Topic Overview
At one
time or another, everyone has had a minor toe, foot, or ankle injury that
caused pain or swelling. Most of the time our body movements do not cause
problems, but it's not surprising that symptoms develop from everyday wear and
tear, overuse, or an injury.
Toe, foot, or ankle injuries most
commonly 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, or 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 and needs to be
evaluated.
Certain athletes, such as dancers, gymnasts, or soccer
or basketball players, have an increased risk of toe, foot, or ankle
injuries.
Older adults are at higher risk for injuries and
fractures because they lose muscle mass and bone strength (osteopenia) as they age. They also have more problems
with vision and balance, which increases their risk of
injury.
Most minor injuries will heal on their own, and home
treatment is usually all that is needed to relieve your symptoms and promote
healing.
Sudden (acute) injury
An acute injury may occur from
a direct blow, a penetrating injury, or a fall, or from twisting, jerking,
jamming, or bending a limb abnormally. Your pain may be sudden and severe.
Bruising and swelling may develop 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. Puncture wounds increase your risk of infection because they are hard to clean and they provide a warm, moist place for bacteria to grow. The bacteria Pseudomonas is a common cause of infections when a puncture wound occurs through the sole of an athletic shoe.
- Injuries to
ligaments that support your joints.
- Injuries to
tendons, such as ruptured tendons in your heel (Achilles tendon). Young boys ages 8 to 14 may have a condition known as Sever's disease, which 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 does not appear to be healing, a condition known as
osteochondritis dissecans may be present, causing
persistent symptoms.
- Pulled muscles (strains).
Muscles of the foot and ankle can be strained and 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, often by "overdoing" an
activity or repeating the same activity over and over. Overuse injuries
include:
Treatment
Treatment for your toe, foot, or ankle
injury may include first aid measures (such as the application of a brace,
splint, or cast), a special shoe (orthotic device), physical therapy,
medicine, and, in some cases, surgery. Treatment depends on:
- The location, type, and severity of your
injury.
- When the injury occurred.
- Your age, your
overall health condition, and your activities (such as work, sports, or
hobbies).
Check your symptoms to decide if and when
you should see a doctor.
Check Your Symptoms
Home Treatment
Most minor injuries will heal on
their own, and home treatment is usually all that is needed to relieve your
symptoms and promote healing. But if you suspect that you may have a more severe
injury, use first aid measures while you arrange for an evaluation by your
doctor.
First aid for a suspected broken bone
- If a bone is sticking out of your skin, do not
try to push it back into your skin. It is better to leave the bone alone and
cover the area with a clean bandage.
- It is important to
control bleeding from your injury.
- Be sure
to remove all anklets or rings immediately. It may be hard to remove the
jewelry after swelling occurs, which in turn can cause other serious problems,
such as nerve compression or restricted blood flow.
- Try to
free your trapped toe or foot if it is stuck in an object, such as a pipe,
toy, or jar.
- Splint your injured area without trying
to straighten your injured limb. Loosen the wrap around the splint if you
develop signs that mean the wrap is too tight, such as numbness, tingling,
increased pain, swelling, or cool skin below the wrap. A problem called
compartment syndrome can develop.
If a cast or splint is applied, be sure to keep it
dry, and try to move the uninjured part of your extremity as normally as
possible to help maintain muscle strength and tone. Your doctor will give you
instructions on how to
care for your cast or splint.
Home treatment for a sore or sprained toe
Home treatment for a minor foot or ankle injury
If
you have a minor injury, try home treatment measures to relieve pain, swelling,
and stiffness.
- Be sure to
remove all rings, anklets, or any other jewelry that goes around a leg or ankle. It
will be harder to remove the jewelry later if swelling
increases.
- Use
rest, ice, compression, and elevation (RICE) to relieve pain and swelling.
- Clean a skin wound as soon as possible to help prevent infection, scarring, and tattooing of the skin from dirt left in the wound. The bacteria Pseudomonas is a common cause of infections when a puncture wound occurs through the sole of an athletic shoe.
- If you have pain from blood under a nail, you can drain it to relieve the pain.
- Walk or bear weight on your affected foot as
long as it is not painful. If it is painful and the pain continues, check your symptoms again.
- Gently massage or rub the area to relieve pain and encourage
blood flow. Do not massage the injured area if it causes pain.
- For
the first 48 hours after your injury, avoid things that might increase swelling
in the injured area, such as hot showers, hot tubs, hot packs, or alcoholic
beverages.
- After 48 to 72 hours, if your swelling is gone, apply
heat and begin gentle exercise to help restore and
maintain flexibility. Some experts recommend alternating between heat and cold
treatments (contrast baths).
- Start exercises using the
MSA process (gentle exercise). MSA stands for movement, strength, and alternate
activities.
- Movement. Resume a
full range of motion as soon as possible after an injury. After 24 to 48 hours
of rest, begin moving the injured area. Stop any activity if it causes pain, and
give the injured area more rest. Gentle stretching will prevent scar tissue
formation that may decrease movement.
- Strength. As soon as the swelling is gone and range of motion is
restored, begin gradual efforts to strengthen the injured area.
- Alternate activities. After the first few
days but while the injury is still healing, phase in regular exercise using
activities or sports that do not place a strain on the injured area. If certain
activities cause pain, stop doing those activities but continue doing your
other exercises.
Range-of-motion exercises
Begin
gentle range-of-motion exercises right after your
injury while you have ice on your ankle. Perform a set of exercises by
repeating them 10 to 30 times. Do each set 3 to 5 times a day.
Try
the following simple
range-of-motion exercises:
- Trace the alphabet with your toe, encouraging
ankle movement 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.
Towel curls. While sitting, place a hand towel on a
smooth floor, such as wood or tile. While keeping your heel on the ground, curl
your toes and grab the towel with your toes to scrunch the towel. Let go, and
continue 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, which connects the calf muscles on
the back of the lower leg to the bone at the base of the heel.
Towel stretch. 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, at first it may be
too painful to pull your toes far enough to feel a stretch in your calf. Use
caution, and let pain be your guide. A little pain is normal, but you should
not 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
maintain flexibility.
Calf stretch. 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 down 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 increased pain or swelling, begin
muscle-strengthening exercises. These exercises should be held for 3 to 5
seconds. Do 15 to 20 repetitions once or twice daily for 2 to 4 weeks,
depending on the severity of your injury.
Start by sitting with
your foot flat on the floor and pushing it 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 balance and control 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 in the next level.
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 six repetitions, holding each for 60 seconds, once a
day.
Take good care of your feet
Do not smoke or use other tobacco products. Smoking slows
healing because it decreases blood supply and delays tissue repair. For more
information, see the topic
Quitting Smoking.
Medicine you can buy without a prescription| Try a nonprescription
medicine to help treat your pain: |
|---|
Talk to your child's doctor before switching back and
forth between doses of acetaminophen and ibuprofen. When you switch between two
medicines, there is a chance your child will get too much medicine. |
Safety tips| Be sure to follow these
safety tips when you use a nonprescription medicine: |
|---|
- Carefully read and follow all directions
on the medicine bottle and box.
- Do not take more than the
recommended dose.
- Do not take a medicine if you have had an
allergic reaction to it in the past.
- If
you have been told to avoid a medicine, call your doctor before you take
it.
- If you are or could be pregnant, do not take any medicine other
than acetaminophen unless your doctor has told you to.
- Do not give aspirin to anyone younger than age 20 unless your doctor tells you to.
|
Symptoms to watch for during home treatment
Call your doctor if any of the following occur during home
treatment:
- Pain or swelling develops.
- Signs of infection develop.
- Numbness; tingling; or cool, pale skin develops.
- Symptoms do not improve with
home treatment.
- Symptoms become more severe or more
frequent.
Prevention
The following tips may prevent toe, foot,
or ankle injuries.
Toe, foot, and ankle tips
- Avoid problems by wearing good footwear. Wear comfortable, supportive shoes.
- Do not walk barefoot in areas such as streets and parks where
you have an increased risk of stepping on an object.
- Use a rubber
mat to stand on if your work requires you to stand on hard surfaces. This will
help to reduce stress on your feet.
- Buy new running shoes often.
Experts recommend getting new athletic shoes every 3 months or after 500 miles
of wear. Overworn shoes may not absorb shock well or provide traction or
protection.
- Reduce your risk of reinjury by wrapping your foot or
ankle or wearing a supportive brace during activities or exercises where injury
is a risk.
- Prevent blisters caused by poorly fitting shoes or
socks.
- Do
exercises for heel pain and tightness. This is especially important for athletes
before they participate in sports. It is also helpful for people who are not
involved with sports.
- To help prevent foot injuries and problems:
- Wear good athletic shoes, such as shoes
with cushioned soles (especially heels) and good arch support. Physical
therapists, orthopedists, podiatrists, and sports medicine health professionals
can advise you.
- Buy new shoes every few months, because 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.
- Be
reasonable in your training:
- Stretch your foot, ankle, and leg
muscles before and after exercise.
- 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).
- Never cut
calluses and corns with a razor or a
pocketknife.
- Avoid foot problems or injuries,
especially if you have
diabetes.
Reduce falls
General prevention tips
- Use a step stool. Do not stand on chairs or
other unsteady objects.
- Wear protective gear during sports or
recreational activities, such as roller-skating or soccer to prevent injuries for you or your child. Supportive splints
may reduce your risk of injury.
- Maintain a reasonable weight for
your height.
- Stretch before and after physical exercise, sports, or
recreational activities to warm up your muscles.
- Walk regularly to
improve circulation, increase flexibility, reduce fatigue, and encourage bone
and muscle development.
- Use the correct techniques (movements) or
positions during activities so that you do not strain your
muscles.
- Avoid overusing your foot and ankle with repeated
movements that can injure your
bursa or tendon. In daily routines or hobbies, examine
activities in which you make repeated movements.
- If you feel that
certain activities at your workplace are causing pain or soreness from overuse,
talk to your human resources department for information on alternative ways of
doing your job or to discuss equipment modifications or other job
assignments.
Keep your bones strong
- Eat a nutritious diet with enough
calcium and
vitamin D, which helps your body absorb calcium.
Calcium is found in dairy products, such as milk, cheese, and yogurt; dark
green, leafy vegetables, such as broccoli; and other
foods.
- Exercise and stay active. It is best to do weight-bearing exercise, such as walking, jogging, stair climbing, dancing, or lifting weights, for 2½ hours a week. One way to do this is to be active 30 minutes a day, at least 5 days a week. In addition to weight-bearing exercise, experts recommend that you do resistance exercises at least 2 days a week. Talk to your doctor about an exercise program that is right for you. Begin slowly, especially if you have not been active. For
more information, see the topic Fitness.
- Do not drink more than 2
alcoholic drinks a day if you are a man, or 1 alcoholic drink a day if you are
a woman. People who drink more than this may be at higher risk for weakening
bones (osteoporosis). Alcohol use also increases your risk of
falling and breaking a bone.
- Do not smoke or use other tobacco
products. Smoking puts you at a much higher risk for developing osteoporosis.
It also interferes with blood supply and healing. For more information, see the
topic
Quitting Smoking.
Possible abuse
Injuries such as bruises, burns,
fractures, cuts, or punctures may be a sign of
abuse. Suspect possible abuse when an injury cannot be
explained or does not match the explanation, repeated injuries occur, or the
explanations for the cause of the injury change. You may be able to prevent
further abuse by reporting it and seeking help.
Preparing For Your Appointment
To prepare for your appointment, see the topic Making the Most of Your Appointment.
You can help your
doctor diagnose and treat your condition by being prepared to answer the
following questions:
- What are your main symptoms?
- How long
have you had your symptoms?
- How and when did an injury occur? How
was it treated?
- Can you walk, or is walking
difficult?
- Have you had any injuries in the past to the same area?
Do you have any continuing problems because of the previous
injury?
- What activities related to sports, work, or your lifestyle
make your symptoms better or worse?
- What home treatment measures
have you tried? Did they help?
- What nonprescription medicines have
you taken. Did they help?
- Do you have any
health risks?