Foot and Heel Injuries
OverviewHeel painMidfootBall of the footForefootToeSkin
Plantar fasciitis assessment and diagnosisInjuries to the foot can be acute meaning sudden onset or chronic which come on gradually often through overuse.
If you are not sure what your injury is why not try our symptom checker? Or below we outline the most common causes of foot and heel pain.

If you have suffered a recent foot injury then you should apply immediate first aid for foot pain. We also explain under which circumstances you should see a doctor

 

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Heel pain

Gradual onset:

Plantar fasciitis causes pain under the heel which comes on gradually and may radiate underneath the foot. It is likely to be worse first thing in the morning.

Bruised heel also causes comes on gradually with pain underneath the heel which doesn't radiate under the foot and improves with rest.

Severs disease is a foot injury which affects children between the ages of 8 and 15 years old causing gradual onset pain at the back of the heel.

Achilles bursitis causes pain at the back of the heel which comes on gradually, often with a prominant lump or swelling at the back of the heel.

 

Sudden onset:

Calcaneal fracture is a broken heel bone and is a sudden traumatic injury caused by a heavy landing with severe pain and swelling. One of the more severe sudden onset foot injuries.

View all causes of heel pain

 

Midfoot pain
Gradual onset:

Navicular stress fracture is a stress fracture of the navicular bone in the middle of the foot. Symptoms include poorly localized ache in the midfoot which gets worse with exercise.

Extensor tendonitis is gradual onset pain and inflammation of the extensor tendons which run along the top of the foot and straighten the toes.

Stress fracture of the foot has symptoms of gradual onset pain through overuse and can apply to any of the bones in the midfoot area including the navicular bone mentioned above.

 

Sudden onset:

Midtarsal joint sprain is an injury to the ligaments in the midfoot area. Pain will be felt on the outside middle of the foot and there may be swelling on the outside top of the joint.

View all causes of midfoot pain

 

Forefoot pain
Gradual onset

Extensor tendinitis is inflammation of the tendons which run along the top of the foot and straighten the toes. Pain is felt along the top of the foot.

Mortons Neuroma or Mortons syndrome is a condition resulting in pain between the third and forth toes cause by compression of a nerve.

Metatarsal stress fracture is a fine fracture in one of the long metatarsal bones in the foot which occurs through overuse and / or poor foot biomechanics.

 

Metatarsalgia is a general term used to cover any forefoot pain but usually refers to inflammation which occurs in the joints between the metatarsal bones in the foot and phalanges bones of the toes.

 

Bunion (Halux valgus) is a painful swelling of the soft tissue on the inside of the joint at the base of the big toe. Often the big toe will look as if it is bent in towards the other toes or even can lie across them.

Gout is a form of arthritis caused by a build up of uric acid within the body which is a waste product of metabolism. Symptoms which include intense pain in the joint around the big toe tend to come on quickly and then last for around a week before easing off.

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Sudden onset

Turf toe can occur after a very vigorous upward bending of the big toe causing a sprain to the ligaments under the toe. Symptoms include swelling and pain at the joint.

View all causes of forefoot pain

 

Toe injuries
Gradual onset

Black toenail is caused either by direct trauma to the toe or can also be caused by repetitive rubbing against the inside of a shoe, for example in the case of long distance runners and is known as Jogger's Toe.

Ingrown toenail or onychocryptis is a common and frustrating cause pain, often caused by improper footwear not allowing the nail to grow properly, or due to poor nail cutting.

Hallux rigidus is a stiff big toe with pain, swelling and inflammation in the joint.

Hammer toe is a condition which causes one or more of the smaller toes to become bent upwards. The toe can be straightened but if ignored may become a permanent deformity.

 

Sudden onset

Broken toe is a fracture to any of the bones in the toes, usually the big toe. Symptoms include pain at which is felt instantly and swelling which comes on quickly.

Dislocated toe usually occurs from a direct trauma to the to resulting in intense pain. A visible deformity may be obvious but this is not always the case.

 

Skin conditions and other foot problems
Athletes foot, also known as Tinea Pedis is a fungal skin infection causing itchy, often peeling or flaking skin is present. A mild case of athletes foot may appear as just dry skin.

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Blisters are caused by friction between the skin and the inside of a shoe or clothing. Heat builds up causing a swelling under the skin which may or may not have blood in it.

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Corns & Calluses occur when there is excess or thickening of the skin, usually on the soles of the feet. Calluses form on weight bearing parts of the body and corns on non weight bearing areas.

 

Verruca is also known as a plantar wart and appears on the sole of the foot. They are the same as warts on any other body part and are caused by a virus, known as human papilloma virus (HPV).

 

Over pronation is where the foot rolls in or flattens too much.

 

Over supination is where the foot rolls out, usually athletes have a high arch also.

 

Gait analysis can be done to identify any biomechanical issues such as overpronation or oversupination.

When should I see a doctor?
If you have any of the following symptoms you should seek further medical assistance.

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Severe pain, especially on walkingSevere swelling (oedema)Altered sensation in the foot – such as a feeling of “pins and needles” (paresthesia) or a “loss of feeling” (anaesthesia) in the foot.Unable to complete normal daily activities after the initial 72 hours.

Further medical assistance can be sought through either your local GP or a private clinician such as a podiatrist, physiotherapist, sports therapist, osteopath or chiropractor. If you have followed the P.R.I.C.E. principles (see below) and are still unable to walk after 72 hours or still have severe pain that is not subsiding after the first 72 hours you should visit your local A&E department for further assessment.

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Secondly, if you have applied for P.R.I.C.E. principles and still have weakness that lasts a long time (more than 2 weeks) or have ongoing discomfort in your foot or heel, you are highly recommended to seek advice from a specialist expert - such as a podiatrist or physiotherapist, osteopath, or chiropractor - who can provide you with advice and an appropriate and effective recovery and rehabilitation program.

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Immediate first aid for acute foot injuries
The PRICE principles (protection, rest, ice, compression and elevation) are the gold standard set for treating acute sports injuries. PRICE should be applied as early as possible and continued for at least the first 24-72 hours.

Protection of the damaged tissue is vital to prevent further damage and enable the healing process to start efficiently and effectively. There are a number of ways to protect the injured area all with the same aim of limiting further movement and use of the joint/muscle/ligament/tendon. One way this can be achieved is using a support or splint.

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Rest - in the early stages, rest is one of the most important components of the P.R.I.C.E principle but is often neglected or ignored. It does not only refer to the prolonged period of time that the athlete will be out of action but also to the immediate period after the injury.

Ice therapy, also known as cryotherapy, is one of the most widely known and used treatment modalities for acute sports injuries. It is cheap, easy to use and requires very little time to or expertise to prepare.

 

The application of ice to an injury:

Decreases the amount of bleeding by closing down the blood vessels (called vasoconstriction).Reduces pain (pain gate theory)Reduces muscle spasmReduces the risk of cell death (also called necrosis) by decreasing the rate of metabolism

 

A cold therapy and compression wrap is a convenient way to apply cold therapy. Ice should not be appllied directly to the skin as it may cause ice burns.

Compression - is applied to minimise the amount of swelling that forms after an injury and should be applied for the first 24 to 72 hours from the onset of injury.

 

The most effective method is by using a compression bandage which is an elasticated bandage that simply fits around the affected limb.

Elevation of the injured limb is the final principle of PRICE but is equally as important as the other 4. Elevation allows gravity to drain the fluid away from the injured site. This aids in decreasing the swelling which in turn may decrease the pain associated with the oedema (swelling).