Plantar fasciitis is the most common cause of heel pain in adults and afflicts approximately 2 million patients per year. The classic symptom of plantar fasciitis is heel pain that typically is worst with the first several steps in the morning and lessens as the day continues. Individuals often have pain at the beginning of an activity that diminishes or resolves as they warm up.
General symptoms recur after the activity and frequently the pain is described as a deep ache or tenderness at the inside front area of their heel. The pain can be accompanied by stiffness, sharp shooting pain, localized inflammation, and often becomes most intense at the end of the day. The plantar fascia is a long, thin ligament that lies directly beneath the skin on the bottom of your foot. It connects the heel to the front and supports the arch of your foot. The plantar fascia is designed to absorb the high stresses and strains we place on our feet. Sometimes, too much pressure damages or tears the tissues. The body’s natural response to injury is inflammation, which results in heel pain and stiffness.
Over time, bone spurs in the heal can form. Although many people with plantar fasciitis have heel spurs, spurs are not the cause of plantar fasciitis pain. One out of 10 people has heel spurs, but only one out of 20 people (5%) with heel spurs has foot pain. Because the spur is not the cause of plantar fasciitis, the pain can often be treated without removing the spur.
Achilles tendonitis is an overuse injury of the Achilles tendon. This is the band of tissue that connects calf muscles at the back of the lower leg to your heel bone. Achilles tendinitis most commonly occurs in runners who have suddenly increased the intensity or duration of their runs. It’s also common in middle-aged people who play sports, such as tennis or basketball, only on the weekends. Chronic tendonitis can lead to tears or even ruptures.
These injuries are serious and can leave permanency of injury and loss in physical performance. Common symptoms of Achilles tendinitis include:
- Pain and stiffness along the Achilles tendon in the morning
- Calf tightness and pain
- Pain along the tendon or back of the heel that worsens with activity
- Severe pain and swelling the day after exercising
- Thickening of the tendon
- Bone spur formation in heal bone at the attachment
- Swelling that gets worse with activity
Tarsal Tunnel Syndrome
Tarsal Tunnel Syndrome is a compression neuropathy and painful foot condition in which the posterior tibial nerve is compressed as it travels through the tarsal tunnel on the inside part of the ankle behind the medial malleolus. The tunnel is covered with a thick ligament (the flexor retinaculum) that protects and maintains the arteries, veins, tendons, and nerve structures that pass through the tunnel space. Compression to the posterior tibial nerve produces symptoms anywhere along the path of the nerve running from the inside of the ankle into the foot. Runners typically aggravate this condition with overuse to the tibialis posterior and flexor digitorum longus muscles as the tendons pass through the tunnel space.
Tarsal tunnel syndrome is similar to carpal tunnel syndrome, which occurs in the wrist. Both disorders arise from the compression of a nerve in a confined space. Common symptoms include:
- Tingling, burning, or a sensation similar to an electrical shock
- Numbness in foot
- Pain, including shooting pain up the shin
- Shin splint like pains on the inside of the shin bone
The simplest definition of turf toe is a big toe sprain. It happens when the toe is forcibly bent up into hyperextension, such as when pushing off into a sprint and having the toe get stuck flat on the ground. This is the typical position of the foot when a turf toe injury occurs. Common tissues injured include the plantar plate under the metatarsophalangeal joint (MTP), strains to the flexor hallucis longus/brevis muscles/tendons, or injury to the sesamoid bones in the tendons. Injuries are graded from one to three — mild to severe.
- Grade 1 — The plantar complex has been stretched causing pin-point tenderness and slight swelling.
- Grade 2 — A partial tearing of the plantar complex causes more widespread tenderness, moderate swelling, and bruising. Movement of the toe is limited and painful.
- Grade 3 — The plantar complex is completely torn causing severe tenderness, severe swelling, and bruising. It is difficult and painful to move the big toe.
Foot injuries can be complicated. The foot takes a lot of physical stress with both static standing postures and with physical activity. Running alone can translate up to 10 times the body’s weight through our feet. Injury, overuse, or conditions causing inflammation involving any of the muscles, ligaments, or tendons in the foot can cause foot tendonitis. Over time, chronic tendonitis can lead to arthritic changes in the joints as cartilage damage increases joint erosion. Resolution typically will include accurate diagnosis, limiting long term inflammation, and retraining poor biomechanics.
Symptoms commonly reported include:
- Pain in the big toe with motion
- Mid-foot arch pains
- Pain or burning on top of the foot
- Pain with curling or extending toes
- Pain on the outside of the foot that travels to the knee
The ligaments of the ankle hold the ankle bones and joint in position. They protect the ankle joint from abnormal movements-especially twisting, turning, and rolling of the foot. A ligament is an elastic structure. Ligaments usually stretch within their limits, and then go back to their normal positions. When a ligament is forced to stretch beyond its normal range, a sprain occurs. A severe sprain causes actual tearing of the elastic fibers. The grade of the sprain is determined by the extent of damage to the ligament fibers:
- Grade 1 sprain — Slight stretching and some damage to the fibers (fibrils) of the ligament.
- Grade 2 sprain — Partial tearing of the ligament, abnormal looseness (laxity) of the ankle joint.
- Grade 3 sprain — Complete tear of the ligament. If the examiner pulls or pushes, gross instability occurs.
It is very important to get treatment to a sprained ankle to decrease pain, inflammation, and prevent lasting effects.