The Achilles tendon is located behind the ankle and connects the heel of the foot to the calf muscles. An Achilles tendon rupture is when this tendon tears.

The Achilles tendon is responsible for push off of the ankle. It connects the calf muscle to the heel bone of the foot.

Injury to the Achilles tendon can occur from a sudden jump or planting of the foot or can occur from chronic repetitive damage or tendonitis. Patients often complain of heel pain and a sensation that someone struck the back of their leg or they were "shot" in the heel when a tear occurs. A "pop" or "explosion" is frequently felt when the tendon ruptures. There is usually swelling and a defect of the tendon as well as weakness of the foot with a tear. Physical examination by a Foot and Ankle Specialist typically confirms the diagnosis; however, in some rare cases an MRI scan may be needed to show the exact location of the tear and the distance between the two tendon edges.

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The Achilles tendon is the largest tendon in the body. It connects your calf muscles to your heel bone and is used when you walk, run, and jump. Although the Achilles tendon can withstand great stresses from running and jumping, it is also prone to tendinitis, a condition associated with overuse and degeneration.

This condition is marked by inflammation and irritation of the Achilles tendon which is located in the back of the ankle. Achilles tendinitis is a fairly common overuse injury that often occurs in middle-aged, recreational athletes. Overuse of the tendon results in noticeable inflammation that may eventually lead to pain and swelling. In addition, Achilles tendinitis can also lead to a series of tears within the tendon, rendering it susceptible to rupture.

Patient Education Sheets

For additional information about treatment, we have included this complete patient eduction sheet as a pdf to view, download and print:

A sprained ankle is a very common injury. Approximately 25,000 people experience it each day. A sprained ankle can happen to athletes and non-athletes, children and adults. It can happen when you take part in sports and physical fitness activities. It can also happen when you simply step on an uneven surface, or step down at an angle.

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.

Ankle sprains happen when the foot twists, rolls or turns beyond its normal motions. A great force is transmitted upon landing. You can sprain your ankle if the foot is planted unevenly on a surface, beyond the normal force of stepping. This causes the ligaments to stretch beyond their normal range in an abnormal position.

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Arch pain, or strain, is most often felt as a burning sensation along the long arch of the foot. There are a number of possible causes for this pain, but the most common are structural problems of the foot and stretching of the plantar fascia that supports the foot.

The latter is a common condition suffered by many athletes called plantar fasciitis. Plantar fasciitis results when the arch is excessively stretched, sometimes due to the condition known as flat feet. The resulting inflammation often leads to considerable pain in the arch and heel areas. The pain can be extreme after prolonged periods of rest such as after a good night's sleep.

If the strain on the arch continues over a period of time and left untreated, a bony protrusion may develop. This is called a bone spur and it is important to have it treated.

Arthritis is a condition that causes joint inflammation, swelling, and pain. The condition occurs when the lubricating cartilage in the joint wears away, leaving irregular cartilage and bone to rub against bone causing pain. This condition is common in people over the age of 50, but can start at younger ages. Several diseases can result in arthritis, but trauma and rheumatoid disease are the most common causes in the ankle. 

Post-traumatic Arthritis

Previous trauma is the single most common cause of ankle arthritis. Such injuries include previous fractures, joint dislocations, or severe ankle sprains, which can occur years before arthritis begins. These injuries can cause permanent damage to joint cartilage surfaces that help to cushion joints. With time, the damage to cartilage worsens and the joints lose that protective covering. Ultimately, the bones in the joint grind against each other with little or no cartilage left. This causes joint inflammation, swelling, and pain.

Rheumatoid and Inflammatory Arthritis

Rheumatoid arthritis (RA) is an autoimmune disease where the body's immune system turns against itself. Rather than working to protect the joints, the body actually produces substances that cause joint inflammation and destruction. RA is a long-term disorder that causes inflammation of multiple joints and surrounding tissue throughout the body. Of those individuals who suffer from RA, nearly 90 percent develop symptoms at the ankle or foot. In most cases, these symptoms initially appear in the toes and then involve the rear portion of the foot and ankle.

Bunions are a common problem that most individuals experience as a painful swelling or a bony protuberance at the inner base of the big toe. This condition is the result of a malalignment of the first toe. These can be hereditary or secondary to wearing high-heeled or narrow toe-box shoes.

Symptoms often include pain, swelling, and abnormal position of the first toe. The technical term for bunions is "hallux valgus" (HV). This refers to the first toe or hallux moving away or abducting from the middle of the foot and then twisting in such a way that the inside edge actually touches the ground and the outside edge turns upward. This term describes the deviation of the toe toward the outside part of the foot.

If left untreated, bunions can worsen over time and cause considerable difficulty in walking, discomfort, and skin problems such as corns. In some cases, a small bursa (fluid-filled sac) near the joint becomes inflamed. This condition is known as bursitis and can cause additional redness, swelling, and pain.

Less frequently, bunions occur at the base of the fifth toe. When this occurs, it is called a "tailor's bunion" or bunionette.

Patient Education Sheets

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Learn about treatment options for this condition:

The claw toe and hammer toe deformities are conditions that are primarily caused by the wearing of footwear that is too tight and fits poorly. In some individuals, these deformities can be congenital or due to other problems.

Claw toes appear exactly as their name would suggest, like a closed fist. Because of the joint variations of the toes (big toes have two bones, the other toes have three), claw toes cannot occur in the big toe. Claw toes are the result of a muscle imbalance that causes some of the tendons and ligaments to become unnaturally tight. The cause of this imbalance includes rheumatoid arthritis, neuromuscular disorders, or other conditions. Because of the deformity, a rigid claw toe has very limited mobility and can be very painful.

A hammer toe is classified on the degree of mobility found in the joint itself. There are two types: rigid and flexible. A rigid hammer toe simply does not have much ability to move and even minimal movement can be painful. A flexible hammer toe, however, does have the ability to move and can be straightened manually.

Diabetics are more likely to be hospitalized for a foot problem than for any other reason! A small cut in the foot of a diabetic can result in a serious consequence. Open wounds in a diabetic can become more easily infected than in a non-diabetic individual. This is because diabetic patients often have poor or compromised "micro-circulation," where the small end blood vessels in the foot are closed. This makes healing and fighting infection a greater challenge for the body. Diabetics can lack some of the "protective sensation" that most people have. That is the ability to feel and avoid painful foot situations, like stepping on a sharp object or the discomfort of improperly fitting shoes.

Through injury and a lack of protective sensation, an ulcer or open wound of the foot can occur. These are the leading cause for limb amputations in people with diabetes with approximately 100,000 leg or foot amputations performed annually in the United States. In fact, diabetes continues to be the most common cause of lower extremity amputations in the country with the rate 15 to 40 times higher than in a non-diabetic. All foot ulcers and wounds need to be inspected by a trained professional.

Flat foot is a condition in which the arch of the foot has collapsed, with the entire sole of the foot coming into direct contact with the ground. Causes of flat feet include genetics, tendon failure, and abnormal tendon function and bone structure.

In most cases, there is no pain associated with flat feet. However, the condition may lead to misalignment to other structures of the feet. Pain may develop in the arch, calf, and perhaps the lower back. In severely flat feet, patients may have pain that makes moving and/or standing difficult. Prolonged standing or strenuous athletic activity often worsens this pain.

The talus is a bone that is an important part of the ankle joint. It helps to transfer weight and pressure forces across the ankle point. It is located between the tibia and fibula of the lower leg and the calcaneus or heel bone. The tibia and fibula are situated on top and around the sides of the talus and thus form the ankle joint. At the point where the talus meets the calcaneus, it forms the subtalar joint. This joint is essential for individuals walking on uneven ground.

The most common site of arthritis in the foot is at the base of the big toe. This joint is called the metatarsophalangeal, or MTP joint. If the joint starts to stiffen, walking can become painful and difficult.

In the MTP joint the ends of the bones are covered by a smooth articular cartilage. If wear-and-tear or injury damage the articular cartilage, the raw bone ends can rub together. A bone spur, or overgrowth, may develop on the top of the bone. This overgrowth can prevent the toe from bending as much as it needs to when you walk. The result is a stiff big toe and pain.

Hallux rigidus usually develops in adults between the ages of 30 and 60 years. No one knows why it appears in some people and not others. It may result from an injury to the toe that damages the articular cartilage or from differences in foot anatomy that increase stress on the joint.

Symptoms

• Pain in the joint when you are active, especially as you push-off on the toes
• Swelling around the joint
• A bump, like a bunion or callus, that develops on the top of the foot
• Stiffness in the great toe and an inability to bend it up or down

Diagnosis

If you find it difficult to bend your toe up and down or find that you are walking on the outside of your foot because of pain in the toe, this may be hallux rigidus. If you wait until you see a bony bump on the top of your foot, the bone spurs will have already developed and the condi­tion will be more difficult to treat.

Your physician will examine your foot and look for evidence of bone spurs. He may move the toe around to see how much motion is possible without pain. X-rays will show the location and size of any bone spurs, as well as the degree of degeneration in the joint space.

Patient Education Sheets

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This injury is a both a fracture and dislocation to the middle of the foot. This is a very important area of the foot as there are a group of small bones that form the arch shape of the foot. These bones are connected to each other in this arch shape by a group of ligaments called the Lisfranc ligaments. Injuries to these bones and Lisfranc ligaments are often caused by falls, twisting injuries, or heavy objects dropping on the foot. The most common problem that can develop in the long-term after these injuries is arthritis in the middle of the foot.

If you sometimes feel that you are "walking on a marble," and you have persistent pain in the ball of your foot, you may have a condition called Morton’s neuroma. A neuroma is a benign swelling of a nerve. Morton’s neuroma is not actually a tumor, but a thickening of the tissue that surrounds the digital nerve leading to the toes.

Morton’s neuroma occurs as the nerve passes under the ligament connecting the toe bones (metatarsals) in the forefoot. Morton’s neuroma most frequently develops between the third and fourth toes, usually in response to irritation, trauma or excessive pressure. The incidence of Morton’s neuroma is 8 to 10 times greater in women than in men.

Symptoms

• Normally, there are no outward signs, such as a lump.
• Burning pain in the ball of the foot that may radiate into the toes. The pain generally intensifies with activity or wearing shoes. Night pain is rare.
• There may also be numbness or an unpleasant feeling in the toes.

Runners may feel pain as they push off from the starting block. High-heeled shoes, which put the foot in a similar position, can also aggravate the condition. Tight, narrow shoes also aggravate this condition by compressing the toe bones and pinching the nerve.

Diagnosis

During the examination, your physician will feel for a palpable mass or a "click" between the bones. He or she will put pressure on the spaces between the toe bones to try to replicate the pain and look for calluses or evidence of stress fractures in the bones that might be the cause of the pain. Range of motion tests will rule out arthritis or joint inflammations. X-rays may be required to rule out a stress fracture or arthritis of the joints that join the toes to the foot.

Patient Education Sheets

For additional information about treatment, we have included this complete patient eduction sheet as a pdf to view, download and print:

Plantar fasciitis is the most common cause of pain on the bottom of the heel. Approximately 2 million patients are treated for this condition every year.

Plantar fasciitis occurs when the strong band of tissue that supports the arch of your foot becomes irritated and inflamed.

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 of your foot, and supports the arch of your foot.

Cause

The plantar fascia is designed to absorb the high stresses and strains we place on our feet. But, sometimes, too much pressure damages or tears the tissues. The body’s natural response to injury is inflammation, which results in the heel pain and stiffness of plantar fasciitis.

Risk Factors

In most cases, plantar fasciitis develops without a specific, identifiable reason. There are, however, many factors that can make you more prone to the condition:

• Tighter calf muscles that make it difficult to flex your foot and bring your toes up toward your shin
• Obesity
• Very high arch
• Repetitive impact activity (running/sports)
• New or increased activity

Heel Spurs

Although many people with plantar fasciitis have heel spurs, spurs are not the cause of plantar fasciitis pain. Because the spur is not the cause of plantar fasciitis, the pain can be treated without removing the spur.

Symptoms

The most common symptoms of plantar fasciitis include:

• Pain on the bottom of the foot near the heel
• Pain with the first few steps after getting out of bed in the morning, or after a long period of rest. The pain usually subsides after a few minutes of walking.
• Greater pain after (not during) exercise or activity

Examination

A comprehensive physical exam is usually enough to diagnose plantar fasciitis.

Patient Education Sheets

For additional information about treatment, we have included this complete patient eduction sheet as a pdf to view, download and print:

Plantar warts are benign growths on the bottom of the foot caused by a virus called the human papillomavirus (HPV). This virus enters the skin through small or invisible cuts. The wart develops in the outer layer of the skin and is typically covered with a layer of callus tissue. Sometimes small black dots are visible. These are blood vessels that grow within the wart. Over time, the wart can grow and other warts can emerge that sometime coalesce into a larger cluster called a mosaic wart. Although warts are generally harmless, they can be quite painful when present on weight-bearing areas of the foot. 

This becomes a fairly common problem for the foot as we enter middle age. The posterior tibial tendon (PTT) itself runs along the inner aspect of the leg and ankle. It helps support the arch of the foot. Posterior tibial tendonitis occurs when this tendon becomes inflamed through overuse. In more severe cases, the inflammation can cause the tendon to tear. Most patients with this problem complain of pain at the inner ankle and arch. Some people may feel unsteady when walking. Without treatment, this condition can cause collapse of the arch and development of arthritis.

One of the most common problems involving the first big toe joint is arthritis. Arthritis at this particular area is also called hallux rigidus. The first toe joint is referred to as the metatarophalangeal (MTP) joint. This joint is where the first metatarsal head meets with the small bone of the big toe. Due to the mechanics of our feet, the big toe joint is especially prone to developing arthritis.

Tarsal tunnel syndrome is compression or squeezing on the posterior tibial nerve at the inner aspect of the ankle. This painful condition is often due to injury or inflammation. Similar to carpal tunnel syndrome, tarsal tunnel refers to the compression of a nerve in a confined space. The tarsal tunnel is an area created by the very strong laciniate ligament that covers a bony canal through which pass some of the major nerve, artery, vein, and tendons of the foot. Individuals who suffer from tarsal tunnel syndrome exhibit symptoms that include tingling, burning sensations, numbness, and shooting pain. These symptoms occur most often at rest or just before sleeping at night.