Understanding Foot and Ankle Pain
A foot or ankle injury is a break or stress fracture of one of the bones. A bone bruise is a firm or swollen area on the skin caused by damage to the underlying bone. This can be a painful lump on the site of the injury. Subluxation or dislocation of the joint or of a tendon is a condition where the tendon no longer runs in its normal groove. This can be detected by a snap or pop at the time of injury, pain and swelling. Tendinitis is an inflammation of a tendon and can cause pain and swelling. A torn or ruptured tendon can also cause pain and swelling in a joint. It may be difficult to move the part of the body if the tendon is completely ruptured. A joint sprain is an injury to a ligament caused by a twisting or impact injury to the joint. A ligament is a rope-like structure which connects two bones together. A sprain is graded on a scale of one to three depending on the extent of the injury. A grade one sprain is a partial tear with mild pain and swelling. A grade two sprain is a near complete tear with moderate to severe pain and swelling. A grade three sprain is a complete tear of the ligament with severe pain, swelling, and joint instability. An injury to the articular cartilage can cause pain and swelling in the joint and may be detected by abnormal clicking or giving way of the joint. A joint cartilage injury may increase the likelihood of getting arthritis in the joint in later life. Ankle injuries include both sprains and fractures of the bone. A sprain is a common injury that involves damage to ligaments when they are stretched beyond their normal range. It is graded in a similar way to a joint sprain with the same criteria. A fracture of a bone in the ankle is usually more severe than a sprain and may require the bone to be put back into position and immobilized using a cast. This is often the case with footballers with fifth metatarsal fractures.
The ankle joint is made up of three bones: the tibia (shin), the fibula (the smaller bone in the lower leg), and the talus (a foot bone).
The foot is an extremely complex structure, made up of 26 bones and 33 joints. It also has a network of more than 100 tendons, muscles, and ligaments. The foot forms two arches (longitudinal and transverse) that are maintained by the ligaments and tendons, and by the way the bones fit together. The bones are held in place by muscles and tendons. The plantar fascia is another important structure in the foot. It is a band of fibrous connective tissue that runs from the heel to the forefoot and is important in maintaining the foot arch.
Common causes of foot pain
Flexor tendonitis: This is pain at the posterior of the ankle and may be a result of acute or chronic trauma to the posterior tibialis tendon. This tendon supports the medial arch and with overuse, it can become inflamed. This condition is often associated with a change in activity and poorly supportive shoewear.
Stress fractures: Are caused by repetitive loading of the bone. Pain is usually reported with a gradual onset and is activity-related. It is also specific to one point and can be elicited with palpation of the bone. Often a history of recent change or increase in activity is reported.
Achilles Tendinosis: This is a degeneration of the tendon’s collagen caused by repetitive microtrauma. This condition usually causes pain at the posterior heel which may radiate up into the Achilles tendon. The pain is typically mild at onset and worsens with activity. Steady-state activity can cause discomfort. Pain is often localized during specific activities like ascending stairs or performing toe raises on a single leg. The tendon may be thickened and develop nodules.
Plantar Fasciitis: The pain is typically in the medial plantar heel and is described as sharp and aching. It is often worse in the morning and after prolonged sitting. It is also associated with an increase in weight-bearing activity.
Overuse conditions—the most common causes of foot pain—are due to repetitive microtrauma to the tendons, bones, and joints. This is sometimes difficult for the patient to recall the event that led to the onset of the pain. The symptoms often have a delayed onset and are associated with increased activity. The specific conditions are:
Common causes of ankle pain
The information referred to above is helpful but having an accurate diagnosis of the cause of ankle pain is even more helpful. This is due to the fact that different causes of ankle pain are treated differently. The exact same injury can vary from patient to patient. For example, the most common injury, an ankle sprain, can vary in severity. There is also the speculation that some ankle sprains may in fact be an undiagnosed fracture. A similar feeling of pain on the outside of the ankle may be caused by the irritation of the peroneal tendons in what is known as peroneal tendonitis. With such great variation in the severity of ankle injuries, and with different causes of the same symptoms, it is best to see a foot and ankle surgeon for a proper diagnosis and treatment plan.
The most common causes of ankle pain can be traced to a mishap that caused an injury. A sprained ankle is a very common cause of ankle pain. Even a slight sprain causes the ligaments on the outside of the ankle to be stretched, and in severe cases, these ligaments may be torn. A fracture, which is a break in one or more of the bones, is another common cause of ankle pain. Those who are less active may experience pain and swelling in the ankles from arthritis. Another common cause of ankle pain is tendonitis. This is the irritation and inflammation of one or more tendons. Tendons are thick, fibrous cords that connect muscle to bone. When they become inflamed, it can cause pain and swelling in the affected area. A more unusual cause of ankle pain is nerve entrapment. This is the compression of a nerve which causes pain to nearby areas.
Differentiating between foot and ankle pain
Well, gentlemen, my initial reaction to the question was the same as yours. Pain is pain. To be honest, the best definition I have come across is an article produced by Egwu MO, Cook J, and O’Donnell P in the ninth volume of “The Foot” in 2007, who stated that the lower limb can be divided into the rear foot, the mid-foot, and the forefoot. They then simplified foot pain as being impossible for a non-podiatrist to define, as the large amount of muscle tendons and ligaments in the area will lead to difficulty in sourcing and locating the pain through the symptom it produces (Egwu MO, 2007). Dishal and Kondisko in 1995 then mentioned that this confusing referral of pain in the foot could often lead to misdiagnosis in the initial cause of the problem in the more proximal areas of the leg or knee (Dishal, 1995).
Foot and ankle pain are very different. Wrong. Pain is pain, it just depends on the degree and intensity of pain suffered. That is what I thought when I studied to do my post-graduate qualification in sports physiotherapy. However, as I delved further into the area, I discovered that the gentleman I was treating had done his law degree and argument was his forte. But it got me thinking, was there a difference between foot and ankle pain? It is an argument I have had with many clients in my career, here is my take on it.
Home Remedies for Foot Pain
Those methods given are proven and simple to do. And also, they don’t cost you much. So why not give them a try?
And the last method is to wear proper footwear. Always wear the right shoes for any occasion. Try to avoid shoes that are too high-heeled and narrow. If you are going on long walks, shoes with good support are best for your feet.
The fourth method is to stretch and strengthen your feet. This method may help prevent foot pain from occurring. Do some exercises with your feet by picking up small objects using your toes. Maybe it sounds silly, but this exercise is effective in preventing any pain in your feet. Then try this exercise for the Achilles tendon. Stand facing a wall with your hands on the wall. Place one leg straight back and the other leg should be bent. Then lean forward.
The third method is to use over-the-counter pain relievers. Sometimes when your foot pain strikes suddenly, you can try this method if you are at work. Go buy any over-the-counter pain relievers to relieve your pain. This method can’t be used for long-term treatment.
The second method is to apply ice or cold packs. By applying ice or cold packs to your foot, you may help reduce any swelling and relieve your pain. Try this straight after you have been on your feet and wearing shoes. Then do an ice massage. Fill a paper cup with water and freeze it.
The first method is to rest and elevate your feet. It is said that resting and elevating your feet can relieve pressure and reduce swelling. Is there any better way to rest your foot than by lying down and elevating your feet? This step is simple and can be done by anyone. You’ll be surprised at how doing nothing for a while can make you feel better.
Here is the part about solutions using home remedies for foot pain (2). This part provides beneficial information about how to relieve your foot pain with simple steps. These methods are proven by lots of people and easy to do.
Rest and elevate your feet
In medical terms, pain is a sign that something is wrong with the body. If it is due to an injury that you have just sustained, this usually means that some soft tissue has been damaged. By resting and not putting any weight on the area, you are following an implicit directive from your body. A bad sprain or a fracture will hurt too much to walk on. If there is no pain with weight bearing, then you can do so. You can tell the difference between a major and a minor injury because the minor ones heal quicker and the pain will be short-lived. Ideally, you should aim to spend at least 40% of the day off the injured leg. The best way to do this is to lie down with the area in question elevated so that it is higher than your heart. This is important for swollen ankles. By doing this, there will be less blood in the area and hence less swelling and pain. (Although less pressure would mean less pain, the slight discomfort of having your leg in the same position for a long time usually balances this out!) The best time to do this is generally in the evening after work and during the day on weekends. If you have an injury that is likely to stop you from going to work, aim to do this as much as possible over the first few days. You might want to combine it with a course of treatment that involves a lot of ice and a little compression!
Apply ice or cold packs
There are several ways you can apply ice – an ice massage, a commercially available ice pack or bag of frozen peas, or you can make your own ice pack by freezing water in a paper cup. Try each method and choose the one that works best for you. Before applying the ice pack, wrap it in a towel to avoid ice burn. Ice massage is the most effective method – it is frugal, less messy and can be done at a time and place that is convenient to you. Fill a small paper cup with water and freeze. Tear off the top part of the cup so that the ice is showing. Instruct the person to sit in a comfortable chair. Rub the ice over the sore area for 5-10 minutes, applying firm, steady pressure. Do not hold the ice still as this can cause an ice burn. Finish the massage when the area becomes numb and has less pain. A good tip is to massage the whole ankle or both feet, this way you can compare the sore area with the unaffected side. An ice massage effectively reduces pain and inflammation and can also be used after activity to prevent an increase in pain. This method is not suitable for those with circulatory problems or hypersensitivity to cold.
Use over-the-counter pain relievers
There are athletes or individuals with chronic pain conditions who may require NSAIDs in order to function without pain. These individuals may need to consult their medical doctor about a prescription NSAID, which has the potential to cause adverse effects, and would require careful monitoring by a medical professional. Always be sure to consult with a medical professional before starting any medication.
A study showed that diclofenac gel was more effective than placebo in the treatment of acute heel pain. This medication is an NSAID that is available only by prescription. Be sure to consult with your foot specialist if you have any interest in this medication.
NSAIDs such as ibuprofen and naproxen are a class of medication that has been found to be effective for treating conditions caused by pain and inflammation, such as tendonitis, and most likely in fibromyalgia. These medications work by reducing the body’s production of prostaglandin, an enzyme that is released in response to injury or in certain disease states, and causes pain and inflammation. It is important to understand the cause of your pain to ensure that NSAIDs are appropriate for your condition. If you are uncertain about whether NSAIDs are appropriate for you, or are concerned about possible side effects, you should consult your medical doctor.
If you have a foot or ankle injury with severe pain and swelling, you should seek medical care to rule out a fracture or other serious injury. Once you have had an x-ray and the fracture or serious injury has been ruled out, your podiatrist may recommend an over-the-counter or prescription nonsteroidal anti-inflammatory drug (NSAID) to help relieve pain and inflammation.
Stretch and strengthen your feet
Strengthening of the foot is also an important aspect for recovery, mainly to prevent future occurrences. Tendon Eccentric Exercises include lowering both heels off a step and raising up on the toes with the knees straight and also with the knees bent. These are done using both feet. An easy way to strengthen the foot for prevention is to scrunch up a towel with the toes. Finally, marble pickup is an exercise used to strengthen by picking up a marble off the ground and placing it into a cup with the toes. These exercises should also be done 10 times for 10 seconds.
Another good exercise is to take a towel and loop it around the ball of the foot. Keeping the knee straight, the knee and towel are pulled towards the chest. This is also held for 10 seconds and repeated 10 times.
One of the best exercises is to sit in a chair with the ankle of the foot to be stretched on the opposite knee. Then, using the hand on the same side as the ankle to be stretched, the toes are pulled backward toward the shin until a stretch is felt in the arch or the back of the ankle. The stretch is held for 10 seconds, and the process is repeated 10 times. There are many variations of this exercise with the same concept.
Stretching the plantar fascia is an important aspect of the recovery process. There are exercises that will work the entire lower extremity, but in order to get the best results, they should be performed at least twice a day. It is not necessary to do all of them, but rather just experiment and find which ones work best for you.
Wear proper footwear
One of the top means of preventing foot pain is by wearing good shoes. The right shoe will help support your feet better and can prevent certain foot conditions and foot pain. There are certain features of shoes that make them good for your feet. A wider toe box is one of these features. A wider toe box will help prevent ingrown toenails and other conditions that cause pain in the front of the foot. The shoe should not collapse in half and should bend in the toes, allowing your foot to take off. This can be tested by taking any shoe you are considering and trying to fold it in half. The arch of the shoe should match the natural arch of your foot. This will prevent pain from flat feet or high arches. You can test the arch of the shoe by taking the insole out of the shoe and putting it on the floor. Step on the insole and see if your foot sits in the insole properly. If you can see the insole, it probably doesn’t match the natural arch of your foot. Shoes that lace up can also help support the foot better and prevent pain in the long run.
Home Remedies for Ankle Pain
After the first 24 hours have passed, it is important to maintain flexibility in the ankle. Start by writing the alphabet in the air with your toes for a minute or two, two to three times a day. This is helpful in maintaining flexibility and range of motion in the ankle. Then, using a towel, place it around the ball of the foot and pull the forefoot towards you while keeping the knee straight. This stretches the calf, which has an effect on the heel cord and the ankle joint. Hold this position for 15-20 seconds and repeat this exercise 4 times on both legs. Another effective stretching exercise is to stand on a step and drop the heel of the injured leg off the edge of the step. Apply pressure to the injured limb and allow the heel to slowly drop down, maintaining pressure, putting the foot in a stretched position. This stretches out the back of the heel and the lower leg. Hold for 15 seconds and repeat 4 times. These exercises and stretches are beneficial for the ankle but should not be performed with pain. If pain persists, stop the exercise and consult a doctor.
Rest and avoid weight-bearing activities
Don’t believe the old wives take on RICE (rest, ice, compression, and elevation). Everyone knows that it doesn’t exist anymore, and what we have from the research is that the rest is by the far the most essential part of that equation. Resting the ankle allows the body to off-load the damaged structure, so it can start repairing. If the structure is still being compressed and loaded as if happens if weight is still being put on the ankle, the body can’t off-load that structure and the repair takes much longer. With rest, it is a way of using basic biology to assure self-healing and repair.
In the acute stage of injury, especially if inflammation is present, you should rest your ankle. Make absolutely sure you give it time to heal. All healing takes time; it’s just that we want to get the right balance between healing well and returning activity. Resting the injured ankle effectively means avoiding weight-bearing it at all, maybe even keeping it elevated for some or all of the time. The only way that rest can be properly effective is by using crutches and taking the weight off the ankle. If you try to hobble about because you haven’t got any, or don’t want to use crutches, you put most of your body weight onto the injured ankle. The result is that it can take four times as long for the injury to mend because, tissues in the ankle are weak and starting to strengthen, and the increased compressive forces can cause more damage right on the point when the tissues are actually repair. As well as rest, completely avoid activities, especially walking on uneven ground or any of those that caused the injury, otherwise you may find that taking one step forwards and two back is all you are doing. Ultimately a period of complete rest and time away from sport activity is the best thing to kick-start your recovery and get you back to being active.
Apply heat or cold therapy
One of the best ways to apply heat at home is to purchase a heating pad. Another simple method is to heat a damp towel in a microwave or a towel dipped in hot water (be careful wringing the water out). There is also a fairly recent product that is an herbal heat bag that can be heated in a microwave. Some find that the odor of these bags to be quite intense. You can apply heat for about 20 minutes and repeat 3x a day. Do not apply heat if there is swelling as it can make it worse. The simplest method is to purchase a pack of frozen peas to use as a flexible ice pack. Applying this to the injured area can mold the pack to the shape of the foot or ankle. You can also ice massage the injured area, which involves moving the ice over the site of pain in a circular motion for 10-15 minutes. A more traditional method is to wet a towel and wrap it around a plastic bag of ice cubes so that the cold water will not drip on the skin. You can ice for about 15-20 minutes and repeat 3x a day. Remember to elevate the area that is being treated to reduce swelling.
Perform ankle exercises and stretches
It is recommended that you continue with these exercises long after the ankle pain has gone for maximum injury prevention. Like all forms of exercise to relieve ankle pain, it is recommended that you consult a doctor or physical therapist for the best information on what exercises are ideal for your specific injury.
Next, and possibly the most important type of exercise for an injured ankle, is proprioception. This is a form of exercise that works on the position and movement of the ankle. This is very important because it is often a lack of proprioception that is the cause for many ankle sprains. A simple exercise to begin with would be to practice standing on the injured ankle without letting the other foot touch the ground. At first, you may find that you can’t do this for more than a couple of seconds because your ankle will feel wobbly and you may not have good balance. Over time and with practice, it will become easier and you can then move onto more difficult exercises such as using a wobble board or balance disc. These devices are designed to be as unsteady as possible so that your ankle has to work very hard to maintain balance and therefore improving its stability.
You can move onto active range of motion exercises when the pain goes down and you have better control of your balance. These exercises involve moving your ankle in different positions using your muscles to move the joint. An example of this would be to trace the alphabet in capital letters with your big toe, keeping the movements as large as possible.
Another example of a PROM exercise would be to sit with your ankle crossed over your knee and, using your hand, move your ankle into different positions that it wouldn’t comfortably go on its own. Remember, when doing these exercises, only go as far as is comfortable and do not try to force the joint into a position that is painful.
In the beginning, you may want to start with some passive range of motion (PROM) exercises, which are exactly what they sound like. You want to move your ankle to the extent of its range of motion using your own physical ability. An example of a PROM exercise would be to place a resistive band around the ball of your foot and, while keeping your leg still, pull your foot up towards you and then push it back down. This will work on the range of motion of your ankle without putting too much strain on the joint.
When your ankle pain has subsided enough to start the healing process, you should begin some exercise and stretching. This will work to return your ankle’s range of motion, strength, flexibility, and stability. With an injured ankle, it is best to start slow and gradually increase the intensity of the exercise.
Use ankle supports or braces
Lace-up ankle braces are the most commonly used braces as they provide equal support to the full ankle. Hinged braces are more supportive and are ideal for moderate to severe ankle injuries. The purpose of an ankle brace is to limit the movement of the ankle joint and increase the stability of the joint. It also reduces the chances of re-injury. So, one can heal more rapidly and enjoy the sports or activities they love to do. Braces can be worn inside the shoes and during daily activities. Excessive use of them should be avoided, as it may decrease muscle strength. We recommend seeking the opinions of experienced healthcare providers before using ankle braces and starting with less supportive braces, then changing to a more supportive one.
One of the most effective ways to reduce pain and increase the strength of the ankle joint is support, such as ankle braces or taping. Ankle supports are very effective in conditions of arthritis and swollen ankles due to sprains. Ankle taping is less effective than ankle braces as it provides more compression than taping. Ankle braces provide a good amount of support without obstructing joint movement. They come in different shapes and sizes, such as lace-up ankle braces, stirrup braces, hinged braces, etc., and should be chosen according to the severity of the injury and based on the opinion of healthcare providers.
Ankle joint is a very important joint for the mobility of the human body. It carries the load of the whole body and the movement of our body is dependent on it. The main bones of the ankle joint are the tibia and fibula, which form a socket in which the talus bone moves. Due to the importance of this joint, it is more susceptible to pain and injuries. The main causes of ankle pain may be due to ill-fitting shoes, sudden twists and turns, overweight, or sometimes repeated sprains.
Maintain a healthy weight and exercise regularly
Maintain a healthy weight and exercise regularly. Maintaining a healthy weight is a natural preventive for ankle pain. Being overweight increases the risk of developing a degenerative or chronic condition in the foot and ankle. Excess weight gain can also accelerate arthritis in the weight-bearing joints. Studies have shown that obesity causes increased pain in the foot and ankle. Obese patients have even reported more foot and ankle pain. It is estimated that for every pound gained, there is added three pounds of stress applied to the knee and up to six pounds of stress applied to the ankle. Walking can be painful and difficult, further limiting an obese person from physical activity. Exercise is an important adjunct to weight control, because it increases metabolism and burns calories. Regular exercise, such as walking or biking, can be beneficial in reducing fat and overall weight. Think of the last time you blew up an inflatable raft. Over-inflation causes added pressure and stress to the seams. This same principle applies to carrying extra weight. Overweight individuals are more likely to injure the muscles, tendons, and bones in their feet and ankles.
When to Seek Medical Help
Generally, foot and ankle pain will go away on its own, but there are certain signs that indicate the need for medical attention. These include: – Pain that is debilitating and is not relieved by rest or over-the-counter medication. – Sudden onset of intense pain. – Inability to put weight on the foot, stand or walk. – Swelling that is accompanied by redness, heat or fever. – A visible deformity or protrusion of bone. – Pain that is not alleviated by ice, elevation and reduction of weight-bearing activity within 48 hours. – Pain that is recurrent or persists for more than 72 hours. – Numbness and tingling. – Pain associated with loss of appetite, weight loss, flu-like symptoms or a general feeling of malaise. If any of these signs are present, then a consultation with a healthcare professional is recommended. Visualization of the inside of the foot and ankle using x-rays, a CT scan or MRI may be required, and the prescription of medical treatment may follow. A detailed explanation of what specifically is wrong with the foot or ankle and the expected outcome of treatment is always given by healthcare professionals. In cases of serious injury or disease, a specialist in foot and ankle surgery may be recommended. Points to remember are that the foot is a very complicated structure, with each foot having 28 bones and 30 joints, and that the importance of our feet in everyday life cannot be underestimated. An accurate diagnosis and medical treatment are essential in maintaining the best possible function and comfort from our feet throughout our lifespan.
Signs that indicate the need for medical attention
Usually, pain and swelling following an acute injury should start to subside after 2-3 days. If there is no significant reduction in the pain and swelling, it may indicate a more serious problem that may require further investigation.
For diabetics with foot and ankle pain, a more cautious approach is required due to their compromised healing ability and increased risk of infection. All foot and ankle injuries in diabetics should be seen by a physician.
If you notice a lump, bump, or any disfigurement around your ankle or foot, this could be a sign of a more serious problem. It may indicate a soft tissue or bony problem and should be evaluated by a healthcare professional.
Any alteration in the way you walk is also a sign that should not be ignored. If you find yourself walking differently because of your foot ailment, it can cause stress on other parts of the foot and/or body, leading to the development of secondary problems.
If your pain continues or worsens, it is a clear indication that something is not right. Pain that is unresponsive to changes in footwear, rest, ice, compression, and elevation, or pain that continues after 5-7 days of the onset of the injury, all indicate that you should seek medical advice.
Importance of consulting a healthcare professional
It has been shown that care from a general practitioner can provide better improvement of symptoms and decrease in foot pain/disability of musculoskeletal foot disorders over 2 years compared to self-referral to a podiatrist. This was a surprising result to the researchers who expected that a podiatrist would show better results. This can be attributed to the fact that podiatrists may be limited to treatment options available in the public health system and would not have an alliance with a general practitioner in some cases to collaborate on the best treatment for the patient.
A good example of this is syndesmosis midfoot pain often being diagnosed as a sprain of the midfoot or a simple ankle sprain. Both of which could lead to further injury of the condition if the person were to continue their activities on it. A health professional can also give you an estimation of time required for recovery and any specifics to your condition that you should keep in mind as well as advise you if there are particular activities you should be avoiding. This is important for forming goals for return to activity and preventing re-injury of the affected area.
Consulting a healthcare professional is very important for assessment and treatment of your foot and ankle pain. They can accurately diagnose the cause of your symptoms and offer you a treatment plan, be it through medication, therapy, or in severe cases, even a surgical option. An accurate diagnosis is very important as many conditions have similar symptoms and may be incorrectly diagnosed by the untrained individual.
