Foot Injuries

Ligament strains

The many joints which comprise the foot are all bound together by ligaments, or thickened protective parts of the joint coverings. Any of these ligaments may be damaged by abnormal strains. Usually, the strain is the result of a suddent twist. The strain may occur gradually, from repeated over-stretching, if, for instance, you wear unsuitable or unaccustomed shoes. In either case, once a ligament is damaged, it will set up a painful spot which will be aggravated each time you subsequently over-stretch that point, or apply pressure over it. Even a tiny ligament can give severe pain when strained, and the pain can persist for some months.

Treatment may consist of an injection from your doctor; rest; supportive strapping; underfoot supports to prevent stress over the damaged ligament; or electrical and exercise therapy from a physiotherapist. Any painful activities increase the damage and prolong the injury: the more you can rest the foot, the quicker it recovers.

Plantar Fasciitis

The plantar fascia may be strained by a change in shoes. When the fascia is strained, it usually becomes painful where the fascia is attached to the heel-bone, and the front of the heel-bone feels tender when you press it. The heel hurts on walking and running, and on standing up after you have been sitting down. It also hurts when the sole of your foot is put on the stretch, for instance if you pull your foot and toes backwards towards you with your hands. Specialist treatment may consist of an injection and/or electrotherapy. A soft arch support will take the pressure off the fascia. Painful activities should be avoided. You can resume sport when the tenderness to pressure under the heel has disappeared.

Metatarsalgia

This is a general term to describe pain in the forefoot, between the metatarsal heads. The pain may be associated with, or caused by, structural defects such as an excessively high arch. Treatment aims to correct the defects and improve overall foot function, usually by exercises to improve the balanced working of all the muscles in the food, and by foot supports to improve the mechanical alignment of the joints.

Bunion

In this condition, technically known as hallux valgus, the big toe is pulled towards the second toe, causing the big toe joint with the first metatarsal to form an angled protrusion on the inner side of the foot. The condition is caused by excessive pull inwards from the tendons acting on the toe. Shoes with pointed toes can contribute to the problem. The deformity may become severe, but it is not necessarily very painful. If it does cause pain, pads are used around the protruding bone, to try to prevent friction from shoes over it. Underfoot support, to try to rebalance the weight-bearing load, may be tried. If the joint becomes very painful, and especially if the second toe is crushed by the sideways drift of the big toe, an operation is needed to remove the protruding part of the bone and straighten the joint.

Tenosynovitis

The tendons over the top of the foot are vulnerable to this condition. A direct blow, friction from tight shoe-laces, or overuse strain, can cause irritation between these tendons and their covering sheaths. Over-stretching the tendons, by extending the ankle and pointing your foot down, is painful. If you touch the tendons and move your foot, you will feel a slight ‘grating’ sensation. Specialist treatment may include an injection, or various forms of physiotherapy treatment. You should check your shoes for tightness over the mid-foot, hard lacing eyelets, or roughness on the shoe tongues. If necessary, you should place a padding along the whole tongue. Painful activities and over- stretching should be avoided until the pain and grating have subsided.

Black toe-nails

These occur because of a direct blow to the nail, or through friction from tight shoes, or from disruption of the nail, for instance if an inner seam in a shoe catches on the toe and lifts the nail away during movement. The blackness is blood and bruising under the toe-nail. If the nail is painful, with a feeling of excessive pressure, you can ease it by boring through the nail with a sterilized needle, to release some of the blood. If the nail is persistently painful, you should ask your doctor either to treat it, or to refer you to a chiropodist or podiatrist (foot specialist). You should take care to trim all your toe-nails evenly, straight across the top of the toes, to avoid the further problem of ingrowing toe-nails.