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Foot and ankle

Nearly one-fourth of all the bones of your body are in your feet, which are designed to withstand the considerable forces required for walking and running. Joints in the foot and ankle are supported by tendons that allow extending and flexing. The pain from injuring one of those bones or tendons can stop you in your tracks – literally.

Sources of foot and ankle pain include fractures, sprains, bunions, plantar fasciitis and arthritis.

Texas Health Resources has a multidisciplinary team of experts who can quickly and effectively diagnose the source of foot and ankle pain and provide you with a range of treatment options. Texas Health has foot and ankle specialists on the medical staff who can perform advanced surgeries, as well as make recommendations about other treatments. Many Texas Health hospitals offer rehabilitation services with advanced equipment and experienced therapists.

Healthy and pain free feet and ankles

    Try these tips for keeping your feet and ankles in good shape:
  • Always warm-up before exercising, and remember to stretch the muscles and tendons that anchor your ankles.
  • Lose weight if you are overweight; extra pounds put strain on your ankles and feet.
  • Alternate your activities; for example, alternate jogging with swimming or cycling.
      The shoes you wear are crucial to keeping your feet and ankles pain free:
    • Wear comfortable, properly fitting shoes. They should have good arch support and cushioning.
    • Wear shoes with adequate room around the ball of your foot and toe.
    • Wear sneakers as often as possible, especially when walking.
    • Avoid narrow-toed shoes and high heels.
    • Replace running shoes frequently.

Diagnosing foot and ankle problems

Your physician will diagnose your foot or ankle problem based on the findings of a medical history, physical exam and diagnostic tests.

    For your medical history, the physician may ask questions such as:
  • Are both of your feet or ankles affected? If only one, which one?
  • Exactly what part of your foot/ankle is affected?
  • Does the pain move from joint to joint, or does it always occur in the same location?
  • Did your pain begin suddenly and severely or slowly and mildly, gradually getting worse?
  • How long have you had the pain?
  • Is it worse at night or when you first wake up in the morning?
  • Does the foot/ankle hurt when you are not bearing weight on it?
  • Does anything make your pain feel better or worse?

During the physical exam the physician will examine your range of motion and nerve function and touch your foot/ankle to locate the area of discomfort.

    Depending on the findings of the medical history and physical exam, your physician may use one or more of the following tests to determine the source of your foot/ankle pain:
  • X-rays
  • Aspiration of synovial fluid (fluid from the joint space) and synovial fluid analysis

Common diagnoses for ankle and foot pain include fractures, sprains, bunions, plantar fasciitis and arthritis.

Treatment for foot and ankle problems

Treatment for foot and ankle problems depends on the diagnosis.

Ankle fracture: A broken ankle is usually casted and requires that no weight be placed on the ankle for a prescribed period of time. Pins, screws and/or plates may be necessary and require surgery for insertion.

Ankle fusion: A surgical procedure to relieve arthritic pain in the ankle; the procedure moves cartilage between bones in the joint and fuses them together with bone grafts and metal hardware to eliminate pain-causing movement.

Ankle sprain: A sprained ankle occurs when small tears are made in the ankle ligaments, which connect bones to one another. The tearing leads to swelling and bruising, making it difficult to bear weight on the joint. Treatment includes keeping weight off the ankle, icing the ankle and taking acetaminophen or ibuprofen for the pain.

Arthritis: Medication is usually prescribed for pain caused by arthritis. Gentle exercise may also be prescribed. Severe cases of arthritis may require ankle replacement.

Bunionectomy: Surgery to correct a deformity that develops as a bony prominence beside the big toe or little toe (tailors bunion) and causes pain when walking and/or wearing shoes; the bone is cut and repositioned so the neighboring joint functions properly.

Flat foot reconstruction: Surgery that corrects angular deformities (often called "fallen arches") through the use of implants and other techniques.

Hammertoes: A condition in which shortened or tightened tendons cause toes to remain constantly in a curled position, resulting in painful corns and calluses; surgery lengthens the tendon and removes a segment of bone so the toe straightens normally.

Lateral ankle reconstruction: Surgery that re-routes a healthy tendon to compensate for one on the outside (lateral) of the ankle that has been damaged or weakened by one or more severe sprains.

Osteochondral cartilage transfer: A procedure that replaces damaged or diseased cartilage in a joint with some of the patient's own healthy cartilage; cartilage is the tissue that cushions joints and keeps bones from rubbing against each other and causing pain; in this surgery, plugs of underlying bone are harvested and transplanted along with the attached cartilage to encourage successful transfer; this operation can usually be done athroscopically.

Plantar fasciitis: Plantar fasciitis occurs when the strong band of tissue that supports the arch of the foot becomes irritated and inflamed. Treatment may include anti-inflammatory medications, heel stretching exercises, rest, ice and night splints. Sometimes the affected foot is placed in a short leg cast to reduce pain, and in a few cases, surgery to release the tight, inflamed band of tissue becomes necessary.

Stress fracture: A stress fracture is a small crack in the bone, which often develops from overuse, such as from high-impact sports like distance running or basketball. Rest is the key treatment for a stress fracture. Protective footwear may be prescribed, and a cast may be needed. Sometimes surgery may be necessary.

Tendon repair: Procedures that reattach reconstruct or replace ankle tendons (e.g. the Achilles tendon) that have been injured.

Total ankle replacement surgery: A surgical procedure whereby the natural ankle joint is replaced with a prosthetic made of metal alloys and high density plastic; ankle replacement is usually needed when arthritic damage causes chronic pain in the joint; replacement is an alternative to ankle fusion surgery, which limits mobility.

After treatment

After your initial treatment for an ankle or foot problem, your physician may prescribe physical therapy to strengthen your joints. Texas Health Resources' hospitals' rehabilitation services offer some of the most advanced equipment and most experienced therapists in North Texas. Rehabilitation usually includes training and exercise with a physical therapist.

Your physician may also suggest a gentle exercise routine that will slowly help you return to your previous strength and ability. Exercise physiologists at Texas Health's fitness centers can help design an exercise program to best meet your needs.

Frequently asked questions

Q: If I am experiencing foot or ankle pain, when should I contact my doctor?

A: Go to the hospital if you have severe pain when not bearing weight; you suspect a broken bone; or there is an audible popping sound and immediate difficulty using the joint. Call your doctor if the swelling does not go down after two to three days of home treatment with ice and rest; or if the pain does not go away after several weeks.

Q: What kind of shoes should I wear to limit ankle and foot pain?

A: Wear comfortable, properly fitting shoes with good arch support and cushioning. Wear low to no heels with adequate room around the ball of your foot and toe.

Q: If I have an ankle sprain or fracture, how long will it be until I can put weight on my ankle?

A: Your specific injury will help determine when you can start putting weight on your ankle. Your physician will assess when they think your ankle is stable enough for you to begin putting weight on it.

Q: If I have an ankle fracture, how long will it take me to return to my daily activities and to sports?

A: Most people return to daily activities within three to four months, but it can take several years for full recovery from a broken ankle. It may take several months for you to return to sports at a competitive level.

Q: What is plantar fasciitis?

A: Plantar fasciitis is irritation and swelling of the thick tissue on the bottom of the foot. The plantar fascia is a very thick band of tissue that connects the heel bone to the toes. This band of tissue is what creates the arch of the foot. When the fascia is overstretched or overused, it can become inflamed. When the fascia is inflamed, it can be painful and make walking more difficult.