Osteoarthritis may occur spontaneously in the ankle joint but is more commonly associated with an injury (usually years before). A severe sprain or repeated sprains with damage to the articular cartilage of the talus can lead to progressive arthritis as can fractures around the ankle joint.
A sudden twisting injury to the foot (usually with sole pointing inwards - inversion injury) may stretch the ligament fibres. This may cause pain, swelling and bruising. Most people are able to walk even with a limp.
Further force may cause the ligament to rupture or for a flake of bone to be pulled from where the ligament attaches. It is not usually possible to put any weight on the ankle following such injuries. Further force may cause fracture of the bones surrounding the ankle and dislocation of the joint. During all these injuries the smooth articular surface of the talus may also be dented as it is forced into the tibia. Sometimes the tendons around the ankle joint may be damaged.
A bunion is a sore bump on the joint connecting the big toe to the foot. It may be secondary to a deformity called hallux valgus - the Latin meaning of "hallux valgus" is turning outward (valgus) of the first toe (hallux). The bump is most often caused by the bony prominence of the metatarsal bone rubbing on the inside of shoes. This rubbing causes inflammation and pain.
Other problems can develop along with hallux valgus. The metatarsal bones can become prominent in the ball of the foot and the small toe joints can become contracted leading to hammer toes. With shoe pressure, corns and calluses can also develop.
Most people's feet have a space on the inner side where the bottom of the foot is off the ground (the "arch of the foot). The height of this arch varies a lot from one person to another. Small children do not have an arch: it develops between the ages of 3 and 10.
People who have a low arch or no arch at all are said to have flat feet. Sometimes they are said to have "fallen arches", but as most of these people always had a low arch the term is misleading.
Arthritis is a common cause of pain and stiffness of the big toe joint (1st Metatarsophalangeal Joint or MTPJ). Hallux = big toe and Rigidus = rigid or stiff. It may affect one or both feet but is not normally associated with generalized arthritis throughout the body. It usually occurs in the 30's to 40's age group but can affect a wider age-range. It often occurs spontaneously (without history of injury). One of the first symptoms is stiffness of the big toe joint - usually bending the toe upwards is difficult (dorsi-flexion) and walking may be painful as the foot "pushes-off" from the ground. There may be a bump on top of the joint which can cause problems with rubbing on shoes (dorsal osteophyte). In the early stages, the actual joint may be well preserved and it is just the dorsal osteophyte that causes the limited movement and pain. The next joint along the big toe (Interphalangeal joint behind the nail) is usually unaffected.
There are may causes including Plantar Fasciitis, a stress fracture of the calcaneus (heel bone) arthritis in the sub-talar joint, thinning of the soft tissue over the heel, hard-heeled shoes, wear and irritation of the nerves around the heel.
The edge of the nail may curve over and dig into the skin - this may be because of its shape, because it becomes sharp at the edge or due to trauma from tight shoes. Often there is no specific cause.
Toes become deformed when the pressures on the toe are stronger than they can resist. This may be because the joints are weak or the pressures strong, or both.
The joints may be weak because they have been damaged by injury or arthritis. The muscles that control them may become unbalanced, so that one set pulls harder than others and causes the toe to bend. In some people the tissues in the lower part of the joint at the base of the toe (MTPJ) become weak, allowing the base of the toe to drift upwards and unbalancing it.
The main pressures which cause those to become deformed come from shoes which press on the tip of the toe either because the shoe is tight or because it has a high heel, which tends to force the toes into the tip of the shoe.
Morton's neuroma is one cause of metatarsalgia (pain in the forefoot), It was described by Thomas Morton in 1876. It is due to inflammation of a nerve in the foot. This inflammation is cause by entrapment of the nerve under the metatarsal heads.
"Neuroma" means nerve tumour (tumour in this case means simply enlargement of the nerve and not malignancy.
Foot and Ankle at The Princess Grace Hospital offers advice and treatment for conditions that affect all parts of the foot and ankle. If you would like to find out more about the treatments we provide for orthopaedic conditions please visit our other musculoskeletal sites:
Knee injuries Musculoskeletal Nerve injuries Shoulder injuries