Pain around the foot and ankle is a common problem in modern shoe-wearing society. Our feet are constantly in contact with the ground, and bear our entire body weight as we rush around performing our daily tasks. Any pain or dysfunction to this region can cause a lot of problems with both livelihood and leisure.

The foot is made up of many bones arranged in arches that terminate at the toes. It is designed in such a way to allow it to adapt to the ground, and yet bear our weight. Because of its complex structure with so many moving parts, problems with a single part can cause problems with the entire foot.

The foot is attached to the body via the ankle, which is a joint formed by 3 bones, the shin and calf bones (tibia and fibula) and the talus (part of the foot). It is supported by 3 groups of ligaments, the upper group (high ankle ligaments), the outer group (lateral ligament complex) and the inner ligament (deltoid ligament). Tendons and muscles pass around the ankle, helping to move and support the foot and ankle. Of note is the large tendon attached to the heel, colloquially known as the Achilles tendon.

What causes pain in the foot and ankle?

The causes are numerous, but broadly, they can be grouped into pain caused by injury, and those caused by non-injurious sources. Injuries around the foot and ankle are common sporting injuries, and are often also caused by accidental falls. Such injuries can result in ligament injuries or fractures around the foot and ankle region.

Examples of injuries are:

• Sprained ankles (ligament injuries) from ‘rolling’ your ankle, during sport or due to walking on uneven terrain. This sometimes also results in cartilage injuries in the ankle joint
• Fractured ankles can also happen with a similar mechanism as sprained ankles
• Toe fractures, which can result from kicking objects, whether during sport or accidentally
• Fractures of the midfoot region (metatarsal and midfoot bones) can occur from falls or crushing injuries
• Fractures of the base of the 5^th metatarsal (outer part of mid foot) can also occur with twisting injuries to the foot
• Fractures of the calcaneus (heel bone) and talus (bone that lies above the heel bone) tend to be high energy injuries sustained from falls from height

Non-injury causes of foot and ankle pain can include:

• Hallux valgus and bunions (where the big toe bends outwards), where pain is felt over the inner part of the big toe and under the second toe
• Tendon overuse, especially of the tendons on the inner (tibialis anterior/posterior) and outer tendons (peroneal tendons)
• Worn out ankle joints (osteoarthritis of ankle)
• Worn out foot joints (midfoot osteoarthritis)
• Inflammation of the heel tendon (Achilles tendinopathy)
• Inflammation of the tissue at the bottom of the heel (plantar fasciitis), which can cause painful first steps after rest and after prolonged walking

What other symptoms may be associated with foot pain?

Besides pain, foot and ankle problems may also be associated with the following symptoms:

• Swelling over the affected areas
• Stiffness of the ankle and of the toes/foot
• Deformity, examples of which include flatfeet, hallux valgus (toe turning out) and bent toes (claw toes and hammer toes)
• Unstable ankles, which might feel loose, and may predispose to recurrent sprains

How is foot pain diagnosed?

Your doctor will conduct a medical interview, during which he/she will ask about your symptoms and your unique requirements. Based on the information gained, he/she will perform a focused examination on the foot and ankle. He/she may also request that you take a short walk in order to observe your gait.

Based on this clinical evaluation, your doctor may recommend some plain X-ray views of the foot and ankle. An MRI scan might be offered if the information gained from the X-rays is not sufficient for a diagnosis.

What treatments are there for foot and ankle pain?

There are a variety of treatments available for foot and ankle complaints. These treatments will be tailored according to your specific condition and needs.

This may include:

• Medications to treat and relieve pain
• Monitored physiotherapy regimes catered to your condition
• Injections to relieve pain arising from worn out tendons
• Keyhole surgery for treatment of joint disorders
• Surgery for fixation of broken bones
• Surgery to repair or reconstruct injured ligaments and tendons
• Surgery to treat arthritis

References:

Related Articles by Dr Yong Ren

• Eliminate Foot and Ankle Pain with These Simple Home Treatments
• Understanding Heel Spurs: Causes, Symptoms, and Treatments
• What is an Ankle Sprain and what to do?