Tendons are like ropes that move the foot and ankle. They attach muscles to bones. When the muscle contracts it pulls the tendon and moves the foot and ankle. Just like a rope that has become worn and frayed with time and use, tendons can also become worn and damaged.
When too much stress is put on a tendon, it can become irritated or inflamed. This is called tendonitis. Tendonitis can happen along the back of the leg and heel (Achilles tendon), inside of the ankle (posterior tibial tendon) or outside of the ankle (peroneal tendons).

What causes tendonitis?

  • Increasing your activity level (such as starting a new exercise program or increasing the amount of exercise that you were already doing)
  • Doing the same movements over and over (such as walking or running)

What can I do about tendonitis that has just started?

  • Rest the leg until there is no heat or redness.
  • Avoid activities that make your pain worse.
  • Cold therapy (ICE)
  • Arrange to see a physiotherapist.
  • Take anti-inflammatory medicine such as ibuprofen (Advil).

What can I do if the tendonitis has been bothering me for a long time?

If the problem lasts more than about three months, changes happen inside the tendon. If you have tendon problems that do not go away after a few months, it is important to talk to your healthcare team because long-term or chronic tendonitis is treated differently. Chronic tendon problems are treated with special exercises taught by a physiotherapist or other health care provider with experience treating tendon problems.

It is important to do the right kind of exercise, so you do not make the tendon problem worse.

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Achilles tendonitis

The Achilles tendon is the largest and strongest in the body and connects the calf muscles to the calcaneus (heel bone). Tendonitis occurs when the tendon becomes irritated or inflamed.

What are the risk factors?

  • Increase in physical activity level, especially running and jumping
  • Tight calf muscles
  • Diabetes
  • Obesity
  • Steroid medications
  • Trauma

What can I do about my Achilles tendonitis?

  • Avoid activities that make your pain worse
  • Rest and cold therapy (ice)
  • Physiotherapy
  • Take anti-inflammatory medicine such as ibuprofen (Advil)
  • Immobilization (sometimes needed)
  • Calf and Achilles stretching

The non-operative treatment is successful in most cases and surgery is rarely indicated.

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Ankle arthritis

Changes in the ankle joint usually begin with changes in the smooth covering that pads and protects the ends of the bones called the cartilage. The cartilage becomes thin, and this change can be seen on x-ray. 

Over the years, as the cartilage wears away and the bone surfaces rub together, a person can have pain and stiffness in the ankle joint. This might become worse when standing or walking. Some people develop a limp when walking. 

People with severe ankle arthritis will be less able to point and bend their foot and might hear a grinding sound when they move their ankle joints.

What causes ankle arthritis?

Some people will develop ankle arthritis after an injury like a bad ankle fracture or if the ankle is injured many times. Ankle arthritis can develop because of the way a person’s bones and joints line up. Other possible causes of ankle arthritis include inflammatory arthritis such as rheumatoid arthritis, crystal arthritis such as gout, or as a result of a serious joint infection.

What can I do about my ankle arthritis?

There are many ways to help your ankle arthritis. The goal is to improve the way you move and decrease your pain.

Reduce the amount of weight on the ankle by:

  • maintaining a healthy weight. (You might need to lose weight.)
  • using a cane, crutches, or a walker
  • sitting to do activities instead of standing

Reduce movement of the ankle joint by:

  • wearing an ankle brace
  • wearing rocker-bottom shoes. Rocker bottom shoes are shoes that have a slightly rounded curve in the sole of the shoe. This curve can help your foot to move more normally if you have stiff or painful joints

Take medicine, it might help. But talk to your doctor before you start taking anything new. Some of the kinds of medicine used to treat ankle arthritis include:

  • acetaminophen, such as Tylenol Arthritis Formula
  • NSAIDs (Non-Steroidal Anti-Inflammatory Drugs), such as ibuprofen (Advil)
  • injections into the joint, such as cortisone, and hyaluronic acid

Can surgery help my ankle arthritis?

Surgery might be suggested if the options listed above do not help your ankle arthritis pain. 

The type of surgery will depend on the amount of arthritis in the ankle. Your surgeon might suggest:

  1. a) ‘cleaning out’ (debriding) the ankle joint or if the arthritis is severe:
  2. b) joining the ankle bones together (an Ankle arthrodesis or Ankle fusion) – see Surgeries – Ankle arthrodesis
  3. c) Total ankle replacement – a surgical procedure in which parts of an arthritic or damaged joint are removed and replaced with a metal, plastic, or ceramic device called a prosthesis – see Surgeries Total ankle replacement

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Flatfoot deformities

A flatfoot deformity happens when the arch of your foot starts to flatten or drop toward the ground. It can also be called “fallen arches”. Many health conditions can create a painful flatfoot.

A flatfoot deformity can happen slowly over time or after an injury.

Some people are born with flat feet, which does not cause any problems for them. A flatfoot deformity is a problem if it causes pain or makes you limp.

What can I do about my painful flatfeet?

  • Use an arch support in your shoe, either an arch support you buy in a pharmacy or shoe store, or an orthotic made specifically for your feet.
  • Work with a physiotherapist to learn how to do exercises that make the muscles and tendons in your foot and lower leg strong and flexible.
  • Talk to your care team about getting a brace for your ankle.

Can surgery help my flatfeet?

Surgery might be suggested if the options listed above do not help your pain. 

Surgery is done to fix the position of the foot and possibly repair the injured tendons. It’s important to remember that you will be non-weight bearing for a few weeks and that the recovery process may be lengthy.

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Hallux Rigidus (Stiff Big Toe)

The big toe joint is called the first metatarsal phalangeal (MTP) joint. This joint connects the head of the first foot bone (metatarsal) with the base of the first toe bone (proximal phalanx). Hallux rigidus is arthritis of the first MTP joint. Pain and stiffness of the big toe joint are common symptoms.

What can I do about my “stiff big toe”?

  • Limit motion of the big toe joint – change in footwear (stiff-soled shoe), orthotics
  • Ice therapy
  • Over-the-counter anti-inflammatory medicine
  • Corticosteroid or hyaluronic acid injections may be used, however with short-term relief

Can surgery help my “stiff big toe”?

If pain persists after the conservative treatment, surgery will be considered. One of the most used techniques is joint arthrodesis (joint fusion) – see Surgeries – Hallux rigidus (Stiff big toe).

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Hallux Valgus (Bunion)

Hallux Valgus (hallux means big toe and valgus means bent out or twisted out) is the medical term for bunion. 

A bunion is a common foot problem where the big toe points towards the second toe and causes crowding. This causes a big bump on the side of the foot, at the base of the big toe. 

The bunion, or bump, can be painful. Wearing tight shoes can make it even more painful. 

You are more likely to get a bunion if you have family members who have also had a bunion. 

It is common for the bump to get bigger over time. 

Most bunions can be managed without surgery.

What can I do about my bunions?

  • Wear comfort shoes with a soft wide-toe box (the part that covers your toes) and avoid tight or sharply pointed shoes.
  • Talk to a shoe repair store about stretching the inside border of the shoe. 
  • Use bunion pads to protect the area from pressure and rubbing. 
  • Wear toe spacers between the big toe and the second toe. 
  • Talk to your healthcare team about orthotics or bunion splints.

Can surgery help my bunions?

Bunion surgery might be considered for people whose bunion pain does not improve after trying the options listed above – see Surgeries – Hallux valgus (Bunion).

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Claw toes

Claw toes are when the muscles in the foot pull the smaller toes into the floor. This happens when some of the longer muscles from the leg pull more than the smaller muscles in the foot. It can also happen after an injury to the tendons in the foot. This problem usually does not affect the big toe but can happen to the four smaller toes. Often the second toe is the worst. 

Claw toes can make fitting into tight shoes uncomfortable. 

Claw toes can cause problems if: 

Is ‘claw toe’ different than ‘hammer toe’?

The names ‘claw toes’ and ‘hammer toes’ are often used to mean the same thing. The main difference between these two problems is the position of the joint at the base of the toes.

What can I do about my claw toes?

Most problems caused by claw toes can be treated with the right footwear and by protecting the bony areas from too much pressure and irritation.

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Forefoot pain – Metatarsalgia

Long-lasting pain in the forefoot is sometimes called ‘metatarsalgia’ (sounds like met-ah-tar-sal-gee-ya). This means there is pain in the joints between the toes and the rest of the foot. These are called the metatarsal joints. 

Patients with metatarsalgia feel pain under the ‘ball’ of the foot, at the base of the problem toes. The pain is described as aching or as a burning feeling that can go right to the ends of the toes. The pain often gets worse when standing and walking on hard surfaces.

What can I do about my forefoot pain (metatarsalgia)?

  • Reduce the amount of weight on the foot:
    • Maintain a healthy weight (You might need to lose weight).
    • Use a cane, crutches, or a walker.
    • Sit to do activities instead of standing.
  • Change your footwear:
    • Wear stiff-soled rocker-bottom shoes with a wide toe box.
    • Talk to your care team about orthotics and shoe inserts (sometimes called ‘metatarsal pads’).
  • Take medicine, it might help. But talk to your doctor before you start taking anything new. Some of the kinds of medicine used to treat metatarsalgia include:
    • NSAIDs (Non-Steroidal Anti-Inflammatory Drugs), such as ibuprofen (Advil).
    • injections into the joint, such as cortisone.

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Morton’s neuroma

Morton’s neuroma is another kind of forefoot pain that usually affects the ‘ball’ of the foot. 

People with Morton’s neuroma often feel pain and pressure where the toes attach to the foot. Sometimes the person also feels numbness along the sides of the toes. Pain is caused when the nerves that run from the toes across the sole of the foot are irritated by the way a person walks.

What can I do about Morton’s neuroma?

There are many ways to treat this condition, but it can take some time and effort to find what will work for you.

  • Reduce the amount of weight on the foot:
    • Maintain a healthy weight (You might need to lose weight).
    • Use a cane or a walking aid.
    • Sit to do activities instead of standing.
  • Changing your footwear:
    • Do not wear high-heeled shoes.
    • Talk to your care team about shoe inserts called ‘metatarsal pads’.
  • Talk to your doctor about taking medicine for pain. The doctor might consider injections into the joint such as cortisone.

Can surgery help with Morton’s neuroma?

Surgery for Morton’s neuroma might be suggested for patients whose pain does not improve after trying the options listed above.

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Plantar Fasciitis

The plantar fascia is a ligament that connects the heel to the front of your foot and supports the arch of your foot. Plantar fasciitis is the inflammation of the plantar fascia. Overuse and repetitive activity are predisposing factors.

Plantar fasciitis is the most common condition causing heel pain. And the available non-operative treatment works in almost all cases.

What can I do about Plantar fasciitis?

  • Work with a physiotherapist to stretch your calf muscles and plantar fascia and strengthen your leg muscles.
  • Change your footwear.
    • Wear stiff-soled shoes. 
    • Avoid sandals and flat shoes.
    • Over-the-counter orthotics.
  • Do not walk barefoot until the pain is gone.
  • You can apply ICE (cold therapy) many times a day for 20 min each time. Remember to put a thin towel between the skin and the ICE pack/bag.
  • Take medicine, it might help. But talk to your doctor before you start taking anything new. Some medications used to treat Plantar fasciitis include: 
    • Over-the-counter anti-inflammatory drugs, such as ibuprofen (Advil) or naproxen.
    • Acetaminophen, such as Tylenol arthritis formula.
    • Injections, such as cortisone.
  • Changing your activity. It would be a good idea to switch from walking and running to swimming or cycling while the symptoms last.
  • Talk to your healthcare team about night splints.

Can surgery help my Plantar fasciitis?

Surgery is rarely needed but is an option in severe cases, after exhaustive non-operative treatment.

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Achilles Tendon Rupture (tear)

The Achilles tendon is the largest and strongest in the body and connects the calf muscles to the calcaneus (heel bone) at the back of the ankle. The Achilles tendon gives your leg strength to walk, run and jump.

What is a ruptured Achilles tendon?

A rupture of the tendon is a tearing and separation of the tendon fibers so that the tendon can no longer perform its normal function. Achilles tendon tears are typically the result of a sudden increase in stress on the tendon or repetitive stress. Ruptures most often occur 2 to 3 inches above the heel bone.

Who is at risk?

Anyone can develop an Achilles tendon tear, but it occurs most frequently in people ages 30 to 50 and is more common in men than in women. A rupture usually occurs during sports activities that involve running and jumping, or trauma such as slips and falls.

What are the symptoms of a torn Achilles tendon?

Common symptoms include:

  • The feeling of being kicked or hit with a hard object in the back of the ankle/leg
  • A popping or snapping sensation (which is sometimes heard) in the back of the ankle/leg
  • Pain and swelling at the back of the ankle/leg
  • Difficulty walking and difficulty rising up on the toes

How is a ruptured Achilles tendon treated?

Treatment can be surgical or conservative (non-surgical).

Conservative treatment consists of placing the foot in a toes-downward position [equinus] and immobilizing (cast) the foot in this position until the tendon has healed. You will be non-weight bearing for several weeks.

The surgery involves making an incision in the back of your lower leg and stitching the torn tendon together. Surgical repair usually results in a quicker recovery and return to regular activities than non-operative treatment – see Surgeries – Achilles tendon rupture.

The surgeon will guide you in choosing the treatment that works for you based on your age, activity level, and medical history.

What happens after Achilles tendon surgery?

You will be non-weight bearing and wearing a cast/splint that will be switched for a walking boot on your first postoperative visit. You may be able to put weight on your affected leg after a few weeks. After proper rehabilitation, full recovery is expected within 8-12 months.

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Ankle Fracture (broken ankle)

The ankle joint is composed of the end of the tibia and fibula, and talus bone: the tibia (shinbone) which forms the inside, or medial portion of the ankle; the fibula (smaller, thinner bone in your lower leg) which forms the lateral, or outside portion of the ankle; and the talus underneath. 

What is an ankle fracture (broken ankle)?

A fracture is a partial or complete break in a bone. Broken ankles involve the distal parts of the tibia and/or the fibula. An ankle fracture can be stable or unstable depending on the alignment of the bones and the stability of the ankle joint.

How do ankle fractures happen?

Ankle fractures are usually caused by a rotational injury. You may experience an ankle fracture from a twisting injury from a simple misstep or fall, or from direct trauma during a motorcycle accident, for example.

How is an ankle fracture treated?

The treatment can be operative or conservative(non-operative). Non-operative treatment may be offered for a stable fracture. For an unstable fracture, surgical treatment will be indicated. Metal plates, screws, or nails may be needed for fracture fixation – see Surgeries – Ankle fracture.

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Ankle Sprain

The ankle is made up of three bones: the tibia, fibula, and talus. Bones are connected by ligaments. An ankle sprain happens when one or more ligaments between these three bones stretch or tear.

How does an ankle sprain happen?

Ankle sprains happen when the foot twists, rolls, or turns beyond normal motions. Usually occurs during activities involving running and jumping, and even stepping on an uneven surface while walking. The ligaments on the outside of the ankle are most commonly affected.

How do I treat my ankle sprain?

After initial orthopaedic evaluation, it can be treated with rest, ice (cold therapy), compression (elastic bandages) and elevation. Patients may benefit from a short period of immobilization in severe sprains.

Work with a physiotherapist to strengthen the muscles in your leg and improve your range of motion.

On some occasions, after the initial recovery process, the patient may develop ankle instability and surgery may be required.

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