What’s Causing My Foot and Ankle Pain?

The foot and ankle are the lowermost parts of the leg. They create a strong, weight-bearing platform on which the weight of the body rests. The foot’s unique shape and our natural ability to balance work together with an intricate system of bones, muscles, and tendons that allow us to move.

The ankle joint is created where the two bones of the lower leg (tibia and fibula) meet the talus bone. Our ankle acts as a hinge, allowing the joint to bend up and down. The heel consists of two bones, the talus and calcaneous bone. The calcaneous is the largest bone in the foot and carries the pressure of our body weight. In the middle of the foot, five tarsal bones work together to reinforce and distribute our weight. The front of the foot houses the metatarsal bones and phalanges (toes). Our toes help us walk, provide balance, bear our body weight, and provide us thrust to walk.

There are a number of conditions that can cause pain in the foot and ankle. Below a few are highlighted, but it isn’t an exhaustive list. If you have foot or ankle pain, talk to your doctor. They may refer you to a podiatrist or orthopedic surgeon for further evaluation.

Osteoarthritis (OA) can affect any joint in your body and is a common cause of foot and ankle pain. OA is a degenerative joint disease that causes the cartilage in your joints to break down. When that layer of cartilage — which is meant to “cushion” the joint and protect the surface of the bones — is damaged or worn away, your bones grind against one another, and that grinding hurts. You can feel it climbing stairs, working in the garden, or simply walking. It may even keep you up at night.

Factors leading to the development and progression of OA can include aging, obesity, joint injuries, and a family history of arthritis (genetics).

A few symptoms of OA include:¹

• Joint ache and soreness
• Pain, especially following activity
• Stiffness after periods of rest
• Swelling

Rheumatoid arthritis (RA) of the foot and ankle is a chronic disease where the body's immune system attacks its own tissue. It affects the joint lining which can cause painful swelling. The swelling can become so severe that it affects the appearance and function of your foot or ankle. This disorder is common in the feet and hands.

A few symptoms of RA include:²

• Stiffness
• Swelling
• Tenderness
• Weakness
• Fatigue

Hammer toes occur from a muscle and ligament imbalance around the toe joint. This causes the middle toe joint to bend, becoming stuck in an upside-down "V" position. The middle three toes are most likely to develop this condition.

A few symptoms of hammer toe include:³

• Physical deformity
• Callus
• Corn
• Joint stiffness
• Swelling

Bunions are caused when the tissue and/or bone of the big toe move out of place. This causes a bulge on the outside of the big toe joint. It can be painful and cause the tip of your big toe to bend closer to the smaller toes. It can also become difficult wearing a variety of shoes. This condition is permanent unless surgically corrected.

A few symptoms of bunions include:⁴

• Bump on the outside of your big toe
• Pain and/or limited movement
• Swelling and inflammation around the joint

A metatarsal fracture occurs when one of the long bones in the middle of your foot is broken. This can occur due to a sudden injury or repeated stress to the area.

Symptoms of a metatarsal fracture include:⁵

• Pain with or after normal activity
• Pain that goes away when resting, then return once activity begins
• Pinpoint pain when touched
• Swelling but not bruising

In an ankle fracture, one or more of the bones in the ankle joint are broken. There can be a simple break in the bone, or several fractures. Twisting, rotating, or rolling your ankle, tripping, falling, or a hard impact can all cause an ankle fracture.

A few symptoms of an ankle fracture include:⁶

• Immediate and severe pain
• Swelling
• Bruising
• Tender to touch
• Inability to bear weight
• Ankle dislocation

The Lisfranc joint is where the metatarsal bones and the bones in the arch (tarsal bones) connect. The Lisfranc ligment joins these two bones together and is important for proper alignment and strength. Injuries in this part of the foot most commonly occur as a result of direct (something heavy falling on the foot) or indirect (twisting the foot) force.

A few symptoms of a Lisfranc fracture include:⁷

• Swelling
• Pain throughout the middle of the foot when standing or when pressure is applied
• Inability to bear weight
• Bruising or blistering on the arch or top of the foot
• Abnormal widening of the foot

Ankle instability occurs when the outside of your ankle repeatedly gives out. Ankle instability is more likely if you’ve suffered repeated ankle sprains. Instability usually occurs while walking or during activity, but it can happen while standing.

A few symptoms of instability include:⁸

• Repeated turning of the ankle
• Persistent discomfort
• Swelling
• Pain
• Tenderness
• Feeling of unstableness

Ankle impingement is common after an ankle sprain. Pain occurs at the front of the ankle, due to squeezing the bony or soft tissues during activities where your toes point upward.

A few symptoms of an ankle impingement include:⁹

• Dull ache at the front of the ankle with rest
• Limited range of motion
• Puffiness or swelling of the ankle joint

A Jones fracture is a break in the long bone on the outside of the foot that is connected to the pinky toe. It usually occurs from stress on the bone caused by repeated motion or a sudden injury.

A few symptoms of a Jones fracture include:¹⁰

• Pain and swelling on the outside of the foot near the pinky toe
• Tenderness
• Bruising

Hallux rigidus is a joint disorder located at the base of the big toe. With time, it becomes harder to bend the big toe. The disorder can be disabling since we use the big toe to walk and stand.

A few symptoms of hallux rigidus include:¹¹

• Pain and stiffness in the big toe during use
• Pain and stiffness aggravated by cold or damp weather 
• Difficulty with certain activities
• Swelling and inflammation around the joint

Flat foot (fallen arch) is a condition where the entire sole of the foot contacts the ground while standing. This is a result of having no arch in the foot. There are different types, stages, and varying degrees of symptoms of flat foot.

A few symptoms of flat foot include:¹²

• Pain on the inside arch or ankle
• Pain on the outside of the foot, just below the ankle
• Feet tire quickly

1. Osteoarthritis (2020). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/osteoarthritis/symptoms-causes/syc-20351925?p=1
2. Rheumatoid Arthritis (2020). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/rheumatoid-arthritis/symptoms-causes/syc-20353648
3. Fletcher, J. (2017, Apr 25). Everything you need to know about hammer toe. Medical News Today. https://www.medicalnewstoday.com/articles/315600
4. Smith, L. (2019, Feb 18). What you need to know about bunions. Medical News Today. https://www.medicalnewstoday.com/articles/310096
5. Payne, J. (2018, Mar 26). Metatarsal Fractures. Patient. https://patient.info/foot-care/heel-and-foot-pain-plantar-fasciitis/metatarsal-fractures
6. Broken Ankle (2020). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/broken-ankle/symptoms-causes/syc-20450025?p=1
7. Lisfranc Fracture (2020). Foot Health Facts. https://www.foothealthfacts.org/conditions/lisfranc-injuries#
8. Chronic Ankle Instability (2020). Foot Health Facts. https://www.foothealthfacts.org/conditions/chronic-ankle-instability#
9. Smith, J. (2018, Oct 6). Anterior Ankle Impingement. Foot Education. https://footeducation.com/anterior-ankle-impingement/
10. Jones Fracture (2020). UPMC Sports Medicine. https://www.upmc.com/services/sports-medicine/conditions/jones-fracture#symptomsdiagnosis
11. Hallux Rigidus (2020). Cedars Sinai. https://www.cedars-sinai.edu/Patients/Health-Conditions/Hallux-Rigidus.aspx
12. DerSarkissian, C. (2020, Mar 07). What are fallen arches? WebMD. https://www.webmd.com/pain-management/what-are-fallen-arches#1