The ankle and foot have a complex anatomy, with many bones, ligaments, tendons and muscles that can become a source of pain. The foot and ankle have 26 bones, 33 joints and over 100 muscles, tendons and ligaments that support the function of the foot.
Common sources of foot and ankle pain include:
- Plantar Fasciitis
- Achilles’ Tendinitis
- Stress fractures
- Ankle sprains
- Morton’s Neuroma
- Referral pain from active trigger points in skeletal muscles
Plantar fasciitis is inflammation of the plantar fascia (connective tissue) of the foot that results in heel and foot pain, most prominently at the heel. Early on, symptoms are worse in the morning, when you get out of bed, and decrease throughout the day. However, as deterioration of the plantar fascia continues, pain is felt more and more throughout the day and eventually at rest.
In some cases, pain may be felt along the medial arch of the foot down to the joints of the 1st and 2nd toes. In advanced cases, pain may radiate into the middle of the foot and to the 3rd and 4th toes. Early identification of the problem is important to the healing process. Many people, in hopes that the issue will disappear on its own, do not seek professional help until the situation has become chronic.
Plantar Fasciitis is typically caused by chronic overload of the foot (working on one’s feet in the wrong shoes or increased running distances are two examples). Tight calf muscles as well as foot overpronation can also contribute to the problem. Irritation of the sciatic nerve may produce symptoms of plantar fasciitis, so a full history and evaluation by your medical massage therapist is important to completely understand your condition. In some cases, a heel spur can develop due to the plantar fascia pulling at the attachment to the bone. In this case, pain can be felt after long periods of standing or walking and eventually with every step.
The Achilles’ tendon is the largest tendon in the body, attaching your calf muscle to your heel. Stress on the tendon from a sudden increase in exercise, tight calf muscles, sports that require jumping, a bone spur, or imbalances in the foot can result in inflammation of the tendon. Symptoms include pain on the heel and along the tendon. Pain is worse after vigorous exercise and there may be a thickening of the tendon.
Treatment consists of resting from activities, anti-inflammatory medications and massage therapy to reduce tension in the calf muscles. Regular stretching of the calf muscles is an important exercise to do at home.
A stress fracture of the foot occurs in one of the 5 metatarsals. Stress fractures are usually caused by overuse and repetitive activity, such as running. They can also result from a sudden increase in activity (especially high impact exercises) or osteoporosis. Symptoms of a stress fracture include:
- Pain that increases during activity and subsides with rest
- Swelling on the top of the foot or on the outside of the ankle
- Tenderness to touch at the site of the fracture
Treatment includes rest, supportive footwear or casting, and anti-inflammatory medication.
The ankle and foot have many ligaments that provide connectivity and support. Any of the ligaments can be injured, but the most common site of an ankle sprain is on the outside of the foot, the talofibular ligament. It is called an inversion sprain, as it usually result from the foot being turned inward, overstretching the ligament.
Symptoms depend upon severity of the sprain, but include pain, swelling and bruising at the site of the sprain. It may be difficult to put weight on the foot. Massage therapy can be very helpful in the recovery from an ankle sprain. The goal of massage in this case is to reduce tension around the damaged area and to apply cross fiber friction massage directly on the ligament in order to promote proper healing.
Morton’s Neuroma is a painful foot condition caused by entrapment of the plantar nerve on the bottom of the foot. It most commonly occurs between the 2nd and 3rd or the 3rd and 4th toes. Wearing high heel shoes is one cause of Morton’s Neuroma. The primary symptom is a burning pain on the bottom of the foot that may radiate into the toes. The pain is worse with activity. Corticosteroid shots are frequently used to treat the condition.
Below are diagrams of numerous muscular trigger points that cause ankle and foot pain.