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Foot Pain

Broken Toes

• The foot is a complex anatomical structure that may be affected by disease within the body or the foot itself.
• The arches of the foot are the primary structures that control the amount of ground force transmitted into the body.
• When pain due to foot pain interferes with your normal activities, you should seek medical advice.
• The foot contains bone and joint, ligament, muscle/tendon, nerve, blood vessels, skin, and soft tissue structures. The disease of any of these structures in the foot can cause foot pain.
• Treatment of foot pain will depend on the cause of the pain and may involve medication, strengthening, stretching, physical therapy, immobilization, and surgery.

Plantar Fasciitis Symptoms and Signs

Plantar fasciitis causes pain and tenderness of the bottom of the foot. The tenderness is usually toward the heel, but the entire sole can be affected. A sign of abnormal tension or tightness that can lead to plantar fasciitis is a bony prominence (heel spur) that develops where the inflamed plantar fascia attaches to the heel bone (calcaneus).

What is the design of the foot?

The foot is an intricate structure of 26 bones, 33 joints, multiple muscles, tendons, ligaments, blood vessels, nerves, and lymphatics. The bones form two crossing arches of the foot. The longitudinal arch runs the length of the foot, and the transverse arch runs the width. The ankle joint is formed by the interaction of the foot and the lower leg, and the toes are on the far side of the foot. The bones of the foot are primarily held together by their fit with each other forming joints surrounded by joint capsules and connected by fibrous tissues known as ligaments. The muscles of the foot, along with a tough, sinewy tissue known as the plantar fascia, provide secondary support to the foot and the longitudinal arch. The foot has internal muscles that originate and insert in the foot and external muscles that begin in the lower leg and attach in various places on the bones of the foot. There are also fat pads in the foot to help with weight-bearing and absorbing impact. Multiple tendons in the foot act together to provide synchronized pull on a bone or joint structures. This allows the foot to remain in optimal alignment. The foot is also covered by dense, soft tissue structures that include capsule, subcutaneous fat, dermal, and epidermal layers. These soft tissue structures work as a unit to function as a primary defense mechanism from external hazards such as infection and trauma. The soft tissue can allow fluid to accumulate, which can cause swelling in the foot.

The foot is the foundation of the movement of the lower extremity. It is an intricate and complex system that provides efficient shock absorption and propulsion for us to walk and run. Pain in the foot indicates that there is something wrong with either the interaction of internal structures of the foot or with how the foot is interacting with external influences. How and when the pain occurs, and the locations of the pain are the primary clues to what may be causing the pain. When there is pain, the body reacts by changing the way it moves or functions to reduce the pain. These compensations or biomechanical changes may prevent the normal movement and cause further injury in the foot and or other parts of the body.

What causes foot pain?

Foot pain may be caused by many different diseases, deformities, biomechanical conditions, improper footwear, or injuries.
Infectious disease, viruses, fungi, and bacteria can cause foot pain. Plantar warts on the bottom of the foot are caused by a virus and can cause irritation and discomfort. Athlete’s foot, which is caused by a fungus, can lead to foot irritation and pain. A common cause of foot pain is an ingrown toenail. Ingrown toenails occur when the edges of the nail grow through or into the skin, resulting in pain and often leading to infection. Patients with diabetes are more prone to infection since their immune system is compromised.

Many systemic diseases, such as diabetes, lupus, gout, and rheumatoid arthritis, can cause foot pain. Rheumatoid arthritis can cause painful inflammation in the joints of the foot, accompanied by alignment changes that lead to foot deformities.
Deformities, such as tarsal coalitions, calcaneal varus, calcaneal valgus, bunions, claw toes, mallet toes, hammertoes, and bone spurs, are common causes of foot pain.

Biomechanical abnormalities from muscle and tendon tightness or laxity, flat feet, or high arched feet often lead to muscle imbalances, deformities, and foot pain.
Trauma from an acute injury or accumulative repetitive injury is a prevalent cause of foot pain. An example of such damage is Achilles tendinitis or rupture. The tendon can rupture from an acute, sudden injury, or it can become inflamed (tendinitis) from repetitive insult to the structure. Small repetitive traumas or pressures may also cause damages to the skin and internal structures. Micro-trauma injuries can be caused by running on uneven surfaces or surfaces that are too hard or too soft, or wearing shoes that have poor force-absorption qualities, are not activity-specific or fit incorrectly.

Wearing shoes that are too tight or high heels can cause pain in the forefoot. Shoes that are tied too tightly can cause pain and bruise on the top of the foot. Improper, non-sport specific shoes for running or cycling can lead to foot pain with activities. Poorly fitting shoes in the short term can cause blisters, bruising, and be a source of athlete’s foot. The long-term effects of poorly fitting shoes may be bunions, corns, calluses, irritation of nerves and joints, and misalignment of the toes. Morton’s neuroma caused by thickening of tissue around a nerve between the toes can cause toe numbness and pain. It may also be aggravated by ill-fitting shoes, as can many foot deformities such as hammertoes, mallet toes, and bunions.

Injuries such as ligament sprains, muscle strains, bruises, and fractures typically occur suddenly (acutely). Sprains, strains, bruises, and fractures may be the result of a single or combination of stresses to the foot. An injury of the foot or ankle occurs when ligaments that hold the bones together are overstretched, and their fibers tear or stretch too far. The looseness of ligaments in the joints of the foot may lead to chronic foot pain, joint instability, and deformity. Repeated overstressing of the same foot structure may cause stress fractures, tendonitis, plantar fasciitis, and acute and chronic osteoarthritis. Stress fractures commonly occur in the metatarsal bones, the long bones of the foot, and can happen in the tarsal or rear-foot bones. These fractures are often called march fractures because it is usually caused by non-distinct and minor stress of excessive walking (marching) rather than a significant traumatic event. 

The muscles and fascia of the foot can be strained by overstretching, overuse, or overloading. Achilles tendonitis is a common injury of the tendon that attaches at the back of the heel. Plantar fasciitis (the most common cause of heel pain) is a result of micro-trauma strain to the broad ligament called the plantar fascia. Tendon pain and swelling from repetitive abnormal strain lead to tendinitis, which can eventually lead to tears in the tendons.

Injury to the bones and joints of the foot can be caused by a single blow or twist to the foot or also by repetitive trauma that can result in a stress fracture. A blunt-force injury such as someone stepping on your foot may result in a bruise (contusion) injury and damage to the muscles and ligaments of the foot. Direct blows to the foot can cause bruising, breaking of the skin, or even fracturing of bones. Metatarsalgia is from the repetitive irritation of the joints of the ball of the foot. The term “stone bruise” is commonly referred to as a specific localized pain and tenderness of the ball of the foot. “Turf toe” is a common athletic injury in which the tendon and capsule under the joint at the base of the big toe is strained. Trauma to the toenail can cause pooling of blood under the nail and the temporary or permanent loss of a toenail. Repetitive injury to the bones, muscles, and ligaments can result in extra bone growth known as spurs or exostoses.
Delayed treatment of many foot pain can lead to complications, chronic long-term pain, disability, and arthritis of the affected foot.

What other symptoms and signs may accompany foot pain?

Pain and point tenderness is the immediate indicators that something is wrong in a specific area. Swelling, redness (erythema), bruising (ecchymosis), numbness/tingling, and shooting pains may also present localized to the injured area. The onset of pain, whether suddenly or over time, is an essential indicator of the problem’s cause. The following questions are also important.
• Is there pain with movement of the affected area?
• Is it affected by weight-bearing?
• Does it change your walking motion?

Bones of the foot are joined together by ligaments. A sprain occurs when the ligaments that hold the bones together are overstretched, and the fibers tear. Point tenderness and looseness of a joint can be indicators of a sprain. Ligament injury is often accompanied by a sense of instability when walking or exercising.
Injury to the bones of the foot can be caused by a single blow or twist to the arch or also by repetitive trauma that can result in a stress fracture. There may be a distinguishable lump or gap at the site of a fracture. The fracture can be accompanied by dislocation of involved joints. In such circumstances, the joint alignments are disrupted in addition to a break in the bone. Fracture and dislocation are common causes of post-traumatic arthritis. This is due to additional injury to joint cartilage.

Muscles and tendons allow movement of the foot in various directions. A strain occurs when a muscle or group of muscles are stressed to the point where there is tearing of the muscle fibers. The muscles and tendons of the foot may be strained by overstretching, overuse, overloading, bruising, or even being lacerated. Weakness in the contraction of a joint, difficulty in stabilizing body parts, and pain working against resistance are signs of muscle problems. Swelling, tenderness, loss of function, and discoloration over and around the injury can be symptoms and signs of a strain.

Bruises (contusions) are most commonly the result of a direct impact injury to the body. Swelling can occur to the foot by a variety of causes, such as having your foot stepped on or by stepping on a rock. Blows to the foot that result in pain, discoloration, swelling, and changes in how you walk may indicate more severe damage such as fractured bone.

Pain and tenderness associated with plantar fascia strains are usually felt on the bottom of the foot between the heel and the base of the toes. Plantar fascia pain may be increased or decreased by stretching of the arch. In mild cases of plantar fasciitis, the pain will decrease as the soft tissues of the foot “warm-up”; however, pain may increase as the use of the foot increases. In more severe cases of plantar fasciitis, pain may increase when the arch is stressed. Often the sufferer of plantar fasciitis will feel pain in the morning until the plantar fascia warms up. Foot pain at night may be a sign of plantar fasciitis, as well as other possible problems. Plantar fasciitis can cause a shift in the weight-bearing surface to avoid pain, which may cause compensation pain in the different areas of the heel.

A sensation of rubbing or burning on the foot’s surface is usually the first sign of a blister. Itching and burning sensations between the toes or around the foot indicate a skin infection or athlete’s foot. Pain and redness at the edge of a toenail are usually the results of an ingrown toenail.


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