Article featured on Mass General Brigham

Athletes generally don’t hesitate to seek medical attention for acute (sudden) foot injuries. But it may be tempting to ignore pain that lingers or pain that comes and goes. This type of chronic pain often occurs with overuse.

Persistent foot pain or pain accompanied by certain other symptoms should be assessed by a specialist.

Foot pain causes

Overuse foot pain can occur in a wide variety of sports, particularly those that involve a lot of running. The most common overuse injuries in the foot are:

• Achilles tendonitis: The Achilles tendon connects the calf muscle to the heel bone. Tendonitis is a common condition that involves irritation and inflammation of a tendon. Untreated, Achilles tendonitis can lead to a tendon tear or rupture.
• Morton’s neuroma: Also called intermetatarsal neuroma, this condition affects the ball of the foot. The nerve tissue thickens, causing pain in that specific area. It may feel like burning, tingling, or like you’re walking on a pebble.
• Plantar fasciitis: This condition happens when the plantar fascia, a band of tissue that supports the arch of your foot, becomes inflamed. Also called plantar heel, it causes heel pain and stiffness.
• Sever’s disease: This condition involves inflammation in the growth plate in the back of the heel. It is a common cause of heel pain, particularly in children who play sports or exercise regularly.
• Stress fracture: A stress fracture is a small crack in a bone. It occurs when too much repetitive pressure is put on a bone over time. Stress fractures can become full fractures if they are not allowed to heal.
• Tarsal tunnel syndrome: This condition involves the posterior tibial nerve, located on the inside of the ankle. If the nerve is compressed (squeezed), it can cause painful feelings like electrical shocks in your ankle and foot.

Early treatment for better outcomes

Some athletes hesitate to seek treatment because they don’t want to hear that they need a procedure or rest. An overuse injury can get worse over time and eventually prevent you from participating in the things you love.

Nobody wants to sideline you from your sport. But a quick checkup on an injury can often prevent you from missing months of your sport, instead of just missing a week or two for rest.

Many overuse injuries can be treated with short-term, non-surgical approaches, such as:

• Activity modifications or a few weeks of rest
• Advice on how to minimize risk factors for foot and ankle pain
• Cast or boot rather than surgery
• Cross-training, such as limiting high-impact movements to a few days a week and adding effective low-impact options
• Corrections to form, such as adjustments to the way you jump or run
• Physical therapy or nutrition counseling for musculoskeletal health
• Proper footwear, such as a different shoe or a corrective insert

Article featured on FootCareMD

If your first few steps out of bed in the morning cause severe pain in the heel of your foot, you may have plantar fasciitis, an overuse injury that affects the sole of the foot. A diagnosis of plantar fasciitis means you have inflamed the tough, fibrous band of tissue (fascia) connecting your heel bone to the base of your toes.

Causes

You’re more likely to develop the condition if you’re female, overweight, or have a job that requires a lot of walking or standing on hard surfaces. You’re also at risk if you walk or run for exercise, especially if you have tight calf muscles that limit how far you can flex your ankles. People with very flat feet or very high arches also are more prone to plantar fasciitis.

Symptoms

Plantar fasciitis typically starts gradually with mild pain at the heel bone often referred to as a stone bruise. You’re more likely to feel it after (not during) exercise. The pain classically occurs right after getting up in the morning and after a period of sitting. If you don’t treat plantar fasciitis, it may become a chronic condition. You may not be able to keep up your level of activity, and you may develop symptoms of foot, knee, hip, and back problems because plantar fasciitis can change the way you walk.

Treatments

Stretch for plantar fasciitisStretching is the best treatment for plantar fasciitis. It may help to try to keep weight off your foot until the initial inflammation goes away. You can also apply ice to the sore area for 20 minutes 3-4 times a day to relieve your symptoms. Rolling a frozen water bottle on the bottom of your foot can be beneficial.

Your foot and ankle orthopaedic surgeon may prescribe a nonsteroidal anti-inflammatory medication such as ibuprofen or naproxen. Home exercises to stretch your Achilles tendon and plantar fascia are the mainstay of treatment and reduce the chance of recurrence.

In one exercise, you lean forward against a wall with one knee straight and heel on the ground. Your other knee is bent. Your heel cord and foot arch stretch as you lean. Hold for 10 seconds, relax and straighten up. Repeat 20 times for each sore heel. It is important to keep the knee fully extended on the side being stretched.

Stretch for plantar fasciitisIn another exercise, you lean forward onto a countertop, spreading your feet apart with one foot in front of the other. Flex your knees and squat down, keeping your heels on the ground as long as possible. Your heel cords and foot arches will stretch as the heels come up in the stretch. Hold for 10 seconds, relax and straighten up. Repeat 20 times.

About 90% of people with plantar fasciitis improve significantly after two months of initial treatment. You may be advised to use shoes with shock-absorbing soles or fitted with an off-the-shelf shoe insert like a rubber heel pad. Your foot may be taped into a specific position.

If your plantar fasciitis continues after a few months of conservative treatment, your doctor may inject your heel with steroidal anti-inflammatory medication. If you still have symptoms, you may need to wear a walking cast for 2-3 weeks or a positional splint when you sleep. In a few cases, surgery is needed for chronically contracted tissue.

Plantar Fascia-Specific Stretching Program

1. Cross your affected leg over your other leg.
2. Using the hand on your affected side, take hold of your affected foot and pull your toes back towards shin. This creates tension/stretch in the arch of the foot/plantar fascia.
3. Check for the appropriate stretch position by gently rubbing the thumb of your unaffected side left to right over the arch of the affected foot. The plantar fascia should feel firm, like a guitar string.
4. Hold the stretch for a count of 10. A set is 10 repetitions.

Perform at least three sets of stretches per day. You cannot perform the stretch too often. The most important times to stretch are before taking the first step in the morning and before standing after a period of prolonged sitting.

Additional Stretch: Achilles Tendon Stretch

1. Place a shoe insert under your affected foot.
2. Place your affected leg behind your unaffected leg with the toes of your back foot pointed towards the heel of your other foot.
3. Lean into the wall.
4. Bend your front knee while keeping your back leg straight with your heel firmly on the ground.
5. Hold the stretch for a count of 10. A set is 10 repetitions.
6. Perform the stretch at least three times a day.

Anti-inflammatory medications can help decrease the inflammation in the arch and heel of your foot. Use the medication as directed on the package. If you tolerate it well, take it daily for two weeks then discontinue for one week. If symptoms worsen or return, resume for two weeks, then stop. You should eat when taking these medications, as they can be hard on your stomach.