Foot Injuries

The bones, connective tissue and small joints of the feet are prone to several types of injuries. Injuries can happen in otherwise healthy joints; however, arthritis and related disease processes can make some more likely. For example, foot bones weakened by osteoporosis are prone to fracture and toes affected by rheumatoid arthritis are more prone to certain deformities, such as hammer toe or claw toe. The following are some of the more common foot injuries and foot problems associated with arthritis and related conditions.

  • Fractures. Any of the foot’s 28 bones can be broken. Here’s how each of the three sections of the foot – the heel, or hind foot; midfoot; and forefoot – can be affected.
    • Calcaneus. A fracture of the heel bone, or calcaneus, can be disabling. Most breaks for the calcaneus are due to a high-energy collision, such as a fall from a high ladder or an automobile accident.
    • Midfoot. Another common site of fractures is midfoot, where bones held together by connective tissue form an arch on top of the foot between the ankle and toes. Dropping something heavy on the foot can break one or more of the bones. Falling or twisting the foot can break or move the bones out of place.
    • Forefoot. A fracture to one of the bones in the forefoot (metatarsals) or toes (phalanges) is painful but is usually not disabling. Fractures in the forefoot may be stress fractures, tiny cracks in the bone surface caused by stress to the bone, such as running long distances or increasing an exercise program too quickly. Others may extend through the bone and be the result of dropping something heavy on the foot or twisting the foot.
  • Claw toe. In this common deformity of the foot, the toes are bent upward from the joint at the ball of the foot and then downward at the middle joint, causing the toes to dig down into the soles of the shoes. Corns may develop over the top of the toe or under the ball of the foot. Poorly fitting footwear is often blamed for claw toe, however, the condition also can result from rheumatoid arthritis or nerve damage from diabetes.
  • Hammer’s toe. In this foot deformity, the second third or fourth toe is bent at the middle joint, giving it the appearance of a hammer. At first, the toes are flexible, but over time they become fixed and can be painful. Corns and calluses can form on the top of the middle joint or at the tip of the toe. The deformity can occur from wearing narrow-toed shoes or from a disease process, such as rheumatoid arthritis.
  • Tarsal tunnel syndrome. Tarsal tunnel syndrome is a compression of the posterior tibial nerve – which supplies sensation to the bottom of the foot and enables the muscle of the foot to move – as it passes from the lower leg to the foot through the tarsal tunnel. The tarsal tunnel is a narrow passageway inside the ankle through which arteries, veins, tendons, and nerves, including posterior tibial nerve, run. Anything that strains the nerve or causes swelling or inflammation of the tunnel or the structures that pass through it can compress the nerve. The result is often pain, tingling, burning, and numbness, usually on the inside of the ankle or bottom of the foot.
  • Charcot Foot. This serious condition occurs when significant nerve damage causes weakening of the bones, which can lead to fractures. As the problem progresses, the joints can collapse, leading to deformity, disability and in some cases, the need for amputation.
  • Bunions. A bunion is a common deformity in which the base of the big toe is enlarged. The skin over the enlarged joint may be red and tender. As the bunion gets larger, you may find it difficult to find comfortable shoes. Walking may be painful. Your big toe may angle toward or move under your second toe. The second toe, in turn, may overlap your third toe, causing pain and deformity of the entire foot. Nine out of 10 bunions occur in women. Bunions are often caused by wearing tight, narrow shoes or high heels.
  • Plantar fasciitis. Plantar fasciitis is inflammation of a thick ligament called the plantar fascia, which runs along the sole of the foot, from the bottom of the heel bone to the toes. It can feel like the arch of the foot is tearing. People with inflammatory forms of arthritis, such as rheumatoid arthritis, ankylosing spondylitis or reactive arthritis, as well as those with fibromyalgia, are more likely to develop plantar fasciitis. Other causes include being overweight, standing too long, having arches that are either too high or too flat or wearing unsupportive, hard-soled shoes.
  • Heel spurs. When plantar fasciitis continues for a long time, a calcium deposit called a heel spur may form where the fascia tissue band connects to the heel bone. In some cases, heel spurs cause pain when walking.
  • Morton’s neuroma. A thickening of the tissue that surrounds the nerve that leads to the toes, Morton’s neuroma often causes pain on the ball of the foot or the sensation of walking on a marble. The condition usually develops between the third and fourth toes, often in response to irritation, trauma or excessive pressure. High-heeled or tight, narrow shoes can make the condition worse.