Foot & Ankle Pain

The foot consists of 26 bones, including the tarsals (bones that span the ankle to midfoot), metatarsals (midfoot), and phalanges (toes). These bones are supported by capsules, tendons, ligaments, and fascia. An injury or abnormality of any of these structures can result in foot pain, which may involve the top, bottom, or sides of the foot. 

Causes of foot pain can include sprains, strains, osteoarthritis, tendonitis, bursitis, and fasciopathy.  

The ankle joint is where your shinbone (tibia), calf bone (fibula), and talus bone meet. It joins your foot to your lower leg. The ankle is supported by cartilage, ligaments, muscles, and tendons. Muscles that act on the ankle (allowing motion at the ankle) generally begin in the leg and cross the ankle joint before attaching in the foot. Ankle pain can be the result of acute injuries, overuse, structural abnormalities, or other underlying conditions.

Ankle arthritis refers to inflammation and degeneration of the cartilage in the ankle joint. It is typically caused by wear and tear over time or as a result of previous injury. As the cartilage wears down, friction between the bones increases, leading to pain, stiffness, swelling, and difficulty moving the ankle. 

Foot arthritis refers to degeneration and inflammation of the cartilage in the joints of the foot. As cartilage breaks down, bones may rub against each other, causing discomfort and limiting movement. 

A sprained ankle occurs when the ligaments surrounding the ankle joint stretch or tear, usually due to sudden twisting or rolling of the ankle. This can happen during sports activities, walking on uneven surfaces, or even simple missteps.

Anterior talofibular ligament (ATFL) sprains are common injuries involving the ligament on the outer (lateral) side of the ankle. These sprains typically occur when the foot forcefully twists inward while the foot is bent downward at the ankle, leading to stretching or tearing of the ATFL.

Injuries from sudden changes in direction or uneven walking surfaces can also cause partial tears in the ATFL. There is an increased risk of this injury when the foot is in a downward flexed position, like when wearing shoes with high heels.

Calcaneofibular ligament (CFL) sprains involve injury to the ligament that connects the heel bone to the fibula. These sprains typically occur when the ankle is forcefully twisted or rolled inward, causing stretching or tearing of the CFL. Sports injuries, falls, or accidents on uneven surfaces can also cause partial tears in the CFL.

The deltoid ligament consists of multiple bands of tissue that support the inner ankle. Deltoid ligament sprains involve injury to part, or all of, this ligament complex. These sprains typically occur due to excessive force applied to the ankle joint, often during activities that involve sudden twisting or impact, such as sports or falls. Injuries during sports or accidents can also cause partial tears in the deltoid ligament.

Posterior tibial tendinopathy refers to degeneration and inflammation of the posterior tibial tendon. This tendon runs along the inner side of the ankle and foot. It supports the arch of the foot and stabilizes the ankle during walking and other weight-bearing activities. 

Achilles tendinopathy involves inflammation and degeneration of the Achilles tendon caused by repetitive stress, overuse, or sudden increases in activity. This tendon connects the calf muscles to your heel bone. 

An Achilles tendon rupture involving a partial or complete tear occurs during activities that involve sudden and forceful pushing off the foot. Patients often feel a sharp and sudden pop in the back of their ankle.

Peroneal tendinopathy refers to a condition involving degeneration, inflammation, or damage to the peroneal tendons. These tendons are located on the outer side of the ankle and foot.

These tendons connect the peroneus (or fibularis) longus and brevis muscles to the underside or outside of the foot. 

The primary functions of the peroneal/fibularis muscles are to provide ankle stability and to promote eversion, or outer movement, of the foot.  

Injuries or conditions affecting the peroneus longus or brevis can include strains, tendinopathy, and tears. 

Plantar fasciitis, better referred to as plantar fasciopathy, is a condition that involves thickening and degeneration of the plantar fascia, the tough band of tissue that runs along the bottom of your foot from the heel to the toes. The plantar fascia helps absorb the impact of walking and running and supports the foot arch.  

Plantar plate sprains or tears involve damage to the plantar plate, a thick ligamentous structure that helps stabilize the toes.

Nerve entrapments or impingements occur in the foot and ankle when a nerve is compressed or irritated by surrounding tissues. They can lead to pain, numbness, tingling, or weakness along the nerve's pathway. 

Tarsal tunnel syndrome occurs when the tibial nerve, or its branches, are compressed when they pass through the tarsal tunnel, which is located on the inside of the ankle. It leads to foot pain and sensory disturbances.

Common nerves that cause foot and ankle pain due to entrapments include:

• Tibial and Plantar Nerves: Run along the inner leg and ankle before traveling under the foot
• Superficial Fibular Nerve: A mixed sensory and motor nerve that provides sensation to the skin on the outer side of the lower leg and the top of the foot, as well as innervating muscles on the outside of the lower leg
• Deep Fibular Nerve: Provides motor and sensory input to the front of the lower leg and part of the top of the foot
• Sural Nerve: A sensory nerve that provides sensation to the skin on the outside of the foot
• Saphenous nerve: A sensory nerve that is actually the terminal branch of the femoral nerve and provides sensation to the skin on the inside of the foot