Foot pain

***This material is only provided as helpful information and not as medical advice and you should consult with your Brooklyn Foot Doctor / Podiatrist for a professional diagnosis. ***
 

Pain in the rearfoot and heel

Plantar Fasciitis (Heel Spur)

Plantar Fasciitis is pain in the heel which may radiate into the arch of the foot. It is a painful condition caused by overuse of the plantar fascia (arch tendon) of the foot. The Plantar fascia is a broad, thick band of tissue that runs from under the heel to the front of the foot. Plantar fasciitis is traditionally thought to be an inflammatory condition. This is now believed to be incorrect due to the absence of inflammatory cells within the fascia. The cause of pain and dysfunction is now thought to be degeneration of the collagen fibers close to the attachment to the calcaneus (heel bone).

Plantar Fasciitis symptoms:

• Heel pain, under the heel and usually on the inside, at the origin of the attachment of the fascia.
• Pain when pressing on the inside of the heel and sometimes along the arch.
• Pain is usually worse first thing in the morning as the fascia tightens up overnight. After a few minutes it eases as the foot gets warmed up.
• As the condition becomes more severe the pain can get worse throughout the day.
• Stretching the plantar fascia may be painful.
• Sometimes there may also be pain along the outside border of the heel due to offloading the painful side of the heel by walking on the outside border of the foot. It may also be associated with the high impact of landing on the outside of the heel if you have high arched feet.
• Plantar fasciitis is common in sports which involve running, dancing or jumping. Runners who overpronate (feet rolling in or flattening) are particularly at risk as the biomechanics of the foot pronating causes additional stretching of the plantar fascia.
   

Plantar Fascia Strain

Painful condition caused by a tear (strain) in the fascia underneath the foot. The plantar fascia or arch ligament is a band that runs from under the heel to the front of the foot. A strain or rupture to this is quite common. The tear might result from trauma or may gradually occur over time.

Plantar Fascia Strain symptoms:

• Localized tenderness and pain over the plantar fascia
• A nodule /  lump in the plantar fascia which might indicate a partial rupture
   

Bruised Heel (Fat Pad Contusion)

Pain from bruising under the heel. The heel bone (calcaneus) is protected by a pad of fat. Repeated pounding of the heel can cause the fat pad to be pushed up the side of the heel leaving less of a protective layer causing heel pain. This injury is also known as Policeman's heel. It is common in sports requiring a lot of impact onto the heel. It is also common in soldiers marching up and down on the parade square.
 

Calcaneal Stress Fracture

Stress fracture of the heel bone or calcaneus. The calcaneus bone is the big heel bone at the back of the foot. Due to overuse a stress fracture can occur in the bone. It is common for soldiers who have to do a lot of marching or road runners.

Calcaneal Stress Fracture symptoms:

• Subtle, gradual onset heel pain.
• Pain is made worse by weight bearing activities.
• Pain is reproduced by squeezing the back of the heel from both sides.
   

Medial Calcaneal Nerve Entrapment (Tarsal Tunnel Syndrome)

Also known as Tarsal Tunnel Syndrome - sharp pain radiating into the arch of the foot, heel and sometimes toes. The tarsals are the long bones of the foot. Just below the bony bit on the inside of the ankle (medial malleolus) is a passage where two nerves run. These nerves are called the medial and lateral plantar nerves. If you overpronate (your foot rolls in when you walk or run) then pressure is put on these nerves which can become inflamed causing tarsal tunnel syndrome.

Tarsal Tunnel Syndrome symptoms:

• Pain (possibly sharp) radiating into the arch of the foot, heal and sometimes the toes.
• Pins and needles or numbness may be felt in the sole of the foot.
• Pain when running.
• Pain when standing for long periods of time.
• Tapping the nerve (just behind the medial malleolus) may reproduce pain.
   

Achilles bursitis (Retrocalcaneal Bursitis)

Pain at the back of the heel caused by in inflamed bursa. Achilles tendon bursitis is a common foot pain in athletes, particularly runners. It can often be mistaken for Achilles tendinitis or can also occur in conjunction with Achilles tendinitis. A bursa is a small sack of fluid that goes between a tendon and a bone in the feet to help the tendon move smoothly over the bone. The retrocalcaneal bursa in situated in the feet between the Achilles tendon and the calcaneus (heel bone). With repeated trauma the bursa can become inflamed. It is possible for the athlete to have both Achilles tendinitis and Achilles tendon bursitis at the same time (Haglund's syndrome).

Retrocalcaneal Bursitis symptoms:

• Pain at the back of the heels especially when running uphill or on soft surfaces.
• Tenderness and swelling which might make it difficult to wear certain shoes on the feet.
• When pressing fingers in both sides of the heel a spongy resistance may be felt.
   

 

Bursitis under the Calcaneus (Heel) Bone

Between the heel bone and fat pad there is a small sack of fluid called a bursa. If this bursa becomes inflamed through over use then pain will result.
 

Blisters

Blisters are caused by friction from shoes or clothing which rubs repeatedly on the skin causing friction burns. When the outer skin layer separates from the inner layers the created space between the layers fills up with lymph fluid.

Pain in the middle of the foot

Navicular Stress Fracture

The navicular bone is a bone in the ankle which sits on top of the calcaneus or heel bone. A stress fracture of this bone is one of the more common stress fractures seen in the feet of athletes, especially those involved in sprinting, jumping or hurdling.

Navicular Stress Fracture symptoms:

• Midfoot ache associated with exercise.
• Pain goes away quickly with rest, but returns during exercise.
• Pain when the thumb is pressed into the top of the foot over the navicular (called the N spot).
• An X-Ray may or may not show the appearance of a stress fracture, therefore a bone scan or MRI may be needed.

Extensor Tendinopathy / Inflammation

This is pain with possible swelling on the top of the foot. The tendons which straighten the toes run along the top of the foot and are known as the extensor tendons. They are the tibialis anterior, extensor hallucis longus, extensor hallucis brevis, extensor digitorum longus and extensor digitorum brevis. These tendons can become inflamed causing pain and swelling. Inflammation of the tibialis anterior is most common but inflammation of the extensor digitorum muscles is rare.

Extensor Tendinopathy symptoms:

• Pain on the top of the foot (dorsal foot pain).
• Diffuse swelling on the top of the foot.
• Pain along the top of the foot which is worse during running.
• Pain when the tendons are passively stretched.

Inflammation of Flexor Tendons of the Toes

Midfoot pain - less common than extensor tendinitis but more painful and disabling. It is more likely to occur in dancers. The tendons which bend the toes originate from two muscles of the lower leg: the Flexor digitorum longus and the Flexor hallucis longus muscles. They run down the inside of the ankle and under the foot to the toes and are known as the flexor tendons.

Flexor Tendinitis symptoms:

• Tenderness along the course of the tendons.
• Pain when the big toe is bent against resistance.
• Pain on the inside back of the ankle.
• Pain in the arch of the foot.

Plantar fascia strain

Painful condition caused by a tear (strain) in the fascia underneath the foot. The plantar fascia or arch ligament is a band that runs from under the heel to the front of the foot. A strain or rupture to this is quite common. The tear might result from trauma or may gradually occur over time.

Plantar Fascia Strain symptoms:

• Localized tenderness and pain over the plantar fascia
• A nodule /  lump in the plantar fascia which might indicate a partial rupture

Lateral Plantar Nerve Entrapment

The lateral plantar nerve passes through the tarsal tunnel between the abductor hallucis muscle and the quadratus planus muscle. This nerve can become trapped causing pain under the heel (medial aspect) and up into the inside of the ankle.

Stress fractures

A stress fracture can occur as a result of prolonged repeated loads on the legs. Long distance runners are susceptible to this type of injury. A stress fracture in athletes occurs mainly in the lower leg and foot (in the calcaneus, navicular and metatarsal bones). A stress fracture of the 2nd or 3rd metatarsal bone is sometimes called a 'march fracture' because soldiers running in boots often get it! Often an x-ray of the injured bone will not show any sign of fracture until the fracture has actually started to heal (2-3 weeks later).

Stress fracture symptoms:

• Pain in the forefoot which gets worse during activity
• Pain in the forefoot caused by running
• Tenderness and swelling at a point on the bone.

Stress fracture of the talus

Stress fracture in the talus bone causing gradual onset pain on the outside of the ankle. The Talus bone is the bone at the top of the ankle which the tibia or shin bone sits on. Stress fractures of the talus are sometimes seen in footballers and track and field athletes. The talus is more susceptible to developing a stress fracture when the ankle is repeatedly overpronated and plantar flexed (or rolling on / flattening at the same time as pointing the foot downwards). This movement is also seen in pole vaulters who plant the pole too late making the foot too far forward at take off.

Talar Stress Fracture symptoms:

• Gradual onset pain on the outside of the ankle.
• Pain is worse during running.
• Tenderness and possible swelling over the sinus tarsi (a small canal where nerves pass.)
• Bone scans and CT scans may confirm the diagnosis.

Sinus Tarsi Syndrome

Poorly localized pain in front of the bony bit on the outside of the ankle (lateral malleolus). The sinus tarsi is a small osseous canal which runs into the ankle under the talus bone. Damage to the sinus tarsi can be caused from overuse in conjunction with overpronation or poor foot biomechanics, however the majority of patients have suffered an inversion ankle sprain at some point in the past. The sinus tarsi has a lot of synovial fluid / tissue which becomes inflamed. This condition may also occur with inflammatory conditions such as gout or osteoarthritis.

Sinus Tarsi Syndrome symptoms:

• Poorly localized pain just in front of the bony bit on the outside of the ankle (lateral malleolus).
• Tenderness on the outside of the ankle - at the opening of the sinus tarsi.
• Passive inversion of the subtalar joint (joint under the talus).
• An anesthetic injection into the painful sinus tarsi will confirm the diagnosis by relieving pain and allowing normal function.
• An MRI scan my show excessive fluid in the sinus tarsi.

Tarsal Coalition

Tarsal coalition is a congenital (born with it) fusion (sticking together) of the foot bones. The most common joints to be affected are the calcaneonavicular joint and the talocalcaneal joint. It usually affects adolescents as the fibrous or cartilaginous joints between the bones ossify (turn to bone) and harden causing a decreased range of motion in the rearfoot causing strain on the ankle joint.

Tarsal Coalition symptoms:

• Pain in the midfoot in adolescents after hard training or activity.
• This injury may become obvious after an ankle sprain when the pain does not appear to get better.
• Reduced joint movement in the ankle.
• An X-ray may show up an osseous coalition and an MRI may show up a fibrous one.

Midtarsal Joint Sprain

The midtarsal joint is also known as Chopart's joint and consists of the talonavicular joint (between the talus and navicular bones) and calcaneocuboid joint (between the calcaeus or heel bone and the cuboid bone). Injury to the midtarsal joint is rare but is more likely seen in gymnasts, football players and sports involving jumping.

Calcaneocuboid Injury symptoms:

• Pain in the outside middle of the foot which may come on after an ankle sprain or similar injury.
• Pain and swelling on the outside top of the joint.
• Placing the foot into inversion may cause pain.
• An MRI scan may be done to confirm the diagnosis.
• An X-ray can be done to rule out a fracture.

Bifurcate Ligament Injury symptoms:

• Pain comes after a severe ankle injury in conjunction with a fracture of the anterior process of the calcaneus.
• Pain on the outside middle of the foot.
• Pain is made worse by plantar flexion and supinating the foot at the same time (pointing the foot down and rolling it outwards).
• An MRI scan can confirm the diagnosis and X-rays should be done to identify a fracture, particularly of the anterior process of the heel bone.

Cuboid Syndrome

Dislocation of the cuboid causing pain when weight bearing on the outside of the foot. Cuboid syndrome occurs when the peroneus longus applies excess traction onto the cuboid bone causing it to partially dislocate. The injury is often associated with peroneal tendinopathy.

Cuboid Syndrome symptoms:

• Pain when weight bearing on the outside of the foot.
• This may follow an ankle inversion sprain.
• Many patients with this condition will significantly overpronate feet (feet roll in or flatten)

Abductor Hallucis Strain

Pain along the inside arch of the foot. The abductor hallucis muscle lies along the inside of the foot. It originates at the calcaneus bone at the back of the foot and inserts on the side of the big toe. It flexes and abducts the big toe and supports the medial (inside) arch of the foot.

Abductor Hallucis symptoms:

• Pain along the inside arch of the foot.
• Person may overpronate (feet roll in and flatten).
• Pain and tenderness when pressing into the foot along the tendon of the abductor hallucis muscle.

Lisfranc's Injury (fracture / dislocation)

A serious injury of the tarsometatarsal joints in the foot which should always be considered if midfoot sprain is suspected. Lisfranc's injury or Lisfranc's fracture-dislocation is rare in sport but if left untreated can have very severe consequences. If a case of midfoot sprain is suspected then Lisfranc's injury should also be considered. The term Lisfranc's joint refers to the tarsometatarsal joints where the long bones (tarsals) in the foot meet the smaller bones (metatarsals) of the toes.

Lisfranc's Injury symptoms:

• Midfoot pain with difficulty placing weight on the foot.
• Some bone deformity, although this is not always the case.
• Swelling on the top of the foot.
• Tenderness on the joints.
• Pressing the foot upwards into plantar flexion causes pain, especially if rotated at the same time.

Inflammation / Rupture of Peroneus Brevis Tendon

Pain at a specific point on the outside of the foot. The tendon of the Peroneus Brevis muscle helps you go up on your toes and also pulls the outside of the foot upwards.  Its tendon attaches to the fifth metatarsal on the outside of the foot. This muscle can get very tight in runners especially those who run a lot on roads.

Peroneus Brevis Tendon Pain symptoms:

The symptoms generally are pain at the point of attachment to the foot.

Tibialis Posterior Tendinopathy

Pain on the inside of the ankle or at the attachment of the tendon to the navicular bone in the boot. The tibialis posterior muscle comes from behind the shin bone (tibia) and runs into a tendon that passes behind the bony bit on the inside of the ankle (medial malleolus). Inflammation can occur around the medial malleolus and further down under the foot where the tendon attaches. If you overpronate you are more likely to suffer from this injury.

Athletes that are involved in sports where the foot rolls in a lot such as speed skating or running on tight bends are also more prone to this injury.

Tibialis Posterior Syndrome symptoms:

• Pain over the attachment of the tendon to the navicular bone in the foot.
• Pain when the tendon slides in the sheath during exercise.
• Swelling around the medial malleolus (bony bit on the inside of the ankle).
   

Peroneal Tendinopathy / Tendinitis

Pain on the outside of the ankle and heel caused by inflammation of the peroneal tendons. The muscles act to plantar flex the foot (point foot downwards) and evert the foot.

Peroneal Tendinopathy symptoms:

• Pain and swelling on the outside of the ankle or heel.
• Pain is worse during activity and gets better with rest.
• Pain when pressing in on the peroneal tendons.
• Pain when the foot is passively inverted and with resisted eversion.
• Calf muscles may be tight.

Blisters

Blisters are caused by friction from shoes or clothing which rubs repeatedly on the skin causing friction burns. When the outer skin layer separates from the inner layers the created space between the layers fills up with lymph fluid.

Forefoot pain

Corns and Calluses

Corns and calluses occur when there is an excess or thickening of hard skin. Poor foot biomechanics can cause excess pressure on certain areas of the foot. This excess pressure causes hypertrophy of the skin (excess skin growing).

Pes Cavus (Claw Foot)

A claw foot is a genetic defect in the foot with a high arch. Claw feet are inflexible. This will often be associated with very tight calf muscles at the back of the lower leg.

Claw foot symptoms:

• Pain in the feet during running.
• Painful toes that are bent and cannot be straightened.

Metatarsalgia (Metatarsophalangeal Joint Synovitis)

Inflammatory condition which occurs in the joints between the metatarsal bones and phalanges.

Metatarsalgia symptoms:

• Pain in the forefoot which is worse when weight bearing.
• Pain is usually of gradual onset.
• Pain and tenderness when pressing in on the joint.
• Bending the toes down can stimulate pain.
• There may be excessive skin or calluses under the foot due to excess pressure. 

   

Morton's Syndrome / Morton's Neuroma

Pain in the forefoot, specifically on one side of a toe and the adjacent side of the next toe. Nerves that transmit messages to the brain from the toes pass between the metatarsal bones (long ones behind the toes). If the arch in your foot is weak then this can cause the metatarsal bones to pinch the nerve causing it to become inflamed. This is most likely to happen between the 3rd and 4th bones causing a pain or numb sensation on the inside of the two toes that the nerve comes from.

Sometimes it is caused by a neuroma or benign tumor on the plantar digital nerves (situated in the web between the toes). It may develop due to ill fitting shoes which press against the nerve. The condition is made worse by athletes who spin on the ball of their foot such as golfers and tennis players.

Morton's Syndrome / Neuroma symptoms:

• Pain on one side of a toe and the adjacent side of the next toe.
• Pain when you squeeze the foot.
• Pain if you press between the bones.

Bunions (Hallux Valgus)

A bunion is a painful swelling of the soft tissue, and bone enlargement over the inside of the ball of the big toe. Often the big toe will look as if it is bent in towards the other toes or even can lie across them.

Bunion pain symptoms:

• Pain in and around the ball of the big toe. This can be from the bone rubbing too much on the shoes.
• You may be unable to wear certain types of shoes.
   

Turf toe (First MTP Joint Sprain)

Sprain at the base of the big toe. Turf toe can occur after a very vigorous upward bending of the big toe. It got it's name due to the fact that it occurs frequently in people who play games on artificial surfaces. The shoe grips hard on the surface and sticks causing bodyweight to go forward and so bending the toe up. It is also common in martial arts. It also occurs often if a person has increased range of motion in the ankle and / or wears soft flexible shoes.

When the toe is bent upwards this causes damage to the ligaments which can become stretched. In addition the surfaces of the bones at the joint can become damaged. An X-ray is useful to confirm that a bone has not been broken.

Turf Toe symptoms:

• Swelling and pain at the joint of the big toe and metatarsal bone in the foot.
• Pain and tenderness on bending the toe or stretching it upwards.

Metatarsal Fracture

Metatarsals are the long bones in the forefoot. There are five of them in each foot and they attach to the phalanges (toe bones) at the front and the Tarsal bones towards the ankle. These bones can be fractured through impact for example a viscous football stud (acute fracture), or more gradual onset as stress fracture.

Stress Fracture
This usually will involve the second, third or forth metatarsal bones. An athlete who has a second toe which is longer than their big toe will be particularly prone to a fracture of the second metatarsal.

 

What are the symptoms of stress fractures?

• A gradual onset of pain.
• Pain on the bone at the point it is broken.
• Swelling is often present.
• An X-ray will often not show the fracture until two or three weeks after it has started to heal.

Blisters

Blisters are caused by friction from shoes or clothing which rubs repeatedly on the skin causing friction burns. When the outer skin layer separates from the inner layers the created space between the layers fills up with lymph fluid.
 

***This material is only provided as helpful information and not as medical advice and you should consult with your foot doctor / podiatrist for a professional diagnosis. ***

For more information on foot pain and foot care and to make an appointment with the Brooklyn Podiatrist Foot Doctor Surgeon, or to treat your foot & ankle, please feel free to contact our office today by calling (718) 266-1986 or clicking here to make an appointment.