Common Causes, Complaints, Diagnosis, Treatment, and How Physical Therapy Can Help
“My heel and arch hurt the worst in the morning” “Twisting and turning really make my Achilles hurt worse” “This shoe has never given me a problem, why does my foot hurt now?” “I’m increasing my fitness program, and now my shin is killing me!”
Research consistently shows that the following contribute to most ankle and foot pain complaints:
- Poor footwear
- Shoes with poor foot support
- Shoes with a narrow-toe box
- Worn-out shoes (even though they may still ‘look’ good)
- High heels
- Cowboy boots
- Ankle sprains
- Foot and ankle fractures
- Ligament and tendon ruptures
- Poor flexibility
- Tight calf muscles
A lack of hip and core strength and stability alters the way our foot hits the ground and can lead to abnormal mechanical stresses. Our bodies function best when we have the appropriate overall balance of strength and flexibility.
- Muscle strains (gastrocnemius or soleus strain/tear, peroneal strain)
- Ligament sprains (ant./post. Talofibular ligament, calcanealfibular ligament, deltoid ligament, ligaments in the forefoot)
- Fractures (tibia/fibula, lis franc, sesamoid, cuboid, stress fractures of the metatarsals or tibia)
- Tendonitis (Achilles, posterior tibial, anterior tibial, flexor hallicus longus, peroneal)
- Arch Pain, Heel Pain (Plantar Fasciitis, heel spur, pes planus, or pes cavus)
- Neuromas (Morton’s neuroma)
- Big Toe pain and/or deformity (Hallux valgus, bunion)
- General anterior or posterior ankle pain (anterior or posterior talocrural impingement, decreased talocrural or subtalar joint mobility)
Along with skilled manual therapy, individualized stretching and strengthening, and patient education, we may incorporate methods such as taping, heat or ice, electric stimulation, and iontophoresis. We also offer video gait analysis with state-of-the-art software to analyze your gait pattern and provide recommendations on appropriate shoe wear for your particular situation. Since 1994 our evidenced based approach has helped thousands of West Michigan patients get back to their lives and on their way to a healthy, happy foot.
Iontophoresis is a treatment for hyperhidrosis — or excessive sweating. It involves sending a gentle electrical current through water to shut down your sweat glands temporarily. If it works for you, you’ll have to keep doing the treatments to maintain the results.
Plantar fasciitis is one of the most common causes of foot pain. 1 It results from irritation of a thick band of tissue, called the plantar fascia, that runs across the bottom of your foot. This fascia connects your heel bone to your toes. Plantar fasciitis (PLAN-tur fas-e-I-tis) is one of the most common causes of heel pain. It involves inflammation of a thick band of tissue that runs across the bottom of each foot and connects the heel bone to the toes (plantar fascia).
Plantar fasciitis commonly causes stabbing pain that usually occurs with your first steps in the morning. As you get up and move, the pain normally decreases, but it might return after long periods of standing or when you stand up after sitting.
The cause of plantar fasciitis is poorly understood. It is more common in runners and in people who are overweight.
Plantar fasciitis typically causes a stabbing pain in the bottom of your foot near the heel. The pain is usually the worst with the first few steps after awakening, although it can also be triggered by long periods of standing or when you get up from sitting.
The plantar fascia is a band of tissue (fascia) that connects your heel bone to the base of your toes. It supports the arch of the foot and absorbs shock when walking.
Tension and stress on the fascia can cause small tears. Repeated stretching and tearing of the facia can irritate or inflame it, although the cause remains unclear in many cases of plantar fasciitis.
Even though plantar fasciitis can develop without an obvious cause, some factors can increase your risk of developing this condition. They include:
- Age. Plantar fasciitis is most common in people between the ages of 40 and 60.
- Certain types of exercise. Activities that place a lot of stress on your heel and attached tissue — such as long-distance running, ballet dancing, and aerobic dance — can contribute to the onset of plantar fasciitis.
- Foot mechanics. Flat feet, a high arch, or even an atypical pattern of walking can affect the way weight is distributed when you’re standing and can put added stress on the plantar fascia.
- Obesity. Excess pounds put extra stress on your plantar fascia.
- Occupations that keep you on your feet. Factory workers, teachers, and others who spend most of their work hours walking or standing on hard surfaces can be at increased risk of plantar fasciitis.
Ignoring plantar fasciitis can result in chronic heel pain that hinders your regular activities. You’re likely to change your walk to try to avoid plantar fasciitis pain, which might lead to foot, knee, hip or back problems.
What can cause foot and ankle pain without injury?
- Reactive arthritis.
- Flat feet.
- Rheumatoid arthritis.
- Achilles tendonitis.
One of the most common causes of chronic foot and ankle pain is arthritis. Arthritis is a degenerative joint disease that can cause pain, stiffness, and swelling in the joints. There are many types of arthritis, but osteoarthritis is the most common type, affecting the feet and ankles.
- Rest. Keep weight off the ankle as much as possible. …
- Ice. Place an ice pack or bag of frozen peas on the ankle for 15 to 20 minutes three times a day.
- Compression. Wrap the area with a compression bandage to reduce swelling.
- Elevation. …
- Pain medicines you can get without a prescription.
- ankle pain is stopping you from doing normal activities.
- the pain is getting worse or keeps coming back.
- the pain has not improved after treating it at home for 2 weeks.
- Do you have any tingling or loss of sensation in your foot?
- you have diabetes and foot pain – foot problems can be more serious if you have diabetes.
- Persistent swelling.
- Chronic pain.
- Persistent numbness or tingling.
- An open wound.
- An infection.
- Tenderness and warmth in your foot accompanied by a fever.
- Pain may increase with activity.
- Stiffness or loss of mobility.
- Deformity of the ankle.
In addition to being a frequent runner, wearing ill-fitting shoes or high heels can cause metatarsalgia. Excess weight can also contribute to metatarsalgia. Having rheumatoid arthritis, osteoarthritis or gout can also contribute to metatarsalgia. Metatarsalgia (met-uh-tahr-SAL-juh) is a condition in which the ball of your foot becomes painful and inflamed. You might develop it if you participate in activities that involve running and jumping. There are other causes as well, including foot deformities and shoes that are too tight or too loose.
Numbness and tingling in the feet or hands. burning, stabbing, or shooting pain in affected areas. loss of balance and coordination. muscle weakness, especially in the feet.
What Is Equinus?
Equinus is a condition in which the upward bending motion of the ankle joint is limited. Someone with an equinus lacks the flexibility to bring the top of the foot toward the front of the leg. Equinus can occur in one or both feet. When it involves both feet, the limitation of motion is sometimes worse in one foot than in the other.
People with equines develop ways to compensate for their limited ankle motion, and this often leads to other foot, leg, or back problems. The most common methods of compensation are flattening of the arch or picking up the heel early when walking, placing increased pressure on the ball of the foot. Other patients compensate by toe walking, while a smaller number take steps by bending abnormally at the hip or knee.
There are several possible causes for the limited range of ankle motion. Often, it is due to tightness in the Achilles tendon or calf muscles (the soleus muscle and/or gastrocnemius muscle). In some patients, this tightness is congenital (present at birth), and sometimes it is an inherited trait. Other patients acquire the tightness from being in a cast, being on crutches, or frequently wearing high-heeled shoes. In addition, diabetes can affect the fibers of the Achilles tendon and cause tightness. Sometimes equinus is related to a bone blocking the ankle motion. For example, a fragment of a broken bone following an ankle injury, or bone block, can get in the way and restrict motion. Equinus may also result from one leg being shorter than the other. Less often, equinus is caused by spasms in the calf muscle. These spasms may be signs of an underlying neurologic disorder.
Foot Problems Related to Equinus
Depending on how a patient compensates for the inability to bend properly at the ankle, a variety of foot conditions can develop, including:
- Plantar fasciitis (arch/heel pain)
- Calf cramping
- Tendonitis (inflammation in the Achilles tendon)
- Metatarsalgia (pain and/or callusing on the ball of the foot)
- Arthritis of the midfoot (middle area of the foot)
- Pressure sores on the ball of the foot or the arch
- Bunions and hammertoes
- Ankle pain
- Shin splints
Most patients with equinus are unaware they have this condition when they first visit the doctor. Instead, they come to the doctor seeking relief for foot problems associated with equinus.
To diagnose equinus, the foot and ankle surgeon will evaluate the ankle’s range of motion when the knee is flexed (bent) as well as extended (straightened). This enables the surgeon to identify whether the tendon or muscle is tight and to assess whether the bone is interfering with ankle motion. X-rays may also be ordered. In some cases, the foot and ankle surgeon may refer the patient for neurologic evaluation.
Treatment includes strategies aimed at relieving the symptoms and conditions associated with equinus. In addition, the patient is treated for the equinus itself through one or more of the following options:
- Night splint. The foot may be placed in a splint at night to keep it in a position that helps reduce tightness of the calf muscle.
- Heel lifts. Placing heel lifts inside the shoes or wearing shoes with a moderate heel takes stress off the Achilles tendon when walking and may reduce symptoms.
- Arch supports or orthotic devices. Custom orthotic devices that fit into the shoe are often prescribed to keep weight distributed properly and to help control muscle/tendon imbalance.
- Physical therapy. To help remedy muscle tightness, exercises that stretch the calf muscle(s) are recommended.|
When Is Surgery Needed?
In some cases, surgery may be needed to correct the cause of equinus if it is related to a tight tendon or a bone blocking the ankle motion. The foot and ankle surgeon will determine the type of procedure that is best suited to the individual patient.
Pain or discomfort can be felt anywhere in the foot. You may have pain in the heel, toes, arch, instep, or bottom of foot (sole).
Foot pain may be due to:
- Being on your feet for long periods of time
- Being overweight
- A foot deformity that you were born with or develops later
- Shoes that fit poorly or do not have much cushioning
- Too much walking or other sports activity
The following can cause foot pain:
- Arthritis and gout — Common in the big toe, which becomes red, swollen, and very tender.
- Broken bones.
- Bunions — A bump at the base of the big toe from wearing narrow-toed shoes or from abnormal bone alignment.
- Calluses and corns — Thickened skin from rubbing or pressure. Calluses are on the balls of the feet or heels. Corns appear on the top of your toes.
- Hammer toes — Toes that curl downward into a claw-like position.
- Fallen arches — Also called flat feet.
- Morton neuroma — A thickening of nerve tissue between the toes.
- Nerve damage from diabetes.
- Plantar fasciitis.
- Plantar warts — Sores on the soles of your feet due to pressure.
- Stress fracture.
- Nerve problems.
- Heel spurs or Achilles tendinitis.
Massage for Foot Pain
- Start by rubbing the soles of your feet.
- Focus on anything that feels tight or feels good when you rub.
- Rub from your heel to the ball of the foot.
- Stretch out your toes and ankles but wiggle them back and forth.
- Rub the tops, sides, and bottom of your toes to get the blood flowing.
Exercises for Foot Pain
Certainly, let’s delve deeper into the science and research behind the causes of ankle and foot pain, as well as the benefits of massage for addressing this pain.
Causes of Ankle and Foot Pain:
Strains and Sprains: Ankle and foot pain can often result from strains (overstretching or tearing of muscles) and sprains (overstretching or tearing of ligaments) due to activities such as sports, sudden movements, or accidents.
Plantar Fasciitis: This condition involves inflammation of the plantar fascia, which supports the arch of the foot. Microtears in the fascia can cause pain, especially upon standing or walking.
Achilles Tendonitis: Inflammation of the Achilles tendon can be caused by overuse, improper footwear, or a sudden increase in activity. This leads to pain and stiffness in the back of the ankle.
Arthritis: Osteoarthritis and rheumatoid arthritis can affect the joints of the ankle and foot, causing pain, stiffness, and reduced range of motion.
Peripheral Neuropathy: Nerve damage, often due to conditions like diabetes, can lead to pain, numbness, and tingling in the feet and ankles.
Stress Fractures: Microscopic fractures in the bones due to repetitive stress or overuse can cause localized pain.
Gout: A form of inflammatory arthritis, gout can lead to the buildup of uric acid crystals in joints, often affecting the big toe and causing intense pain.
Benefits of Massage for Ankle and Foot Pain:
Pain Modulation: Massage therapy can trigger the release of endorphins and other neurotransmitters that help reduce pain perception. This can provide temporary relief from acute or chronic pain.
Muscle Relaxation: Massage techniques such as effleurage and petrissage can help relax muscle fibers and reduce muscle tension. This can be particularly beneficial for conditions like strains and muscle-related pain.
Improved Circulation: Massage increases blood flow to the affected areas, promoting the delivery of oxygen and nutrients while aiding in the removal of metabolic waste products. Improved circulation supports tissue healing and reduces swelling.
Fascial Release: Techniques like myofascial release can target the fascia, a connective tissue that can become tight and restrictive, contributing to pain. By releasing fascial restrictions, massage may alleviate pain and improve mobility.
Neuromuscular Facilitation: Massage can stimulate neuromuscular pathways, helping to restore proper muscle function and coordination, which can be important for addressing imbalances contributing to pain.
Reduction of Trigger Points: Trigger points are hyperirritable knots in muscles that can refer pain to other areas of the body. Massage therapy can help deactivate these trigger points, reducing pain referrals.
Lymphatic Drainage: Gentle massage techniques promote lymphatic circulation, aiding in the removal of excess fluid and reducing swelling in injured or inflamed tissues.
Psychological Effects: Massage promotes relaxation and reduces stress, which can indirectly contribute to pain relief. Stress reduction supports the body’s natural healing processes and can improve overall well-being.
Research on Massage for Ankle and Foot Pain:
A study published in the “Journal of Physical Therapy Science” in 2016 found that massage therapy combined with conventional treatment significantly improved pain and functional status in patients with plantar fasciitis.
Research published in the “Journal of Sports Science & Medicine” in 2014 demonstrated that massage therapy was effective in reducing pain and improving function in individuals with ankle sprains.
A systematic review published in the “Journal of Foot and Ankle Research” in 2014 indicated that massage therapy could provide short-term pain relief for people with rheumatoid arthritis and osteoarthritis of the foot.
A study published in the “Archives of Physical Medicine and Rehabilitation” in 2005 found that massage therapy was effective in reducing pain and increasing range of motion in patients with Achilles tendonitis.
Research published in the “International Journal of Therapeutic Massage & Bodywork” in 2016 highlighted the positive effects of massage therapy in reducing pain and improving the quality of life in individuals with peripheral neuropathy.
It’s important to note that while these studies demonstrate potential benefits, more research is needed to fully understand the mechanisms behind massage therapy and its effectiveness for specific causes of ankle and foot pain. Additionally, individual responses to massage can vary, and its benefits may be most effective when used as part of a comprehensive treatment plan that includes medical evaluation, physical therapy, and lifestyle modifications.
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*Disclaimer: This information is not intended to be a substitute for professional medical advice. You should not use this information to diagnose or treat a health problem or disease without consulting with a qualified healthcare provider. Please consult your healthcare provider with any questions or concerns you may have regarding your condition. The information provided is for educational purposes only and is not intended as a diagnosis, treatment, or prescription of any kind. The decision to use, or not to use, any information is the sole responsibility of the reader. These statements are not expressions of legal opinion relative to the scope of practice, medical diagnosis, or medical advice, nor do they represent an endorsement of any product, company, or specific massage therapy technique, modality, or approach. All trademarks, registered trademarks, brand names, registered brand names, logos, and company logos referenced in this post are the property of their owners.