time or another, everyone has had a minor toe, foot, or ankle injury that
caused pain or swelling. Most of the time our body movements do not cause
problems, but it’s not surprising that symptoms develop from everyday wear and
tear, overuse, or an injury.
Toe, foot, or ankle injuries most
commonly occur during:
Sports or recreational
Work or projects around
In children, most toe, foot, or ankle injuries occur during
sports, play, or falls. The risk for injury is higher in sports
with jumping, such as basketball, or sports with quick direction change, such
as soccer or football. Any bone injury near a joint may injure the growth plate (physis) in a child and needs to be
Certain athletes, such as dancers, gymnasts, or soccer
or basketball players, have an increased risk of toe, foot, or ankle
Older adults are at higher risk for injuries and
fractures because they lose muscle mass and bone strength (osteopenia) as they age. They also have more problems
with vision and balance, which increases their risk of
Most minor injuries will heal on their own, and home
treatment is usually all that is needed to relieve your symptoms and promote
Sudden (acute) injury
An acute injury may occur from
a direct blow, a penetrating injury, or a fall, or from twisting, jerking,
jamming, or bending a limb abnormally. Your pain may be sudden and severe.
Bruising and swelling may develop soon after your injury. Acute injuries
Bruises (contusions). After an ankle injury,
bruising may extend to your toes from the effects of gravity.
Puncture wounds. Sharp objects, such as nails, tacks, ice picks, knives, teeth, and needles, can all cause puncture wounds. Puncture wounds increase your risk of infection because they are hard to clean and they provide a warm, moist place for bacteria to grow. The bacteria Pseudomonas is a common cause of infections when a puncture wound occurs through the sole of an athletic shoe.
Injuries to tendons, such as ruptured tendons in your heel (Achilles tendon). Children ages 8 to 14 may have a condition known as Sever’s disease, which causes injury to the
growing bone where the Achilles tendon is attached. This usually occurs during
activity and is relieved with home treatment.
Injuries to your joints (sprains). If a
sprain does not appear to be healing, a condition known as osteochondritis dissecans may be present, causing
Pulled muscles (strains).
Muscles of the foot and ankle can be strained and can also
Overuse injuries occur when too much
stress is placed on your joint or other tissue, often by “overdoing” an
activity or repeating the same activity over and over. Overuse injuries
Retrocalcaneal bursitis, which is
inflammation of the bursa. This condition causes swelling and tenderness of the
back of the heel and ankle. Pain usually gets worse while you are wearing shoes and during activity, and
it improves during rest.
Plantar fasciitis, which is an inflammation of the plantar fascia, a broad, flat
ligament on the bottom of the foot that extends from the front of the heel to
the base of the toes and helps maintain the arch of the foot.
Metatarsalgia, which is pain in the front (ball) of
Treatment for your toe, foot, or ankle
injury may include first aid measures (such as the application of a brace,
splint, or cast), a special shoe (orthotic device), physical therapy,
medicine, and, in some cases, surgery. Treatment depends on:
The location, type, and severity of your
When the injury occurred.
Your age, your
overall health condition, and your activities (such as work, sports, or
Severe pain (8 to 10): The pain
is so bad that you can’t stand it for more than a few hours, can’t sleep, and
can’t do anything else except focus on the pain.
Moderate pain (5 to 7): The pain is bad enough to disrupt your
normal activities and your sleep, but you can tolerate it for hours or days.
Moderate can also mean pain that comes and goes even if it’s severe when it’s
Mild pain (1 to 4): You notice the pain,
but it is not bad enough to disrupt your sleep or activities.
Major trauma is any event that can
cause very serious injury, such as:
A fall from more than 10 ft (3.1 m) [more than 5 ft (1.5 m) for children under
2 years and adults over 65].
A car crash in which any vehicle
involved was going more than 20 miles (32 km) per
Any event that causes severe bleeding that you cannot
Any event forceful enough to badly break a large bone (like an arm bone or leg bone).
Pain in children under 3 years
It can be hard to tell how much pain a baby or toddler is in.
Severe pain (8 to 10): The
pain is so bad that the baby cannot sleep, cannot get comfortable, and cries
constantly no matter what you do. The baby may kick, make fists, or
Moderate pain (5 to 7): The baby is
very fussy, clings to you a lot, and may have trouble sleeping but responds
when you try to comfort him or her.
Mild pain (1 to 4): The baby is a little fussy and clings to you a little but responds
when you try to comfort him or her.
Pain in children 3 years and older
Severe pain (8 to 10): The pain
is so bad that the child can’t stand it for more than a few hours, can’t sleep,
and can’t do anything else except focus on the pain. No one can tolerate severe
pain for more than a few hours.
Moderate pain (5 to 7): The pain is bad enough to disrupt the child’s normal activities and
sleep, but the child can tolerate it for hours or days.
Mild pain (1 to 4): The child notices and may complain of the pain,
but it is not bad enough to disrupt his or her sleep or activities.
Shock is a life-threatening condition that may quickly occur
after a sudden illness or injury.
Symptoms of shock (most of which will be present) include:
Passing out (losing consciousness).
Feeling very dizzy or
lightheaded, like you may pass out.
Feeling very weak or having
Not feeling alert or able to think clearly. You
may be confused, restless, fearful, or unable to respond to questions.
Shock is a life-threatening condition that may occur quickly
after a sudden illness or injury.
Symptoms of shock in a child may include:
Passing out (losing consciousness).
Being very sleepy or hard
to wake up.
Not responding when being touched or talked to.
Breathing much faster than usual.
The child may not know where he or she is.
With severe bleeding, any of these may
Blood is pumping from the wound.
bleeding does not stop or slow down with pressure.
Blood is quickly soaking through bandage after bandage.
With moderate bleeding, any of these may
The bleeding slows or stops with pressure but
starts again if you remove the pressure.
The blood may soak through
a few bandages, but it is not fast or out of control.
With mild bleeding, any of these may be
The bleeding stops on its own or with
The bleeding stops or slows to an ooze or trickle after
15 minutes of pressure. It may ooze or trickle for up to 45 minutes.
When an area turns blue, very pale, or cold, it can mean that there has been a sudden change in the blood
supply to the area. This can be serious.
There are other reasons
for color and temperature changes. Bruises often look blue. A limb may turn
blue or pale if you leave it in one position for too long, but its normal color
returns after you move it. What you are looking for is a change in how the area
looks (it turns blue or pale) and feels (it becomes cold to the touch), and
this change does not go away.
Symptoms of infection may
Increased pain, swelling, warmth, or redness in or
around the area.
Red streaks leading from the area.
Pus draining from the area.
Certain health conditions and medicines weaken the immune system’s ability to fight off infection and
illness. Some examples in adults are:
Diseases such as diabetes, cancer, heart disease,
Long-term alcohol and drug
Steroid medicines, which may be used to treat a variety
Chemotherapy and radiation therapy for
Other medicines used to treat autoimmune
Medicines taken after organ transplant.
having a spleen.
You may need a tetanus shot depending
on how dirty the wound is and how long it has been since your last shot.
For a dirty wound that has
things like dirt, saliva, or feces in it, you may need a shot if:
You haven’t had a tetanus shot in the past 5
You don’t know when your last shot was.
For a clean wound, you may
need a shot if:
You have not had a tetanus shot in the past 10
You don’t know when your last shot was.
Seek Care Today
Based on your answers, you may need care soon. The
problem probably will not get better without medical care.
Call your doctor today to discuss the symptoms
and arrange for care.
If you cannot reach your doctor or you don’t
have one, seek care today.
If it is evening, watch the symptoms and
seek care in the morning.
Most minor injuries will heal on
their own, and home treatment is usually all that is needed to relieve your
symptoms and promote healing. But if you suspect that you may have a more severe
injury, use first aid measures while you arrange for an evaluation by your
First aid for a suspected broken bone
If a bone is sticking out of your skin, do not
try to push it back into your skin. It is better to leave the bone alone and
cover the area with a clean bandage.
to remove all anklets or rings immediately. It may be hard to remove the
jewelry after swelling occurs, which in turn can cause other serious problems,
such as nerve compression or restricted blood flow.
If a cast or splint is applied, be sure to keep it
dry, and try to move the uninjured part of your extremity as normally as
possible to help maintain muscle strength and tone. Your doctor will give you
instructions on how to care for your cast or splint.
If you do not have diabetes or peripheral arterial disease, your sore or sprained toe
can be “buddy-taped” to your uninjured toe next to it. Protect
the skin by putting some soft padding, such as felt or foam, between your toes
before you tape them together. Your injured toe may need to be buddy-taped for
2 to 4 weeks to heal. If your injured toe hurts more after buddy-taping it,
remove the tape. Then check your symptoms again.
Home treatment for a minor foot or ankle injury
you have a minor injury, try home treatment measures to relieve pain, swelling,
Be sure to
remove all rings, anklets, or any other jewelry that goes around a leg or ankle. It
will be harder to remove the jewelry later if swelling
rest, ice, compression, and elevation (RICE) to relieve pain and swelling.
Clean a skin wound as soon as possible to help prevent infection, scarring, and tattooing of the skin from dirt left in the wound. The bacteria Pseudomonas is a common cause of infections when a puncture wound occurs through the sole of an athletic shoe.
If you have pain from blood under a nail, you can drain it to relieve the pain.
Walk or bear weight on your affected foot as
long as it is not painful. If it is painful and the pain continues, check your symptoms again.
Gently massage or rub the area to relieve pain and encourage
blood flow. Do not massage the injured area if it causes pain.
the first 48 hours after your injury, avoid things that might increase swelling
in the injured area, such as hot showers, hot tubs, hot packs, or alcoholic
After 48 to 72 hours, if your swelling is gone, apply heat and begin gentle exercise to help restore and
maintain flexibility. Some experts recommend alternating between heat and cold
treatments (contrast baths).
Start exercises using the
MSA process (gentle exercise). MSA stands for movement, strength, and alternate
Movement. Resume a
full range of motion as soon as possible after an injury. After 24 to 48 hours
of rest, begin moving the injured area. Stop any activity if it causes pain, and
give the injured area more rest. Gentle stretching will prevent scar tissue
formation that may decrease movement.
Strength. As soon as the swelling is gone and range of motion is
restored, begin gradual efforts to strengthen the injured area.
Alternate activities. After the first few
days but while the injury is still healing, phase in regular exercise using
activities or sports that do not place a strain on the injured area. If certain
activities cause pain, stop doing those activities but continue doing your
gentle range-of-motion exercises right after your
injury while you have ice on your ankle. Perform a set of exercises by
repeating them 10 to 30 times. Do each set 3 to 5 times a day.
Trace the alphabet with your toe, encouraging
ankle movement in all directions.
Sit in a chair with your foot
flat on the floor. Slowly move your knee from side to side while keeping your
foot pressed flat.
Towel curls. While sitting, place a hand towel on a
smooth floor, such as wood or tile. While keeping your heel on the ground, curl
your toes and grab the towel with your toes to scrunch the towel. Let go, and
continue scrunching up the entire length of the towel. When you reach the end
of the towel, reverse the action by grabbing the towel with your toes,
scrunching it, and pushing it away from you. Repeat the exercise until you have
pushed the entire length of the towel away from you.
About 48 to 72 hours after
your injury, start exercises to stretch your Achilles tendon, which connects the calf muscles on
the back of the lower leg to the bone at the base of the heel.
Towel stretch. If you can’t stand, sit with your knee
straight and a towel looped around the ball of your foot. Gently and slowly
pull back on the towel for 15 to 30 seconds until you feel your calf stretch.
Repeat 2 to 4 times. In moderate to severe ankle sprains, at first it may be
too painful to pull your toes far enough to feel a stretch in your calf. Use
caution, and let pain be your guide. A little pain is normal, but you should
not feel moderate to severe pain. Do this exercise 2 or 3 times each day for
about a week. Then, make Achilles stretches part of your daily routine to
Calf stretch. If you are able to stand,
you can do this exercise by facing a wall with your hands at shoulder level on
the wall. Place your injured foot behind the other with the toes pointing
forward. Keep your heels down and your back leg straight. Slowly bend your
front knee until you feel the calf stretch in the back leg. Repeat as above.
As soon as
you can bear weight without increased pain or swelling, begin
muscle-strengthening exercises. These exercises should be held for 3 to 5
seconds. Do 15 to 20 repetitions once or twice daily for 2 to 4 weeks,
depending on the severity of your injury.
Start by sitting with
your foot flat on the floor and pushing it outward against an immovable object
such as a wall or heavy furniture. After you feel comfortable with this, try
using rubber tubing looped around the outside of your feet for resistance.
While still sitting, put your feet together flat on the floor.
Press your injured foot inward against your other foot.
place the heel of your other foot on top of the injured one. Push down with the
top heel while trying to push up with your injured foot.
Balance and control exercises
When you are able to
stand without pain, you can begin balance and control exercises. You can start
by standing in a doorway and lightly holding on to the doorjamb. When you can
do this for 60 seconds, try adding the advanced moves in the next level.
Stand on your injured foot only and
hold your arms:
Out to the side with your eyes
Across your chest with your eyes open.
the side and close your eyes.
Across your chest and close your
Do six repetitions, holding each for 60 seconds, once a
Take good care of your feet
Wear supportive footwear to prevent re-injuring
your foot or ankle.
Aspirin (also a nonsteroidal
anti-inflammatory drug), such as Bayer or Bufferin
Talk to your child’s doctor before switching back and
forth between doses of acetaminophen and ibuprofen. When you switch between two
medicines, there is a chance your child will get too much medicine.
Be sure to follow these
safety tips when you use a nonprescription medicine:
Carefully read and follow all directions
on the medicine bottle and box.
Wear good athletic shoes, such as shoes
with cushioned soles (especially heels) and good arch support. Physical
therapists, orthopedists, podiatrists, and sports medicine health professionals
can advise you.
Buy new shoes every few months, because padding
wears out. Also buy new shoes if the tread or heels wear down. The expense is
worth preventing ongoing (chronic) foot or ankle problems.
reasonable in your training:
Stretch your foot, ankle, and leg
muscles before and after exercise.
Avoid rapidly increasing the
number of miles you run, running or training uphill, and running on hard
surfaces, such as concrete.
Avoid excessive sprinting (short, rapid
bursts of running).
Use a step stool. Do not stand on chairs or
other unsteady objects.
Wear protective gear during sports or
recreational activities, such as roller-skating or soccer to prevent injuries for you or your child. Supportive splints
may reduce your risk of injury.
Maintain a reasonable weight for
Stretch before and after physical exercise, sports, or
recreational activities to warm up your muscles.
Walk regularly to
improve circulation, increase flexibility, reduce fatigue, and encourage bone
and muscle development.
Use the correct techniques (movements) or
positions during activities so that you do not strain your
Avoid overusing your foot and ankle with repeated
movements that can injure your bursa or tendon. In daily routines or hobbies, examine
activities in which you make repeated movements.
If you feel that
certain activities at your workplace are causing pain or soreness from overuse,
talk to your human resources department for information on alternative ways of
doing your job or to discuss equipment modifications or other job
Keep your bones strong
Eat a nutritious diet with enough calcium and vitamin D, which helps your body absorb calcium.
Calcium is found in dairy products, such as milk, cheese, and yogurt; dark
green, leafy vegetables, such as broccoli; and other
Exercise and stay active. It is best to do weight-bearing exercise, such as walking, jogging, stair climbing, dancing, or lifting weights, for 2Â½ hours a week. One way to do this is to be active 30 minutes a day, at least 5 days a week. In addition to weight-bearing exercise, experts recommend that you do resistance exercises at least 2 days a week. Talk to your doctor about an exercise program that is right for you. Begin slowly, especially if you have not been active. For
more information, see the topic Fitness.
Do not drink more than 2
alcoholic drinks a day if you are a man, or 1 alcoholic drink a day if you are
a woman. People who drink more than this may be at higher risk for weakening
bones (osteoporosis). Alcohol use also increases your risk of
falling and breaking a bone.
Do not smoke or use other tobacco
products. Smoking puts you at a much higher risk for developing osteoporosis.
It also interferes with blood supply and healing. For more information, see the
topic Quitting Smoking.
Injuries such as bruises, burns,
fractures, cuts, or punctures may be a sign of abuse. Suspect possible abuse when an injury cannot be
explained or does not match the explanation, repeated injuries occur, or the
explanations for the cause of the injury change. You may be able to prevent
further abuse by reporting it and seeking help.