injured ankle

By: Sarah Burns DPM, FACFAS and Daniel Lowinger DPM, FACFAS

An overuse injury occurs when too much stress is placed on a part of the body by ‘overdoing’ an activity or repeating the same activity over and over.

The most common overuse foot injury is plantar fasciitis. Plantar fasciitis is a type of stabbing heal pain that involves irritation of a thick band of tissue on the bottom of your foot that connects your heel to your toes. Plantar fasciitis pain is often the worst in the morning and may improve as the day goes on. It does not result in bruising and rarely results in acute swelling and inability to bear weight.

Initial treatment includes the RICE protocol (rest, ice, compression, and elevation), supportive shoes, and stretching. If pain persists, you should be evaluated by a foot and ankle specialist. Surgery for plantar fasciitis is uncommon, but performed in some cases, especially when significant deformity or instability is involved.

Stress fractures (breaks) are another type of overuse foot injury. These occur most commonly in the metatarsal bones, the bones of the mid-foot, but can happen in any bone of the foot. A possible break in one of these bones should be ruled out for anyone with pain and swelling at the top of the foot. This type of break is treated by restricting movement, which may include a fracture sandal, modified insole, cast boot, or non-weight-bearing activity depending on location and severity. Runners and obese patients who do a lot of walking are at more risk for several types of stress fractures. These may require X-rays or MRI for diagnosis. Custom foot orthotics are often used to help treat and prevent return of symptoms.

Sesamoid stress fracture (break) is the only stress fracture that commonly causes pain at the bottom of the foot, near the big toe joint. These are treated like metatarsal stress fractures.

Metatarsophalageal (toe joint) capsulitis most commonly affects the second toe joint. This injury is usually caused by a lot of motion in the bones of the mid-foot, an area in which there normally would be very little movement. This condition is treated like metatarsal stress fractures initially, but more often recurs and requires additional treatment including orthotics reconstructive surgery to address the deformity.

Foot and ankle tendons are also susceptible to repetitive stress injury. Achilles tendinitis, posterior tibial tendinitis, and peroneal tendinitis are common among these. These typically respond well to alteration of activity and therapeutic exercise. Heel lifts are effective for both, as is arch support and stable shoes. If you’re not improving with these measures, there may be a more structural injury that will need further testing and treatment. Consulting with a foot and ankle surgeon may be required to address these problems.

Seeking Care for Ankle and Foot Injuries

If you have questions about ankle and foot injuries, call The Polyclinic Podiatry Department at 206.860.4457 for diagnosis and comprehensive treatment.


May 6, 2019 | by The Polyclinic