PROBLEM AREAS ON THE FOOT
Foot problems are a true epidemic, with certain areas most vulnerable.

 

 

First Metatarsal Jam
Excess pressure and stress through the big toe into the first metatarsal joint behind it is a very common problem. It’s almost always due to wearing shoes that are too small. Cyclists are often vulnerable here. This injury involves the bone of the big toe, the phalanx, jamming back into the first metatarsal bone. The first metatarsal joint, between the two bones—the ball of the foot—becomes inflamed and painful. In some situations, when the onset of the problem is very slow, the joint does not elicit pain, but rather the foot adapts by creating another problem elsewhere secondary to the first metatarsal. In a real sense, other parts of the foot are sacrificed to take away some of the stress of the first metatarsal. This is not an uncommon way for the body to adapt when a very important structure, such as the first metatarsal joint, has excessive stress placed upon it. Many ankle, heel, knee, and other problems may be caused by a first metatarsal jam.
This first metatarsal jam can be assessed using two key indicators: the toe itself, and the shoe.
In the toe, pain and swelling in the area of the first metatarsal joint are common. Even a relatively minor jamming of the metatarsal joint over a long period will cause swelling of the joint. This is evident by a slight enlargement of the joint, with a warm feeling to the touch due to inflammation. Sometimes a discolored toenail due to the constant pressure from a shoe that’s too tight is obvious. This is especially common in people who wear tight shoes. Even a single long workout or race in shoes that don’t fit properly could create a first metatarsal problem complete with blackened toenail. The reason for the toenail’s discoloration is tiny hemorrhages underneath the nail, similar to other bruises.
The shoes can also give clues to a first metatarsal jam. Because the foot is wedged forward into the shoe, many toenails can jam into the front of the shoe. Over time, the toenail can bore a hole into the shoe, but more often shoes are discarded before this happens. Even a toenail that is not very long can do this if the shoe is sufficiently tight. This wear pattern can usually be felt inside the shoe. With your fingers, feel inside the shoe in the area where your toenail would rub. You may feel a roughened spot and, in some cases, a layer of material may have worn off the inside of the shoe. This means the shoe is too small—specifically, too short. Keeping the toenail properly trimmed can be helpful, but wearing the proper shoe size is necessary to prevent a return of the problem.
If you have a removable insole, take it out and study it. Look at the wear pattern, especially the indentation made from the toes. Observe any areas compressed by the toes that are not completely on the insert, like they should be. Toes that overlap the top of the insert obviously indicate a too-small shoe.
In a foot that has an atypical shape, or in people with unusual circumstances such as soccer, which requires kicking, other metatarsals can have the same fate. In addition, other traumas can create this problem as well, such as a fall while wearing soft shoes or severely stubbing your toe.
“Turf toe” is basically the same condition. The toe is injured during forced metatarsal movements, such as a push-off injury or other trauma. It usually includes the sesamoid bones under the first metatarsal joint. They may become inflamed, and sometimes fractured. This is evident from local tenderness or pain on the bottom of the foot under the first metatarsal joint.

 

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Ankle Sprain
Some experts suggest everyone who sprains an ankle have an X-ray, the only way to determine if a fracture is present. But others say this leads to many unnecessary X-rays and expense when other options can help rule out fracture. One issue is clear: Every person with a sprained ankle should be treated as an individual. A professional consensus, known as the “Ottawa Ankle Rules,” uses specific questions and examination of key areas to help determine the risk of bone fracture and if an X-ray is necessary.
Immediately after spraining your ankle, a question that should be asked is whether you can bear weight on that foot and ankle, even if it’s painful. A second question is whether you can walk four steps, unaided, even with severe pain or a limp, right after your injury. A health professional may also ask you to do this if you go to the emergency room. If you’re able to accomplish these tasks, an X-ray may not be recommended because the chances of a fracture are extremely low.
However, despite your ability to bear weight or walk, certain pain patterns may still indicate a potential fracture leading a doctor to X-ray your ankle. The risk of fracture is higher if there is pain in either bone of the inner or outer ankle, along with tenderness in any of the following bone areas:

 

 

 
  • The back edge or tip of the lateral (outside) ankle bone
  • The back edge or tip of the medial (inside) ankle bone
  • The base of the fifth metatarsal (the little toe)
  • The navicular bone in the middle of the foot
It should be noted that an X-ray does not always show a fracture if one is present. Some fractures are missed because of technically inadequate X-rays, and even good-quality X-rays may not demonstrate the fracture due to its size, swelling of surrounding tissues, or other reasons.

 

 

Plantar Pain
Pain in the bottom of the foot, generally referred to as plantar pain, can come from a variety of sources. Almost all plantar pain is functional, and therefore X-rays will be negative and the problem can usually be corrected conservatively. If you have plantar pain, first carefully check the skin since a small cut, splinter, piece of glass, wart, or other similar problem can be the cause.
Plantar pain inside the foot, especially in the mid- or hind-foot, frequently comes from tight plantar muscles. This tightness is most often secondary to other muscle inhibition. A “diagnosis” of plantar fasciitis is not indicative of the cause of the problem, and no single remedy for this named condition has proven successful. Two people with the same plantar pain due to tight plantar muscles may have very different causes.
A so-called bone spur may be present in some chronic cases of plantar pain. This is usually associated with long-term plantar muscle tightness. In this case, the tendon of the plantar muscles that attaches to the calcaneus (heel) bone may contain calcium deposits. On an X-ray, this gives the appearance of a pointed “spur” which can give a false impression of a pointed sharp object in your foot. This is another example of the body compensating for a problem: In order to further support the area, the body deposits calcium in the tendon.
Correction of plantar pain usually occurs with improvement of muscle function. In addition to local treatment, chronic problems such as this may require improvements to the body chemistry through better diet and nutrition.
Ingrown Toenail
An ingrown toenail is a common foot problem. It usually occurs in the big toe due to either poor fitting shoes, improper nail trimming, or both. The area becomes inflamed and painful, and can lead to secondary fungal or bacterial infections.
Conservative treatment is usually effective, including accommodative shoes. Warm foot soaks and proper nail trimming are also very effective. Trimming the nail is best accomplished by cutting it straight across rather than at a curve.

 

 

Stress Fractures
In addition to fractured bones due to trauma, stress fractures are not uncommon in the foot. Stress fractures are usually less severe than other fractures in bones but can still be a significant problem. Most importantly, getting a stress fracture means something is wrong—with training, diet and nutrition, hormones, body mechanics (especially muscle balance), training or racing shoes, and others. Low vitamin D levels are often associated with stress fractures. In many athletes, a combination of factors contributes to a stress fracture.
Pain from a stress fracture typically improves with rest and worsens with activity. There is often some swelling in the area, but sometimes it’s not noticeable. The swelling around the bone may prevent a proper diagnosis by X-ray within the first two weeks of injury. Only after some healing has taken place will the X-ray show the problem. In these situations, a bone scan may locate the stress fracture.
Most stress fractures will heal well, more quickly in a healthy athlete, without major therapy. Rest, cooling the site of fracture, cessation of weight-bearing exercise, and hard-soled flat shoes are often sufficient, but each case must be treated individually. Aspirin and other NSAIDs must be avoided as they can delay bone healing.