Ankle and Heel Problems
Pain in your ankles and heels is not only a nuisance, but it may also be an indication of a serious problem with one or both of your feet. The following are common problems associated with ankle and heel pain.
Ankle Fractures (Broken Ankle)
A fractured ankle, also known as a broken ankle, occurs when one or more of the three bones that make up the ankle joint are partially or completely broken. The severity of ankle fractures can vary greatly from: minor cracks in a single bone, to multiple fractures and displacement of the ankle joint.
Because it can be easy to mistake an ankle fracture for an ankle sprain, a physician should evaluate every ankle injury. Quick and accurate diagnosis of an ankle fracture is necessary to ensure proper healing of the joint.
Causes of ankle fractures
Ankle fractures occur when your ankle joint is forced beyond its normal range of motion. If the ankle is not straightened immediately, the bones that make up the joint can crack or fracture in an instant.
Fractures often result from the same type of movements that cause ankle sprains, including:
- "Rolling" the ankle in or out while walking or running.
- Jumping or landing on an uneven surface.
- Severe force applied to the ankle joint (possibly from impact during a car accident or other trauma).
- Twisting the ankle side to side.
While many ankle fractures occur when a running or jumping athlete slips or rapidly changes direction, it is just as easy for you to sustain an ankle fracture while out enjoying a leisurely walk or carrying out typical housework.
Fractured ankle symptoms
Unlike ankle sprains, where you can usually walk on your injury, ankle fractures are more painful. Most people cannot put weight on a fractured ankle.
Common symptoms of a fractured ankle include:
- Bruising and swelling.
- Inability to walk (however, never assume because you can walk your ankle is not broken).
- Severe and immediate pain.
- Visible deformity of the ankle joint (bone looks dislocated or protrudes through the skin).
Both an ankle fracture and severe ankle sprain will produce immediate pain and swelling at the joint. While a severe sprain will heal in a week or two and pain will subside, a fractured ankle will continue to hurt until the injury is treated.
Treatment of fractured ankles
It is important to see a physician right away following any ankle injury. The doctor will examine your foot and ankle region, looking for dislocation, and may order x-rays or imaging tests to determine the extent of the injury. Because every ankle fracture is unique, treatment will vary depending on the severity of your injury. On average, a fractured ankle will require 4-8 weeks to heal.
Minor fractures can be managed as an ankle sprain and treated using the R.I.C.E. guidelines of rest, ice, compression, and elevation.
Serious fractures are always treated with immobilization, where the ankle and foot are protected with a cast to allow the bone(s) to heal. Your doctor may recommend a "walking cast", which will allow your foot to bear weight, or a non-weight bearing cast, which will require the use of crutches to move around.
Depending on the severity of the fracture and degree of discomfort experienced after the injury, your doctor may also prescribe pain medication.
If the bones in the ankle joint cannot be realigned, or if any bone has broken through the skin of the ankle, surgical intervention might be necessary. Your surgeon will select the procedure that is appropriate for the injury.
If you have sustained a serious ankle injury, make sure to visit your doctor as soon as possible. The earlier an ankle fracture is diagnosed the sooner treatment can begin.
Among the most common of orthopedic injuries, ankle sprains can affect people at every activity level - from professional athletes to the most sedentary persons. In fact, in the United States alone, approximately 25,000 ankle sprains occur each day. That amounts to millions of sprained ankles each year.
The frequency of ankle sprains does not make them any less painful or serious. Proper diagnosis and care are necessary to help speed the recovery process of these injuries.
Causes of ankle sprains
An ankle sprain can occur during sports and when carrying out daily activities. Most ankle sprains occur when you step onto an uneven surface or otherwise twist your foot. Common causes of sprained ankles include: stepping onto an uneven sidewalk, awkwardly planting your foot when running or walking, or having your foot stepped on while participating in a sport.
These and other movements can cause the ligaments surrounding the ankle to be stretched too far, causing a partial or complete tear. This ligament tear creates the pain and swelling associated with ankle sprains.
Ankle sprain symptoms
Swelling, bruising, tenderness, and pain are common symptoms of sprained ankles. Although the majority of ankle sprains result in pain on the outside of the ankle, about 10 percent of sprained ankles will cause pain and swelling on the inside of the ankle. The degree of these symptoms will vary based on the grade of your sprain.
- Grade I: Stretching and some microscopic tearing of the ligament. A minor ankle sprain which typically causes some pain and swelling. However, with most minor sprains, you will be able to walk without the use of crutches, although your ability to run, jog, and jump will be limited.
- Grade II: Partial tearing of the ligament. You will most likely feel more pain and swelling and notice bruising, which is caused by bleeding. Walking will be painful, but not unbearable, as long as you take it easy and only take a few steps at a time.
- Grade III: Complete tear of the ligament. The most painful of ankle sprains. With a complete tear, you might feel as though your ankle is not stable. Walking may be unbearable without the use of crutches.
Treatment of ankle sprains
For grade I and II ankle sprains, you should be able to treat yourself, using the R.I.C.E. guidelines of rest, ice, compression, and elevation. Be sure to give your ankle a chance to heal by resting it; this means limit walking on it. Putting ice on your sprained ankle will help reduce the swelling. Compress the ankle using Ace bandages, but do not wrap it too tightly; the wrap should allow for blood flow to your foot. Whenever possible, keep your injured ankle elevated above your heart.
If you believe you have a grade III ankle sprain or if your ankle does not show improvement after several days of home treatment, visit your doctor. Serious ankle sprains can lead to long-term ankle instability if not properly treated.
Arthritis is a condition in which you experiences pain within a joint. With more than 30 joints in the foot, it is common for the feet and ankle to be affected by arthritis. The pain and inflammation commonly associated with arthritis may affect balance and movement. There is no cure for arthritis, but there are treatment options to help manage symptoms. It is important to begin treatment as soon as possible to reduce pain, and prevent the condition from becoming more severe.
There are three types of arthritis that may affect your ankle:
- Osteoarthritis is a degenerative condition that typically affects individuals later in life. The surface of bones becomes worn over time causing inflammation and pain in the joint. As the condition progresses, your joint becomes stiff, limiting range of motion.
- Post-Traumatic Arthritis is similar to osteoarthritis, but develops after an injury and can affect individuals at any age. In most cases, you won't experience symptoms until several years after the injury.
- Rheumatoid Arthritis is a disease in which your own immune system destroys cartilage surrounding the joints. As the cartilage deteriorates, the bones begin to rub together causing the surrounding tissues to become inflamed. This can become increasingly painful over time.
Causes of arthritis
Each type of arthritis has a different cause:
- Osteoarthritis is caused by wear and tear on your bones and occurs with age. As the surface of the bones in your ankle and feet become worn, the joints become painful and inflamed.
- Post-traumatic arthritis can occur if your bones and cartilage don't heal properly after a severe sprain or fracture. When the bones and cartilage are not properly aligned, pain and inflammation of the surrounding tissues can result. However, it takes time for the bones to wear down, so symptoms of arthritis do not typically present themselves until years after the injury.
- Rheumatoid arthritis is thought to be caused by an infection or environmental factor which triggers the disease and causes substances to attack the joint. While the disease is not inherited, genetics may play a role in making you more susceptible to the disease.
Symptoms of arthritis include:
- Joint inflammation.
- Loss of balance and lack of movement as a result of pain or swelling.
- Pain surrounding the joint.
- Stiffness of the joint.
Treatment of arthritis
Arthritis can typically be controlled through non-surgical treatments, but surgery may also be considered.
Non-surgical treatments include:
- Anti-inflammatory medications.
- Brace or cane for support.
- Exercise or physical therapy.
- Pain medications.
- Physician-administered injections of steroid medication.
- Shoe inserts or arch supports.
If symptoms persist, surgery may be an option. Surgery may involve removing excess tissue around the joint (arthroscopic debridement), fusing the joint together (arthrodesis), or replacing the affected joint (arthroplasty).
- Arthrodesis is a procedure that involves fusing the bones of the joint together using pins, plates, screws, or rods. In some cases, a brace may need to be worn following surgery in order to help with healing. This procedure is typically successful, but over time arthritis may develop in the surrounding joints.
- Arthroplasty involves replacing the joint with a prosthetic. This procedure provides relief from pain and inflammation. It also allows for better movement of the affected joint, which puts less strain on surrounding joints and minimizes the chance for arthritis to develop elsewhere.
- Arthroscopic Debridement is a minimally invasive procedure, which allows for quicker recovery time than traditional surgery. During the procedure, the surgeon looks for any abnormalities and removes inflamed tissue and loose cartilage from around the joint.
To determine which treatment will be most beneficial for your particular condition, consult your physician.
Chronic Lateral Ankle Pain
Chronic lateral ankle pain is a condition in which you experience a recurring pain concentrated on the outside (lateral) part of the ankle. A condition common to athletes, this type of long-term discomfort is related to frequent ankle injuries and often follows a serious sprain or fracture.
Causes of chronic lateral ankle pain
A common cause of chronic lateral ankle pain is incomplete healing of the ankle joint after a serious sprain. Following any type of damage to the ligaments, which stabilize the ankle joint, the ankle will not be as strong as it was prior to the injury. If the ligaments are not allowed to heal properly, chronic pain in the joint and further injury may result.
Chronic lateral ankle pain can also be attributed to:
- A fracture in the bones that make up the ankle joint.
- Arthritis of the ankle joint.
- Inflammation of the ankle joint lining.
- Nerve injury.
- Scar tissue in the ankle (placing pressure on the ligaments).
- Torn tendon or tendonitis.
Chronic lateral ankle pain symptoms
Chronic lateral ankle pain is characterized by swelling and stiffness near the ankle joint, as well as recurring pain on the outside of the ankle that worsens with exercise. The pain can be brought on by walking and playing sports, or it can manifest as a dull and constant ache.
One of the more distressing symptoms of chronic lateral ankle pain is a constant feeling of ankle instability. People with chronic lateral ankle pain often have difficulty walking in high heels or on uneven ground and are prone to repeat ankle injuries.
Treatment of chronic lateral ankle pain
Treatment for chronic lateral ankle pain will depend on the final diagnosis by your physician. Conservative treatments include:
- Ankle brace.
- Anti-inflammatory medication (to reduce swelling).
- Physical therapy (designed to strengthen muscles and restore joint motion).
- Steroid injections.
When pain can be attributed to a past fracture, the physician may recommend immobilization to allow the bone to heal.
If conservative treatment fails to reduce the chronic pain, surgery might be necessary. Surgical treatment can involve everything from the removal of loose fragments of bone, to cleaning the surface of the joint or repairing damaged ligaments or tendons.
If you suffer from chronic lateral ankle pain, make sure to consult a doctor. A physician can help create a treatment plan that will relieve the chronic pain associated with ankle injuries.
Gout is a form of arthritis that most commonly affects the big toe, but can affect other joints as well. This condition can be either acute or chronic. Acute gout typically affects only one joint and is not recurring, while chronic gout reoccurs and may involve multiple joints. If left untreated, chronic gout can harm joints, tendons, and tissues, causing loss of motion and severe joint pain. Gout is more common in men and postmenopausal women.
Causes of gout
Gout is caused by a high level of uric acid in the blood. The hard salts of uric acid build up in the joints, causing them to become inflamed. In some cases, the high level of uric acid is caused by your body producing too much of the chemical; in other cases, your body has difficulty removing uric acid, and it builds up. However, having a high level of uric acid in the blood is not usually harmful, and many people with a high level of uric acid will never develop gout.
Your risk of developing gout increases if you:
- Are overweight.
- Consume large amounts of alcohol.
- Eat too much meat and fish containing purines (a chemical compound that is metabolized into uric acid).
If you have gout, you will typically experience symptoms in the middle of the night. The most common symptom of gout is a sharp pain or throbbing in your big toe or another joint such as the ankle or knees. This pain is often accompanied by redness and swelling.
Some individuals may have only one gout attack in their lifetime. For others, gout may develop into a chronic condition that reoccurs every so often. Sometimes months, even years will go by before another gout attack. Subsequent gout attacks usually last longer.
Treatment of gout
If you are suffering from gout, it is important to rest the joint. You can take anti-inflammatory medication, such as ibuprofen, to reduce swelling. However, it is important that you avoid aspirin, as it can increase the uric acid level in the blood.
If symptoms are severe or recurring, visit a doctor for treatment. Your doctor can prescribe stronger non-steroidal anti-inflammatory drugs (NSAIDs) and painkillers. In some cases, a shot of corticosteroids may also be administered. Symptoms can be relieved within a day when treated the right away.
If you have chronic gout, medications can be prescribed to reduce uric acid buildup in your blood. Future attacks may also be prevented by adjusting your diet to include a variety of healthy foods while avoiding alcohol and limiting consumption of foods high in purine such as meat, seafood, asparagus, spinach, kidney beans, mushrooms, gravy, and yeast.
Haglund's deformity refers to a bony protrusion at the back of your heel that becomes inflamed. This condition can affect one foot or both and is often referred to as the "pump bump" since it typically affects young women who wear high-heeled shoes.
Causes of Haglund's Deformity
Wearing high-arched shoes that cause the heel to tilt back, toward the tendon is the most common cause of Haglund's Deformity. By walking in shoes with high-arches and firm backs, you put pressure on the back of your heel. This pressure irritates the area surrounding the enlarged bone, causing the soft tissue that acts as a cushion between the bone and Achilles tendon to become inflamed.
Heredity may play a role in Haglund's Deformity, as foot structure may make you more prone to developing the condition. Placing more weight on the outside of the heels when you walk can also increase your chances of developing the deformity, as this motion causes the bone and tendon to rub together. Once the condition starts to develop, it can worsen if your Achilles tendon is tight and inflexible, as this can compress the already inflamed tissues.
Haglund's Deformity symptoms
Symptoms of Haglund's deformity include:
- A large bump on the back of your heel.
- Pain near your Achilles tendon.
- Redness surrounding the affected area.
- Swelling of the soft tissues on the back of your heel.
Treatment of Haglund's Deformity
Both non-surgical and surgical treatments are available for Haglund's deformity depending on the severity of the condition. Non-surgical treatment works to reduce inflammation and pain, but will not reduce the bony protrusion.
Non-surgical treatments include:
- Applying ice or cold compact to the affected area for 20 minute intervals throughout the day to reduce swelling.
- Reducing inflammation using ultrasound therapy.
- Taking anti-inflammatory medication to reduce pain and swelling.
- Using topical pain medication.
- Wearing a cast or boot to immobilize the foot and allow the tendon and surrounding tissues to heal (typically reserved for more severe cases).
Preventive steps to hinder increase in severity
There are also steps you can take to prevent Haglund's deformity from becoming more severe. These include:
- Placing heel lifts in your shoes with high arches to help reduce pressure on the heel.
- Stretching to help your Achilles tendon become more flexible.
- Using arch supports to control motion of the foot.
- Wearing backless shoes or shoes with soft backs to reduce pressure and irritation.
- Wearing heel pads to reduce irritation.
If non-surgical treatments are unable to provide sufficient relief for your symptoms, you may benefit from surgery. Contact your doctor to discuss surgical options and determine which procedure would best meet your needs.
A callus is an area of thick, hard skin that develops due to pressure or friction. A callus on your heel forms as your body's way of protecting itself, but may cause discomfort and be a source of self-consciousness.
Causes of a heel callus
Calluses can form on the heel due to pressure or continuous rubbing. Heel calluses are typically caused by ill-fitting shoes or standing for long periods of time. Individuals who are obese often suffer from calluses due to the amount of pressure placed on their feet.
Heel callus symptoms
A heel callus is a small patch of skin on the heel that may be:
- Dry and flaky.
- Rough to the touch.
Treatment of heel calluses
Calluses can typically be treated by softening and smoothing the affected skin. You can use a pumice stone to remove dead skin cells and rough areas to make the skin smoother. Applying lotion to the affected area once or twice a day can also soften the skin.
In addition to keeping the skin moisturized, you should wear comfortable shoes and avoid putting unnecessary pressure on your feet. Placing heel inserts inside of your hard-soled shoes will provide more cushion and reduce pressure on your heels. With treatment, the skin on your heel may remain thicker and protected but will have an even texture and more pleasing appearance.
In extreme cases, calluses can be surgically removed, but this is not usually recommended. Since calluses develop to toughen up the skin and prevent cuts and infection, they will likely return, often thicker than before. It is especially important that you do not try to remove calluses yourself with a razor or other sharp object, as you can remove too much skin and risk infection. If an infection develops, seek medical treatment, as this can become a more serious problem.
Heel fissures, or cracked skin on your heels, can be a source of discomfort and self-consciousness. Heel fissures often develop when calluses are already present on the outer edge of your heel, as this skin is usually hard and dry, making it more prone to cracking.
If left untreated, the cracks can become deep and start to bleed, or may become infected. This is especially dangerous for individuals with weakened immune systems.
Causes of heel fissures
Xerosis or dry skin is the most common cause of heel fissures. Heel fissures may also form when continuous pressure is placed on the heels. This typically occurs as a result of walking or standing on the feet for long periods of time. Wearing shoes with open backs may also lead to heel fissures, as the lack of heel support allows the fat to expand and pressure on the heel causes the skin to crack.
You may have an increased risk of developing heel fissures if you:
- Are overweight.
- Frequently wear shoes with open backs.
- Have a health condition that can cause dry skin such as diabetes or underactive thyroid.
- Have inactive sweat glands.
- Spend most of the day on your feet.
- Suffer from psoriasis or eczema.
Heel fissures symptoms
Heel fissures typically affect both feet, but may only occur on one foot. Individuals who suffer from this condition typically have hard, dry, cracking skin on the heels. Heel fissures may develop on one side of the heel or around the whole outer edge. The condition is usually painful, particularly when weight is placed on the heel. Bleeding may occur, especially if the cracks are deep.
Treatment of heel fissures
Since heel fissures are often caused by dry skin, it is important to keep your skin moisturized. A pumice stone can be used to remove dry, flaky skin. Once the dry skin has been removed, lotion can be applied to keep the remaining skin soft and healthy. It is best to apply lotion to your feet at the start of the day and again before bed.
Also be sure to wear comfortable shoes that keep your heel enclosed. Avoid wearing shoes with open backs, as the lack of support around the heel allows the fat to expand, and pressure can cause the skin to crack, particularly if the skin is already dry.
If cracking is severe and bleeding occurs, or if an infection develops, seek medical treatment.
A heel spur is an abnormal growth on the heel bone that forms in the shape of a hook. Heel spurs are often associated with a condition called plantar fasciitis, an irritation of the tissue on the bottom of the foot; however, heel spurs can also form when no other symptoms of plantar fasciitis are present.
Causes of heel spurs
A heel spur is caused by calcium deposits that develop when the plantar fascia (strip of fibrous tissue on the bottom of your foot) begins to pull away from the heel. Heel spurs are typically associated with plantar fasciitis, a condition in which the plantar fascia becomes inflamed.
In most cases, the inflamed tissue is what causes the pain. However, individuals who have a heel spur without any symptoms of plantar fasciitis may not experience pain while others may experience excruciating pain when standing or walking due to the heel spur itself.
Individuals who have flat feet or unusually high arches are most likely to develop a heel spur due to the structure of their feet. Women are also more susceptible to the condition since they frequently wear heels and other high-arched shoes.
Heel spur symptoms
Symptoms of a heel spur include:
- A bony hook-shaped protrusion that develops on your heel.
- Pain in the back of the foot that is typically worse in the morning.
- Severe pain when standing or walking.
- Tightness in the strip of tissue on the bottom of your foot.
Treatment of a Heel Spur
Heel spurs can typically be treated by:
- Applying ice or a cold pack to reduce inflammation.
- Resting and staying off your feet.
- Stretching and doing light exercises to relax the tissues around your heel bone.
- Taking anti-inflammatory medication.
- Wearing night splints to stretch the arch while sleeping.
- Wearing shoe inserts to provide proper arch support.
It may take a while for the pain and inflammation to subside, but if symptoms persist after a few weeks, consult your physician.
Since heel spurs form due to the plantar fascia stretching and pulling away from the heel, it is important to determine the root cause of this stretching so pain and inflammation can be prevented in the future. For instance, if one has flat feet that causes the plantar fascia to extend too far, arch supports can help prevent the condition from reoccurring. To prevent a recurrence, it is important to wear shoes that fit properly, use shoe inserts to relieve pressure, and continue stretching every day to relieve tightness.
Osteochondritis dissecans (OCD) is a condition that occurs when blood supply to the bone and cartilage in the ankle joint is cut off. Usually the condition develops as a result of some kind of trauma to the ankle. If left untreated, a fragment of bone can become detached inside the joint and cause chronic pain.
Though rare, osteochondritis is found mostly in young athletes, especially those involved in sports that require repetitive movement like jumping and pivoting.
Causes of osteochondritis
There are multiple factors that contribute to the development of osteochondritis. In most cases, the condition can be traced to a previous injury to the talus bone, which is usually caused by a sprained ankle.
Causes of osteochondritis dissecans can include:
- Ankle injury - A severe ankle sprain can fracture the talus bone in the ankle. If the fragment moves, it will cause pain and discomfort. Even a minor sprain can cause damage to the articular surface of the talus, reducing the bone's blood supply.
- Loss of blood supply - Vascular insufficiency may also lead to osteochondritis. This eventually causes the death of bone tissue.
The progression of osteochondritis can be slow or rapid. The damaged bone and its cartilage may stay in place for some time, causing only minor discomfort. When a fragment of bone detaches, pain will worsen. It is important to see a physician if you feel your pain is progressing.
Symptoms of osteochondritis:
- Ankle instability (or a feeling of your ankle joint giving way).
- Ankle stiffness (especially after your ankle has been at rest).
- Limited range of motion.
- Pain (often triggered by physical activity).
- Swelling of the ankle joint.
Treatment of osteochondritis
Osteochondritis treatment will depend on the extent of injury to the affected joint. If the damage is limited to bruising of the bone, resting the joint might be all that is required. In most cases, the initial damage to the talus bone is not recognized early; unfortunately, by the time the diagnosis is made a lesion has formed, or a fragment has detached from the bone.
Most physicians will initially recommend conservative treatment to reduce pain, this may include:
- A brace to immobilize the joint.
- Anti-inflammatory medications.
- Limiting physical activity (particularly sports).
- Physical therapy.
- Resting your ankle.
If pain persists for more than three months; if motion of the ankle joint is restricted; and if conservative treatment has failed to reduce swelling, surgery is an option. The exact treatment will be tailored to your specific type of injury, but surgical options include the removal of loose bone fragments, reattachment of loose cartilage, and bone drilling (to promote blood flow). The goal of any surgical procedure on the joint will be to restore blood flow to the joint and improve mobility.
Millions of men and women suffer from the debilitating effects of heel pain. The most common source of this pain is plantar fasciitis, a condition caused by inflammation of the thick band of tissue that runs across the bottom of the foot.
Plantar fasciitis is common in runners and anyone who is on their feet for long periods of time. People who are overweight, women who are pregnant, and those who wear shoes that lack arch support are also at risk for developing plantar fasciitis.
Causes of plantar fasciitis
Plantar fasciitis affects all age groups and is one of the most common complaints relating to the foot. It is caused by damage to the ligament (plantar fascia) that supports the arch of the foot.
The plantar fascia ligament is like a rubber band that stretches and contracts with movement. It absorbs both weight and pressure. Repeated strain from various types of activity can cause small tears in the ligament, which produces sharp pain in the heel.
Factors that may increase the risk of developing plantar fasciitis include:
- Age (plantar fasciitis is more common in people age 40-60).
- Excessive pronation (inward roll of your feet when you walk).
- Foot problems (flat feet or high arches place added stress on the plantar fascia).
- Improper shoes (no arch support).
- Obesity or significant weight gain.
Plantar fasciitis symptoms
Plantar fasciitis produces a stabbing or throbbing pain in the heel of the foot. The pain is usually sharpest in the morning and tends to fade to a dull ache over the course of the day. Pain will often reappear following physical activity or with movement after a long period of sitting down.
Plantar fasciitis usually affects only one foot, but it can occur in both feet though it is rare.
Treatment of plantar fasciitis
No single treatment will work for everyone, but most people who develop plantar fasciitis can reduce their heel pain in just a few months with proper home care. Conservative treatment is successful in 90 percent of cases.
Initial treatment may include:
- Anti-inflammatory medication.
- Orthotic inserts.
- Physical therapy and stretching.
- Resting and icing your foot.
If pain persists, you should tell your doctor. Surgery to release the taut ligament is an option, and your physician can prescribe steroid injections to reduce pain. It is important to be consistent with your treatment. It can take anywhere from a few months to a year for the pain associated with plantar fasciitis to disappear.
If you are suffering from severe pain in your ankles or heels, you should visit your doctor for examination and treatment.