Foot Pain

Foot Pain

Article by John Miller

Foot Pain

Foot pain and injury are widespread. You can source foot pain from local structures such as muscles, ligaments, bones and joints, or it can be referred from other sources, including your lower back and other systemic diseases such as diabetes.

Because foot pain can have many causes, it is crucial to assess foot pain by a health professional with a particular interest in managing foot pain. Only then can you be confident that your foot pain treatment addresses the “right” cause of your foot pain.

When Should You Worry About Foot Or Ankle Pain?

Some cases of foot and ankle pain require urgent attention.

Sudden Onset Foot Or Ankle Pain

Traumatic injuries that occur at speed or involve a multi-direction component such as twisting may result in foot or ankle fractures or significant soft tissue injuries, e.g. syndesmosis or high ankle sprains.

The Ottawa Ankle Rules determine the need for X-rays in acute ankle or foot injuries.

Ankle X-ray is only required if:

  • There is any pain in the malleolar zone; and,
  • Any one of the following:
    • Bone tenderness along the distal 6 cm of the posterior edge of the tibia or tip of the medial malleolus, or
    • Bone tenderness along the distal 6 cm of the posterior border of the fibula or end of the lateral malleolus, or
    • An inability to bear weight immediately and in the emergency department for four steps.

Foot X-ray is indicated if:

  • There is any pain in the midfoot zone; and,
  • Any one of the following:
    • Bone tenderness at the base of the fifth metatarsal (for foot injuries), or
    • Bone tenderness at the navicular bone (for foot injuries), or
    • An inability to bear weight immediately and in the emergency department for four steps.

Chronic Ligament Instability

Chronic ligament instability in your foot and ankle can cause premature osteoarthritis and joint deformity. Some conditions can be safely rehabilitated without surgery, whereas other conditions, such as a Lisfacnc injury, may require surgical repair.

Please consult your doctor or physiotherapist for specific foot or ankle injury advice.

Gradual Onset Pain That Fails to Improve

Stress Fractures

Stress fractures can be serious. While you may not have had a sudden traumatic injury, the ankle and foot are highly susceptible to stress fractures. Several bones in your foot can have their blood supply compromised by a stress fracture, leading to bone necrosis (death). These potentially life-changing conditions should seek an early assessment from your doctor or physiotherapist.

The good news is that most ankle and foot pain is not sinister and improves with physiotherapy and other non-surgical options.

Please ask your physiotherapist or doctor for advice.

What Are 7 Common Foot, Ankle & Heel Injuries?

Why Does It Hurt Under Your Feet?

One of the most common patient questions we receive is, “Why does it hurt under my feet?”. While there can be many causes of pain under your foot, most symptoms arise from a few common conditions.

Based on many potential sources of your foot pain, the treatment will always vary depending upon your specific diagnosis, and rehabilitation needs to return you to the functional activities in your life.

For specific advice regarding the cause of your foot pain and the best treatment plan, please consult your trusted healthcare practitioner with a special interest in foot pain.

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Book Your Appointment Here!

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Article by John Miller

When Should You Worry About Foot Or Ankle Pain?

Some cases of foot and ankle pain require urgent attention.

Sudden Onset Foot Or Ankle Pain

Traumatic injuries that occur at speed or involve a multi-direction component such as twisting may result in foot or ankle fractures or significant soft tissue injuries, e.g. syndesmosis or high ankle sprains.

The Ottawa Ankle Rules determine the need for X-rays in acute ankle or foot injuries.

Ankle X-ray is only required if:

  • There is any pain in the malleolar zone; and,
  • Any one of the following:
    • Bone tenderness along the distal 6 cm of the posterior edge of the tibia or tip of the medial malleolus, or
    • Bone tenderness along the distal 6 cm of the posterior border of the fibula or end of the lateral malleolus, or
    • An inability to bear weight immediately and in the emergency department for four steps.

Foot X-ray is indicated if:

  • There is any pain in the midfoot zone; and,
  • Any one of the following:
    • Bone tenderness at the base of the fifth metatarsal (for foot injuries), or
    • Bone tenderness at the navicular bone (for foot injuries), or
    • An inability to bear weight immediately and in the emergency department for four steps.

Chronic Ligament Instability

Chronic ligament instability in your foot and ankle can cause premature osteoarthritis and joint deformity. Some conditions can be safely rehabilitated without surgery, whereas other conditions, such as a Lisfacnc injury, may require surgical repair.

Please consult your doctor or physiotherapist for specific foot or ankle injury advice.

Gradual Onset Pain That Fails to Improve

Stress Fractures

Stress fractures can be serious. While you may not have had a sudden traumatic injury, the ankle and foot are highly susceptible to stress fractures. Several bones in your foot can have their blood supply compromised by a stress fracture, leading to bone necrosis (death). These potentially life-changing conditions should seek an early assessment from your doctor or physiotherapist.

The good news is that most ankle and foot pain is not sinister and improves with physiotherapy and other non-surgical options.

Please ask your physiotherapist or doctor for advice.

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Call Us or Book Online 24-hours

Foot & Ankle Pain FAQs & Products

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Article by John Miller

Common Youth Leg Injuries

Why are Children's Injuries Different to Adults?

youth sports injuries

Adolescent Leg Injuries

Adolescent injuries differ from adult injuries, mainly because the bones are still growing. The growth plates (physis) are cartilaginous (strong connective tissue) areas from which the bones elongate or enlarge. Repetitive stress or sudden large forces can cause injury to these areas.

In the adolescent leg, common injuries include:

Osgood-Schlatter's Disease

Pain at the bump just below the knee cap (tibia tubercle). Overuse injuries commonly occur here. The tibia tubercle is the anchor point of your mighty quadriceps (thigh) muscles. Because of excessive participation in running and jumping sports, the tendon pulls bone off and forms a painful lump that will remain forever. This type of injury responds to reduced activity and physiotherapy.

More info: Osgood Schlatter's Disease

Sinding-Larsen-Johansson Disease

Pain at the lower pole of the knee cap (patella). Overstraining causes Sinding-Larsen-Johansson disease. Because of excessive participation in running and jumping sports, the tendon pulls bone off the knee cap. This type of injury responds to reduced activity and physiotherapy.

More info: Sinding Larsen Johansson Syndrome

Anterior Knee Pain

Anterior knee pain or patellofemoral syndrome frequently gets passed off as growing pains. Cause of this pain includes overuse, muscle imbalance, poor flexibility, poor alignment, or more commonly, a combination of these. Anterior knee pain is one of the most challenging adolescent knee injuries to sort out and treat. Accurate diagnosis and treatment with the assistance of a physiotherapist with a particular interest in this problem usually resolves the condition quickly.

More info: Patellofemoral Pain Syndrome

Knee Ligaments

The cartilage between the leg bones has a better blood supply and is more elastic in adolescents than adults. As adolescents near the end of bone growth, their injuries become more adult-like. Hence more meniscal and ACL (anterior cruciate ligament) injuries are likely. MCL (medial collateral ligament) injuries result from a lateral blow to the knee. Pain felt on the inner side (medially) of the knee. MCL injuries respond well to protective bracing and conservative treatment.

More info: Knee Ligament Injuries

ACL (Anterior Cruciate Ligament) Injuries

This traumatic knee injury is significant. Non-contact injuries of the ACL are becoming more common than contact injuries of the ACL. Adolescent females are at high risk. Combination injuries with MCL or menisci are common. Surgical reconstruction is needed if the adolescent wishes to continue participating in "stop-and-start" sports.

More info: ACL Injury

Meniscal Injuries

Your meniscus is crescent-shaped cartilage between the thigh (femur) and lower leg (tibia). Meniscal injuries usually result from twisting. Swelling, catching, and locking of the knee are common. If physiotherapy treatment does not resolve these damages within six weeks, they may require arthroscopic surgery.

More info: Meniscus Tear, Discoid Meniscus

Sever's Disease

Heel pain is commonplace in young adolescents due to the stresses of their Achilles tendon pulling upon its bony insertion point on the heel (calcaneum). It is a common overuse injury due to excessive training and competition, particularly when loads are increased dramatically in a short period. Diminished flexibility and muscle-tendon strength mismatching may predispose you. Physiotherapy, reduced activity, taping and orthotics are the best ways to manage this debilitating condition for the active young athlete.

More info: Sever's Disease

Ankle Sprain

An ankle sprain is probably the most common injury seen in sports. Ankles sprains involve stretching of the ligaments and usually occur when the foot twists inward. Treatment includes active rest, ice, compression and physiotherapy rehabilitation. With the correct treatment, a low ankle sprain usually improves in two to six weeks. Your ankle physiotherapist should check even simple ankle sprains to eliminate high-ankle sprains. A residually stiff ankle post-sprain can predispose you to several other lower limb issues.

More info: Sprained Ankle

Patellar Instability

Patellar (kneecap) instability can range from partial dislocation (subluxation) to dislocation with a fracture. Partial dislocation treatment is conservative. Dislocation with or without fracture is a much more severe injury and usually will require surgery.

More info: Patella Dislocation

Osteochondritis Dissecans

The separation of a bone from its bed in the knee joint is Osteochondritis Dissecans (OCD). This injury is usually due to one major macro event with repetitive macro trauma that prevents complete healing. This injury is potentially severe. Treatment varies from rest to surgery. An Orthopaedic Surgeon's opinion is vital.

More info: Juvenile Osteochondritis Dissecans (JOCD)

Growth Plate Fractures

A fracture through the growth plate can be a severe injury that can stop the bone from growing correctly. These fractures should be treated by an Orthopaedic Surgeon, as some will require surgery.

Avulsion Fractures

youth pelvis hip avulsion

Image source: https://radiologyassistant.nl/pediatrics/hip/hip-pathology-in-children

An avulsion fracture occurs when a small segment of bone attached to a tendon or ligament gets pulled away from the main bone. The hip, elbow, and ankle are the most common locations for lower limb avulsion fractures in young sportspeople.

Treatment of an avulsion fracture typically includes active rest, ice and protecting the affected area. This active rest period is followed by controlled exercises that help restore range of motion, improve muscle strength and promote bone healing. Your physiotherapist should supervise your post-avulsion exercises. Most avulsion fractures heal very well.  You may need to spend a few weeks on crutches if you have an avulsion fracture around your hip. An avulsion fracture to your foot or ankle may require a cast or walking boot.

An excessive gap between the avulsed bone fragment and main bone may not rejoin naturally in rare cases. Surgery may be necessary to reunite them. In children, avulsion fractures that involve the growth plates also might require surgery. All avulsion fractures should be reviewed and managed by your trusted physiotherapist or an Orthopaedic Surgeon.

For more information regarding your youth sports injury, please consult your physiotherapist or doctor.

Youth Leg Injuries

Pelvis & Hip

Knee

Heel & Ankle

Common Youth & Teenager Sports Injuries

Common Youth Neck & Back Pain

Common Youth Arm Injuries

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Common Stress Fracture Related Conditions

General Info

Spinal Stress Fractures

Lower Limb Stress Injuries

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Article by Alex Clarke

How Can You Tell The Difference Between Heel Spurs And Plantar Fasciitis?

Well, unless you have X-ray vision, you can’t! First, let’s look at what heel spurs and plantar fasciitis are.

Heel Spurs

Heel spurs are bony growths that extend from the heel bone called the calcaneum. They occur in response to an overload of tissue. The plantar fasciitis, the connective tissue that runs through the foot's arch, pulls at its attachment point at the heel. Excessive pulling may overload this attachment point. The body’s response to this excessive loading is to lay down more bony tissue to strengthen the area. The problem may be that this harder bony structure can further irritate the softer tissue around it.

It is not uncommon to have heel spurs without any pain. However, a heel spur's presence makes plantar fasciitis more likely.

More info: Heel Spurs.

Plantar Fasciitis

To describe this condition briefly, the connective tissue helping to provide stability to the foot's arch (plantar fascia) can become irritated (inflamed) and /or change the fascia fibre shape. Your plantar fascia is a thick fibrous band of connective tissue originating on the heel's bottom surface and extending along the sole towards the toes. Your plantar fascia passively limits the over-flattening of your arch. It is known as plantar fasciitis when your plantar fascia develops micro tears or becomes inflamed.

More info: Plantar Fasciitis

How Do We Tell The Difference?

We use imaging such as X-ray, ultrasound, or MRI to determine the presence of a heel spur. We can also use ultrasound or MRI to diagnose plantar fasciitis. We can also use some clinical tests and look for key symptoms such as first-step pain to diagnose plantar fasciitis without needing expensive imaging.

Remember that the two can occur together, or you can have a heel spur without plantar fasciitis or plantar fasciitis without a heel spur!

Heel Pain FAQs & Products

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Acute Injury Signs

Acute Injury Management.

Here are some warning signs that you have an injury. While some injuries are immediately evident, others can creep up slowly and progressively get worse. If you don't pay attention to both types of injuries, chronic problems can develop.

For detailed information on specific injuries, check out the injury by body part section.

Don't Ignore these Injury Warning Signs

Joint Pain

Joint pain, particularly in the knee, ankle, elbow, and wrist joints, should never be ignored. Because these joints are not covered by muscle, pain here is rarely of muscular origin. Joint pain that lasts more than 48 hours requires a professional diagnosis.

Tenderness

If you can elicit pain at a specific point in a bone, muscle, or joint, you may have a significant injury by pressing your finger into it. If the same spot on the other side of the body does not produce the same pain, you should probably see your health professional.  

Swelling

Nearly all sports or musculoskeletal injuries cause swelling. Swelling is usually quite obvious and can be seen, but occasionally you may feel as though something is swollen or "full" even though it looks normal. Swelling usually goes along with pain, redness and heat.

Reduced Range of Motion

If the swelling isn't obvious, you can usually find it by checking for a reduced range of motion in a joint. If there is significant swelling within a joint, you will lose range of motion. Compare one side of the body with the other to identify major differences. If there are any, you probably have an injury that needs attention.

Weakness

Compare sides for weakness by performing the same task. One way to tell is to lift the same weight with the right and left sides and look at the result. Or try to place body weight on one leg and then the other. A difference in your ability to support your weight is another suggestion of an injury that requires attention.

Immediate Injury Treatment: Step-by-Step Guidelines

  • Stop the activity immediately.
  • Wrap the injured part in a compression bandage.
  • Apply ice to the injured part (use a bag of crushed ice or a bag of frozen vegetables).
  • Elevate the injured part to reduce swelling.
  • Consult your health practitioner for a proper diagnosis of any serious injury.
  • Rehabilitate your injury under professional guidance.
  • Seek a second opinion if you are not improving.

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