Why Does My Foot Hurt?

Why Does My Foot Hurt?

Plantar fasciitis, bunions, or achilles tendonitis got you down? If you’re experiencing pain in your feet, we can help you pinpoint the source of your discomfort and recommend the best course of treatment for your condition.

While joint pain of any kind can put a serious damper on your ability to participate in sports or exercise regularly, pain in the feet can be especially debilitating. If you’re having difficulty simply staying on your feet throughout the day, a number of conditions could be to blame.

From Morton’s neuroma in the ball of your foot to Achilles tendonitis in the ankle, the first step to seeking relief from your pain is identifying its source. We’ve identified the most common conditions that affect the feet, and what you can do to address your symptoms.

1. BACK OF THE FOOT

If you’re experiencing burning, swelling, or stiffness in the back of your foot, you could be suffering from Achilles tendonitis. Most common in athletes whose sports are centered around running, jumping, or lunging, Achilles tendonitis occurs when the Achilles tendon (which controls flexing of the foot or ankle) becomes inflamed due to injury or overuse. The pain may worsen with intense exercise, particularly if you wear tight shoes when working out.

Most cases of Achilles tendonitis can be effectively treated by regularly resting and icing the tendon and wearing soft, loose shoes with special orthotic inserts. If the pain persists, taking anti-inflammatory medication or cortisone shots can help. If necessary, you can also opt for a physical therapy program designed to restore the tendon’s range of motion and redevelop the surrounding muscles.

2. BOTTOM OF THE FOOT

Pain in the bottom of the foot could result from several sources — but if it’s concentrated in the heel, the arch, or both, it’s most likely the product of plantar fasciitis, which is an inflammation of the tissue that runs from the heel to the base of the toes. Pain in this area of the foot may also be caused by a heel spur, which is an abnormal bone growth that usually forms in response to poorly fitting shoes, improper posture, or frequent running. Some patients suffer from heel spurs and plantar fasciitis at the same time.

In the case of heel spurs, relief can generally be found through the use of orthotic inserts. Meanwhile, the treatments we recommend for plantar fasciitis are similar to treatments for Achilles tendonitis: rest, icing, orthotic shoe inserts, and physical therapy. Anti-inflammatories and corticosteroid shots can provide additional relief. If your symptoms don’t improve in a year, you’ll likely need to undergo a short procedure to remove the damaged tissue.

3. SIDE OF THE FOOT

Pain or discomfort on the side of the foot is a common sign of a bunion: a bony protrusion on the side of the big toe that forces it to slant against the remaining toes. In addition to pain and swelling, bunions can alter the shape of your foot, making it more difficult to wear certain shoes.

Bunions are permanent, so if they’re causing you particular distress, you should discuss bunion removal surgery with a qualified orthopedic specialist. Otherwise, wearing wider, more comfortable shoes or custom-made inserts can help.

4. BALL OF THE FOOT

High heels and ill-fitting shoes are the most common source of pain in the ball of the foot, which can be a sign of metatarsalgia or Morton’s Neuroma. Metatarsalgia is a more general inflammation, while Morton’s neuroma is a compression or thickening of a nerve in the ball of the foot. For athletes, this pain can be a consequence of repeated stress or overuse.

Metatarsalgia usually responds well to rest and physical therapy, but more advanced cases of Morton’s neuroma may require further treatment. If you still feel pain after trying different shoes and custom shoe inserts, anti-inflammatories, and corticosteroid injections, your podiatrist may suggest surgery to remove the damaged portions of the nerve.

Stress Fractures in Young Athletes

Teen girl holding ice pack on shinCompetitive sports can give some young athletes an edge over their peers. When fun, teamwork, and good sportsmanship are the top goals, sports can improve young kids’ physical and emotional health, self-esteem, and even their relationship skills. Unfortunately, young athletes must also compensate for still-growing bones, tendons, and muscles. Sometimes sports injuries happen.

The most common type of sports injury is an overuse injury such as a stress fracture. Overuse injuries are becoming more common in young athletes Playing sports year-round without time off doesn’t give young bodies enough time to rest and recover.

How stress fractures happen

Stress fractures happen when muscles are too tired to take on the impact of exercise, and the bones absorb the added stress. When those bones become too strained, they develop a tiny break known as a stress fracture.

 

Most stress fractures affect the bones in the lower leg. Stress fractures are also common in the feet.

These are the most common causes of stress fractures:

  • Increasing the frequency or intensity of exercise too quickly
  • Suddenly changing the workout surface
  • Getting sudden and significantly more playing time
  • Using or wearing gear that doesn’t offer enough support, such as shoes that are worn out
  • Insufficient periods of rest between practice or events

Stress fractures can happen during any number of sports, but they tend to be most frequent in young athletes who participate in sports that involve running and jumping, such as basketball, gymnastics, and track and field. These sports involve repetitive movements that strain the muscles and bones. This increases the risk for a stress fracture.

Preventing stress fractures

Parents and coaches can do many things to help reduce the risk for stress fractures in growing bones. Make sure that your young athletes follow these guidelines:

  • Eat a balanced, nutritious diet rich in calcium and vitamin D for strong, healthy bones.
  • Participate in conditioning practice for sports.
  • Do cross-training (alternating types of physical activities).
  • Stick to sports that are age-appropriate.
  • Always warm up before practice or games and cool down afterward.
  • Get a complete physical exam before participating in sports.
  • Wear athletic shoes (and any other needed gear) that are appropriate for the sport and that offer plenty of protection and cushioning.
  • See a healthcare provider for any persistent pain or limp.
  • Drink plenty of fluids and stay hydrated for practices and games.
  • Don’t resume sports or exercise too quickly after a stress fracture or other injury.

Also, make sure that your child’s coach is aware of the signs of stress fracture. This may be milder in nature than a more severe sports injury. Pain, particularly pain that gets better when the child is allowed to rest, is the most common symptom of a stress fracture.

Stress fractures typically heal with rest alone, but injured athletes may need to take off from their sport for as long as 6 to 8 weeks to properly recover. If your child complains of any pain that persists during sports, schedule a visit with your child’s healthcare provider.

Bunion Surgery

Bunion Surgery

What is bunion surgery?

Bunion surgery is done to reduce the pain and correct the deformity caused by a bunion. A bunion (hallux valgus) is an enlargement of the bone or tissue around a joint at the base of the big toe or at the base of the little toe. This one is called a “bunionette” or “tailor’s bunion.” Bunions often form when the joint is stressed over a prolonged period. Most bunions form in women, primarily because women may be more likely to wear tight, pointed, and confining shoes. Bunions may be inherited as a family trait. Bunions may also result from arthritis. This often affects the big toe joint.

Before surgery is considered, your healthcare provider may recommend first wearing comfortable, well-fitting footwear (particularly shoes that conform to the shape of the foot and do not cause pressure areas). He or she may also suggest using splints and orthotics (special shoe inserts shaped to your feet) to reposition the big toe and/or provide padding. For bunions caused by arthritis, medicines may help reduce pain and swelling.

If these treatments don’t help, your healthcare provider may suggest surgery. This often resolves the problem. The goal of surgery is to relieve pain and correct as much deformity as possible. The surgery is not cosmetic and is not meant to improve the appearance of the foot.

Other related procedures that may be used to help diagnose foot disorders include X-rays of the bone and foot. Please see these procedures for more information.

The type of surgical procedure performed depends on the severity of the bunion, your age, general health, activity level, and the condition of the bones and connective tissue. Other factors may influence the choice of a procedure used:

  • Mild bunion. For this type of surgery, the surgeon may remove the enlarged portion of bone and realign the muscles, tendons, and ligaments surrounding the joint.
  • Moderate bunion. For a moderate bunion, the surgeon may cut the bone and shift it to its proper position. Whether or not the bone is cut depends on the severity and location of the deformity. In addition, the surrounding tendons and ligaments may need to be repositioned.
  • Severe bunion. For a severe bunion, surgery may involve removing the enlarged portion of the bone, cutting and realigning the bone, and correcting the position of the tendons and ligaments.
  • Arthritic bunion or big toe joint. If the joint is damaged beyond repair, as is often seen in arthritis, it may need to be fused. This allows the bones to heal together and eliminate movement and pain. Occasionally, joint replacement implants may be used in the reconstruction of the big toe joint.

Why might I need bunion surgery?

You may need bunion surgery if you have severe foot pain that happens even when walking or wearing flat, comfortable shoes. Surgery may also be needed when chronic big toe inflammation and swelling isn’t relieved with rest or medicines.

Other reasons for surgery include toe deformity, a drifting in of the big toe toward the small toe, and an inability to bend and straighten the big toe.

There may be other reasons for your healthcare provider to recommend bunion surgery.

What are the risks of bunion surgery?

As with any surgical procedure, complications can happen. Some possible complications may include:

  • Stiffness
  • Numbness
  • Swelling
  • Delayed healing
  • Infection

Other complications may include recurrence of the bunion, nerve damage, and continued pain. The surgery may also result in overcorrection of the problem, in which the big toe extends away from the other toes.

There may be other risks depending on your specific medical condition. Be sure to discuss any concerns with your healthcare provider before the procedure.

How do I prepare for bunion surgery?

  • Your healthcare provider will explain the procedure to you and offer you the chance to ask any questions that you might have about the procedure.
  • You will be asked to sign a consent form that gives your permission to do the procedure. Read the form carefully and ask questions if something is not clear.
  • In addition to a complete medical history, your healthcare provider may perform a complete physical exam to make sure that you are in good health before undergoing the procedure. You may undergo blood tests or other diagnostic tests.
  • Tell your healthcare provider if you are sensitive to or are allergic to any medicines, latex, tape, and anesthetic agents (local and general).
  • Tell your healthcare provider of all medicines (prescribed and over-the-counter) and herbal supplements that you are taking.
  • Tell your healthcare provider if you have a history of bleeding disorders or if you are taking any anticoagulant (blood-thinning) medicines, aspirin, or other medicines that affect blood clotting. It may be necessary for you to stop these medicines before the procedure.
  • If you are pregnant or suspect that you are pregnant, you should notify your healthcare provider.
  • You may be asked to fast for 8 hours before the procedure, generally after midnight.
  • You may receive a sedative before the procedure to help you relax. Because the sedative may make you drowsy, you will need to arrange for someone to drive you home.
  • Based on your medical condition, your healthcare provider may request other specific preparation.

What happens during bunion surgery?

Bunion surgery may be done on an outpatient basis or rarely as part of your stay in a hospital. Procedures may vary depending on your condition and your healthcare provider’s practices.

Most bunion surgery is performed under ankle block anesthesia, in which your foot is numb, but you are awake. Occasionally, general or spinal anesthesia is used.

Generally, bunion surgery follows this process:

  1. You will be asked to remove clothing and will be given a gown to wear.
  2. An intravenous (IV) line may be started in your arm or hand.
  3. The skin over the bunion will be cleansed with an antiseptic solution.
  4. If a local anesthetic is used, you will feel a needle stick when the anesthetic is injected. This may cause a brief stinging sensation. If general anesthesia is used, you will be put to sleep using intravenous medicine.
  5. The healthcare provider will cut, realign, and possibly remove portions of bone, ligaments, and tendons of the affected foot based upon the severity of the bunion.
  6. The healthcare provider will close the opening with stitches and apply a sterile bandage or dressing.

What happens after bunion surgery?

After your surgery, you will be taken to the recovery room for observation. Your recovery process will vary depending on the type of anesthesia that is given. The circulation and sensation of the foot will be monitored. Once your blood pressure, pulse, and breathing are stable and you are alert, you will be taken to your hospital room or discharged to your home.

Your healthcare provider will give you specific instructions for caring for your foot at home during the first few weeks after surgery. You may be discharged from the hospital wearing a special surgical shoe or cast to protect your foot.

Once you are at home, you will need to rest and keep the foot elevated on 1 or 2 pillows to help reduce pain and swelling. Your healthcare provider may also recommend that you apply ice and limit walking. You may be advised to use a cane or walker following surgery.

It is important to keep the dressing clean and dry. You should cover the dressing with a plastic bag or plastic wrap and tape it with plastic tape when showering. An alternative is to take a sponge bath. The stitches will be removed during a follow-up visit, generally scheduled about two weeks after surgery.

Take a pain reliever for soreness as recommended by your healthcare provider. Aspirin or certain other pain medicines may increase the chance of bleeding. Be sure to take only recommended medicines. Your healthcare provider may also prescribe antibiotics to help prevent infection following your surgery.

Notify your healthcare provider to report any of the following:

  • Fever of 100.4°F (38°C) or higher, or as directed by your healthcare provider
  • Redness, swelling, bleeding, or other drainage from the incision site
  • Increased pain around the incision site
  • Swelling in lower leg of the affected foot

Your healthcare provider will advise you as to your postoperative activities. Your foot may need continuous support from dressings or a brace for 6 to 8 weeks after surgery. You may need to refrain from driving for a week or more after surgery.

Exercises or physical therapy may be recommended to help the foot recover its strength and range of motion after surgery. High heels should be avoided for at least 6 months after surgery.

Your healthcare provider may give you additional or alternate instructions after the procedure, depending on your particular situation.

Next steps

Before you agree to the test or the procedure make sure you know:

  • The name of the test or procedure
  • The reason you are having the test or procedure
  • What results to expect and what they mean
  • The risks and benefits of the test or procedure
  • What the possible side effects or complications are
  • When and where you are to have the test or procedure
  • Who will do the test or procedure and what that person’s qualifications are
  • What would happen if you did not have the test or procedure
  • Any alternative tests or procedures to think about
  • When and how will you get the results
  • Who to call after the test or procedure if you have questions or problems
  • How much will you have to pay for the test or procedure

Stress Fractures

What are stress fractures?

Anatomy of the foot
Click Image to Enlarge

A stress fracture is a very small, fine break in the bone caused by continuous overuse. Stress fractures often occur in the foot after training for basketball, running, and other sports. While stress fractures can occur in many bones that are subjected to repetitive activities, the bones of the legs and feet are at greatest risk. The bones in the midfoot (metatarsals) in runners are especially vulnerable to stress fractures.

What are the symptoms of a foot stress fracture?

A stress fracture may not cause obvious swelling. But symptoms can occur a bit differently in each person. Symptoms may include:

  • Pain in the front of the foot, often after long or intense bouts of exercise
  • Pain that goes away after exercise, then returns when exercise is continued

The symptoms of stress fractures can be like other health conditions. Always see your doctor for a diagnosis.

How is a stress fracture diagnosed?

Diagnosis of a stress fracture usually is confirmed with a complete health history and a physical exam. X-rays often cannot see stress fractures because they are so fine. So a bone scan or an MRI may be done. Once calluses form around the fracture, an X-ray can confirm a stress fracture.

Treatment for a stress fracture

Treatment is aimed at relieving pain and giving the fracture time to heal, usually around 6 to 8 weeks. Specific treatment for a stress fracture will depend on:

  • Your age, overall health, and health history
  • How serious your injury is
  • How well you are able to handle certain medicines, procedures, and therapies
  • How long your injury is expected to last
  • Your opinion or preference

Treatment may include:

  • Rest
  • Protection of the fracture site with reduced weight bearing
  • Cold packs
  • Medicine such as ibuprofen
  • Shock-absorbing shoes to use during exercise
  • Running on soft surfaces, such as grass
  • Physical therapy
  • Switching to a less stressful activity, such as swimming or biking
  • Wearing a brace or cast

Bone Spurs Are a Thorny Problem

If you wonder what that stabbing pain is in your heel, it may be a bone spur.

Bone spur is a general term used to describe a knobby, abnormal bone growth. Bone spurs are also known as osteophytes. Scientists believe bone spurs happen because of osteoarthritis or when the body tries to heal itself after a trauma by replacing bone. The growth is usually small and often unnoticed.

Although bone spurs can form on any bone, they usually happen on joints where 2 bones come together, or where ligaments or tendons attach to bones. Areas that tend to develop bone spurs are the neck, shoulders, elbows, spine, hips, knees and heels. Spurs are not painful, but they can cause pain if they rub on a nerve or other tissue.

Older adults are more prone to developing bone spurs. Spurs can also happen in young athletes or dancers because of the added stress on their muscles, ligaments, and tendons. Pain may happen while the spur is forming, but can settle down. In some cases, pain may continue and get in the way of physical activity.

These are reasons to see your healthcare provider about a bone spur:

  • You discover an abnormal growth.
  • You experience pain associated with the growth.
  • You experience pain or weakness at a joint.
  • You have difficulty walking because of pain in the knees or heel.

Your healthcare provider may prescribe rest, anti-inflammatory medicines or physical therapy if the spur is creating problems for you. These noninvasive treatments usually are effective in treating the bone spur.

In rare instances, surgery may be recommended if the spur and resulting inflammation are creating serious physical problems like prohibiting walking, and the spur is not responding to other forms of treatment.

Gout

What is gout?

Gout is a health problem that causes inflamed, painful joints. The symptoms are caused by deposits of urate crystals at the joints. Gout used to be associated with kings who overindulged in rich food and wine. In truth, anyone can get gout. Gout affects more men than women. It is often linked with obesity, high blood pressure, high levels of lipids in the blood (hyperlipidemia), and diabetes.

What causes gout?

Gout is caused by monosodium urate crystal deposits in the joints. This is due to an excess of uric acid in the body. Too much uric acid may be caused by several things. It may be caused by the body making too much uric acid. Or the kidneys may not get rid of enough uric acid. It may also be caused by eating a lot of foods that are high in purines. Purines turn into uric acid in the body.

Foods high in purines include:

  • Alcoholic drinks and sugary drinks high in fructose
  • Certain meats, such as game meats, kidney, brains, and liver
  • Dried beans and dried peas
  • Seafood, such as anchovies, herring, scallops, sardines, and mackerel

Gout attacks may be triggered by any of the following:

  • Drinking alcohol
  • Eating a lot of protein-rich foods
  • Emotional stress
  • Fatigue
  • Illness
  • Minor surgery

Who is at risk for gout?

You are at higher risk for gout if you:

  • Are a man
  • Are a postmenopausal woman
  • Have kidney disease
  • Have high blood pressure, high cholesterol, or diabetes
  • Have family members with gout

What are the symptoms of gout?

Gout causes sudden, recurrent attacks of symptoms that often occur without warning. Severe, chronic gout may lead to deformity. Symptoms can occur a bit differently in each person. Common symptoms include:

  • Chills
  • Fever
  • General feeling of illness
  • Hard lumps of urate crystal deposits under the skin (tophi)
  • Severe, sudden pain in one or more joints, most often the joint in the big toe
  • Skin that is red or purple, tight, and shiny over the joint
  • Swollen joint(s)
  • Warmth in the joint area

Some symptoms of gout can be like other health conditions. Make sure to see your healthcare provider for a diagnosis.

How is gout diagnosed?

The process starts with a medical history and a physical exam. A fluid sample may be taken from the joint and checked for urate crystals.

How is gout treated?

Treatment will depend on your symptoms, your age, and your general health. It will also depend on how severe the condition is. Treatment may include:

  • Avoiding alcoholic drinks
  • Colchicine, an oral or IV medicine to relieve pain and inflammation
  • Corticosteroids to reduce inflammation
  • Drinking more nonalcoholic fluids
  • Eating less protein-rich foods
  • Medicine to block production of uric acid in the body
  • Medicine to lower the uric acid level in the blood
  • Nonsteroidal anti-inflammatory medicines to relieve pain and inflammation
  • Surgery to remove extremely large tophi
  • Weight loss, if obesity is an issue

Talk with your healthcare provider about the risks, benefits, and possible side effects of all medicines.

What are the complications of gout?

People with gout have a higher risk for kidney stones, due to crystal deposits in the kidneys. They can also have kidney damage. Crystal deposits in the joints can cause some disability due to stiffness and pain.

Living with gout

You can reduce the risk of future flare-ups of gout and decrease their severity by taking medicine as prescribed. If you are given medicine to take when a flare-up occurs, it is best to start taking it at the first sign of symptoms. Or get medical attention at the first sign of symptoms. To help prevent episodes of gout:

  • Talk with your healthcare provider before taking any new medicine, including over-the-counter medicines
  • Drink plenty of water
  • Don’t drink alcohol
  • Exercise regularly
  • Lose weight if needed
  • Don’t eat foods that are high in purines

When should I call my health care provider?

If your symptoms get worse or you have new symptoms, let your healthcare provider know.

Key points about gout

  • Gout causes inflamed, painful joints due to urate crystal deposits at the joints.
  • Gout can also cause urate crystal deposits that cause lumps under the skin.
  • Gout can be triggered by eating foods high in purines and drinking alcohol.
  • Treatment of gout is aimed at reducing pain and the risk of future flare-ups.
  • Gout can be managed with medicines and lifestyle changes.

Next steps

Before you agree to the test or the procedure make sure you know:

  • The name of the test or procedure
  • The reason you are having the test or procedure
  • What results to expect and what they mean
  • The risks and benefits of the test or procedure
  • What the possible side effects or complications are
  • When and where you are to have the test or procedure
  • Who will do the test or procedure and what that person’s qualifications are
  • What would happen if you did not have the test or procedure
  • Any alternative tests or procedures to think about
  • When and how will you get the results
  • Who to call after the test or procedure if you have questions or problems
  • How much will you have to pay for the test or procedure