Podiatry Foot Problems

The Achilles tendon is the largest tendon in the human body and can withstand forces of 1,000 pounds or more. It also is the most frequently ruptured tendon, usually as a result of a sports injury. Both professional and weekend athletes may suffer from Achilles tendonitis, a common overuse injury and inflammation of the tendon.

Events that can cause Achilles tendonitis may include:

• Hill running or stair climbing.
• Overuse, stemming from the natural lack of flexibility in the calf muscles.
• Rapidly increasing mileage or speed when walking, jogging, or running.
• Starting up too quickly after a layoff in exercise or sports activity, without adequately stretching and warming up the foot.
• Trauma caused by sudden and/or hard contraction of the calf muscles when putting out extra effort, such as in a sprint.
• Improper footwear and/or a tendency toward overpronation.

Achilles tendonitis often begins with mild pain after exercise or running that gradually worsens. 

Other symptoms include:

• Recurring localized pain, sometimes severe, along the tendon during or a few hours after running.
  
• Morning tenderness about an inch and a half above the point where the Achilles tendon is attached to the heel bone.
• Sluggishness in your leg.
• Mild or severe swelling.
• Stiffness that generally diminishes as the tendon warms up with use.

Treatment normally includes:

• A bandage specifically designed to restrict motion of the tendon.
• Taking nonsteroidal anti-inflammatory medication for a period of time. Note: Please consult your physician before taking any medication.
• Orthotics, which are corrective shoe inserts designed to help support the muscle and relieve stress on the tendon. Both nonprescription orthoses (such as a heel pads or over-the-counter shoe inserts) and prescribed custom orthotics may be recommended depending on the length and severity of the problem.
• Rest and switching to exercises that do not stress the tendon (such as swimming).
• Stretching and exercises to strengthen the weak muscle group in front of the leg, calf, and the upward foot flexors, as well as massage and ultrasound.

In extreme cases, surgery is performed to remove the fibrous tissue and repair any tears.

Peroneal tendons support two important foot muscles (Peroneus Brevis and Peroneus Longus) that originate on the outside of the calves. These two muscles allow you to roll to the outside of your foot while standing.

Peroneal tendons are also called stirrup tendons because they help hold up the arch of the foot. The two muscles are held in place by a band of tissue, called the peroneal retinaculum. Injury to the retinaculum can cause this tissue to stretch or tear. When this happens, the peroneal tendons can dislocate from their groove on the back of the fibula. The tendons can be seen to roll over the outside of the fibula, which damages the tendons.

Skiing, football, basketball, and soccer are the most common sports activities leading to peroneal tendon dislocation. In some cases, ankle sprains also have caused this condition. Patients usually have to use crutches after such an injury, in order to allow the retinaculum tissue to heal and the tendons to move back to their natural position on the fibula. Sometimes a splint or compression bandage is applied to decrease swelling. Anti-inflammatory medications and ice are often part of the treatment. Note: Please consult your physician before taking any medications.

In moderate to severe cases of injury, when the peroneal retinaculum is torn or severely stretched and susceptible to dislocation, surgery may be required.

Ankle sprains are caused by an unnatural twisting or force on the ankle bones of the foot, which may result in excessive stretching or tearing of one or more ligaments on the outside of the ankle. The severity of the sprain can impact the degree of damage as well as the type and duration of treatment. If not properly treated, ankle sprains may develop into long-term problems.

Primary symptoms of ankle sprains are pain following a twist or injury, swelling, and bruising.

Treatment includes resting and elevating the ankle and applying ice to reduce swelling.

Compressive bandages also may be used to immobilize and support the injury during healing. Serious ankle sprains, particularly among competitive athletes, may require surgery to repair and tighten the damaged ligaments.

To prevent ankle sprains, try to maintain strength, balance, and flexibility in the foot and ankle through exercising, stretching, and wearing well-fitted shoes.

Chronic lateral ankle pain is recurring or chronic pain on the outside part of the ankle that often develops after an injury such as a sprained ankle.

Signs and symptoms include:

• Ankle instability.
• Difficulty walking on uneven ground or in high heels.
• Pain, sometimes intense, on the outer side of the ankle.
• Repeated ankle sprains.
• Stiffness.
• Swelling.
• Tenderness.

Although ankle sprains are the most common cause of chronic lateral ankle pain, other causes may include:

• A fracture in one of the bones that make up the ankle joint.
• Arthritis of the ankle joint.
• Inflammation of the joint lining.
• Injury to the nerves that pass through the ankle. In this case, the nerves become stretched, torn, injured by a direct blow, or pinched under pressure.
• Scar tissue in the ankle after a sprain. The scar tissue takes up space in the joint, putting pressure on the ligaments.
• Torn or inflamed tendon.

Treatments for chronic lateral ankle pain include:

• Over the counter or prescription anti-inflammatory medications to reduce swelling. Note: Please consult your physician before taking any medications.
• Physical therapy, including tilt-board exercises that focus on strengthening the muscles, restoring range of motion, and increasing your perception of joint position.
• Ankle braces or other supports.
• Steroid medication.
• Immobilization to allow the bone to heal (in cases of fractures).

Capsulitis is an inflammation of the ligament on the bottom of the foot. It is usually caused by trauma or abnormal structural functioning, which overstretches the ligament that attaches one of the toe bones to a metatarsal bone. Wearing high heels or other poorly fitting footwear and performing repetitive activities that bend the toes, such as ladder climbing, are also known causes.

Pain in the forefront of the foot is the most common symptom of capsulitis. Capsulitis is often misdiagnosed as Morton's neuroma because of similar symptoms.

Noninvasive treatments are used to resolve capsulitis, including:

• Wearing low-heeled shoes with firm soles that fit properly.
  
• Decreasing or temporarily discontinuing the activity responsible for the onset of the inflammation.
• A short course of oral anti-inflammatory medication. Note: Please consult your physician before taking any medications.
• Cortisone injections.

Flat feet are a common condition of the foot structure. In infants and toddlers, prior to walking, the longitudinal arch is not developed and flat feet are normal. Most feet are flexible and an arch appears when children begin standing on their toes. The arch continues to develop throughout childhood, and by adulthood most people have developed normal arches.

Flat feet are generally associated with pronation, a leaning inward of the ankle bones toward the center line. Shoes of children who pronate, when placed side by side, will lean toward each other (after they have been worn long enough for the foot position to remodel their shape). Many people with flat feet do not experience pain or other problems. When pain in the foot, ankle, or lower leg does occur, especially in children, the feet should be evaluated.

Painful progressive flatfoot, otherwise known as tibialis posterior tendonitis or adult-acquired flatfoot, refers to inflammation of the tendon of the tibialis posterior. This condition arises when the tendon becomes inflamed, stretched, or torn. Left untreated, it may lead to severe disability and chronic pain. People are predisposed to tibialis posterior tendonitis if they have flat feet or an abnormal attachment of the tendon to the bones in the midfoot.

Nonsteroidal anti-inflammatory medications, icing, physical therapy, supportive taping, bracing, and orthotics are common treatments for painful progressive flatfoot. Note: Please consult your physician before taking any medications. In some cases, a surgery may need to be performed to repair a torn or damaged tendon and restore normal function. In the most severe cases, surgery on the midfoot bones may be necessary to treat the associated flatfoot condition.

Pain in the area between the arch and toes, or ball of the foot, is generally called metatarsalgia. The pain usually centers on one or more of the five bones (metatarsals) in this mid-portion of the foot. Also known as dropped metatarsal heads, metatarsalgia can cause abnormal weight distribution due to overpronation.

Metatarsalgia occurs when one of the metatarsal joints becomes painful or inflamed. People often develop a callus under the affected joint. Metatarsalgia also can be caused by arthritis, foot injury (from sports, a car accident, or repeated stress), hard surfaces (cement or tile floors), and specific footwear (rigid-soled work boots).

A simple change of shoes may solve the problem. In more severe cases, custom orthotics may be prescribed to alleviate the pain and prevent overpronation.

Sesamoids are small bones that are connected only to tendons or are embedded in muscle. This structure appears in only a few places in the human body, one of which is the foot. Two very small sesamoids (about the size of a kernel of corn) are found in the underside of the forefoot near the big toe—one on the outer side of the foot and the other closer to the middle of the foot. Sesamoids provide a smooth surface over which the tendons slide, thus increasing the ability of the tendons to transmit muscle forces. In the foot, sesamoids assist with weight-bearing and help elevate the bones of the big toe.

Like other bones, sesamoids can fracture. Additionally, the tendons surrounding the sesamoids can become irritated or inflamed, which is called sesamoiditis and is a form of tendonitis. Sesamoiditis is a common condition among ballet dancers, runners, and baseball catchers because of the pressures placed on their feet.

Symptoms include:

• Pain under the big toe or on the ball of the foot.
  
• Swelling and bruising.
• Difficulty and pain in bending and straightening the big toe.

Surgery is usually not required to treat sesamoiditis. Treatments generally include:

• Discontinuation of the activity causing the pain and inflammation.
  
• Over-the-counter pain medications and anti-inflammatories, such as ibuprofen and aspirin. Note: Please consult your physician before taking any medications.
• Icing the sole of the foot.
• Wearing shoes that are soft-soled and low-heeled.
• Using cushioning in shoes to relieve stress.
• Injection of a steroidal medication to reduce swelling.

If symptoms persist, you may need to wear a removable brace on the leg for 4-6 weeks to give the inflammation time to subside and the bones to heal.