Ankle pain is common in patients of all ages and can come from a variety of sources, including arthritis and tendinitis. Learn more about ankle pain, including common causes and available treatment options.
Foot & Ankle pain is very common amongst runners and athletes. But can also occur due to chronic conditions, falls and automobile injuries. Some chronic conditions that cause foot and ankle pain are arthritis, neuropathy, bunions or tendinitis.
Find out more about foot and ankle pain below, including some common causes and available treatments for various conditions.
Metatarsalgia is inflammation of the ball of the foot — the area of the sole just below the toes. Symptoms may include sharp, aching or burning pain. The pain may be worse when the person walks, runs or stands, especially when they undertake these activities barefoot or on a hard surface.
Numbness, tingling and sharp or shooting pain may also occur in the toes, or the person may feel as if there’s a pebble in their shoe. These symptoms may cause the person to walk abnormally, leading to pain elsewhere in the body, such as the hip or back.
While older adults and those with diabetes are more likely to experience metatarsalgia, anyone can develop the condition. It’s especially common in those who engage in high-impact sports, such as running and tennis, as well as in those who wear high heels and narrow shoes. Being overweight places more pressure on the feet, making metatarsalgia more likely. Those with unusual bone structure in the feet, such as flat feet, high arches and bunions, may also be more prone to developing metatarsalgia.
Resting the feet, applying ice and taking over-the-counter pain medications may ease the pain of metatarsalgia. However these approaches may only provide short-term relief. People experiencing metatarsalgia may find it beneficial to consult with a physical therapist or physiatrist to discuss treatment options such as cortisone injections, shoe modifications, metatarsal pads, shoe inserts or arch supports may help alleviate discomfort. A well-trained physical therapist can determine if your foot mechanics need to be improved with gentle and effective therapies. If pain persists despite implementing conservative measures and foot abnormalities — such as hammertoes — are present, surgery may be recommended to realign the metatarsal bones.
Plantar fasciitis is a condition characterized by inflammation of the plantar fascia, a thick band of tissue that connects the heel bone to the toes. Although plantar fasciitis is primarily a foot disorder, it can also cause a reduced range of motion in the ankle. The main symptom of plantar fasciitis is stabbing pain near the heel, which often occurs after long periods of inactivity, such as when someone gets out of bed in the morning after lying down for seven or eight hours.
Some people are more likely than others to develop plantar fasciitis. Age is one of the most significant risk factors, as plantar fasciitis typically develops between the ages of 40 and 60. Additional risk factors include obesity, running, participating in certain types of dance and having extremely high arches.
Plantar fasciitis accounts for one million patient visits per year in the United States, making it the most common cause of heel pain.
Plantar fasciitis may be treated with medications, noninvasive therapies or procedures. Prescription and over-the-counter drugs relieve inflammation, reducing pain and stiffness. Physical therapy is used to strengthen the leg muscles and stretch the plantar fascia, which may improve ankle stability and relieve foot pain. Wearing orthotics or night splints may also help with the management of plantar fasciitis. Orthotics merely support the arches, while splints stretch the arches and the calf muscles.
Ultrasonic tissue repair and extracorporeal shock wave therapy are used to treat plantar fasciitis that doesn’t respond to medications or noninvasive therapies. Both treatments are used to heal the damaged tissue in the plantar fascia. In rare cases, surgery may be performed to detach the plantar fascia from the heel bone.
A bunion is a painful, bony bump that develops at the joint at the base of the big toe. In addition to pain, which may be constant or intermittent, bunion symptoms include redness and swelling of the big toe joint, development of corns and calluses and limited ability to move the big toe.
Most bunions form over time, as pressure at the base of the toe causes the big toe to move out of position, bending inward toward the second toe. A bunionette, or tailor’s bunion, is a type of bunion that develops on the outside of the foot at the joint of the little toe.
A common foot disorder, bunions affect about 33% of adults in the United States, and women are more likely than men to develop bunions.
While the cause of bunions is unknown, doctors believe consistently wearing tight, narrow shoes and high heels causes the toes to compress and overlap. Heredity may also play a role, with certain foot shapes, structures and mechanics being more prone to developing bunions. People with inflammatory conditions, such as rheumatoid arthritis, are also more likely to have bunions.
Applying ice to the painful bunion, taking over-the-counter pain medications, using bunion pads to eliminate irritation of the bunion and receiving cortisone injections may help alleviate discomfort. Choosing roomy, well-fitting footwear with wide toe boxes and using shoe inserts may help keep the bunion from worsening.
Physical therapy is a viable option to help maintain joint alignment and prevent the progression of deformity.
A bunionectomy — the surgical removal of the bunion and straightening of the big toe — is an option for those experiencing frequent bunion pain that interferes with daily activities.
An ankle sprain occurs when the ankle twists into an awkward position, stretching the ligaments that connect the ankle bones. A popping sound or sensation may occur at the time of injury.
A person with a sprained ankle is likely to experience pain when trying to place weight on the affected ankle and foot, and the ankle may appear bruised and swollen. The ankle may be tender to the touch, and its range of movement may be limited.
Ankle sprains are the most common musculoskeletal injury primary care providers treat. People of all ages can sprain their ankles, and the injury may be mild or severe.
Falls and missteps are frequent causes of sprained ankles. Wearing inappropriate or poorly fitting shoes, walking on uneven surfaces, having a prior ankle injury and being in poor physical condition all increase a person’s chances of sustaining a sprained ankle. People who participate in sports are also prone to ankle sprains.
For the first two or three days following an ankle sprain, using the RICE method typically helps reduce pain and swelling. This involves resting the ankle, applying ice for 20 minutes every two to three hours, wrapping the ankle with a compression bandage and elevating the ankle above the level of the heart. Over-the-counter pain medications may help ease discomfort.
For more severe ankle sprains, a doctor may stabilize the ankle with a brace or a walking boot, and crutches may be necessary to assist with mobility. Once the pain and swelling subside, a doctor or physical therapist may suggest exercises to restore the ankle’s strength, range of motion, stability and flexibility. If the ankle heals improperly, surgery may be necessary to repair or reconstruct a ligament.
Ankle neuropathy is the term for nerve damage in the ankle. Nerves in the ankles that are damaged or compressed can cause unpleasant symptoms in the ankles, feet and toes. Symptoms include:
There are several subcategories of ankle neuropathy, and symptoms can depend on which nerves are affected. For example, in Morton’s neuropathy, the nerves leading to the toes are compressed, causing symptoms in the toes and the ball of the foot. Other types include tarsal tunnel syndrome, Baxter’s nerve entrapment and peroneal neuropathy. A very common form of neuropathy is diabetic neuropathy. This is very common amongst diabetics after chronically elevated levels of glucose effects the delicate coating (myelin sheath) around the nerves. This is described as pain during the night which seems to improve with walking and activity.
Neuropathy can happen to many parts of the body but is most common in the legs and feet.
Some lifestyles, activities and medical conditions may increase the risk of neuropathy. Examples include:
Avoiding stress on the feet and ankles as well as managing other health conditions can help reduce the risk of neuropathy.
Treatment for neuropathy typically involves pain medication or nerve pain medication (ie. Gabapentin, Lyrica). This approach is only designed to provide short term benefit and no corrective goal. Physical therapy can strengthen the foot and ankle, increase blood flow as well as help with compressed nerves. Orthotic shoe inserts can also help, especially if the neuropathy is due to flat feet, high arches or unusual pressure on the feet. Acupuncture is a well-documented approach to treating neuropathy due to it’s success in improving blood flow to injured tissue.
Morton’s neuroma is a painful condition involving swelling and inflammation of the nerve between the toe bones. Typically, the nerve between the third and fourth toe is affected. Morton’s neuroma is a painful condition involving swelling and inflammation of the nerve between the toe bones. Typically, the nerve between the third and fourth toe is affected. Morton’s neuroma may cause a burning pain that radiates from the ball of the foot into the toes, and the toes may tingle and feel numb. The person may feel as if there’s a stone in their shoe.
About 33% of people have Morton’s neuroma, and women are eight to 10 times more likely than men to develop the condition. Shoe style has an impact on the development of Morton’s neuroma, as high heels and restrictive, narrow styles can put pressure on the balls of the feet and limit toe movement.
People with foot abnormalities, such as flat feet, high arches, bunions or unusually positioned toes, are also more prone to developing Morton’s neuroma. Those who engage in certain high-impact sports, including running and tennis, repeatedly put a lot of pressure on the balls of their feet, making them more likely to develop Morton’s neuroma.
Self-care measures for treating Morton’s neuroma include resting the feet, applying ice and taking nonsteroidal anti-inflammatory drugs. A doctor may also administer anti-inflammatory and anesthetizing drugs via injection to alleviate the pain. Choosing shoes with plenty of room in the toe box and using arch supports, metatarsal pads and orthotics may help ease discomfort and prevent future flare ups.
Doctors sometimes use a freezing procedure called cryogenic neuroablation to destroy nerve cells in the affected area to alleviate pain. Alternatively, radiofrequency ablation heats the nerve tissue to reduce pain. In some cases, a neurectomy is required. This procedure removes part of the nerve tissue surgically to help ease discomfort.
Achilles tendinitis and Achilles tendon tears are two common injuries that occur in the tendon that stretches from the heel, up the ankle and to the lower leg. Tendinitis is an inflammation of this tendon, and when it occurs at the ankle portion of the tendon, it’s referred to as non-insertional Achilles tendinitis. A tear in the Achilles tendon is more serious. Tears can be partial or full ruptures of the tendon. This usually requires surgical intervention to reattach the tendon to the bone.
Both Achilles tendinitis and tears are fairly common sports injuries, especially in people who don’t regularly exercise or participate in sports. Achilles tendinitis can develop when the tendon is subjected to repeated stress, such as during high-impact exercise. Sudden stretching of the Achilles tendon, including during sports activities that involve quickly speeding up or twisting the ankle, can also cause tendinitis. If the twist or stretch is too abrupt, the tendon can tear. Sometimes there’s an audible popping sound when the tendon ruptures, and the pain is typically more intense than the pain of tendinitis.
Shortly after injury, resting the ankle and applying ice will speed up healing. Pain medication can help ease the symptoms, which may last from 3 to 6 months after the injury. Ultimately, physical therapy will restore ankle function, strengthen ligaments and tendons and prevent future injury. PRP or Platelet-rich plasma injections are another tendinitis treatment that may work for some people. Surgery is not usually recommended for tendinitis, but surgery may be needed to repair a torn Achilles tendon.
Arthritis is a disease that causes inflammation of one or more joints. There are over 100 forms of arthritis, many of which affect the ankle. Arthritis of the ankle develops when cartilage wears away, causing the bones that form the ankle to rub against each other. This leads to pain and inflammation.
Although symptoms of ankle arthritis may arise suddenly, they usually develop gradually. Symptoms include:
Approximately 23% of Americans have been diagnosed with some form of arthritis, and almost 50% of people over 65 have received an arthritis diagnosis. Osteoarthritis is the most common joint disease worldwide, with 1% of osteoarthritis cases affecting the ankle. Arthritis is more likely to develop with age, and it affects women more often than men. It is also more common in obese people.
Lifestyle modifications, such as losing weight and avoiding activities that cause discomfort, are the first step in dealing with ankle arthritis. Taking over-the-counter pain medications, applying ice, supporting the ankle with a brace and using a cane or walker may also be helpful. Cortisone injections may be effective in reducing pain. A physical therapist may recommend exercises to help strengthen the ankle muscles and improve balance.
When conservative treatments don’t provide enough relief, surgery is an option. The surgeon may remove bone spurs, alleviating pain while maintaining function. An ankle fusion fuses two bones, reducing pain but limiting movement of the ankle. For those with advanced ankle arthritis, a surgeon may perform a total ankle replacement, which preserves mobility while alleviating pain.
Come see our experienced clinicians to find out what’s causing your ankle pain and how it can be treated. Our staff helps you understand techniques for treatment, including options such as Micro-Vas Therapy, and what might be best for your condition. Contact us for an appointment today.