Common Foot & Ankle Conditions

 

Foot/Ankle Fractures
Foot/Ankle Fractures can be caused by acute trauma from sports, accidents or other activities. You can also develop stress fractures from overuse.

Achilles Tendon Trauma  

Achilles Tendon Ruptures are somewhat common in athletes and are frequent in “weekend warriors.” Patients often describe feeling like someone kicked them in the leg when their Achilles tendon snaps. Ruptured Achilles tendon will result in difficulty walking, inability to extend your foot at the ankle joint and possible pain (some ruptures are relatively pain-free once the rupture occurs).

Achilles Tendonitis is often seen in overuse conditions and usually presents as recurring pain during or following activity, morning stiffness in the leg that decreases with activity and possible swelling. This can be a precursor to a full tendon rupture. 

Ankle Sprains
Ankle Sprains are the most common athletic injury. Nearly 85% of ankle sprains that occur are lateral ankle sprains (affect the ligaments on the outside of the ankle joint). An ankle sprain occurs when the ankle rolls, causing these ligaments to be stretched or torn. Most sprains occur when participating in sports or by twisting the ankle when walking on an uneven surface. Some individuals, due to their bone structure or foot type, are more prone to ankle sprains. Fractures may present with ankle sprains; fractures can also mimic signs and symptoms of an ankle sprain.

Tendon and Muscle Injuries
There are several tendons and muscles in both the lower leg and foot.  These can be injured with increased activity, overuse or during a fall.  Tendon and muscle injuries usually present with intermittent pain, possible swelling, and early muscle fatigue during activity.

Motor Vehicle Injuries
Motor Vehicle Injuries can result in a host of foot and ankle problems, from fractures to tendon and muscle injuries most commonly, and occasionally to nerve or blood vessel damage. Pain in the legs following a motor vehicle accident is highly suggestive of some type of injury. Certain injuries sustained during a motor vehicle accident may not become painful until a few days to weeks following the injury.

Crush Injuries
Crush Injuries whether on the job or due to a motor vehicle accident, are serious injuries and can be limb-threatening. Multiple fractures are often associated with crush injuries. Rapid swellings, color changes, feelings of immense pressure or pain out of proportion to the injury are possible indications of a serious crush injury, and when left untreated, can have serious consequences.

Achilles Tendonitis
Achilles Tendonitis can cause inflammation and degeneration of the Achilles tendon; when not treated it can progress to rupture of the Achilles tendon. Achilles tendonitis may be associated with trauma; it may also be due to overuse. It can develop gradually without a history of trauma; this form of Achilles tendonitis is usually due to wear and tear. Achilles tendonitis is aggravated by activities that repeatedly stress the tendon, causing inflammation. It is a common problem often experienced by athletes, particularly distance runners. The most common cause of Achilles tendonitis is over-pronation (flat feet). This occurs because the arch collapses upon weight bearing, stressing the Achilles tendon. Other factors that can lead to Achilles tendonitis are improper shoe selection, inadequate stretching prior to engaging in athletics, a short Achilles tendon, direct trauma (injury) to the tendon and heel bone deformity.

Ankle Instability
Ankle Instability often results from a previous history of chronic ankle sprains.  Signs of ankle instability include difficulty walking on uneven ground, difficulty walking in high heels, frequent ankle sprains, feelings of instability in the ankle, pain, swelling, and stiffness.  Continued ankle sprains on a weak ankle can lead to more serious problems in the ankle joint.

Ankle and Foot Arthritis
Feet are especially prone to develop arthritis because they absorb high amounts of pressure. Symptoms include aching or generalized pain in one joint or an entire area of your foot. There are certain types of arthritis which cause more deformity and pain. 

Rheumatoid Arthritis often causes moderate to severe bone changes in the feet, especially in the toes and the ball of the foot. The feet can become very painful and difficult to walk on.  

Osteoarthritis is due to wear and tear (normal arthritis) or trauma. 

Gout is a form of arthritis that occurs as a result of the build-up of uric acid in the body and in the joint fluid. This accumulation of uric acid typically occurs when the body has difficulty processing certain protein substances that are found naturally in our diets. The tendency to accumulate uric acid is often hereditary. Gout usually starts with a sudden onset of intense pain in one or more joints, usually the big toe joint of the foot. The pain is accompanied by redness, swelling and warmth over the joint. All arthritic conditions may contribute to or result from bunion and hammertoe deformities.

Arch Pain
Arch Pain has several different causes. It may be due to plantar fasciitis, flat feet, or imbalance in the feet caused by problems ranging from bunions to overuse of muscles/tendons. Arch pain generally worsens with prolonged standing; excess or increased activity may also fatigue the arch and cause pain.   Arch pain due to flat feet can result in chronic pain and foot fatigue and may even be debilitating when long-standing.

Athlete’s Foot
Athlete's Foot is a skin disease caused by a fungus. It may present between the toes or on the bottoms of the feet. Occasionally it presents on the tops of the toes. It can appear as dry and scaly skin or as tiny pustules (similar in appearance to acne). Both forms of athlete’s foot cause intense itching and may worsen without treatment.

Ball of Foot pain (Metatarsalgia)
Metatarsalgia can be caused by inappropriate shoes, an injury to the area, repetitive stress to the area or abnormal foot mechanics. Bunions and hammertoes can make the problem worse. Sometimes high arches or arthritis can also cause metatarsalgia. The most common symptom is pain in the ball of the foot.

Bunions
Bunions are most often a symptom of abnormal mechanics of the foot. Bunions are often genetically inherited. People with flat feet are most prone to developing bunions. Bunions also may be associated with various forms of arthritis. If your child has the same foot type, there is a possibility that a bunion will eventually develop. Pain often develops as bunions progress due to pressure from shoes. Pain also develops because the way the foot functions changes as the bunion progresses — this is the body’s attempt to accommodate the bunion. Bunions can also develop on the outside of the foot; these are known as Tailor’s Bunions.

Circulatory Disorders
Circulatory Disorders or poor blood supply to the lower extremity can cause discomfort or pain when you walk. The pain can occur in your hips, buttocks, thighs, knees, shins or upper portions of your feet. 

Peripheral Vascular Disease affects arteries that carry blood away from your heart to your limbs.  You are more likely to develop peripheral arterial disease as you age. Smoking or having diabetes increases your chances of developing the disease sooner. You may not feel any symptoms from peripheral artery disease at first. The most common symptom is intermittent claudication. Peripheral arterial disease can lead to ulcerations. In advanced cases, these ulcerations may result in limb loss if left untreated.

Intermittent Claudication is discomfort or pain in your legs that happens when you walk and goes away when you rest. You may not always feel pain; instead you may feel tightness, heaviness, cramping or weakness in your leg.

Corns and Calluses
Corns and Calluses are a sign of an underlying pressure point. The tissue that forms is your body’s attempt to cushion the area. Corns and calluses may present due to rubbing between toes or on shoes, a prominent piece of bone (exostosis or hypertrophic growth of bone) or misaligned bones during walking.

Diabetic Foot
Diabetics are at a high risk for developing a serious foot condition at some time in their life which can result in hospitalization. Most of these problems are preventable through proper care and regular visits to a foot and ankle specialist. Common serious problems include infection, ulcerations or gangrene that may lead, in severe cases, to amputation of a toe, foot or leg. The key to amputation prevention in diabetic patients is early recognition and regular foot screenings (a minimum of every 6 months), from a podiatric physician. Diabetic patients are typically eligible for custom extra depth shoes and custom molded insoles. Custom diabetic shoes and insoles help prevent many of the foot and ankle problems and complications associated with diabetes.

Early warning signs of a problem in diabetic feet may include:
-skin color or temperature changes
-swelling or pain in foot/ankle or legs
-open sores that are slow to heal
-ingrown toenails
-bleeding or cracks in the skin

Flatfoot
Or flattened arches, often results in hammertoes, bunions, plantar fasciitis, as well as a variety of other foot and ankle problems. Flat feet are often genetic. If you previously had normal arches and have recently noticed “fallen arches,” you may have acquired flatfoot due to tendon dysfunction. This condition is very common in adults.

Fungal Nail Infections
Fungal Nail Infections are a common problem and can persist for some time before first causing symptoms. Fungal nails are often characterized by a change in thickness and color of the nail. In addition to causing difficulty and pain when walking or running, fungal nail infections are often accompanied by a secondary bacterial and/or yeast infection in or about the nail plate.

Geriatric Foot Care
Elderly patients often have difficulty reaching their feet to provide proper care. In addition, poor eyesight often presents a risk of cutting one’s foot with home foot care. Many elderly patients have some form of peripheral vascular disease; a decrease in blood flow to the feet present an increased risk for complications due to home/self foot care (foot care not performed under the supervision of a physician).

Hammertoes
Tendon imbalance is the major cause of toe deformities in adults. The tendons may stretch or tighten to compensate for imbalance of the foot. Thus, people with abnormally long toes, flat feet or high arches have a greater tendency to develop toe deformities. Over time, the toe may become permanently deformed and arthritic changes may develop.


Heel Spurs
Heel Spurs are present in two locations — on the bottom of the heel (plantar heel spurs) and on the back of the heel near the Achilles tendon. 

Planter Heel Spurs are usually associated with plantar fasciitis. These heel spurs are a benign reactive process and are the body’s response to pull or strain on the plantar fascia. Plantar heel spurs do not cause the actual pain; they are merely a result of the stress caused by plantar fasciitis. 

Posterior Heel Spurs may be due to the mechanical workings of your feet or may be due to excess use of high heels. They can also occur with certain forms of Achilles tendonitis. Posterior heel spurs are often irritated from rubbing on shoes.

Ingrown Toenails
Ingrown Toenails occur when the curvature of the nail pushes down the side of the toe and goes into the skin. This causes pain and discomfort and, in many cases, can result in infection. The leading cause of ingrown toenails is pressure from shoes or improper trimming of the nail. Improper nail spa services can also cause an ingrown toenail. Nail shape, which is usually inherited, may predispose a patient to ingrown toenails.

Neuromas
Neuromas are also referred to as a "pinched nerve" or a nerve tumor. A neuroma is a benign growth of nerve tissue frequently found between the third and fourth toes. You may feel pain, burning, tingling or numbness between the affected toes and in the ball of the foot. Pain is often increased in tighter shoes and while walking. You may feel a sensation like there is a small pebble or a bunch in your sock in the affected area.

Plantar Fasciitis (or Heel Spur Syndrome)
Plantar Fasciitis commonly results from inflammation of the band of fibrous connective tissue (fascia or "ligament") running along the bottom of the foot from the heel to the ball of the foot. The condition occurs when the plantar fascia is strained over time beyond its normal extension, causing the soft tissue fibers of the fascia to tear or stretch at points along its length. This commonly leads to inflammation, pain and possibly the growth of a bone spur where it attaches to the heel bone.

Pediatric Foot and Ankle Problems
Children suffer from many of the same conditions that adults do. In addition, a child can present with painful flat feet which limit activity, in-toeing gait which may result in constant tripping and an increased number of falls, clubfoot (severe in-toe type gait), limb length discrepancy, dislocated or dislocatable hip and a variety of other conditions which may or may not be associated with other medical problems.

Peripheral Neuropathy (numbness from Diabetes or other conditions)
Peripheral Neuropathy is due to lack of protective pain sensation. This can be caused by various conditions such as: Diabetes or high blood sugar (can lead to ulcerations), neurovascular factors leading to blood vessel damage that carry oxygen and nutrients to the nerves, autoimmune factors that cause inflammation in nerves, mechanical injury to nerves such as tarsal tunnel syndrome, genetic factors leading to nerve disease or smoking/alcohol use. Extremity symptoms may be described as numbness, tingling, or pain in the toes, feet, legs, hands, arms and fingers. Individuals with peripheral neuropathy may also get wasting of the muscles of the feet or hands.

Warts
Warts are caused by a virus that enters the body through a break in the skin. Warts can appear in anyone, but are most common in children. Warts can be picked up at a swimming pool, at the gym or from a friend or family member. The virus grows in warm, moist environments. Plantar warts often spread to other areas of the foot, increase in size and can form into a cluster. They may be difficult to distinguish from calluses. However, what differentiates them from a callus is that they have tiny black dots on the surface layer which are ends of capillary blood vessels. Plantar warts can be very painful and tender. Plantar warts can also be spread from your feet to your hands.

Wounds/Ulcers
Foot Ulcers are sores that occur on the feet of people with diabetes or other conditions that cause peripheral neuropathy. Foot ulcers can also occur due to issues with circulation, or peripheral vascular disease. Diabetic foot ulcers usually occur on the bottom of the foot and are the leading cause of leg amputations in the United States. However, the sooner diabetic foot ulcers are treated, the better the outcome. If undetected, the sore may become larger and infected. Leading causes of ulceration are neuropathy (decreased feeling in your feet), peripheral arterial disease, venous disease, improper shoes, foot deformities, decreased vision and/or smoking.