Your feet are made up of an intricate network of bones, ligaments, tendons, and muscles. Although strong enough to bear your body weight, they can be prone to injury and pain when subjected to increased stress, poor mechanics, and poor support.
PLANTAR FASCIITIS
Plantar fasciitis is caused by inflammation of the thick, shock-absorbing fibrous tissue under the foot. It is one of the most common causes of heel pain. Prolonged loading that exceeds tissue tolerance causes microtrauma within the fascia, leading to irritation and/or inflammation, which in turn results in pain. Plantar fasciitis often occurs without obvious cause.
Symptoms
Stabbing pain located under the sole of the foot or at the heel. It is usually worse in the morning, or after periods of inactivity or exercize.
Causes and risk factors
Adults aged 40 to 60, participating in certain types of exercize (ex.: long-distance running, ballistic jumping activities, ballet dancing, aerobic dance), having poor foot mechanics or wearing unsuitable footwear such as flip flops, being obese, and belonging to certain occupations. As an example, people who stand on hard surfaces for extended periods of time can accelerate damage to their plantar fascia. Activity and sports-specific exercizes, activity modification, general conditioning (strength and cardiovascular training) can help reduce risk factors associated with this condition.
Prevention
Identifying the root cause of the injury will generally guide the treatment plan. Manual release techniques and instrumented-assisted soft tissue therapy help to break up scar tissue and can help increase blood flow, and thus tissue oxygenation, increasing the rate of tissue recovery. Acupuncture, chiropractic care and photobiomodulation/laser therapy can also help promote healing and minimize barriers to recovery. Ensuring optimization of foot, ankle, knee, and hip alignment can also help reduce stress.
Treatment options
For immediate self-care in case of a sprain, try the R.I.C.E. approach: rest, ice, compression, elevation.
What’s next?
Continued specific rehabilitation protocols, orthotics, activity modifications and continued maintenance care can help decrease the risk of re-injury and minimize the risk of barriers to recovery.
BUNIONS
Bunions are bumps that occur either at the outside or inside of the foot near the toes. Bumps on the inside of the feet are usually referred to as standard bunions, or hallux valgus[NW8] , while bumps on the outside of the feet are called tailor’s bunions.
Symptoms
A visible bump on the side of your big toe may be a bunion. These conditions can cause pain with prolonged standing and walking and may lead to inflammation and irritation of the inside and outside toes and forefoot. People with a bunion may also present with tenderness on or around the big toe, a callus or corn on the bone below the big toe, and difficulty moving the big toe.
Causes and risk factors
Wearing tight or narrow shoes can cause bunions to develop. Tight shoes put pressure on the metatarsophalangeal joint (MTP), which is where the bone of the foot meets the bone of the big toe. Bunions may be the result of the foot structure you inherited, or tight or ill-fitting shoes. Wearing improper footwear, having a family history of bunions, or contracting certain diseases may increase the likelihood of developing a bunion. Women in general are more likely to have bunions due to increased pressure from narrow footwear.
Treatment options
Activity modification and wearing proper footwear is the first line of defense against bunions. Orthotics can help limit the progression of bunions, reduce pain associated with the condition, and in some cases, help reverse the process. Other treatment approaches may also help manage the discomfort associated with the condition.
HEEL SPURS
Heel spurs are bony bumps that occur at the calcaneus[NW9] (heel bone). The two most common locations for heel spurs to develop are the underside of the foot near the heel where the plantar fascia attaches, and where the Achilles tendon attaches at the back of the heel. It can also be associated with other secondary conditions such as plantar fasciitis and Achilles tendinopathies.
Symptoms
Heel spurs can be painless, but they can also cause significant pain and dysfunction. Many people describe the pain of a heel spur as a stabbing or dull pain that is worse with walking after periods of immobility. In general, the cause of pain is not the heel spur itself, but the soft-tissue injury associated with it.
Causes and risk factors
Repeated overuse injuries [NW10] creates inflammation of the foot’s supportive structure. This chronic inflammation leads to calcium deposits at ligament attachment points, resulting in bony bumps. Wearing well-fitting and appropriate footwear with proper support, warming up, doing stretching exercizes before physical activity, and pacing yourself, can help reduce the risk of suffering from heel spurs.
Treatment options
The goal of treatment is to decrease the pain and inflammation associated with this condition. Exercizes, instrument-assisted soft tissue therapy, acupuncture, custom-made orthotics, and other treatment approaches may be implemented to help manage this condition. If conservative treatments fail, surgery may be necessary.
CLAW/MALLET/HAMMER TOE
Toes can sometimes end up in strange positions and orientations. The most common ones are called claw, mallet, and hammer toes.
Symptoms
This condition may or may not cause pain and discomfort, depending on severity and associated localized inflammation. Limited range of motion of the toes may also occur.
Causes and risk factors
Generally speaking, it is not fully understood why these toe conditions occur. They often develop suddenly and may even be apparent at birth. Genetics, arthritis, toe injuries, tight footwear or other foot problems like high arches or bunions can influence these conditions. They can sometimes be indicators of more serious medical conditions, such as rheumatoid arthritis, diabetes, or cerebral palsy.
Treatment options
Wearing proper footwear, orthotics, cushions, splints, or pads, and doing certain exercizes may help alleviate symptoms. Other treatment options, including photobiomodulation/laser therapy, may help manage symptoms associated with these conditions.
GOUT
Gout is a condition that generally causes sudden and severe pain at the big toe.
Symptoms
Gout is characterized by sudden, severe attacks of pain, swelling, redness and tenderness at the joint level. This commonly occurs at the base of the big toe but can occur anywhere in the body. Attacks usually occur suddenly. You may experience gout that comes and goes or develop more chronic gout over time that may damage your joints.
Causes and risk factors
Overabundance of uric acid in your body. People who eat diets rich in meat and seafood, drink beverages sweetened with fruit sugar (fructose), consume alcohol, are obese, take certain medications, have had surgeries, have a family history of gout or have certain medical conditions, as well as men between the ages of 40 and 50 and postmenopausal women, are all at increased risk of suffering from gout.
Treatment options
The main approach to treatment is managing risk factors. Although we cannot address the cause of the condition, our clinic has been able to help with symptomatic relief in patients living with various underlying conditions thanks to photobiomodulation/laser therapy.
STONE BRUISE/METATARSALGIA
The term “stone bruise” is often used interchangeably with metatarsalgia. It is described as pain under the forefoot and feels as though there is a stone in your shoe. Conditions that are often confused with stone bruises are plantar fasciitis, sesamoiditis, stress fractures, heel spurs and Morton’s Neuroma.
Symptoms
The area between your toes and arch may feel tingly or numb, sharply painful, or like you have a pebble in your shoe. Symptoms may improve on their own.
Causes and risk factors
The most common cause is impact injury to the bottom of the foot. Ill-fitting shoes, high-impact exercize, underlying biomechanical conditions affecting the feet or lower limbs, obesity and other medical conditions may also be contributing factors.
Treatment options
Resting your feet, using ice packs, and avoiding aggravating factors (ex.: wearing uncomfortable footwear, walking barefoot, not wearing heels) [NW11] will help manage inflammation. Orthotics can help correct biomechanical anomalies and often result in symptoms resolving in a short period of time. Laser/photobiomodulation therapy can also help manage inflammation associated with this condition and lead to symptomatic relief.
FLAT FOOT
Flat foot (Pes Planus) is a common postural deformity in which the arches of the foot collapse.
Symptoms
Having flat feet is usually painless. However, some people may experience foot pain at the heel or arch area, pain that worsens with activity and swelling along the inside of the ankle. Due to biomechanical changes that occur with the condition, flat feet can also contribute to problems with the ankles, knees, hips, and lower-back area.
Causes and risk factors
Flat feet can occur when the arches don’t develop during childhood and is often thought to be a genetic condition. In other cases, the condition develops as a result of injury, cumulative stress (years of wearing improper footwear) or from the simple wear and tear of aging.
Treatment options
Usually, flat feet require treatment only if they are problematic and cause you grief. In this case, orthotics can help correct the arch and minimize biomechanical impact related to the condition. Foot strengthening and coordination exercizes can also help.
MORTON’S NEUROMA
Morton’s Neuroma is characterized by pain or numbness that generally occurs between the third and fourth toes.
Symptoms
Sharp or burning pain, numbness and tingling in the ball of the foot and in the area between the toes. Sensation commonly described as having a pebble in your shoe. Typically, Morton’s Neuroma does not present with any observable signs.
Causes and risk factors
Thickened tissue around the interdigital nerves in the ball of the foot, between the arch and the toes. This usually occurs secondary to repetitive mechanical irritation of the area. Morton’s Neuroma has been linked to wearing high-heeled or tight footwear, to high-impact sports such as running and jumping, and to foot or gait abnormalities.
Treatment options
Wearing properly fitting shoes or resting your feet is generally the first line of treatment. If symptoms don’t improve, other forms of treatment might be warranted, like custom orthotics or another type of supporting device, physical therapy, and photobiomodulation/laser therapy.
SESAMOIDITIS
Sesamoids are small bones that tendons use as pulleys in the feet. These ensure proper functioning of our feet by guiding tendons and allowing them to transmit muscle forces. Sesamoiditis is an inflammation of these bones that causes pain.
Symptoms
Pain under the big toe at the ball of the foot. It may come on gradually or suddenly, as is the case with fractures and other acute traumas. You may experience pain while walking or standing and difficulty bending and straightening your big toe. Swelling and bruising may be present.
Causes
Sesamoiditis occurs when sesamoids are injured or inflamed. Certain specific activities are often associated with this condition, like doing ballet dancing, or playing the catcher position in baseball. In both instances, the foot is held in compromised positions. Another example is running, where the foot is subjected to repetitive stress.
Treatment options
First line of treatment includes limiting any aggravating activities, resting and icing the soles of your feet, wearing soft-soled, low-heeled shoes, and avoiding activities that cause your weight to shift onto the balls of your feet. If symptoms persist, orthotics or a brace may be used to support the area and limit stress. Photobiomodulation/laser therapy and other treatment approaches may be able to limit stress and therefore reduce inflammation.
DIABETIC NEUROPATHY
Diabetic neuropathy occurs when unregulated high blood sugar causes nerve damage. A common area in the body where this happens is the feet.
Symptoms
Usually, symptoms develop gradually, and often patients do not notice anything is wrong until significant nerve damage has occurred. As the disease progresses, patients may experience tingling, pins and needles or other changes in sensitivity, as well as problems with walking.
Causes and risk factors
Uncontrolled high blood sugar weakens the walls of the small capillary blood vessels that supply nerves with oxygen and nutrients, resulting in damaged nerves. Smoking, excess weight and kidney disease can also increase the risk of developing diabetic neuropathy.
Treatment options
If you have diabetes and you develop these symptoms, you should see your medical doctor right away as they can sometimes lead to complications such as infection and injury. Maintaining adequate blood sugar levels helps reduce the risk of diabetic neuropathy and is of paramount importance in managing this type of condition. Various sources and organizations like Diabetes Canada provide information and advice on this topic.
Although the Robichaud-Lévesque clinic does not manage diabetes directly, we can help manage certain complications associated with diabetic neuropathies.
OTHER CONDITIONS
Ankle sprains and strains
All joints and muscles in the foot are susceptible to potential sprains and strains. The most common ankle sprain is the lateral ankle sprain, where the ankle rolls inward, but medial ankle sprains (ankle rolls outward) and high-ankle sprains (foot is forcibly pushed upward) are also common. For more information, please see our page on sprains and strains.
Fractures and stress fractures
Fractures can occur anywhere in the foot or ankle. They can happen as the result of a fall or sudden impact, or, as in the case of running, after repeated stress is applied to a bone, which can lead to stress fractures. For more information, please see our page on fractures.
Osteoarthritis (OA)
Commonly affects the big toe but can occur at any joint in the foot or ankle. For more information, please see our page on osteoarthritis.