Foot and Ankle Problems
Achilles tendon rupture
The Achilles tendon is a strong, flexible band of fibrous tissue that joins the muscles in the calf of the leg to the bone of the heel. The rupture, or tearing of the Achilles tendon is a serious injury that causes sudden pain behind the ankle. This injury most commonly occurs in runners or while playing sports. It is typically seen in men (30-40 years old) who are unconditioned, casual athletes.
A ‘snap’ may be heard as the rupture occurs, with extreme pain around the tendon. Swelling and bruising may also occur in this area. This will be shown by an immediate weakness of ‘push-off’ when walking. Early treatment of this injury can often lead to a quicker recovery. Anyone who suspects they have an Achilles tendon rupture should seek urgent medical attention.
An ankle fracture, also called a broken ankle, means one or more of the bones that make up the ankle are separated. It is possible that the ligaments that normally hold the ankle in position may also be damaged. There are various different types of ankle fracture and in general, the more bones that are broken, the more unstable the ankle becomes.
Ankle fractures can result in pain, swelling, bruising, and tenderness in the surrounding area. Patients may find it too painful to walk or will walk with a limp. A wide range of surgical and non-surgical treatment methods are available for ankle fractures, based on the severity of the injury.
Ankle sprains cause an injury to the ligaments around the ankle. The most common symptoms are swelling, bruising and feeling as though the joint may ‘give-way.’ The pain can be very sharp but usually decreases with time, rest, elevation, ice and compression. However, if the pain is extreme and continues for over 48 hours, it should be checked by a doctor.
Heel pain – plantar fasciitis
Plantar fasciitis is a painful foot condition involving the thick connective tissue that supports the arch of the foot. It is more common in middle-aged men and casual runners. Pain is usually felt over the heel on the bottom of the foot but may also occur also in the arch of the foot.
Symptoms are usually most severe early in the morning after sleep. During the day this pain may decrease but it often returns after sports activities or standing or walking for a long time. Basic treatment includes rest, ice, massage therapy, stretching and shoe splints. Surgery is rarely needed. About 70% of patients with plantar fasciitis also have a heel spur.
Heel spurs are closely associated with heel pain (planter fasciitis), and are a type of bone spur (an osteophyte). Heel spurs are small bone pieces that dislodge from the heel and poke out of the bone.
Although bone spurs themselves are not painful, if a heel spur hits a nerve in the foot, it can cause pain. It can be especially painful when walking or exercising first thing in the morning and towards the end of the day. Doctors diagnose heel spurs using X-rays and may also take CT scans or MRI scans of the foot for a clearer picture to determine proper treatment.
Osteoarthritis is the most common type of arthritis. Ankle osteoarthritis involves the ‘wearing-out’ the joints between the shin bone (tibia) and ankle bone (talus). This type of arthritis often follows a previous injury, such as an ankle fracture.
When it affects the ankle joint it can produce swelling, stiffness and pain, and may eventually result in joint deformity, loss of joint function, and decreased ability to walk. Initial treatment may include medication to reduce the inflammation, special shoes, and physiotherapy. Surgical treatment may be needed in some cases.
Someone with arthritis of the big toe (hallux rigidus) often feels stiffness and pain. This may become worse with motion, or when bone spurs on top of the toe joint are rubbed. Swelling and inflammation around the joint may also occur.
Since arthritis of the big toe is a progressive condition, the sooner it is diagnosed, the easier it is to treat. Non-surgical treatment may include anti-inflammatory medication, stiffer soles and wide shoes. In some cases, surgery is the only way to eliminate or reduce pain. There are several types of surgery for treatment of hallux rigidus, which can be discussed after proper diagnosis.
A Morton’s neuroma is an abnormal growth of a nerve between the toes. This condition is benign (not a cancer) but it can become a painful annoyance. Shooting pain and numbness on the ball of the foot may extend to the toes around the neuroma. A Morton’s Neuroma may also feel like a loose stone, rolling around under the foot, sometimes causing a sharp ‘click’.
Wearing suitable footwear, foot massage and the use of padded shoe inserts can reduce pain and pressure on the ball of the foot. A cortisone injection at the site of the neuroma may also help. Further treatment would involve foot surgery to release the affected nerve in Morton’s Neuroma.
A bunion is a painful bump at the base of the big toe. It occurs when the big toe leans too much towards the second toe, which can also lead to hammer toe. Bunions are commonly caused by unsuitable footwear (eg, high heels, tight shoes).
Bunions vary in size and symptoms. Skin on the bump may thicken and become inflamed, swollen and painful. A fluid filled sac (bursa) may also develop over the toe joint. An X-ray can reveal the extent of the bunion and any associated arthritis. The use of good footwear and supportive custom-made shoe inserts (orthotics) can help to ease the pain. If bunion surgery is needed, the specific operation will depend on the extent of the toe deformity.
A hammer toe occurs when the middle of the toe abnormally points upwards. This usually affects the second toe, and is often caused by a big toe bunion leaning onto the second toe. A painful callous often forms on top of the first joint in the hammer toe.
Wearing protective padding, custom-made shoe inserts (orthotics) or wider shoes can help relieve pressure on the toe. If these treatments fail to work, surgery may be needed to straighten the toe. This is usually performed in combination withbunion surgery.
Ingrown toenails are an abnormal growth of both the toenail and the surrounding tissues. Irritation from the toenail often causes swelling and inflammation of these tissues. Any pressure on the toenail will also be painful. Initial treatment involves wearing suitable footwear, regular soaking of the toe and leaving the toenail untrimmed. Infection will require antibiotics. Surgery can be used to treat ingrown toenails if they become a recurring problem and this may involve the partial or entire removal of the toenail.