing intensity, distance or time of training too quickly.  Lack of variation in training regimes can also cause overuse and discomfort. 
  • Some rheumatological conditions or diabetes 

Common symptoms 

You may notice a tender, warm, red lump at the back of your heel and the tendon may feel tighter than that of the opposite foot. 

The area may feel stiff for a short while in the morning (especially going downstairs)but settle when you start walking.  

Pain can occur when you have walked or run for a period of time and gets worse the more you walk or run. For some people however, they are able to exercise through the initial pain but then worsen again after rest. 

How to deal with it?  

The Achilles tendon becomes painful and swollen because it has been overloaded, i.e.:  it is unable to adapt with the load placed upon it. Total rest can make matters worse, causing weakness. 

Activity modification 

Modifying your daily activities by reducing the activity that has caused your problem will help. For example, some runners will find that not running for the first six weeks of starting the Achilles strengthening exercises should help.  After this time running can be restarted gradually. 

In the meantime, switching to other exercise types, where weight through the heel is reduced such as swimming and cycling may help to maintain your cardiovascular fitness level. 

Exercise 

The most effective treatment is to perform a training programme which strengthens the tendon by loading it and therefore allowing rapid healing.  A demonstration of this can be found by viewing the leaflet here 

Videos of of the Achilles rehabilitation programme can be found at the following links:

Non-insertional Achilles Tendinopathy

Insertional Achilles Tendinopathy

This exercise will be painful to start with, but be reassured that this will get easier and you will not be doing any harm. This treatment plan may take around three months to make a difference, so don’t give up too early. 

Do not attempt these exercises if the pain is disabling or you are unable to bend your ankle.

Please consult a doctor or physiotherapist if you are unsure how to perform your exercises, or if symptoms do not settle or worsen after 12 weeks.  

Ice Therapy 

Some people find using ice on the hot, swollen area can help.  

Use a damp cloth containing an icepack (or bag of frozen peas) on the painful area to help numb the pain Apply it for up to 20 minutes, up to three times a day. 

  • People should be cautious using these treatments if they have altered skin sensation or circulatory problems.  
  • Check the skin regularly during and after the ice pack application 
  • Stop if there is excessive pain, numbness or tingling  
  • Do not put ice directly on to the skin as this may cause a burn. 

Pain medication 

Movement may be sore and painkillers like paracetamol can ease the pain.  If you are able to take Ibuprofen, it will bring down swelling, allowing you to move more freely. 

Do not take ibuprofen for 48 hours after an initial injury as it may slow down healing. 

If you do require pain medication, you need to take it (paracetamol) regularly When taking medication please follow the instructions on the packet and inform the pharmacist of any conditions that you suffer with. 

Guidelines can be found on the NHS website: 

https://www.nhs.uk/medicines/ibuprofen-for-adults/ 

https://www.nhs.uk/medicines/paracetamol-for-adults/ 

For up to date guidelines from the government about Ibuprofen use and Coronavirus (COVID-19)

https://www.gov.uk/government/news/ibuprofen-use-and-covid19coronavirus

 

Avoiding Achilles Pain

You can reduce your risk of developing Achilles pain by performing strengthening exercises regularly.  

Footwear also plays a big part in the prevention of Achilles pain.  Make sure that the shoes you have are supportive and appropriate for the activities you use them for.  They should fit properly are not be worn out (you should consider renewing your trainers after about 500 miles of use). 

Tibialis posterior tendinopathy

Coming soon.

Peroneal tendinopathy

Coming soon.

Other causes of ankle pain

Coming soon – Tarsal tunnel syndrome, Referred pain

Avoiding foot and ankle pain

Lifestyle 

Smoking, being physically inactive and overweight can all increase the risk of developing musculoskeletal damage.  These lifestyle factors are also closely linked with long-term diseases such as heart problems and diabetes which can result in delayed and poor healing. 

Activity 

Regular physical activity can reduce the risk of foot and ankle problems by strengthening the supporting muscles. 

Regular weight bearing activity such as walking can help to prevent osteoporosis – the pulling and tugging on bones by muscles during exercise helps to maintain bone strength. 

Musculoskeletal pain can take around 6 weeks to recover.  A modification or reduction in activity can sometimes help.  If your pain worsens considerably or does not improve after 6-8 weeks please see your GP. 

Keep active and avoid a sedentary lifestyle.  Aim to do at least 30 minutes of moderate physical activity most days of the week including exercises which encourage flexibility and strength. Find something you enjoy! 

Weight 

Being overweight or obese can cause musculoskeletal pain and mobility problems as well as anxiety and depression. Increased weight will add pressure on the lower legs and feet, thereby increasing symptoms in these areas. 

Keeping active and eating a healthy, balanced diet will help reduce weight loss.  Reducing your sugar and fat content and eating smaller sized portions will help with this.   www.livewelldorset.co.uk   

Smoking 

Smoking affects the circulation and therefore slows and impairs healing particularly in the lower leg and feet 

You are 4 times more likely to quit smoking with support from Stop Smoking Services than by going it alone. www.livewelldorset.co.uk

Foot pain

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Osteoarthritis

Coming soon – Midfoot, Toes, Hallux rigidus

Plantar Fasciitis

What is it? 

The plantar fascia is a strong fan-like band of connective tissue that runs from the ball of your foot and attaches to the heel bone. Its main purpose is to support the arch of your foot when it is placed under load. 

Plantar fasciitis is a common condition (sometimes known as Policeman’s Heel), whereby this fascia gets irritated and pain is often felt under the heel and sometimes along the arch of the foot.  

What are the common symptoms of plantar fasciitis? 

You will often feel pain when you first start to walk after sleeping or prolonged rest, which eases to a manageable ache as you get moving. 

People often describe that the pain feels better during exercise but returns after restingIt can sometimes be painful to raise your toes off the floor 

What causes plantar fasciitis? 

It often occurs after extended periods of walking on hard surfaces or in different shoes (flip flops for example). 

A gradual build up to new activities is recommended.  . 

There is sometimes no apparent reason as to why you have developed plantar fasciitis however some other possible causes include: 

  • being overweight,  
  • loss of range of movement in the ankle – this can be either due to joint stiffness or tight calf muscles. 
  • very high foot arches or the opposite – flat feet. Both of these can put strain on the plantar fascia 
  • poorly fitting shoes  
  • often diabetics get this condition 

How to deal with it? 

The average plantar heel pain episode lasts longer than 6 months and it affects up to 10-15% of the population. However, approximately 90% of cases are treated successfully with conservative care. 

Although it can be very painful there are a number of things you can do to help the symptoms.  

Massage 

You can use a golf ball or even better, a firm spikey massage ball to massage under your foot, rolling it along the arch to your heel. 

Ice Therapy 

Using ice on the sole of your foot can help to ease the pain, especially towards the end of the day. Use a damp cloth containing an icepack (or bag of frozen peas) over the painful area to help numb the pain. Leave it on for 10-15 minutes. 

You may also roll your foot over a frozen bottle of water in a similar way to the golf ball massage above 

When using ice therapy as a treatment:  

  • You should be cautious using these treatments if you have altered skin sensation or circulatory problems.  
  • Check the skin regularly  
  • Stop if there is excessive pain, numbness or tingling  
  • Do not put ice directly on to the skin as this may cause a burn. 

Medication  

Painkillers like paracetamol will ease the pain, but need to be taken regularly in order to control the pain. Always follow the instructions on the packet.

Anti-inflammatories like ibuprofen can help with swelling, and therefore help you move more freely. Follow the instructions on the packet and discuss using them safely with a pharmacist, especially if you have any underlying health conditions

However, you should not take ibuprofen for 48 hours after an initial injury as it may slow down healing.

Up to date guidelines can be found on the NHS website:

https://www.nhs.uk/medicines/ibuprofen-for-adults/

https://www.nhs.uk/medicines/paracetamol-for-adults/

For up to date guidelines from the government about Ibuprofen use and Coronavirus (COVID-19)

https://www.gov.uk/government/news/ibuprofen-use-and-covid19coronavirus

Morning Routine 

Some people find warming the sole of your foot first thing in the morning helps to get you started (e.g. rub the sole of your foot or rest it on a heat pack/ wheat bag/ warm water from the shower).  

Stretch the sole of your foot before standing, after sitting or lying down. Firmly hold all the toes and bend them back until you feel a stretch in the arch of your foot.  

Don’t go barefoot for the first hour of the day and gently stretch your calf once you are up and moving around. 

Exercises  

Many people find simple exercises for the calf and foot very helpful. You can find them in the additional resources section or follow this link:  

https://www.versusarthritis.org/media/21790/plantar-exercise-sheet.pdf 

Doing these exercises regularly can help you recover more quickly – remember it may take some months for this condition to settle down. 

Keep up your fitness levels by switching to lower impact activity such as swimming or cycling. 

Footwear  

Try to avoid walking barefoot on hard surfaces. Wearing supportive shoes with a cushioned heel is advisable. Some people find ‘soft spot’ heel inserts help in the acute phase, giving local cushioning to the heel. 

Weight loss 

Losing weight will reduce the amount of pressure through your footimproving your symptoms and reducing of the chances of recurrence. 

How to avoid it? 

As with all MSK conditions it is important to keep active. Keeping in a routine of activity will help. If you are starting something new, then is it advisable to gradually build up the activity. 

Footwear is nearly always a factor in influencing plantar fasciitis.  Old worn out shoes or trainers may not give your foot the support it needs during your activity. If you are a runner, it is advisable to change your trainers after about 500 miles of use.  

Remember to tie your shoelaces up properly to maximise the support around the arch.  Avoid just slipping trainers on and off.

Forefoot pain/Metatarsalgia

Forefoot pain that occurs on the balls of the feet and sometimes the toes. It can be extremely painful. The forefoot is complex and pain can be caused by the joints, nerves, ligaments or muscles.

Coming soon – Orthotics, Podiatrist

Hammer toe/claw toe

Coming soon.

Bunions and bunionettes

What is it?

Also known as Hallux Valgus, a bunion is a change in the structural alignment of the bones in the foot, where the big toe angles toward the smaller toes. For more information click here (https://www.nhs.uk/conditions/bunions/) 

The change in the big toe position starts to crowd the smaller toes and makes the   foot wider causing footwear fitting difficulties. 

Podiatrists can help with treatments and advise throughout.  

Treatments include:  

  • Comfortable, well fitting, wider footwear that reduces pressure on the affected toes. Shoes with a strapping device (laces or Velcro)with a low heel and a deep toe box/forefoot part allow more room for the toes. 
  • Removal of hard skin that has developed over the joint – gently file it and apply moisturising cream to soften the skin
  • Make changes to any activity that regularly stresses the foot. 
  • Take pain killers such as paracetamol and anti inflammatories such as ibuprofen (if usually tolerated) as required. 
  • Surgery to straighten the toes is only endorsed by this NHS Trust, College of Podiatry and the Royal College of Surgeons in the latter stages of the condition when there is extreme pain. 

Stress fracture

Coming soon.

Neuroma

What is it?

A neuroma is a swelling or thickening of a nerve which results in compression and irritation against other tissues between the metatarsal heads on the ball of the foot. For more information click here 

Treatments include:  

  • Rest the foot 
  • Keep pressure off the forefoot by wearing comfortable shoes which are wide and have a strapping device such as a lace or Velcro strap, deep toe box/forefoot part to allow enough room for the toes.  
  • Take anti-inflammatory medications such as ibuprofen when needed, if you are usually able to tolerate them. 
  • Wear a device known as an orthoses with a metatarsal dome in the shoe 
  • If symptoms do not settle please visit your GP for further advice. 

Other causes of foot pain

Coming soon – Referred pain, Ganglions, Flat foot

Avoiding foot and ankle pain

Lifestyle 

Smoking, being physically inactive and overweight can all increase the risk of developing musculoskeletal damage.  These lifestyle factors are also closely linked with long-term diseases such as heart problems and diabetes which can result in delayed and poor healing. 

Activity 

Regular physical activity can reduce the risk of foot and ankle problems by strengthening the supporting muscles. 

Regular weight bearing activity such as walking can help to prevent osteoporosis – the pulling and tugging on bones by muscles during exercise helps to maintain bone strength. 

Musculoskeletal pain can take around 6 weeks to recover.  A modification or reduction in activity can sometimes help.  If your pain worsens considerably or does not improve after 6-8 weeks please see your GP. 

Keep active and avoid a sedentary lifestyle.  Aim to do at least 30 minutes of moderate physical activity most days of the week including exercises which encourage flexibility and strength. Find something you enjoy! 

Weight 

Being overweight or obese can cause musculoskeletal pain and mobility problems as well as anxiety and depression. Increased weight will add pressure on the lower legs and feet, thereby increasing symptoms in these areas. 

Keeping active and eating a healthy, balanced diet will help reduce weight loss.  Reducing your sugar and fat content and eating smaller sized portions will help with this.   www.livewelldorset.co.uk   

Smoking 

Smoking affects the circulation and therefore slows and impairs healing particularly in the lower leg and feet 

You are 4 times more likely to quit smoking with support from Stop Smoking Services than by going it alone. www.livewelldorset.co.uk

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Soft tissue injuries

Acute ankle injury

Ankle sprain is a soft tissue injury typically occurring from an inversion (inwards) or eversion (outwards) force. Most ankle sprains can be managed at home. Typically there will be an event which causes pain i.e. slip, trip or fall.

Symptoms include:

  • localised swelling
  • bruising
  • pain
  • stiffness and loss of function

The pain can be particularly strong in the first three weeks, this is the inflammatory phase and you may need a walking aid to help you get around, typically these injuries last 4 to 6 weeks depending on the severity.

OTTOWA Ankle Rules 

  • Pain over medial (inside and/or lateral (outside) ankle bones 
  • Unable to walk more than 4 steps immediately and since the injury 

If you experience both of these symptoms then you should attend ED as you may require an x-ray. 

Most ankle sprains can be managed at home. 

Painkillers like paracetamol will ease the pain, but need to be taken regularly in order to control the pain. Always follow the instructions on the packet. 

Anti-inflammatories like ibuprofen can help with swelling, and therefore help you move more freely. Follow the instructions on the packet and discuss using them safely with a pharmacist, especially if you have any underlying health conditions

However, you should not take ibuprofen for 48 hours after an initial injury as it may slow down healing.

Up to date guidelines can be found on the NHS website:

https://www.nhs.uk/medicines/ibuprofen-for-adults/

https://www.nhs.uk/medicines/paracetamol-for-adults/

For up to date guidelines on the government about Ibuprofen use and Coronavirus (COVID-19)

https://www.gov.uk/government/news/ibuprofen-use-and-covid19coronavirus

DAY 1 – Early Management

Protect by minimising use of the affected area and initially avoiding stretching the area which could cause further injury. You may need a walking aid to help you get around.

Rest can be beneficial in the very early stages of the injury (days 1-4)Painkillers like paracetamol will ease the pain and ibuprofen will bring down swelling. However, you should not take ibuprofen for 48 hours after your injury as it may slow down healing. When taking medication please follow the instructions on the packet and inform the pharmacist of any conditions that you suffer withIn the early stages, gentle active movements and specific exercises can help decrease pain and swelling, they also promote good tissue healing with less unwanted scar tissue and joint stiffness.  

Ice pack/frozen peas wrapped in a damp cloth, placed on the swollen ankle for up to 20 minutes at a time, 3 times a day. So long as there is swelling you will need to continue ice therapy, often beyond the third week.   

  • Please note only use ice if you have normal skin sensation  
  • Check the skin regularly  
  • Stop if there is excessive pain, numbness or tingling  
  • Do not put ice directly on to the skin as this may cause a burn. 

Compression of the swollen ankle can be achieved by using a tubigrip or crepe bandage, this should reach from just below the knee to the ball of your foot/toes. It should compress firmly but not restrict flow and create a tourniquet.  

Elevation. Gravity causes fluids to gather in the ankle. By elevating your foot you can manage this problem. Elevate your leg by putting a pillow/blanket under your feet. 

WEEK 1 – Early Mobilisation

These exercises should be performed three times daily. 

Sitting or lying. Rotate your ankle so you are drawing circles with your foot. Change directions. 

Sit with one leg straight out in front of you. Put a towel around your foot. 

Gently pull the towel and feel the stretch in your calf.  

Hold approx. 20 secs. Repeat 3 times.

Heel and toe tapping 3 minutes 3 times / day 20 second hold three times 3 minutes 3 times / day 

WEEK 2 – Strengthening Exercises

Progress from walking, to fast walking as able. Try to walk as normally as possible. 

Heel hover off a step (isometrics) Holding onto some support i.e. handrails or chair. With the balls of your feet on the edge of the step, hold the ankle in a static position with your knees slightly bent. Transfer more weight onto the affected ankle as tolerated. Hold 45 seconds. Repeat three times. Progress to double leg heel raises and when able try single leg. 

Balance practice- transfer weight from one foot to another. Progress to balancing on one foot. To increase difficulty close eyes or place arms above head/ throw a ball against a wall. 

As you start to do these exercises you may feel there is some discomfort, however, this is okay and you should continue. If you have discomfort and pain for more than 2 hours after these exercises, then you shoulder reduce the number and gradually build up again. 

Recovery time and returning to activity 

It usually takes 6 weeks to heal from simple soft tissue injuries to the hip or knee.  However, everyone recovers from injuries at different rates. Some may be back in 2 weeks however for some it can take up to 3 months.    

Returning to work – Gradually build up your strength and function, practice doing similar tasks that you would do at work before returning. Start doing this little and often ensuring there is minimal pain or swelling. 

Returning to hobbies/sport – it is advised not to return to these activities until you have full strength and range of movement without pain or swelling. Try to practice the specific movements of your hobby / sport in a controlled manner and build up the time and intensity that you do the movements before returning to your activity fully.    

Further links 

Further links for information on ankle pain 

https://www.csp.org.uk/conditions/managing-your-bone-joint-or-muscle-pain/managing-your-ankle-pain  

https://www.versusarthritis.org/about-arthritis/conditions/foot-and-ankle-pain/ 

https://www.nhs.uk/conditions/foot-pain/ankle-pain/ 

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