News Category: Foot

Doctors at eight centers studied the use of a high-energy electrohydraulic shock-wave (EHSW) device to treat plantar fasciitis. The study was done in two phases. The first phase involved 20 patients and tested the treatment for safety. The second phase had 344 patients and looked at both safety and effectiveness of this treatment method.

All patients had heel pain lasting at least six months. Everyone had been treated with physical therapy, orthotic devices, and drugs, but they didn’t get better. In the second phase there were two groups of patients. One group received shock-wave treatment to the bottom of the foot. The second group had a placebo treatment (shock waves that weren’t absorbed).

Results were measured before treatment, three months after treatment ended, and one year after treatment ended. Pain levels and X-rays of heel spurs were used to measure results. Success was defined as 50 percent improvement in pain on first walking in the morning. Success also meant the patient didn’t use any pain relievers for any reason.

The authors reported that age isn’t linked with success of treatment. Patients who had symptoms for less time had better results. Patients in the treatment group had a better response than the placebo group. No one was made worse by the treatment.

The authors say there is plenty of proof that shock-wave treatment helps reduce heel pain caused by plantar fasciitis. EHSW should be used after conservative treatment, but before surgery.

Ballet dancers are subject to many injuries of the feet. The base of the second toe is the most common place for a fracture in a dancer. Dancers don’t seek help for injuries unless they simply can’t dance at all. And treatment for a foot fracture is rest for six weeks, a definite “no-no” for a serious dancer.

This case report of a stress fracture shows how early diagnosis and treatment is difficult, leading to prolonged problems. A 24-year old ballet dancer reported pain on the top of his foot along the base of the second toe. The pain lasted two months before an X-ray was taken. The X-ray was negative.

Diagnosis was made with further imaging studies. The dancer took six weeks off from dancing but didn’t get relief from his symptoms. Six months later, he was still having pain. Surgery was done at 10 months to remove a piece of bone that wasn’t healing. A new piece of bone was grafted into the site.

The dancer was back to dancing three months later with no symptoms. X-rays a year later showed complete healing of the area. The authors suggest keeping a close watch on such a stress fracture to make sure healing is long-lasting.

Turf toe. Sesamoid injury. Great toe sprain. Hallux limitus. All these terms refer to a sprain of the big (or first) toe. The joint at the end of the first toe is called the metatarsophalangeal joint (MPJ). Sprains or jamming of this joint are common in athletes. Therapists at the Healthsouth Sports Medicine and Rehab Center in Florida report the results of a study on treatment for this problem.

The authors looked at 20 patients with MPJ pain, loss of motion, and weakness. Everyone got the standard 12 physical therapy sessions for four weeks. Treatments included heat and/or cold, exercise, and electrical stimulation. Ten patients also had gait training and joint mobilization along with strengthening of the toe flexor muscles.

Joint mobilization is used to help restore joint motion. The therapist moves the joint in a specific direction with a certain type of movement and repetition. In this study the sesamoid bones were mobilized. The sesamoids are two tiny pea-shaped bones underneath the long bone of the foot where it attaches to the big toe.

The authors found that the group who got sesamoid mobilization, gait training, and flexor strengthening did much better. They had more joint motion, greater strength, and lower pain levels compared to the other group.

The authors conclude that the right treatment is important early after hallux limitus. Without proper treatment, the patient can go on to develop chronic pain and loss of function. The plan of care should include mobilization, gait training, and special exercises to strengthen the toe flexors.

Can people with flat feet get help by using taping to support the arch? That is the focus of this study by physical therapists in Australia. They measured pressure through the bottom of the foot in 60 subjects. Each subject naturally had more than normal pronation. Foot pronation is the medical term for flat feet.

Then the researchers used a special taping technique called the low-Dye taping (LD) method. Taping supports the arch, reduces stress through the foot, and improves muscle activity around the foot and ankle. LD taping is named after Dr. Ralph Dye, who first used and reported on this method in 1991.

Pressure through the foot was measured again right away after putting on the tape. The researchers were looking for changes in pressure before and after taping. All testing was done barefoot with tape in place. Each person walked over a special pressure-sensitive platform.

The researchers found a big difference when using the tape. Decreased pressure was seen under the heel and along the inside edge of the foot. Pressure was increased under the toes and along the outside edge of the foot.

They concluded that LD taping can decrease the amount of foot pronation while walking. Pressure under the foot is redistributed right away. Using LD taping may be a good way to see if a permanent shoe insert called an orthotic would help in the long term.

Pain in the back of the heel doesn’t sound like such a serious problem. But it can be disabling. The pain is usually caused by stiff-backed shoes and repetitive motions such as running. Eventually a bursa in the heel becomes irritated and inflamed. A bursa is a fluid-filled sac that cushions bones and soft tissues where they rub against each other. The Achilles tendon may also degenerate and become tender where it enters the heel bone. This can make it hard for doctors to tell exactly where the pain is centered.

Most patients with severe heel pain get better with conservative treatments over time. But about 10 percent of people don’t get better. These patients end up needing surgery. Surgery is done to remove the irritated tissue. The surgeon also shaves off the tip of the heel bone at an angle that will help prevent the pain from coming back.

In the past this surgery has always been done as an open procedure. This means it was done with one or more cuts in the skin and soft tissues. For this surgery, the open procedure has a somewhat high rate of complications, including infections and changed nerve sensations.

The endoscope has revolutionized surgery. An endoscope is a tube that can be placed through a very small incision. The endoscope allows surgeons to use tiny cameras to see the inside of the heel, rather than using large cuts. This study looked at how effective endoscopic heel surgery was compared to open surgery.

The authors looked at results in 50 heels, all at least two years after surgery. Results for both open and endoscopic surgery were mostly good. And both groups took about the same amount of time to recover from surgery. However, the endoscopic surgeries were done more quickly, and patients got out of the hospital sooner. More importantly, endoscopic surgeries had fewer complications. The endoscopic surgery also left a smaller scar.

The authors conclude that endoscopic surgery is a good option for this surgery. More study is needed on a bigger group of patients. The authors warn surgeons that the endoscopic technique takes some time to master. The authors also note that patients with calcium deposits and severe degeneration of the Achilles tendon probably do better with open surgery.

Think about your first steps in the morning out of bed. Do you hit the floor running, or do you hobble around in extreme pain? Many people with plantar fasciitis can only dream about running anytime of the day.

Plantar fasciitis is an inflammation of the soft tissues on the bottom of the foot. It can cause mild to severe heel pain when putting the foot down and standing. Fortunately it doesn’t last long for most people. But for those who still have pain months later, there’s hope.

Physical therapists at Ithaca College have found a simple stretching exercise that works. While sitting on the edge of the bed, the patient crosses the painful leg over the knee of the other leg. If you are trying this yourself, pull the toes back toward the shin until a stretch is felt in the arch or plantar fascia.

The stretch is held for 10 seconds and repeated 10 times–before getting out of bed. The same stretch is done three times each day. In this study the plantar fascia stretching exercise was compared to the usual calf-stretching exercise for the Achilles tendon.

The Achilles tendon stretch is done against the wall. The calf to be stretched is back, and the heel is kept on the ground. You lean forward, supporting your upper body against the wall. This stretch can be done right after getting out of bed in the morning and repeated twice more during the day.

Stretching first thing in the morning is important to stop the cycle of small areas of tearing and inflammation that can cause the symptoms of plantar fasciitis in the first place. Patients doing plantar fascia stretching had better results. They had less pain and more function than those in the Achilles tendon stretching group. The researchers think this is because the plantar fascia stretch targets the soft tissues where the problem is located.

A simple stretching program of this kind may get you back on your feet faster. It’s a possible option to surgery for the 10 percent of people who have plantar fasciitis that doesn’t go away with time.

Plantar fasciitis (PF) is a painful condition affecting the heel. The causes of PF are not well understood, though it is especially common in runners. It usually gets better with time, anti-inflammatory medicine, and physical therapy. But when PF doesn’t improve, pain and symptoms can last for months. Surgery can bring relief–but not always. And surgery can sometimes create new complications.

Doctors and therapists have been searching for alternative treatments for PF. Shock wave treatment has shown some success in treating PF. Shock waves are administered with a machine that emits low-energy electromagnetic pulses to the treatment area.

These doctors in Germany tested a specific schedule and dosage of shock waves to treat PF. The patients were all runners who had heel pain from PF for longer than one year, despite trying many conservative treatments. Their pain levels and function were recorded. Then half of the patients got three shock wave treatments, with one week between treatments. The other half of the patients got sham treatments. Neither group got any other treatment during this time.

The patients were seen six months and again one year after treatment. Both groups had gotten better. However, the group that had gotten shock wave treatments reported significantly less pain and significantly better function. At one year, 72 percent of the treatment group said their pain had been cut at least in half, compared to 35 percent of the sham group. Similar numbers in both groups needed further treatment, and one patient in each group had needed surgery. There were no major side effects from shock wave treatment, although patients found it unpleasant.

Based on this and other research, the authors feel that shock wave therapy has been proven successful in treating PF. They recommend shock wave treatments to patients with PF who have not gotten relief from other conservative treatments over a period of at least six months.

They may not make you run faster or jump higher. Yet the material in the running shoe you wear does seem to make a difference. This study tested different shoes to shed some light on the mechanics of running.

When you run, your foot hits the ground with high impact. This study helps prove that the muscles of the leg adjust to this impact through a process called muscle tuning. Muscle tuning lessens the effects of impact on the tissues of the leg.

The midsole of running shoes also helps lessen the effects of impact. These researchers tested two different midsoles on six different runners. They found major differences in the muscle tuning between different shoes. And muscle tuning was significantly different between individual runners. Some runners did better with a hard midsole, while others benefitted from a softer one.

A better understanding of how our legs work when we run may help researchers find ways to treat or prevent conditions caused by the wear and tear of impact on the body. And who knows, maybe it will spur shoe companies to develop a “super shoe” that really makes us run faster.

When the big toe gets pushed over toward the second toe, a condition called hallux valgus develops. When this shift in toe alignment happens, the second joint of the big toe becomes large and prominent. This bump along the inside edge of the big toe is commonly known as a “bunion.”

Hallux valgus is often the result of wearing narrow, pointed shoes. Women are affected most. Other causes include heredity, stroke, flat feet, a tight Achilles’ tendon, and other internal foot disorders.

Treatment may begin with a change in shoes or foot inserts. The shoe should have a wide box so that each toe has enough space to lie flat inside.

Doctors in Taiwan have devised a new treatment method. This is a shoe insert with a special toe separator. It’s called a foot-toe orthosis. The orthosis must be placed under the foot with the toes separated and placed carefully around a special upright post. The foot and foot-toe inserts are then placed inside the shoe.

A small group of women tried this treatment. Over a three-month period of time, their ability to walk improved. They could walk for longer distances and with less pain. According to the authors of this study, it isn’t clear how long the insert must be worn. More studies are needed to find out if the changes are permanent.

The foot is a delicate yet strong collection of oddly shaped and spaced bones. The feet support hundreds of pounds of weight in some people. The foot is divided into three main parts: the hindfoot (heel), midfoot, and forefoot (toes). There are many joints in the foot that are held together by ligaments.

Injury to the midfoot is rare in nonathletic adults. But it’s the second most common foot injury in athletes. Football offensive linemen are the most likely athletes to be injured in this way. It only takes a low-velocity, indirect force to disrupt the ligaments when the foot is in just the right position. Other athletes affected include soccer, baseball, and basketball players. Cross-country athletes with a midfoot sprain have also been reported.

Such a midfoot sprain can tear the Lisfranc ligament. This ligament is the largest in the midfoot area. It connects the cuneiform bone in the midfoot to the base of the second toe bone. Dislocation of the bone can occur if there is enough damage to the ligament and capsule.

Doctors at Duke University recently identified a way to diagnose and classify this problem. They found that X-rays in the standing position (weight-bearing) are the best for showing separation between the bones. Bone scans are another form of imaging and are 100 percent sensitive for bone injuries. Bone scans show minor changes in bone metabolism and blood flow when other tests appear normal.

This information is important because it helps doctors choose the best tests and treatment. Athletes want to return to their sport as quickly as possible with no pain and full function. The wrong treatment can delay this by weeks to months.

Heel pain is a common foot problem in the United States. There are many possible causes of heel pain. Plantar fasciitis is one. The plantar fascia is a thick band of tissue under the foot. It starts on the bottom of the heel bone and goes to the base of each toe.

Getting up in the morning is the hardest thing for a patient with plantar fasciitis. That first contact with the floor is often very painful. The pain usually subsides after getting up and moving around. It may come back later in the day after any period of rest or inactivity.

Many patients get help for this problem with shoe inserts, anti-inflammatory drugs, stretching, massage, and taping the foot. When these treatments don’t work, a special splint can be worn at night. The splint holds the ankle in a position called dorsiflexion. In this position, the foot is angled upward toward the face.

Splinting for plantar fasciitis was first used in the early 1990s. Since that time, studies have been done to show how well it works. Researchers report success, but getting patients to wear the device every night is sometimes a problem. Scientists are trying to improve the design of the splint to make it more comfortable. They believe that a better splint will give even better results.

A new splint that allows for slight movement has been studied. It is called a dynamic splint. It holds the foot in dorsiflexion, allows the foot to move out of that position, and then returns the foot to dorsiflexion. A spring-loaded ankle hinge makes this possible.

Night splints are an effective tool in the treatment of plantar fasciitis. A new, more comfortable splint is on the market. Increased comfort means the patient will probably wear it more often and get better results. Pain relief was reported by 75 percent of the patients after only one month. This improvement was still present six months later.

Computer technology and the Internet are opening up new doors for doctors. Computerized searches of medical articles make it possible to find out which treatments are best for each problem. Reports from doctors around the world can be included.

One area of study is the treatment of the ruptured Achilles tendon. This is a common athletic injury of the tendon attached to the calf muscles in the lower leg. It can happen in any age group. There are many different ways to treat it. In fact, a computer search of reported studies counted 41 different ways to surgically repair this.

Large variations in treatment options used for Achilles tendon tears makes it impossible to show which one way is best. Just knowing that this is the current state of affairs will help doctors. They can start designing studies that will report the final outcome of each treatment. By comparing the treatment method with the final result, the best treatment options can be found.

Doctors can also compare patients’ ages with the treatment given and the final result. It may be that older patients need a different treatment approach than young athletes. From the data collected so far, it seems that older patients do better without surgery after Achilles rupture. The choice of a brace that allows them to stay active seems best.

It’s amazing that in today’s advanced medical world, a problem as common as a ruptured Achilles tendon has no known “best” treatment. This is true for many other conditions, too. Improving research is the first step toward changing this trend. Using computers to collect data and share information is the next step.

Soccer players are often benched because of tendon problems. Sometimes they have to quit playing altogether. The Achilles (heel) tendon and patellar (knee) tendon are the most commonly affected. When changes start to occur, the tendon begins to thicken and become spindle-shaped. This is called tendinosis.

At first, tendinosis is silent, without any symptoms for the player. The danger is that the tendon can rupture without warning. Coaches and players would like to be able to predict which players might have these problems during the season.

New technology has made this possible. High-frequency sound waves allow doctors to take pictures of the tendons. By bouncing sound waves off the tissue, a picture of the area is seen on a screen. This use of sound waves is called ultrasonography. A special probe is used against the skin to direct the sound waves through the area. This testing doesn’t need surgery and isn’t expensive.

It is also very accurate. Tendon changes that are present before injury or rupture are seen early with ultrasonography. Over half of the players tested for tendinosis got better with treatment or by themselves. One-third of the cases ruptured during the season.

Ultrasound can detect tendon changes that can be treated. The tissue still has a chance to heal and may do so on its own. Doctors aren’t able to predict who will rupture a tendon. However, for the first time, they are able to see which players are at risk for a serious tendon injury. Future studies will look for ways to prevent tendinosis and rupture.

Many children and adults have flat feet. Doctors call this a flat-foot deformity. Children don’t always “outgrow” being flat-footed. Flat feet may not cause any pain. Yet for some people, foot pain is a problem. Many people with flat feet go without any treatment. Others use an insert in the shoe that helps hold the foot in an arched position. These inserts are called orthotics.

Researchers are trying to find out if orthotics really work. Do orthotics support the arch and stabilize a flat foot? If yes, which ones are best?

Orthotics can be pre-made (prefabricated) or specially made for an individual patient. Initial studies are looking at prefabricated inserts. This style of orthotic comes in various shoe sizes, but all styles have the same basic shape.

Orthotics help support the arch and hold the foot in a better position. However, the improvement in foot pain was much less than expected. Even so, many people get relief from foot pain with prefabricated orthotics. It may be that improvement in foot comfort and relief from foot pain is from other factors. For example, orthotics may help by providing better shock absorption. This information may help improve the design of future orthotics.

Children and adults with cerebral palsy, spinal cord injuries, or other diseases of the nervous system often have foot and ankle problems. The most common of these is a tight calf muscle that limits ankle motion. Dorsiflexion is the term used to describe movement of the ankle as it bends upward toward the face. This is the motion most often limited by foot or ankle problems.

Adults without neurological diseases can also have foot pain and loss of ankle motion. This is not as common as in the group with neurological disorders and hasn’t been studied much. A group of orthopedic doctors decided to test ankle dorsiflexion in normal adults with foot pain. They wanted to know if people without neurological disease have tight calf muscles and if that tightness causes foot pain.

People with foot pain do have tighter calf muscles than the healthy adult without foot pain. This causes a loss of ankle motion. Whether it causes the foot pain or occurs as a result of foot pain remains unknown. It is suspected that the muscle tightness leads to problems in the foot. More studies are needed to answer this question completely.

Physical therapists and athletic trainers often use tape to hold the foot of a patient or athlete in one position. The most common reason for taping the foot is to address pronation, otherwise known as flat feet.

Taping is used to hold the ankle in a “neutral” position. Neutral means that the ankle and foot aren’t rolled in or out but that they stay in the middle. In this position, the ankle is stable and has the best strength. If taping is successful, a more permanent support such as a foot orthotic is ordered. An orthotic is an insert put inside the shoe that holds the foot in place.

There are many different ways to tape the foot. It isn’t known yet which method works the best. Some studies have shown that the tape doesn’t keep the ankle in neutral after vigorous exercise. Several physical therapists studied the use of one particular kind of taping for the foot. This method, called low-Dye arch taping is used to keep the foot from rolling into a pronated position.

The therapists found that this taping method (designed to reduce pronation) held the foot position. Even after ten minutes of normal walking, the tape held the neutral position. Another study is needed to see if the tape will keep the neutral position after more active (or longer) exercise.

Heel pain makes up 15 percent of all foot-related problems. The most common cause of heel pain is plantar fasciitis. This is an overuse injury with pain and swelling of the soft tissues on the bottom (sole) of the foot.

The fascia is a tough covering of tissue around the muscles. The fascia is very thick and strong in the sole of the foot. This helps support the weight of the body on the small undersurface of the feet. There are many possible causes of plantar fasciitis. A high arch or flat arch changes the amount of pressure on the fascia. Excess body weight, loss of the fat pad in the foot, or a sudden increase in activity can also cause problems.

The symptoms of plantar fasciitis include heel pain when first getting up in the morning. Pain may also occur after standing on hard surfaces, when rising up on tiptoes, or when climbing stairs. Pressing on the inside of the heel causes tenderness for patients with plantar fasciitis.

There are many treatments for plantar fasciitis. These include taping, medications, shoe inserts (orthotics), stretching, ice or heat, and night splints. No one knows if one method works alone or if several methods must be used. One group of physical therapists looked at the effects of foot orthotics on pain and function for people with plantar fasciitis.

Foot orthotics are made of materials that can be molded to support the foot. Orthotics can be rigid, semirigid, or soft, depending on the stiffness of the materials used to make them. Orthotics fit inside the shoe under the foot.

A group of 15 adults (men and women) with plantar fasciitis used semirigid orthotics. All of the patients had been in pain for a long time and had tried many other treatments. With semirigid orthotics, these patients had pain relief within two weeks. These results suggest that semirigid orthotics can be used alone to provide quick relief from persistent heel pain.

For some people, it’s hard enough to get up in the morning. You may have an especially painful start to your day, if you have plantar fasciitis in your feet when they hit the ground. Plantar fasciitis is pain on the underside of the heel when standing or walking. This can be caused by many things–a tight calf muscle, high arch, or repeated stress on the thick tissues underneath the foot. Repeated stress where the plantar fasci attaches to the heel bone sets up a cycle of inflammation. Usually, this causes a bone spur to form.

Foot problems of this kind occur in about 10 percent of the general adult population. This increases with age. More than half of all older adults (over 65 years) have foot pain of this type. Women are affected twice as often as men, especially during midlife. The pain is the worst when first placing the feet on the floor after resting or sleeping for hours.

A new treatment for plantar fasciitis is being tried. It is called extracorporeal shock waves. Extracorporeal shock waves were first used for kidney stones 20 years ago. Now, shock waves are being used for orthopedic problems. The idea is that the shock waves stimulate healing in the tendons and nearby bones. Most likely, the shock waves help release growth factors and increase blood supply to the area.

Researchers in Germany tried using two different levels of low-energy shock waves on people with plantar fasciitis. There were 112 people in the study. They had all undergone treatment without success. Previous treatment included ice, medication, stretching exercises, splints, shoe inserts, and physical therapy.

Of the two groups, the patients who had the higher dose of shock waves had more relief from symptoms. They could press the spot without causing pain or tenderness, and they could walk without pain. The improvements lasted six months for most people. By five years, the results were about the same for the two groups. This was because the group with the lower shock-wave treatment eventually had surgery.

Therapy options for painful plantar fasciitis now include shock-wave treatment. There are very few side effects with this treatment, and patients may avoid surgery. The effects last up to six months for most people, but only 11 percent still have relief after five years. The U. S. Food and Drug Administration (FDA) has approved shock waves as therapy for heel pain. However, more studies are needed before using this treatment as the first therapy applied.

A fracture in the main bone of the little toe is called a Jones fracture. Technically speaking, this fracture involves the upper column of the fifth metatarsal bone. This type of fracture is difficult to treat, especially in athletes. Without surgery, these fractures may not heal properly, leading to more fractures and other problems.

With the athlete’s long-term health in mind, doctors have started fixing Jones fractures with special screws. Overall, this method seems to be successful. But lately, some doctors have noticed more cases in which this treatment has failed. What causes treatment failure in athletes who have screw fixation for Jones fractures? And how can failures be avoided?

To answer these questions, researchers studied the records of 15 athletes who had screw fixation for Jones fractures. Six of the patients were division 1 college or professional athletes. The other patients were recreational athletes. Their average age was 22.

The patients had screw fixation of the broken bone using an imaging technique called fluoroscopy. In some cases, bone grafts were used. After surgery, patients wore walker boots or splints on the operated leg. They returned to full activity when their symptoms were gone and X-rays showed that the bones were healing together at the fracture site.

In six cases (40 percent), screw fixation did not work. Four of these patients fractured the foot again when they returned to full activity. In two of the failed cases, the bones simply did not heal together.

Patients whose treatment failed went back to full activity two weeks sooner than those who had good results (seven versus nine weeks total). Though all patients were without symptoms when they resumed activity, X-rays showed that only one in six patients whose treatment failed had complete bone healing by that point. In contrast, six out of seven patients who had good results showed complete bone healing when they went back to full activity.

Involvement in sports seemed to make a difference in how soon they returned to full activity and the success of treatment. Eighty-three percent of the failed cases were division 1 or professional athletes. Interestingly, elite athletes said their symptoms had gone away three weeks sooner than the other patients did. Researchers suspect that these athletes may have a higher tolerance for pain. They may also be more eager to get back into the game. Several of the elite athletes went back to full activity without getting a doctor’s okay first.

Though the group studied was small, these results show that going back to vigorous activity too soon after screw fixation can lead to poor results. Surgical technique (use of bone grafts and size of screws) wasn’t related to failure. However, a history of previous fractures was linked to treatment failure. The absence of symptoms during recovery does not prove the patient is ready for full activity. Patients need to wait until X-rays show complete healing before they return to full-impact activities after screw fixation for a Jones fracture.

Every parent comes face to face with childhood injuries. Sometimes it’s hard to know the seriousness of the injury. Does your child need to see a doctor?

The foot is one of the parts of the body that is especially challenging. A broken bone in the foot of an infant or toddler is rare since most of the bones are still more like cartilage (similar to the gristle in meat or chicken). But in the older child, a broken bone or fracture in the foot is possible. By the time a child turns 10 years old, the bones of the foot have hardened as expected.

As with most injuries in children, foot fractures occur more often in boys than in girls. Car accidents, jumping or falling from heights, and lawnmower accidents are the most often reported causes of broken feet. Accidents occur with all kinds of lawnmowers, but most occur when young children are hit by riding mowers.

Examining the foot can be challenging if the child is frightened and unable to cooperate or if there is swelling and pain. Doctors have tests and new technology to help identify the problem. Finding a foot fracture early is important because without treatment other problems can occur.

For example, some of the bones of the foot do not have much of a blood supply. A fracture can stop the blood from reaching the bone. When this happens, the bone can die, a condition called osteonecrosis (“osteo” refers to bone; “necrosis” is death). Another problem is when a large amount of swelling puts pressure on the nerves, muscles, and blood vessels. This can lead to a condition called compartment syndrome, which needs immediate medical attention.

A visit to the doctor is advised anytime a child reports toe, ankle, or heel pain with swelling, tenderness to touch, and difficulty moving the toes or ankle. This is especially true if the child can’t fit the foot into a shoe, tie the shoe, put any weight on the foot, or walk without limping. A toddler will be able to crawl without difficulty but will limp with walking. Early identification of a broken bone and early treatment of muscle or ligament injuries can prevent further problems.