Foot and Ankle Pain and Injury

The Achilles tendon is the largest tendon in your body. It is used pretty much whenever you move your leg, but perhaps most notably during jumping. This is when it is most vulnerable to injury.

An Achilles tendon injury occurs when the tendon becomes strained, inflamed or torn due to overuse or sudden stress. A total rupture of the tendon, which most people are familiar seeing in sports, typically happens when there is an acute action or event that stresses the tendon on top of prolonged overuse.

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The Achilles tendon is the largest tendon in the body. When it becomes irritated and inflamed from overuse or wear and tear as we age, it can get painful and stiff.

It is often caused by any of the following:

• Rapidly increasing exercise intensity or duration
• Tight calf muscles
• Skipping warm-ups or stretching
• Running on hard or uneven surfaces
• Wearing unsupportive or worn-out shoes
• Bone spurs at the heel where the tendon attaches

Symptoms often begin as mild discomfort and gradually worsen with activity. Common signs include:

• Pain and stiffness along the back of the heel or tendon, especially in the morning
• Swelling that worsens throughout the day
• Pain that increases with activity or exercise
• Tenderness or thickening along the tendon
• Severe pain the day after exercising
• Swelling or fullness on the back side of the heel
• Bone spur formation in chronic cases

If you hear a “pop” or experience sudden sharp pain, see a doctor immediately (Urgent Care or Emergency Room) — it may be a rupture rather than tendinitis.

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A broken ankle can be a simple break of one bone or several bones that make up your ankle. The more bones that break, the more difficult it is to walk or put any pressure on the joint.

Ankle fractures occur most often from:

• Rolling or twisting the ankle while walking or running
• Tripping or falling from a height
• Direct impact, such as during a car accident or sports injury

You might have an ankle fracture if you’re experiencing any of the following symptoms:

• Immediate and severe pain
• Swelling or bruising around the joint
• Tenderness to the touch
• Inability to put weight on that foot or ankle
• Visible deformity or a bone that looks “out of place”

Your treatment plan will vary by the type(s) of bones that are broken and the severity of the injury. If the broken bone is not out of place, nonsurgical treatment may be an option. These range from wearing a high-top tennis shoe for added stability to a short leg cast.

If the ankle fracture is more severe or complex, surgery may be recommended. The OrthoNebraska team will work collaboratively with you to determine your needs, risks and the appropriate treatment plan.

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Ankle sprains are among the most common orthopedic injuries, from twisting your ankle stepping off a curb or landing wrong during a game of basketball. With the right care, you can get back to the activities you love without lasting issues. Mild sprains usually heal in 1-3 weeks, moderates sprains in 3-6 weeks and severe sprains can take 6-12 weeks or longer.

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Bunions are an often painful bony bump that develops over time when pressure on the big toe joint causes the big toe to lean toward the second toe. While anyone can get a bunion, women are generally more susceptible because of the tighter, narrow shoes they typically wear. If not treated a bunion can lead to bursitis or chronic pain and arthritis.

The causes of bunions include:

• Wearing narrow, tight or high-heeled shoes
• Have a family history of bunions or flat feet
• Pre-existing inflammatory conditions (rheumatoid arthritis, polio) or neuromuscular disorders
• Repetitive micro-trauma to the foot

Bunions are typically treated using non-surgical methods, including a combination of orthotics, icing, footwear modifications and medications. If nonsurgical methods are ineffective, surgery may be recommended. The OrthoNebraska team will work collaboratively with you to determine the appropriate treatment plan.

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Corns are calluses that form on the toes due to pressure from bones pushing up against shoes. They can be caused by ill-fitting shoes, high heels, socks that don’t fit properly and rubbing from seams or stitches inside the shoe. Calluses can occur anywhere on the body, including other parts of the foot and ankle, but are treated much the same.

You should see a specialist if your corn or callus becomes very painful or inflamed, you have signs of infection, or if you’ve tried self care without improvement.

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These issues can develop quietly, so consistent monitoring and early medical attention are key. People with diabetes need to be extra vigilant about foot care, as poor circulation and nerve damage can lead to small blisters becoming serious infections quickly.

The most effective way to prevent them is through strict blood sugar control and daily foot inspections.

A typical complication from diabetic feet are diabetic neuropathies, the most common of which is known as Charcot neuroarthropathy or Charcot foot. This is caused by undetected injuries to the bones of the foot due to the loss of feeling, which can cause significant deformity and disability if left untreated.

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A fallen arch with the foot pointed out is considered to be flat feet. Damage to the tendon located on the inside of the foot and ankle is the main cause of flat feet. Women and athletes participating in high-impact sports are at greater risk for developing flat feet, in addition to those with obesity, diabetes and hypertension.

You may have flat feet if you have any of these symptoms:

• Pain along the inside of the foot and ankle
• Pain that worsens with activity
• Pain on the outside of the ankle
• Swelling or painful, bony bumps on the top or bottom of the foot
• Shin splints, knee, hip or lower back pain due to altered gait
• Secondary conditions like bunions, hammer toes or arthritis

Treatment for flat feet ranges from nonsurgical methods such as orthotics and braces to surgery. The OrthoNebraska team will work collaboratively with you to determine your needs, risks and the appropriate treatment plan.

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Fractures of your toes and forefoot are relatively common and often the result of a direct blow to the foot or overuse and repetitive stress from high-impact sports like running and basketball.

Symptoms of a toe or forefoot fracture include:

• Bruising or discoloration that extends to nearby parts of the foot
• Pain when walking or putting weight on that foot

If you’ve noticed swelling, bruising or pain when you walk — especially after an injury or long periods on your feet — it could be more than a simple sprain. If you feel you may have a foot fracture, apply ice immediately, elevate your foot, do not put weight on that foot and add light compression by wrapping your foot. Seek care care right away, or at the least after a couple days if you symptoms do not improve.

If a fracture is confirmed, treatment will depend on the location of the injury and the type of fracture. For broken toes, “buddy taping” might be recommended. When the fracture is in the forefoot, elevation and limited weight-bearing are likely treatments with the possibility of a cast or walking boot. Surgery is not often recommended for foot fractures, but may be if it is complex or at risk for improper healing.

The OrthoNebraska team will work collaboratively with you to determine your needs, risks and the appropriate treatment plan.

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Inflammation in one or more of your foot or ankle joints is likely considered to be arthritis. Arthritis takes several forms in the foot or ankle:

• Osteoarthritis (wear and tear)
• Rheumatoid arthritis (autoimmune disease)
• Post-traumatic arthritis (post-injury).

You may be suffering from foot or ankle arthritis if you have one or more of the following symptoms:

• Pain with movement or activity
• Swelling, warmth or redness
• Tenderness when pressure is applied
• Stiffness after sitting or sleeping
• Difficulty walking or doing normal activities

While there is no cure for arthritis, treatment is typically non-surgical and could include: lifestyle changes, physical therapy, devices such as a brace or orthotics or anti-inflammatory medications. If your pain causes significant disability and is not significantly improved by nonsurgical treatments, surgery may be recommended. The OrthoNebraska team will work collaboratively with you to determine and the appropriate treatment plan for your individual needs.

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Gout is an autoimmune disease characterized by intense bouts of intense pain and swelling. It is caused by a high concentration of uric acid in your blood that forms crystals in your joints and your body attacks as if an infection. People with diabetes are more at risk.

Gout typically — but not always — starts in the big toe before affecting other joints. The pain is so intense and sudden that you may not even be able to tolerate light touches to the affected joint. If left untreated, gout tends to progress quickly throughout the body.

Gout is typically treated nonsurgically using a combination of medications and injections. They craft treatment plans after determining the specifics of your diagnosis. Lifestyle changes can also play a huge role in helping prevent gout attacks. Rarely, surgery with an orthopedic surgeon can be recommended.

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Hammer toe typically occurs in the second, third or fourth toes. It’s a deformity in which the middle joint is bent, resembling a hammer. If treatment is sought out early, hammer toes can be corrected; however if left untreated, a correction will require surgery. The most common cause of hammer toes is wearing shoes that don’t fit properly (too tight/narrow).

Symptoms of hammer toes include:

• Pain when wearing shoes
• Swelling or redness around the affected joint
• Inability to straighten the toe
• Difficulty walking
• Corns or calluses on the middle joint or tip of the toe

If treated early on, hammer toes can be corrected by footwear changes, exercises, or orthotics. If the toe joint is rigid and nonsurgical treatment does not alleviate symptoms, surgery may be recommended.

The OrthoNebraska team will work collaboratively with you to determine your needs, risks and the appropriate treatment plan.

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Heel pain is the most common foot and ankle health complaint. If ignored, it is likely to worsen and become a chronic condition. Typically heel pain is either located beneath the heel or behind the heel. For those with plantar fasciitis, the risk of developing a heel spur is greater. But plantar fasciitis is just one potential cause of heel pain. There can be many causes that our experts can work with you to pinpoint with precision.

Once the root cause of your heel pain is identified, our team will work with you to discuss the severity of your pain and will co-develop a treatment plan that is most effective based on your condition, needs and lifestyle.

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Ingrown toenails occur when the nail or skin grows over the edges of the nail, which is often caused by tight shoe wear and improper grooming. Prevention involves protecting feet from trauma and wearing fitting shoes with enough room for toes while also keeping nails trimmed straight across without rounding corners. Keeping feet clean and dry can also help reduce the risk of ingrown toenails.

Symptoms include hard, swollen and tender toes, redness, pain and swelling at the corner of the nail, as well as possible infection and pus drainage from the area.

Treatment includes soaking your foot in warm water 3-4 times daily, wearing comfortable shoes with adequate room for toes, taking ibuprofen/acetaminophen for pain relief if needed, and possibly surgical removal of part or all of the toenail if infection persists.

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Morton’s Neuroma is a thickening of the tissue that surrounds the digital nerve leading to your toes. It typically develops between the third and fourth toes, following irritation, trauma or excessive pressure.

You might be experiencing Morton’s Neuroma if you have any of these symptoms:

• Narrow or tight shoes that compress the toes
• High-heeled shoes, which place the foot in a “push-off” position
• Repetitive trauma or pressure on the forefoot

Generally, nonsurgical treatment will provide relief, including some combination of medications, injections, orthotics and footwear modifications.

If the non-surgical treatments do not prove to help, your orthopedic specialist might eventually recommend surgery. The OrthoNebraska team will work collaboratively with you to determine your needs, risks and the appropriate treatment plan.

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Sprains and strains are often caused during sports activities or daily tasks. Sprains are ligament injuries and strains are muscle or tendon injuries.

Most acute (sudden) injuries of this type can be treated using the RICE method:

• Rest
• Ice the injury site for 20 minutes at a time, several times a day
• Compression bandage
• Elevate the injury site above your heart

However, moderate sprains usually result in a pretty loose joint. While rarely requiring significant treatment, bracing or other equipment may be helpful. Severe sprains are torn ligaments, which typically require medical attention. They may be treated by home exercises or physical therapy or in the case of tears, surgery would sometimes be recommended. At OrthoNebraska, we believe in working together to arrive at a treatment plan that balances the risks and benefits.

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Turf toe injuries are the name used to referring to a sprain of the primary joint in the big toe. Although probably most common in American football, it can happen to anyone who hyperextends their toe as the result of a bent (think of a sprinter start) motion and lots of force.

You may be experiencing a bunion if you have any of these symptoms in your big toe:

• Swelling
• Bruising
• Pain when trying to move the toe around (range of motion)

For surgery to be required for turf toe is extremely rare. RICE (rest, ice compression and elevation), bracing or taping, a walking boot, and physical therapy will most likely be used in some combination depending on the severity of your injury and how your recovery is progressing.

The OrthoNebraska team will work collaboratively with you to determine the appropriate treatment plan that fits your needs, activities and schedule.

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Infections

Skin infections are common, and while most can occur anywhere on the body, a few are exclusive or most commonly found on the feet. They can be spread through skin-to-skin contact or indirectly through contaminated objects.

Symptoms of a skin infection may include lesions, blisters, or sores. Infections include molluscum contagiosum and herpes simplex virus, as well as bacterial infections such as staph, which is the most commonly transmitted. Dermatophyte fungus or tinea pedis (Athlete’s Foot) infections are also commonly seen in sports with close contact such as wrestling.

Treatments is highly varied depending on the exact infection and location.

Warts

Caused by the human papilloma virus (HPV), warts can be acquired by anyone, but most commonly are transmitted in locker rooms or other shared areas. Warts typically don’t have any non-aesthetic symptoms unless they are located in an area that can cause pain from wear.

Treatments range from over-the-counter acid or freezing treatments to cryotherapy or an in-office wart removal procedure.

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