Toe, foot, and ankle injuries: Overview
Everyone has had a minor toe, foot, or ankle injury that caused pain or swelling. Most of the time our body movements don't cause problems. But sometimes symptoms develop from everyday wear and tear, overuse, or an injury.
Toe, foot, or ankle injuries most often occur during:
- Sports or recreational activities.
- Work-related tasks.
- Work or projects around the home.
In children, most toe, foot, or ankle injuries occur during sports, play, or falls. The risk for injury is higher in sports with jumping, such as basketball. And it's higher in sports with quick direction change, such as soccer or football. Any bone injury near a joint may injure the growth plate (physis) in a child. It needs to be checked.
Certain athletes, such as dancers, gymnasts, and soccer or basketball players, have a higher risk of toe, foot, or ankle injuries.
Older adults are at higher risk for injuries and fractures. That's because they lose muscle mass and bone strength as they age. They also have more problems with vision and balance. These problems increase their risk of injury.
Most minor injuries will heal on their own. Home treatment is usually all that's needed.
Sudden (acute) injury
An acute injury may occur from a direct blow, a penetrating injury, or a fall. It can also happen if you twist, jerk, jam, or bend a limb abnormally. Your pain may be sudden and severe. Bruising and swelling may start soon after your injury. Acute injuries include:
- Bruises (contusions). After an ankle injury, bruising may extend to your toes from the effects of gravity.
- Puncture wounds. Sharp objects such as nails, tacks, ice picks, knives, teeth, and needles can all cause puncture wounds. These wounds increase your risk of infection because they are hard to clean. They also provide a warm, moist place for bacteria to grow.
- Injuries to ligaments that support your joints.
- Injuries to tendons, such as ruptured tendons in your heel (Achilles tendon). Children ages 8 to 14 may have a condition known as Sever's disease. It causes injury to the growing bone where the Achilles tendon is attached. This usually occurs during activity and is relieved with home treatment.
- Injuries to your joints (sprains). If a sprain doesn't seem to be healing, you may have a condition called osteochondritis dissecans (OCD). It causes lasting symptoms. In OCD, a piece of bone or cartilage (or both) inside a joint loses blood supply and dies. Symptoms include pain and swelling.
- Pulled muscles (strains). Muscles of the foot and ankle can be strained. They can also rupture.
- Broken bones (fractures), such as a broken toe.
- A bone moving out of place (dislocation).
- A crushing injury, which can lead to compartment syndrome.
Overuse injuries
Overuse injuries occur when too much stress is placed on your joint or other tissue. It often happens when a person "overdoes" an activity or repeats the same activity over and over. Overuse injuries include:
- Retrocalcaneal bursitis, which is inflammation of the bursa. It causes swelling and tenderness of the back of the heel and ankle. Pain usually gets worse while you are wearing shoes and during activity. Pain improves during rest.
- Achilles tendinitis or tendinosis (tendinopathy). This is the breakdown of soft tissues in and around the Achilles tendon, which connects the calf muscles to the heel bone.
- Stress fracture. This is a hairline crack in a bone.
- Plantar fasciitis. This is inflammation of the plantar fascia, a broad, flat ligament on the bottom of the foot. This ligament extends from the front of the heel to the base of the toes. It helps maintain the arch of the foot.
- Metatarsalgia, which is pain in the front (ball) of the foot.
Treatment
Treatment for your toe, foot, or ankle injury may include first aid (such as using a brace, splint, or cast), a special shoe (orthotic device), physical therapy, or medicine. In some cases, surgery is needed. Treatment depends on:
- The location and type of injury, and how bad it is.
- When the injury occurred.
- Your age, your overall health, and your activities (such as work, sports, or hobbies).
What are infections of the toe, foot, or ankle?
Some infections of the toe or foot are minor. These include fungal infections (such as athlete's foot) and a viral infection from a plantar wart.
More serious infections of the toe, foot, or ankle include:
- A skin infection (cellulitis).
- A pus-filled pocket (abscess). This can happen just under the skin surface or deep in tissue.
- A joint infection (septic arthritis).
- A bursa infection (septic bursitis).
- A bone infection (osteomyelitis).
How are toe, foot, or ankle infections treated?
Minor infections of the toe, foot, or ankle may go away on their own or with home treatment. For example, athlete's foot can be treated at home using an antifungal medicine. Over-the-counter antifungals are often tried first. Talk to your doctor if your symptoms don't improve with home treatment or your symptoms are getting worse.
Keep the area clean, and be sure to see your doctor if you have signs of a more serious infection. These include a fever or increased pain, swelling, warmth, or redness. You may need antibiotics or other treatment. Prompt treatment can help prevent serious problems.
Preventing foot problems
You can help prevent foot injuries and problems.
- Avoid going barefoot.
Wearing shoes can help prevent punctures and other injuries to your feet.
- Wear good athletic shoes.
Shoes should have cushioned soles (especially heels) and good arch supports. Physical therapists, orthopedists, podiatrists, and sports medicine health professionals can advise you.
- Buy new shoes every few months.
Padding wears out. Also buy new shoes if the tread or heels wear down. The expense is worth preventing ongoing (chronic) foot or ankle problems.
- Check your feet every day.
Take a look at your feet to see if you have pressure spots, redness, or blisters.
- Be reasonable in your training:
- Always take time to warm up before you exercise. And stretch and cool down when you are done.
- Avoid rapidly increasing the number of miles you run, running or training uphill, and running on hard surfaces, such as concrete.
- Avoid excessive sprinting (short, rapid bursts of running).
- Avoid sudden changes in your training program. Gradually increase the amount of exercise you are doing until you reach your training program goals.
Caring for a minor toe, foot, or ankle problem
Try the following tips to help relieve toe, foot, or ankle pain, swelling, and stiffness.
- Clean a skin wound as soon as you can.
This will help prevent infection, scarring, and tattooing of the skin from dirt left in the wound.
- Check your feet every day.
Take a look at your feet to see if you have pressure spots, redness, or blisters.
- Remove all jewelry.
Remove rings, anklets, and any other jewelry that goes around your leg, ankle, or toe. It will be hard to remove the jewelry after swelling starts.
- Rest.
It's important to rest and protect the affected area.
- Use ice.
Put ice or a cold pack on the affected area for 10 to 20 minutes at a time. Try to do this every 1 to 2 hours for the next 3 days (when you are awake).
- Wrap the affected area.
Compression, or wrapping the area with an elastic bandage (such as an Ace wrap), will help reduce swelling. Don't wrap it too tightly, because that can cause more swelling below the affected area. Loosen the bandage if it gets too tight. Signs that the bandage is too tight include numbness, tingling, increased pain, coolness, and swelling in the area below the bandage.
- Elevate the affected area.
Try to keep the area at or above the level of your heart to help reduce swelling. Prop up the area on pillows while you apply ice and anytime you sit or lie down.
- Stop, change, or take a break from any activity that causes your symptoms.
- Avoid "running through the pain." It may increase damage to your foot.
- Try changing your exercise routine if you think running or another high-impact sport is causing your foot pain. Switch to a low-impact exercise activity for a while. Try things like cross-country skiing, stair-climbing machines, biking (regular or stationary), rowing, and swimming.
- Use sensible sports-training techniques. For example, wear the right shoes, and stretch before activities.
- Avoid more swelling.
For 48 hours, avoid things that might increase swelling. These things include hot showers, hot tubs, hot packs, and drinks that contain alcohol.
- Apply heat.
- After 2 or 3 days, you can try applying heat to the area that hurts. Types of heat therapy include microwavable packs and disposable heating patches.
- Apply heat for 10 to 20 minutes at a time.
- You might also try switching between cold and heat.
- Take care of blisters.
Try using a donut-shaped moleskin pad. Leave the area over the blister open. Home treatment for blisters depends on whether the blister is small or large and whether it has broken open.
- Try massage.
Gently massage your feet to reduce discomfort, relax your feet, and promote circulation.
- Choose your footwear carefully.
- Wear comfortable and supportive shoes and socks. Look for roomy footwear, and avoid high heels.
- Try using an orthotic shoe device, such as an arch support. It may help relieve your foot pain.
- Do foot exercises.
Try heel-cord exercises to increase your strength and flexibility, if your heel or heel cord (Achilles tendon) is tight and painful. Try a standing calf stretch, towel scrunch, or seated calf stretch using a towel. These may help relieve your heel pain.
If you need to use a wrap for more than 48 hours, you may have a more serious injury that needs to be checked by a doctor.
How can you find the right shoes when you have foot problems?
Here are some things to look for when shopping for a shoe that won't make foot or toe problems worse:
- A low heel. Avoid high-heeled, narrow, or pointed-toe shoes. High-heeled shoes increase pressure on the front of the foot and on the toe joints. If you cannot avoid wearing pumps or high-heeled shoes, choose shoes with heels that are no more than 2 in. (5 cm) high.
- A wide and deep toe box (the area that surrounds the toes). There should be about 0.5 in. (1.3 cm) of space between your longest toe and the end of the shoe. You should be able to wiggle your toes in your shoes.
- A shoe that has a soft but rigid back to keep your heel from slipping out.
- A sole that doesn't hurt. For some people this means a flexible sole that allows your toes to bend as you walk. For other people, a firm sole that helps the joints stay straight is more comfortable.
- A shoe that allows the ball of your foot to fit snugly into the widest part of the shoe.
- A shoe with laces, Velcro, or a zipper rather than a slip-on shoe. Athletic shoes are a good choice.
- Shoes that breathe when your feet sweat. Avoid plastic or vinyl shoes.
- Shoes that do not have seams that may rub against or irritate the skin over your foot problem.
Who is at risk for a toe, foot, or ankle infection?
People who have diabetes, peripheral arterial disease, or a weak immune system are more likely than others to get a toe, foot, or ankle infection. They are also more likely to have other problems from an infection. This includes inflammation of the entire body (sepsis), which can cause death.
How can exercise help someone with a toe, foot, or ankle injury?
After an injury, it's important to slowly get back to your regular activities. There are stretching and strengthening exercises that you can do to help you get back your range of motion and strength in the injured area. And when you are able to stand without pain, there are balance and control exercises you can do.
Range-of-motion exercises
Start gentle range-of-motion exercises right after your injury while you have ice on your ankle.
Try these simple range-of-motion exercises:
- Trace the alphabet with your toe. Let your ankle move in all directions.
- Sit in a chair with your foot flat on the floor. Slowly move your knee from side to side while keeping your foot pressed flat.
You can also try towel curls. While you sit, place a hand towel on a smooth floor, such as wood or tile. Keeping your heel on the ground, curl your toes and grab the towel with your toes to scrunch the towel. Let go, and keep scrunching up the entire length of the towel. When you reach the end of the towel, reverse the action by grabbing the towel with your toes, scrunching it, and pushing it away from you. Repeat the exercise until you have pushed the entire length of the towel away from you.
Stretching exercises
About 48 to 72 hours after your injury, start exercises to stretch your Achilles tendon. This tendon connects the calf muscles on the back of the lower leg to the bone at the base of the heel. Two stretches to try are:
- Towel stretch.
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If you can't stand, sit with your knee straight and a towel looped around the ball of your foot. Gently and slowly pull back on the towel for 15 to 30 seconds until you feel your calf stretch. Repeat 2 to 4 times. In moderate to severe ankle sprains, it may be too painful at first to pull your toes far enough to feel a stretch in your calf. Use caution, and let pain be your guide. A little mild pain is normal, but you shouldn't feel moderate to severe pain. Do this exercise 2 or 3 times each day for about a week. Then make Achilles stretches part of your daily routine to stay flexible.
- Calf stretch.
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If you are able to stand, you can do this exercise by facing a wall with your hands at shoulder level on the wall. Place your injured foot behind the other with the toes pointing forward. Keep your heels on the floor and your back leg straight. Slowly bend your front knee until you feel the calf stretch in the back leg. Repeat as above.
Strengthening exercises
As soon as you can bear weight without worse pain or swelling, start exercises to strengthen your muscles. Hold the exercises for 3 to 5 seconds. Do 15 to 20 repetitions once or twice a day for 2 to 4 weeks, depending on how bad your injury is.
Start by sitting with your foot flat on the floor. Push your foot outward against an immovable object such as a wall or heavy furniture. After you feel comfortable with this, try using rubber tubing looped around the outside of your feet for resistance.
While still sitting, put your feet together flat on the floor. Press your injured foot inward against your other foot.
Next, place the heel of your other foot on top of the injured one. Push down with the top heel while trying to push up with your injured foot.
Balance and control exercises
When you are able to stand without pain, you can begin single-leg balance exercises. You can start by standing in a doorway and lightly holding on to the doorjamb. When you can do this for 60 seconds, try adding the advanced moves listed below.
Stand on your injured foot only and hold your arms:
- Out to the side with your eyes open.
- Across your chest with your eyes open.
- Out to the side, and close your eyes.
- Across your chest, and close your eyes.
Do 6 repetitions, holding each for 60 seconds, once a day.
What causes inflammation of a toe, foot, or ankle?
Inflammation may occur:
- From overuse or minor injuries. For example, there may be inflammation with conditions such as gout, bursitis, or tendinitis.
- As part of a disease process. For example, gout may cause pain, swelling, redness, and warmth that occurs all of a sudden in a big toe joint. Autoimmune diseases often lead to inflammation. These diseases include lupus, rheumatoid arthritis, and scleroderma.
Inflammation may also be caused by an infection. Infections can occur without a known injury to the affected area. Signs of infection may include:
- Increased pain, swelling, redness, or warmth around the affected area.
- Red streaks extending from the area.
- Pus draining from the area.
- Fever.
It may be hard to tell if inflammation is caused by an infection or by something else. Be sure to assess all of your symptoms.
What is inflammation of a toe, foot, or ankle?
Inflammation is the response of the immune system to injury or infection. It may result in pain, swelling, redness, warmth, or loss of function in the affected body part. Inflammation may affect joints, such as the ankles. Or it may affect extremities, such as the feet or toes.
How can the right shoe help with foot problems?
Footwear plays a large role in the development of foot and toe problems such as bunions, calluses and corns, and hammer, claw, and mallet toes. Shoes that don't fit properly make these conditions worse and more painful. But wearing the right shoes may help keep foot problems from becoming worse.
A comfortable, well-fitted shoe offers you the best chance of:
- Relieving pain in the foot or toe that is caused by a deformity or joint problem.
- Preventing a foot or toe problem from getting worse.
- Preventing a toe joint problem from returning after corrective surgery.
Before shopping for shoes for your foot problem, ask your foot doctor for recommendations.
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