Comprehensive, evidence-based information on every major foot and ankle condition — from understanding your diagnosis to knowing when surgery is the right choice.
Painful bony prominence at the base of the big toe. Progressive deformity affecting 23% of adults.
What is a Bunion?
A bunion (hallux valgus) is a bony bump that forms on the joint at the base of the big toe. The big toe is pushed toward the second toe, causing the metatarsophalangeal joint to protrude. Bunions are more common in women and worsen with narrow or high-heeled footwear, though genetics plays the primary role.
Wide toe-box shoes, avoiding heels >2 inches. First-line and most important conservative intervention. Expert Consensus
Bunion pads, spacers between toes, custom orthotics for arch support. Reduces pain but does not correct deformity.
NSAIDs for acute flares, ice therapy, activity modification during painful periods.
Lapidus procedure (first TMT fusion, most durable), Chevron osteotomy (mild-moderate), Scarf osteotomy. Surgery corrects deformity and provides long-term relief. 2024 systematic review supports minimally invasive techniques for mild-moderate deformity. Surgery NOT recommended for cosmetic reasons alone.
▶ Bunion Overview & Treatment Options
Toe deformity where one or more toes bend abnormally at the middle joint, causing pain and pressure.
Hammertoe is a deformity where one or more toes (usually 2nd–4th) bend abnormally at the middle joint. The condition may be flexible (correctable by hand) or rigid (fixed deformity). Early intervention with conservative measures can prevent progression.
Deep, wide toe box; avoid pointed shoes. Allows toes to rest in natural position without pressure.
Towel curls, marble pickups for flexible hammertoes; silicone toe sleeves for comfort. Best results when started early.
Custom devices to redistribute pressure and support the metatarsal arch.
Arthroplasty (flexible hammertoes) — removes portion of bone; Arthrodesis (rigid hammertoes) — pins/fuses the joint. Highly effective when correctly timed.
Most common cause of heel pain, affecting 2 million Americans annually. Severe morning pain with first steps.
The most common cause of heel pain, affecting 2 million Americans annually. Plantar fasciitis is inflammation of the plantar fascia — the thick band of tissue connecting the heel to the toes. Classic symptom: severe pain with the first steps in the morning, typically improving with activity.
Plantar fascia-specific stretching (3× daily), calf/Achilles stretching, prefabricated orthotics with arch support. Grade A Evidence — Studies show 80% improve with 6 weeks of stretching protocol alone.
Night splint (particularly effective for morning pain), NSAIDs, ice massage, footwear modification.
PRP injection. STRONG RCT Evidence — 2024 meta-analysis of 24 RCTs (1,653 patients): PRP superior to corticosteroids at 3 and 6 months.
After 6-12 months of failed conservative therapy: Endoscopic plantar fascia release (EPFR). 87% excellent/good satisfaction at 12 months.
▶ Evidence-Based Plantar Fasciitis Stretches
Thickening of tissue around a nerve between metatarsal bones, causing burning pain in the ball of the foot.
A thickening of the tissue around a nerve between metatarsal bones (usually 3rd and 4th), causing burning pain, numbness, or a 'pebble in the shoe' sensation in the ball of the foot. More common in women and often provoked by tight footwear.
Bony outgrowths on the heel bone, often associated with plantar fasciitis.
Bony outgrowths on the underside of the heel bone (calcaneus), often forming in association with plantar fasciitis. Important note: the spur itself rarely causes pain — the surrounding inflammation does.
Heel spurs are treated identically to plantar fasciitis. The treatment ladder includes stretching, orthotics, NSAIDs, and PRP injection for persistent cases. The spur does not need to be surgically removed in most cases. Treating the underlying plantar fasciitis inflammation provides relief without addressing the bony spur.
Chronic lateral ankle instability affecting 40% of people who sustain ankle sprains. Feeling of giving-way during activity.
Chronic lateral ankle instability (CLAI) occurs when the outer ankle ligaments become lax after repeated sprains, causing ongoing giving-way, pain, and fear of re-injury. Affects up to 40% of people who sustain ankle sprains if inadequately rehabilitated.
Balance/proprioception training (BOSU, single-leg exercises), peroneal muscle strengthening, ankle bracing during sport. First-line therapy for most patients.
If failed conservative after 3-6 months: Brostrom-Gould lateral ligament reconstruction — 90%+ success rates, return to sport in 4-6 months.
Insertional and midsubstance tendinopathy. Eccentric loading is gold-standard therapy.
Achilles tendinopathy encompasses insertional tendinopathy (at heel insertion) and midsubstance tendinopathy. Achilles rupture is a separate, acute injury. All require careful staging for appropriate treatment.
Grade A Evidence — Eccentric loading program for 12 weeks. Pain is expected during loading — this is therapeutic. This is the gold standard first-line treatment.
Heel lift in shoe, avoiding hills and speed work, structured return-to-activity protocol.
Evidence is conflicting — 4 RCTs showed NO significant benefit over saline placebo. PubMed 32798020. Eccentric exercise remains the gold standard.
After 6+ months of structured rehabilitation failure: Debridement, paratenon release, or Haglund's resection.
Usually post-traumatic. TAR vs. fusion: comparable long-term outcomes with different trade-offs.
Unlike hip and knee arthritis, ankle arthritis is usually post-traumatic (from prior fractures or instability), not primary degenerative. The ankle is the most congruent joint in the body and uniquely resilient — but once cartilage is lost, progression can be rapid.
Activity modification, NSAIDs, ankle brace/AFO, physical therapy, weight management.
PRP/BMAC for early-moderate arthritis. Emerging Evidence BMAC shows improved cartilage repair on MRI but functional outcomes data is limited (Level II-IV studies, 2025 review). May delay need for surgery.
Total Ankle Replacement (TAR): Superior pain relief, preserves motion, lower complication rates (13.1% vs. 31.4% fusion). Best for elderly patients.
Ankle Fusion (Arthrodesis): Reliable, durable pain elimination. Comparable long-term outcomes after 48 months. Best for younger, highly active patients.
2024 meta-analysis: Both show comparable long-term outcomes; TAR had better short-term pain scores.
▶ Ankle Arthritis Treatment Options
Most common musculoskeletal injury. 40% progress to chronic instability if inadequately rehabilitated.
Ankle sprains are the most common musculoskeletal injury. 40% progress to chronic instability if inadequately rehabilitated. Ottawa Ankle Rules determine imaging need.
Ankle Sprains: RICE (Rest, Ice, Compression, Elevation) → early weight-bearing as tolerated → rehabilitation focused on proprioception and strength. Recovery timeline depends on grade of sprain (I-III).
Fractures: Non-displaced fractures can be managed conservatively with immobilization. Displaced or unstable fractures require surgical fixation with plates and screws.
Fatigue fractures from repetitive loading. High-risk fractures require early surgical intervention.
Fatigue fractures from repetitive loading. Most common sites: 2nd/3rd metatarsal (low risk), 5th metatarsal (Jones — high risk, requires surgery), navicular (high risk). Key diagnostic feature: activity-related pain that improves completely with rest.
Hyperextension sprain of the first MTP joint. Common in football, soccer, and basketball.
Hyperextension sprain of the first metatarsophalangeal (MTP) joint, causing acute pain and swelling in the big toe. Affects football, soccer, basketball athletes. Can involve ligament, cartilage, and sesamoid injuries. Severity is graded I-III by extent of soft tissue damage.
Adult acquired flatfoot from posterior tibial tendon dysfunction. Can progress from flexible to rigid.
Flatfoot deformity ranges from flexible (foot appears flat only when standing) to rigid (fixed deformity). Adult acquired flatfoot (AAFD) is usually caused by posterior tibial tendon dysfunction (PTTD). Can progress from flexible to rigid over time if left untreated.
Supportive orthotics, physical therapy (focusing on posterior tibial tendon strengthening), bracing (UCBL or AFO), weight management. Most effective when caught early.
For rigid deformity: Calcaneal osteotomy + tendon transfer, or triple arthrodesis for the most rigid cases. Goals include restoring alignment and improving function.