PAIN AND ORTHOPAEDICS · Health guide
Foot and Ankle Pain: Causes and Treatment
Sprains, tendon problems and loading difficulties in foot and ankle pain: a guide to weight bearing, balance and a safe return to activity.
Updated: · General information
Who is affected?
Foot pain is among the common musculoskeletal problems, particularly in women. The main causes are overuse, unsuitable footwear and repetitive minor injury. Although it can occur at any age, it is more frequent in middle-aged and older women; the risk is higher in athletes, dancers, those who wear high-heeled or narrow shoes, and people with diabetes, inflammatory arthritis or a congenital foot deformity such as flat foot.
Causes and diagnosis
The principal causes are ankle sprains, heel spur, plantar fasciitis, tendinitis, bursitis, arthritis, nerve entrapments, problems of the foot arch, fractures and toe deformities. Plantar fasciitis is the most important cause of heel pain in middle and older age. Plain radiography may be used where a fracture is suspected, MRI for soft-tissue injuries, blood tests to assess arthritis and ultrasound to assess inflammation.
Treatment and prevention
Orthoses, suitable footwear, compression stockings, medication, physical therapy and injections form the basis of conservative treatment; anti-inflammatory drugs may be used where the cause is inflammatory. Cold application can help in acute trauma and heat in degenerative conditions; minimally invasive options such as prolotherapy, PRP and steroid injection may also be considered. It is advisable to choose footwear that supports the sole, to leave about 1 cm between the toes and the end of the shoe, to prefer breathable materials, to change shoes and socks regularly, to keep weight under control, to exercise regularly and to use an insole on medical advice.
The timing and site of the pain
Pain that begins with the first steps in the morning, after a long walk, or following a sprain may point to different causes. Swelling, bruising, the fit of footwear and the ability to bear weight on the foot are all assessed. Where there is diabetes or loss of sensation, skin wounds are of particular importance.
Why is balance trained after a sprain?
Even when the pain has eased, control of the ankle and confidence in it may not have fully returned. Rehabilitation addresses range of movement, strength and balance together. Return to running and to changes of direction is planned on the basis of functional assessment, not simply the number of days that have passed.
Your questions
Patient information
Is every heel pain a heel spur?
No. Heel pain has more than one cause; a spur seen on a radiograph is not always the source of the pain.
If I can bear weight after a sprain, does that mean there is no fracture?
Being able to bear weight does not entirely exclude a fracture. Marked bony tenderness, deformity or persisting symptoms require assessment.
