What causes foot and ankle pain?
Your ankle and foot contain more than two dozen bones and joints, and all of them need to roll in their preferred path for each step to feel smooth. When one of those joints cannot move fully, a protective reflex fires and the muscles around it spasm. Many of those muscles attach at the heel, run along the bottom of the foot and end at the toes, so a stuck joint can show up as heel pain, arch pain or pain on the top of the foot.
Heel pain that is worst in the morning is classic. Tissue tightens while you sleep, and when there is a movement dysfunction in the foot, the secondary spasm pulls hard on the heel with your first steps. Heat in the morning can help in the short term. Restoring the foot's joint motion is what resolves it.
A rolled ankle can leave joints in the ankle and foot stuck long after the swelling is gone. The ankle feels stiff or unstable, you lose the balance and control you once had, and you may start to favor the other side.
Too many miles, too fast, or long stretches on concrete can push the foot past the range it can control. Pain may follow along the shin, the heel or the arch. Fix the mechanics, rebuild ankle and trunk control and you can wean back into running.
Tendons such as the Achilles and tibialis anterior cross many small joints. When those joints do not move, the tendon loses pliability and becomes irritated and inflamed, often with a false sense of weakness. Restoring the joint movement lets the inflammation settle and full strength return.
Shoes, inserts and changes at the big toe joint, including bone spurs, change how the forefoot moves. Improving the motion around those structures can make up much of the difference, so long walks become possible again.
When the foot cannot roll through each step, the knee, hip and low back absorb the difference. That is why foot pain often travels with knee or back pain, and why we assess the whole leg instead of the foot alone.
