​​​​​​​​Achy feet. Sore ankles. Tender toes. If you feel foot or ankle pain, you’re not alone. This type of discomfort affects nearly 40 percent of American adults. Walking, running, standing, and even wearing shoes can be more uncomfortable.

In a recent webinar, orthopedic surgeon Robert Kulwin, MD, from The Christ Hospital Physicians – Orthopaedics & Sports Medicine discussed the most common causes behind foot and ankle pain and available treatment options.

If foot or ankle pain impacts your mobility and limits your daily activities, here’s what Dr. Kulwin wants you to know.

Heel pain

Heel pain is common, Dr. Kulwin says. It can affect anyone, but it appears most often in older individuals.

“Up to 42 percent of people over age 65 experience some kind of heel pain,” he says. “And half of those people rate their heel pain as disabling.”

There are several different conditions that can cause heel pain. These are the three most common:

Achilles tendinosis

Achilles tendinosis happens when small tears and inflammation develop in your Achilles tendon resulting in thickening and pain. Overuse, muscle tightness, certain antibiotics or autoimmune disorders cause most cases.

You’re likely to feel symptoms when you’re active, first get out of bed in the morning, or stand up after sitting for a while. The most common signs are:

• Dull pain while walking

• Soreness

• Stiffness

• Swelling

• Tenderness

Nonsurgical, conservative treatments are the first-line options to treat Achilles tendinosis. Treatment usually starts with physical therapy. Experts also recommend an immobilization boot with heel lifts to limit ankle movement rest the tendon. Dr. Kulwin says this approach reduces discomfort and inflammation for 80 percent of people.

If those steps don’t work, surgery is an option. Orthopedic surgeons can perform a tendon debridement to remove the damaged part of your tendon​.

Insertional Achilles tendonitis

Insertional Achilles tendonitis is also called Haglund’s deformity or a “pump bump.” It’s a growth that forms on the back of your heel where your Achilles tendon attaches to your bone. You may develop this condition if you have high-arch feet, tight calves or overuse your heels in activities like long-distance running. These bumps cause pain, swelling and inflammation. They can make wearing shoes uncomfortable.

Providers also start with conservative treatments for insertional Achilles tendonitis. Based on your needs, they may recommend:

• A boot

• Dry needling

• Heel lifts

• Night splint (a brace that hugs your foot and calf during sleep)

• Physical therapy

• Stretching

In cases where these therapies aren’t successful, you may need surgery. During this procedure, the surgeon detaches your tendon, removes the unhealthy tissue and reattaches the remaining tendon to your bone. Dr. Kulwin says the surgery is effective, but recovery may take several months.

Plantar fasciitis

Plantar fasciitis is a common, painful condition. It affects your plantar fascia tendon, the thick band of tissue that connects your toes to your heel. According to the National Institutes of Health, roughly 10 percent of people—most between ages 40 and 60—will experience plantar fasciitis during their lives.

Plantar fasciitis develops when you have tight calf muscles that limit your ability to bend your ankle, Dr. Kulwin says. Instead, you bend through your foot, which pulls on where the plantar fascia attaches to the heel bone. Over time, repeated pulling causes tearing and degeneration of the plantar fascia that can be quite painful.

“With plantar fasciitis, think about your leg and foot as a bow with a bowstring,” he says. “You’re putting extra pressure on the front of your foot. When you flatten your foot out, it tugs and tugs in the back, eventually leading to the tears that cause pain and irritation.”

Almost all cases resolve within a year, he says. To help relieve your discomfort, providers may recommend these conservative treatments:

• Arch supports

• Boots

• Dry needling

• Gel heel cups

• Night splint

• Oral steroid medication

• Physical therapy

• Shoes with significant sole support

• Stretching

If these treatments don’t work, experts may recommend two other last-line options:

• Steroid injections: Your doctor can inject anti-inflammatory medication directly into your plantar fascia tendon. Dr. Kulwin cautions that these injections are painful. They may also cause tendon rupture or shrink the fat pad that cushions your heel.

• Surgery: In a quick, 10-minute procedure, surgeons make an incision in your calf muscle to relieve the tension pulling on your tendon. You may experience some minor damage to the sural nerve that runs down the back of your leg and mild loss of calf strength. Functional recovery is relatively quick, but it can take 3-4 months for the pain to entirely subside.

Ankle sprains

Ankle sprains are one of the most common orthopedic injuries. Doctors treat approximately 3 million of these partial or complete ligament tears annually. Roughly 50 percent are athletic injuries. But you can also cause a sprain by simply stepping or twisting your ankle the wrong way.

Stabilizing your ankle and getting you back on your feet are the keys to effective treatment, Dr. Kulwin says. In most cases, doctors recommend the RICE (rest, ice, compression and elevation) method paired with a brace and physical therapy. Severe sprains may require a boot.

This conservative approach may not work if the sprain causes:

• Anterior impingement: This is when bone spurs or persistent swelling in the front of your ankle joint lead to chronic pain. Surgeons can use a minimally invasive arthroscopic procedure to remove damaged tissue and reduce swelling and inflammation.

• Chronic instability: The ligaments in your ankle don’t heal properly and remain loose, causing your ankle to wobble or “give way” frequently. Surgeons can perform ligament reconstruction to strengthen your ankles.

• Osteochondral defect: This is damage to the top of your ankle bone and cartilage caused by a severe sprain. Treatment involves minimally invasive surgery to remove and replace unhealthy bone and tissue.

• Peroneal tendon tear: This is a tear in the tendons on the outside of your ankle that connect your lower leg muscles to your foot. These tears cause instability and chronic pain. For treatment, surgeons can remove the inflamed lining of your ankle and fix any tears.

Arthritis

Like heel pain, arthritis in the foot or ankle is common. It can affect anyone, but it appears most often in people over 50.

Ankle arthritis

Ankle arthritis happens when the cartilage in your ankle wears away and your bones rub together. It typically develops after an ankle fracture. It’s less common than hip or knee arthritis and can be trickier to deal with because your ankles are a much smaller joint, so withstand much higher pressure than knees.

Dr. Kulwin says nonsurgical, conservative treatments are first-line options for ankle arthritis, too. Most providers initially recommend:

• Activity changes

• Anti-inflammatory medications (NSAIDs)

• Braces and shoe modifications

• Corticosteroid injections

• Hyaluronic acid injections

• Weight loss

For severe arthritis, your doctor may recommend surgery. Surgeons at The Christ Hospital can offer three procedures. Based on your symptoms and unique needs, a surgeon will talk with you about the risks and benefits of these surgeries:

• Ankle fusion (arthrodesis): This surgery uses nails, plates and screws to connect your ankle bones into one piece. It can reduce pain and swelling.

• Ankle replacement: Surgeons remove your damaged ankle and replace it with artificial parts. This surgery reduces pain and restores more natural movement. Talk with your surgeon about the types of available replacements.

• Cheilectomy: This surgery removes bone spurs in your ankle to reduce pain and improve mobility.

Midfoot arthritis

Midfoot arthritis develops when the cartilage from the joints in the middle of your foot breaks down and becomes inflamed. It causes pain and stiffness. You may have trouble walking. And a large bump may grow on top of your foot, making shoes uncomfortable.

Like most foot and ankle conditions, experts recommend nonsurgical treatment options first. To relieve your discomfort, Dr. Kulwin recommends:

• Anti-inflammatory medication

• Calf stretches

• Midfoot rocker shoes (shoes with a curved sole that promotes a rolling motion while walking or running)

• No shoelaces over your midfoot area

When these therapies don’t work, surgeons can offer two procedures:

• Deep peroneal nerve (DPN) excision: This procedure cuts the nerve that provides feeling to the top of your foot. It can result in immediate pain relief.

• Fusion: Like an ankle fusion, a surgeon connects the bones in your midfoot. Recovery can take up to 10 weeks.

Big toe arthritis

Big toe arthritis, also called hallux rigidus, is the most common form of foot arthritis. It causes pain and stiffness in your first metatarsophalangeal (MT) joint, where your big toe connects to your foot. This type of arthritis causes discomfort when your big toe bends backward. As a result, wearing shoes, particularly high heels, is often uncomfortable.

The most common symptoms are:

• Bone spurs

• Bursitis/cysts

• Dorsal bunions (large bumps on top of your toe)

• Swelling

According to Dr. Kulwin, big toe arthritis develops for many reasons. Your risk is higher if you:

• Have a flattened MT joint

• Have gout

• Have high arches

• Have a long big toe

• Previously injured your big toe

To relieve your symptoms, experts often recommend these nonsurgical, conservative options:

• Activity modifications (not bending your foot up)

• Anti-inflammatory medication

• Lower heel heights

• Orthotics
  

• Steroid injections

• Turf toe plates (inserts that reduce the flexibility of your shoes)

If you need a more permanent pain-relief solution, Dr. Kulwin says two surgical options are available:

• Cheilectomy: This is the surgical removal or shaving down of the bone spur on top of your toe. The procedure works well for pain localized to your toe. It also lets you keep mobility in your toe joint.

• Fusion: If big toe arthritis triggers pain through your entire foot when you walk, this procedure can help. It offers more reliable pain relief, but your recovery is longer. You’re also limited to shoes with heels less than two inches.

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