Ankle and Foot pain

What your diagnosis means

Our feet carry us through thousands of steps a day, so it's no wonder we notice when they hurt. The first steps out of bed in the morning, a long day on hard floors, a favourite pair of shoes that suddenly feels wrong. When you ask about it, you may be handed a label: plantar fasciitis, Achilles tendinopathy, a sprained ankle, Morton's neuroma or a bunion.

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Some of these names are a bit of a mouthful, and it's easy to come away unsure what they mean. On this page I'll explain what each common ankle and foot diagnosis describes.

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A quick tour of the ankle and foot

The ankle is a hinge where the two shin bones (tibia and fibula) meet a bone in the foot called the talus. Ligaments hold it together, including a group on the outer side. At the back, the Achilles tendon, the biggest and strongest tendon in the body, connects the calf muscles to the heel bone. Under the foot, a thick band of tissue called the plantar fascia runs from the heel to the toes, supporting the arch. Between the long bones that lead to the toes run small nerves, and at the base of the big toe is the joint we push off from when we walk.

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Plantar fasciitis

Plantar fasciitis is one of the most common labels for heel pain or arch pain. It describes strain and irritation of the plantar fascia, where it attaches to the heel bone and along the arch. The '-itis' ending means inflammation. People given this label typically describe pain under the heel or arch that's worst with the first steps after sleeping or resting, eases a little as they get moving, then builds again with long periods of standing or walking.

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Achilles tendinopathy

Achilles tendinopathy describes an Achilles tendon that has become painful, stiff or irritated, often because it has been asked to do more (or sometimes less) than it's used to. You may have heard it called Achilles tendonitis. Many clinicians now prefer 'tendinopathy', because the label describes changes in the tendon that aren't usually down to inflammation.

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There are two main types. Mid-portion tendinopathy affects the tendon about 2 to 6 cm above the heel and is more common in active people. Insertional tendinopathy affects the point where the tendon joins the heel bone. People given either label often describe stiffness first thing in the morning or after rest.

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Ankle sprain

An ankle sprain means one or more ligaments around the ankle have been stretched or torn. The classic sprain happens when the foot rolls inwards, which affects the ligaments on the outside of the ankle. Most sprains feel better after about two weeks.

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Morton's neuroma

Morton's neuroma describes a thickening of the tissue around a small nerve between the long bones of the foot, usually between the third and fourth toes. People given this label often describe a sharp, burning or shooting feeling there, or a sense of standing on a pebble, sometimes with tingling or numbness in the toes.

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Bunions

A bunion, known medically as hallux valgus, describes a bony lump on the side of the foot at the base of the big toe, with the big toe angled towards the other toes. The skin over it may be hard, swollen or red. The cause isn't fully known, although bunions are more likely if shoes don't fit well.

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These labels describe what a scan or examination shows. They don't explain why pain persists and for many people the nervous system is an important part of the picture.

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Where arthritis fits

Arthritis can affect the feet and ankles too including Osteoarthritis, Gout and Rheumatoid Arthritis. These are different conditions. Osteoarthritis is often put down to 'wear and tear' or age but as seen on x-rays are common with people with no pain. So, they don't always explain why a foot hurts. 

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To understand how these differ from osteoarthritis, read my page on what arthritis means.