Common Causes of Foot and Ankle Pain

Foot and ankle pain can develop suddenly after an injury or gradually from arthritis, repetitive activity, sports, footwear, overuse or changes in the tendons and joints.

Because the foot and ankle contain numerous bones, joints, tendons, ligaments and nerves, pain in the same general area can come from very different conditions.

Pain around the heel may be associated with plantar fasciitis, Achilles tendon problems or other causes. Pain along the inside or outside of the ankle may involve tendons, ligaments or the ankle joint itself. Pain in the midfoot or forefoot can result from arthritis, stress injuries, nerve problems and other conditions.

Determining the actual source of the symptoms is important before deciding on treatment.

Plantar Fasciitis and Heel Pain

Plantar fasciitis is one of the most common causes of heel pain.

Patients often experience pain along the bottom of the heel that is particularly noticeable with the first few steps after getting out of bed or after sitting for an extended period.

Symptoms can develop gradually and may become persistent despite changes in shoes, stretching or reduced activity.

Although the condition is commonly called plantar “fasciitis,” chronic cases may involve degenerative changes within the plantar fascia rather than simply inflammation.

Treatment may include activity modification, stretching and rehabilitation, footwear changes, orthotics and other nonsurgical treatments.

For persistent cases, shockwave therapy or selected image-guided procedures may also be considered.

Heel Spurs

Patients with heel pain are sometimes told that a heel spur seen on an X-ray is responsible for their symptoms.

However, heel spurs can also be present in people who have little or no pain.

The presence of a spur therefore does not automatically mean that the spur itself needs to be removed.

In many cases, symptoms are more closely associated with the plantar fascia and surrounding tissues.

This is one reason imaging findings should be interpreted together with the patient's symptoms and examination rather than treated in isolation.

Achilles Tendon Pain

The Achilles tendon connects the calf muscles to the heel and is one of the largest and strongest tendons in the body.

Achilles tendinopathy can cause pain, stiffness and thickening of the tendon.

Symptoms may occur in the middle portion of the tendon or closer to where the Achilles attaches to the heel.

Runners and athletes frequently develop Achilles problems, but the condition can also occur in people who are not participating in high-level sports.

Chronic Achilles tendinopathy is not necessarily an inflammatory problem, despite frequently being called “Achilles tendonitis.”

Treatment may include progressive strengthening, activity modification, footwear changes and other nonsurgical treatments. For selected chronic cases, shockwave therapy, PRP or image-guided tendon procedures may be considered.

Ankle Sprains and Ligament Injuries

Ankle sprains are among the most common sports and recreational injuries.

They frequently occur when the ankle rolls inward, placing stress on the ligaments along the outside of the ankle.

Many ankle sprains recover without surgery, but persistent pain, swelling or instability after what seemed like a routine sprain deserves further evaluation.

Some patients can develop chronic ankle instability after repeated injuries. Others may have associated tendon injuries, cartilage damage, fractures or other problems that were not initially recognized.

The fact that an injury was originally diagnosed as an “ankle sprain” does not necessarily explain symptoms that continue for months afterward.

Peroneal Tendon Problems

The peroneal tendons travel along the outside of the ankle and help stabilize the foot and ankle during walking, running and other activities.

Peroneal tendinopathy or tendon tears can cause pain and sometimes swelling along the outside of the ankle.

Symptoms may develop gradually from repetitive activity or occur following an ankle injury.

Because peroneal tendon pain can resemble a lateral ankle sprain, persistent pain along the outside of the ankle may warrant further evaluation.

Diagnostic musculoskeletal ultrasound can be particularly useful for examining these tendons dynamically as the foot and ankle move.

Posterior Tibial Tendon Problems

The posterior tibial tendon travels along the inside of the ankle and plays an important role in supporting the arch of the foot.

Problems involving this tendon can cause pain and swelling along the inside of the ankle and may eventually contribute to progressive flattening of the arch.

Patients may notice increasing difficulty walking, exercising or performing a single-leg heel raise.

Early recognition can be important because treatment options may differ depending on how advanced the tendon problem and associated foot deformity have become.

Nonsurgical treatment may include activity modification, rehabilitation, bracing, orthotics and other treatments depending on the condition.

Ankle Arthritis

Arthritis can affect the ankle just as it affects the knee, hip and other joints.

Unlike knee and hip osteoarthritis, ankle arthritis frequently develops after a previous injury such as a fracture or significant ligament injury.

Patients may experience pain, stiffness, swelling, loss of motion and difficulty walking or exercising.

Not every patient with ankle arthritis requires immediate surgery.

Depending on the severity of the arthritis and symptoms, nonsurgical treatment may include activity modification, bracing, medications, rehabilitation and selected image-guided injections.

For appropriately selected patients, regenerative treatments such as PRP may also be discussed.

Arthritis of the Foot

The foot contains numerous joints that can develop arthritis.

Arthritis may affect the big toe, midfoot, hindfoot or other joints and can cause pain with walking, standing and exercise.

Because several small joints are located close together, determining exactly which joint is responsible for the symptoms can sometimes be challenging.

Physical examination and imaging can help localize the problem.

When an injection is appropriate, ultrasound guidance can help the physician accurately target the intended joint.

Stress Fractures and Bone Stress Injuries

Foot and ankle pain in runners and other active patients can sometimes result from a bone stress injury rather than a tendon or ligament problem.

Stress injuries may occur when repetitive loading exceeds the bone's ability to recover.

Patients may notice progressively worsening pain with activity and localized tenderness.

These injuries are important to identify because simply continuing to exercise through the pain can potentially make the problem worse.

Depending on the suspected injury, X-rays or more advanced imaging may be necessary.

Is Your Foot Pain Coming From a Nerve?

Not all foot pain originates from a joint, tendon or ligament.

Nerve irritation or compression can produce burning, tingling, numbness or shooting pain in the foot and ankle.

Symptoms can originate locally or occasionally result from nerve problems higher in the leg or spine.

Because nerve pain requires a different treatment approach than plantar fasciitis, arthritis or tendinopathy, identifying the source of the symptoms is important.

Do You Need an MRI for Foot or Ankle Pain?

Not every patient with foot or ankle pain needs an MRI.

The appropriate imaging depends on the suspected diagnosis.

X-rays can be useful for evaluating arthritis, fractures, alignment and other bony abnormalities.

Diagnostic musculoskeletal ultrasound can evaluate many of the tendons, ligaments and soft tissues surrounding the foot and ankle in real time. Ultrasound also allows the physician to examine certain structures dynamically while the patient moves the foot.

MRI may be appropriate when more detailed evaluation is necessary, a stress injury or significant structural problem is suspected, or the diagnosis remains uncertain.

The goal is to obtain the imaging that is most likely to provide useful information rather than automatically ordering an MRI for every painful foot or ankle.

How We Diagnose Foot and Ankle Pain

Treatment should begin by determining what structure is causing the symptoms.

An evaluation may include a review of when the pain began, previous injuries, sports and exercise activities, footwear, treatments already attempted and the movements that reproduce the symptoms.

The physical examination can help distinguish between tendon problems, ligament injuries, arthritis, plantar fascia conditions, nerve problems and other causes.

When appropriate, our physicians can use digital X-ray and diagnostic musculoskeletal ultrasound as part of the evaluation.

If an MRI, additional imaging or surgical consultation is necessary, we can recommend that as well.

Can Foot and Ankle Pain Be Treated Without Surgery?

Many common foot and ankle conditions can initially be treated nonsurgically.

Depending on the diagnosis, treatment may include activity modification, rehabilitation and strengthening, footwear changes, orthotics, bracing, medications and image-guided procedures.

For certain chronic tendon and soft-tissue conditions, shockwave therapy, PRP or other image-guided procedures may also be considered.

The appropriate treatment for plantar fasciitis may be very different from treatment for ankle arthritis, an Achilles tendon injury or a nerve problem.

That is why our approach begins with the diagnosis rather than selecting an injection or procedure before identifying the source of the pain.

PRP for Foot and Ankle Conditions

Platelet-rich plasma (PRP) is prepared from a patient's own blood and contains concentrated platelets and associated signaling proteins.

PRP may be considered for certain chronic tendon, ligament or joint conditions in appropriately selected patients.

Potential applications around the foot and ankle may include selected Achilles tendon problems, other chronic tendinopathies and certain arthritic joints.

However, PRP is not appropriate for every foot or ankle condition.

A significant tendon rupture, fracture or advanced structural problem should not simply be injected without considering whether another treatment is more appropriate.

At Carolina Nonsurgical Orthopedics, regenerative treatment begins by establishing the diagnosis and determining whether PRP is a reasonable option for the individual patient.

Shockwave Therapy for Plantar Fasciitis and Tendon Pain

Shockwave therapy is a noninvasive treatment that may be considered for certain chronic musculoskeletal conditions.

Two common foot and ankle applications are chronic plantar fasciitis and Achilles tendinopathy.

Shockwave treatment is performed externally and does not require an injection into the painful tissue.

It may be particularly useful when symptoms have persisted despite more basic conservative treatments.

Whether shockwave is appropriate depends on the diagnosis, duration of symptoms and other individual factors.

Why Image Guidance Matters for Foot and Ankle Procedures

The foot and ankle contain numerous small joints, tendons, ligaments, nerves and blood vessels located close together.

When an injection or procedure is performed, accurately identifying the treatment target can be particularly important.

Musculoskeletal ultrasound allows the physician to visualize many of these structures and guide the needle in real time.

This can be useful when performing procedures involving tendons, small joints and other structures throughout the foot and ankle.

At Carolina Nonsurgical Orthopedics, image guidance is an important component of many of the orthopedic procedures we perform.

When Should You See a Foot and Ankle Specialist?

Consider an orthopedic evaluation when foot or ankle pain:

• Persists despite rest or activity modification

• Interferes with walking or exercise

• Prevents you from running or playing sports

• Causes recurrent swelling

• Is associated with weakness or instability

• Causes numbness, burning or tingling

• Began following an injury

• Continues despite previous treatment

• Has become progressively worse

• Is limiting your ability to remain active

More urgent evaluation may be appropriate following significant trauma, inability to bear weight, obvious deformity or symptoms concerning for infection.

When Is Foot or Ankle Surgery Necessary?

Many foot and ankle problems can be treated without surgery, but nonsurgical care is not appropriate for every condition.

Certain fractures, complete tendon ruptures, severe ligament injuries, significant deformities and advanced joint damage may require surgical treatment.

Our focus on nonsurgical orthopedics does not mean avoiding surgery when it is clearly the better option.

Instead, our goal is to identify the problem and determine whether reasonable nonsurgical treatments exist before an operation is pursued.

Staying Active With Foot and Ankle Pain

Foot and ankle pain can make exercise difficult because these structures absorb substantial forces during walking, running and sports.

Complete inactivity, however, is not always necessary.

Depending on the diagnosis, patients may temporarily tolerate activities such as cycling, swimming or other lower-impact exercise while reducing activities that place greater stress on the injured structure.

As symptoms improve, a gradual return to loading and activity may be appropriate.

The objective is not simply to tell active patients to stop exercising. It is to identify the problem and develop a plan that helps them return to the activities that are important to them.

Foot & Ankle Pain Treatment in Raleigh & Cary, NC

Foot and ankle pain does not automatically mean you need surgery.

At Carolina Nonsurgical Orthopedics, our physicians evaluate plantar fasciitis, Achilles tendon problems, ankle injuries, arthritis, chronic tendon conditions and other causes of foot and ankle pain.

Treatment may include rehabilitation recommendations, bracing or orthotics, image-guided procedures, PRP, shockwave therapy and other nonsurgical options when appropriate.

If foot or ankle pain is interfering with walking, exercise, sports or everyday activities, schedule an orthopedic evaluation at our Raleigh or Cary, NC location.