We can help you heal foot & ankle pain and injury
The foot is the workhorse of our bodies and provides the foundation for movement, shock absorption, and propulsion for us to walk and run. Pain and injury to the foot can hinder our ability to be mobile.
The foot and ankle are composed of multiple joints and function to maintain balance and a sense of body position while providing support and motion for most activities. Foot and ankle injuries are common in both day-to-day life and in sports.
The true ankle joint is composed of three bones, the two leg bones (tibia and fibula) and the foot bone, talus. The ankle has many ligaments that provide support and structure. There are tendons that run through the ankle to help with movement of the foot.
The foot has three main segments, the hind foot, mid foot, and forefoot. The hind foot is where the calcaneus and talus bones are located and is a common site of injury as it has the heel bone that absorbs and distributes forces and where the achilles tendon from the leg attaches. The mid-foot contains the cuboid, cuneiforms, and navicular bones. The forefoot contains the metatarsal bones and phalanges of the toes. There are articulations and joints between bones and ligaments that connect these bones.
VSMD Approach
At VSMD, we diagnose foot and ankle injuries and issues by analyzing medical history, conducting a physical exam, and using imaging such as ultrasound and x-ray. Based on the findings, the doctor may recommend a conservative treatment to reduce pain and swelling and allow the foot to heal properly. In case of a tear or fracture, the doctor may prescribe a more involved approach to initiate the healing process.
For most foot and ankle issues, a non-surgical regiment with frequent evaluation by the doctor is the best course. At VSMD, we treat each patient through a holistic lens. Our doctors not only evaluate the feet but also accompanying systems.
Causes of Foot and Ankle Pain and Injury
There are many injuries that can occur at and near the foot and all athletes are subject to have injury whether from sprains, mis-footing, twisting, or overuse. Below are some common injuries and conditions that affect the foot and ankle.
Common Conditions Treated by VSMD include:
Achilles Tendinopathy
The achilles tendon is a thick band of fibrous tissue along the back of the ankle that attaches the calf muscle to the heel bone. It is under stress during activities that use the calf repeatedly, like jumping and running. Even walking can overload the tendon, particularly in people with less flexibility or strength. Other factors like being overweight, having diabetes, or having feet that toe-in or toe-out can also affect the tendon. Achilles tendinopathy refers to the condition where the stress to the tendon causes small tears in the tendon which can increase in size over time with repeated stress. Tendinitis is irritation and inflammation of the tendon that is typically caused by a recent stress or injury. Once the inflammation phase resolves, the tendon is in a state of repair. During the repair phase, continued stress and injury may lead to degenerative changes and is referred to as tendinosis.
Symptoms may include pain and swelling in the calf and heel. The symptoms are usually worse with physical activity that causes calf stretching and better with rest.
Stress Fracture
Stress fractures are bone injuries that occur due to repetitive and prolonged use due to too much stress on a bone. Stress fractures are common in the leg and foot bones (femur, tibia, and metatarsals). This injury occurs gradually over time. Risk factors of stress fractures include repetitive high impact activities, increase in training volume or intensity, and poor fitting athletic gear or improper use of athletic equipment. Female athletes are at higher risk and improper nutritional balance can increase risk. Symptoms typically include pain in the area of fracture that gets worse with repeated use.
Metatarsal stress fractures occur in the metatarsal bones of the forefoot. These are the long bones between the mid foot bones and the toes. Metatarsal bones are responsible for balance and distribution of forces from the arch of the foot. Metatarsal stress fractures are common in long distance runners and athletes who have a lot of high intensity or long duration exercises.
Navicular stress fractures occur in the navicular bone, a tarsal bone of the mid foot. The navicular bone is a central component to the arch of the foot and distributes and absorbs a lot of forces during activity. Navicular stress fractures are more common among runners and jumpers. Sports like distance running, ballet, and gymnastics are at high risk of this injury. Symptoms may include pain in the mid foot area that gets worse with time and with continued activity.
Metatarsalgia
Metatarsalgia refers to pain in the balls of one’s feet. The metatarsals are the foot bones that correspond to this area. High-level dancers, track-and-field athletes, and baseball catchers are commonly affected, due to the repetitive bursts of impact or quick transfers of force to the forefoot, which can lead to direct stress on the metatarsals. In addition, exaggerated or abnormal foot mechanics, such as the demi pointe position in ballet dancers, can lead to excessive pressure on the bones and ligaments in this area.
Risk factors include anatomic variations of the foot including arch, toe, and pronation of the foot.
Other conditions that may have similar symptoms include stress fractures, sesamoiditis (inflammation of the sesamoid bones of the big toe), Morton’s neuromas (irritation of the nerves between the toes), “tarsal tunnel syndrome” (irritation of the tibial nerve), and tears of the “plantar plate” (ligament on the sole of the foot).
Symptoms may include pain that is dull or aching and pain with push off during walking and running. Pain worsens with activity and gradually becomes worse over time.
Sever's Disease
Sever’s disease is inflammation and irritation of the heel bone where the achilles tendon inserts. Sever’s occurs in the pediatric and youth population as a growth plate disturbance. The injury occurs gradually over time due to repetitive stress of the growth plate and is called apophysitis. Sever’s is common in youth sports that involve running and jumping like basketball and running. Risk factors include repetitive jumping and running, no rest period between seasons, tight calf muscles, year-round sport with no break.
Symptoms may include heel pain that is worse with activity or following activity, pain that worsens with continued stress to the heel, limping, and reduced sport due to pain.
Runner's Toe
Runner’s toe is a blood blister that forms under the toenail (also called subungal hematoma). This can occur due to injury or due to repetitive stresses on the toes. Runners, dancers, tennis players, and rock climbers are commonly affected. Symptoms of runner’s toe may include pain and bruising discoloration of the nail.
Posterior Tibial Tendinopathy
The posterior tibial tendon and muscle act to point the foot in and down. Tendinopathy is a general term that includes tendonitis (acute inflammation) and tendinosis (degeneration of the tendon over time). The posterior tibial tendon also helps to stabilize the ankle as it courses through the inside (medial) part of the ankle. Runners more commonly experience degeneration of the tendon, particularly runners who overuse or over pronate. Dancers are more susceptible to acute injury of the tendon. Posterior tibial tendinopathy is more common in people who have flat feet.
Symptoms may include pain behind the inside ankle bone (medial malleolus) that is worse with walking or lifting the foot up. Pain can sometimes be felt up the back of the calf where the posterior tibial muscle is located.
Tinea Pedis
Tinea pedis is a fungal infection of the foot. This is commonly called athlete’s foot and is characterized by intense itching. The condition is commonly picked up and shared in moist, damp, and dark environments like athletic locker rooms and aquatic center changing rooms. Sweaty and damp athletic sneakers can also harbinger fungus when they have not dried fully between use and increase chances of developing tinea pedis.
Symptoms of tinea pedis may include intense itching in between and around the toes, red skin in the same area, and the infection may spread with itching and scratching if not treated. Infections that have spread to the toenails can cause discoloration and brittle nails. This may require longer treatment durations.
Achilles Tendon Rupture
An achilles tendon rupture involves a complete tear of the tendon on the back of the ankle. The achilles tendon connects the calf muscle to the heel bone in the back of the lower leg. Rupture occurs most commonly in the 30’s to 40’s but can happen at any age. It is more common in males than females. Tendon rupture is associated with activities like sprinting or pushing off (e.g. basketball, tennis). Many times, there is not a specific injury and the rupture is not preceded by achilles tendon pain.
Risk factors for achilles tendon rupture include age, tight calf muscles, inactive lifestyle, steroid medications, certain antibiotics, and medical conditions like diabetes, gout, rheumatoid arthritis, and kidney disease.
Symptoms may include a sudden onset of pain in the back of the lower leg, audible pop, swelling, bruising, and weakness of the foot and calf.
Plantar Fasciitis
The plantar fascia is located on the underside of the foot. It is a thick band of fibrous tissue that runs from the inside edge of the heel to the toes. The plantar fascia provides support to the arch and it is also a shock absorber. Fasciitis refers to inflammation of the plantar fascia. Risk factors to developing plantar fasciitis are tight calf muscles, flat feet, repetitive stresses to the fascia, or a recent increase in your activity level.
Symptoms may include pain on the bottom of the foot at the heel that is worse in the morning, after periods of sitting, and following activities. The pain typically improves with use throughout the day; however, in more severe cases, the pain may occur during activities that require weight-bearing.
Peroneal Tendon Injury
The peroneal tendons (fibular tendon) connect muscles on the outside (lateral) calf to the foot to allow movement of the foot up and out. Injury occurs from improper or rapid increases in training, or overuse in sports or activities that involve repetitive ankle motion, such as dancers, runners, and soccer players. Athletes with poor fitting shoes, higher arches, or inward-turned heels are at higher risk for developing peroneal tendon injuries due to the increased stress placed on the peroneal tendons. The types of peroneal tendon injuries include tendonitis (inflammation of the tendon), subluxation (movement of the tendon from its normal position), and tendinosis (degenerative tearing of the tendon fibers).
Symptoms may include pain and swelling on the outside (lateral) part of the ankle, weakness or instability of the ankle, and/or a snapping sensation while walking.
FHL Tendinopathy
The flexor hallucis longus (FHL) tendon connects a muscle in the calf to the great toe to help flex, or bend, the great toe. Repetitive activities like pushing off with the foot and toes may cause inflammation and irritation of this tendon. Turning the foot out (everting) or rolling out the foot may worsen tendon injury. The “turnout” maneuver in dancers, particularly young dancers who are still working on form, are at high risk of developing FHL tendon injury. Runners (sprinters) and ballet dancers commonly develop this condition; however it is seen in a wide array of sports that involve sprints from a stopped position (football, soccer, track, lacrosse, etc).
Symptoms may include pain and swelling over the back part of the ankle, clicking or grinding sensation (worse from en pointe position in dancers), and pain that is made worse by activity.
Extensor Tendinopathy
Extensor tendinopathy causes pain of the tendons along the top of the foot, which are responsible for flexing the foot and toes up. Tendonitis is caused by inflammation, which is typically present in the first couple of weeks. If the problem is not treated, then, after the first couple of weeks, the inflammation goes down, but the tendon begins to break down in a process called tendinosis.
The tendons that may be involved in extensor tendinopathy include extensor hallucis longus, extensor digitorum longus, extensor hallucis brevis, and tibialis anterior. The injury is caused by overuse but can be associated with excessive compression of the middle of the foot by laces that are too tight, or improperly fitting footwear. This condition is common in dancers, figure skaters, skiers, and runners.
Symptoms may include pain of the top of the foot, swelling, pain made worse by activities (particularly, running up or downhill).
Ankle Sprain & High Ankle Sprain
Ankle sprains are among the most common sports related injuries. They typically result from twisting or rolling the ankle and cause injury to the supportive ligaments. The ligaments of the ankle joint help to stabilize the joint and prevent rolling the ankle during regular activity. Ankle sprains may damage one or more ligaments resulting in stretching or partial or complete tearing. A high ankle sprain refers to injury to the area between the two leg bones, tibia and fibula. These bones are connected by a strong ligament that is susceptible to injury with forceful outward rolling of the foot causing the two leg bones to be pulled away from each other.
Ankle Impingement
Ankle impingement is a condition that causes pain during ankle range of motion due to a soft-tissue or bony abnormality. Soft-tissue impingement results from irritation to the joint capsule, or the joint’s ligaments or cartilage, which may thicken over time. Bony impingement results from improper healing of an injury leading to scarring and bone spurs. In both types, soft tissue gets pinched when bending the ankle. In most cases, the impingement symptoms follow acute traumatic events, usually ankle sprains or small injuries, that accumulate over time from repetitive activities such as running and jumping.
Impingement of the ankle is typically divided into two main types:
Anterior ankle impingement: This occurs in the anterior (front) part of the ankle and is very common in all athletes who sustain repetitive ankle dorsiflexion (bending up at the ankle joint), such as soccer players, football players, dancers, gymnasts, and runners. Symptoms may include pain over the front-outside aspect of the ankle that is reproduced with cutting and pivoting movements, swelling, and limited range of motion.
Posterior ankle impingement: This occurs in the posterior (back) part of the ankle and is common in athletes who sustain forced plantar flexion (bending down at the ankle joint). It is recognized most often in ballet dancers who stand in the demi pointe or en pointe positions, but can also be seen in runners and soccer players. It is also seen more frequently in athletes who have an accessory or extra bone in the back of the ankle, known as the os trigonum, as this can lead to pinching of the ankle capsule. Symptoms may include posterior heel pain which is worse during specific movements, swelling, and limited range of motion.