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Lower Leg/Ankle/Foot

Plantar fasciitis is the most common cause of pain on the bottom of the heel. Common symptoms of plantar fasciitis include pain on the bottom of the foot near the heel, pain with the first few steps after getting out of bed in the morning or after a long period of rest, and an increase in pain after (not during) physical activity.

Plantar fasciitis refers to inflammation of the plantar fascia, the thick, fibrous band that runs along the bottom of the foot. The plantar fascia is critical in maintaining the foot’s complex arch system and is designed to absorb the high stresses we place on our feet. It also plays a role in balance and fine control of certain phases of the athlete’s gait.

When too much pressure damages or tears the tissues inflammation follows, which results in heel pain and stiffness. The pressure can occur from a direct, acute injury to the plantar fascia, however it more typically develops from repeated trauma to the tissue resulting from high arches, uneven leg length, improper biomechanics, or overuse. The tissue damage usually occurs where the fascia attaches to the calcaneus (heel bone).

Achilles tendonitis causes pain in the back of the leg or above the heel. It is caused by repetitive or intense strain on the Achilles tendon, the band of tissue that connects your calf muscles to your heel bone. This tendon is used when you walk, run, jump or push up on your toes. Although the Achilles tendon can withstand great stresses from running and jumping, it is also prone to tendonitis, a condition associated with overuse and degeneration.

Overuse, or overload, occurs when there is a sudden increase in the amount or intensity of exercise activity, or when musculoskeletal imbalances place added stress on the Achilles tendon with regular activity, such as when the calf muscles are tight. Degeneration also occurs when the structure of the Achilles tendon weakens with age, which can make it more susceptible to injury.

Turf toe is a sprain of the main joint of the big toe. It occurs when the toe is hyperextended. Sprains of the big toe joint became especially prevalent in football players after artificial turf became more common on playing fields – hence the term “turf toe.” Although often associated with football, turf toe occurs in a wide range of sports and activities.

The big toe is made up of two joints. The largest of the two joints is the metatarsophalangeal joint (MTP), where the first long bone of the foot (metatarsal) meets the first bone of the toe (phalanx). The smaller joint is the proximal interphalangeal joint (PIP). In turf toe, the MTP joint is injured. The joint is surrounded by important structures that hold it in place and prevent it from dislocating. Together these structures are referred to as the “plantar complex.” Turf toe refers to an injury to any soft tissue structure of the plantar complex. As with all sprains, there are three grades of sprains, from mild to severe.

  • Grade 1. The plantar complex has been stretched causing pin-point tenderness and slight swelling.
  • Grade 2. A partial tearing of the plantar complex causes more widespread tenderness, moderate swelling, and bruising. Movement of the toe is limited and painful.
  • Grade 3. The plantar complex is completely torn causing severe tenderness, severe swelling, and bruising. It is difficult and painful to move the big toe.

Ankle sprains are a very common injury, and can happen to anyone. A sprain can occur when you take part in sports and physical fitness activities, or when you simply step on an uneven surface, or step down at an angle.

Ligaments are elastic structures that attach bone to bone. The ligaments of the ankle hold the ankle bones and joint in place. They protect the ankle joint from abnormal movements – especially twisting, turning, and rolling of the foot. Sprains occur when a ligament is forced to stretch beyond its normal range. A severe sprain causes actual tearing of the elastic fibers. Ankle sprains occur when the foot twists, rolls or turns beyond its normal motions. This results in pain and swelling.

Ankle sprains can occur when the foot rolls inward (inversion ankle sprain), or outward (eversion ankle sprain), relative to the ankle. People often recall hearing a “pop” when the ankle sprains. There are 3 types (or grades) of ankle sprain:

  • Grade 1 Sprains. The ligament is mildly damaged in a Grade 1 Sprain. It has been slightly stretched with some damage to the fibers of the ligament, but is still able to help keep the ankle joint stable.
  • Grade 2 Sprains. This is often referred to as a partial tear of the ligament. The ligament stretches to the point that abnormal laxity of the ankle joint occurs, resulting in instability.
  • Grade 3 Sprains. This type of sprain is most commonly referred to as a complete tear of the ligament. The ligament has been split into two pieces resulting in gross instability.


Shin Splints (medial tibial stress syndrome) is an inflammation of the muscles, tendons, and bone tissue around the tibia. It is characterized by pain that typically occurs along the inner border of the tibia (shinbone), where the muscles attach to the bone. Shin splints develop when the muscle and bone tissue (periosteum) in the leg become overworked by repetitive activity. When overworked, or fatigued, the muscles and tendons lose their ability to adequately absorb the damaging shock force from physical weight-bearing activities, resulting in the soft tissue being partially torn away from the bone.

The repetitive activities that lead to overworked tissues can come from either overload or biomechanical inefficiencies. Overload includes sudden changes in physical activity, such as increased frequency, duration, or intensity. Biomechanical inefficiencies include flat feet, abnormally rigid arches, or exercising with improper or worn-out footwear. Shin splints are common in runners and in those who participate in activities that require sudden stops and starts, such as basketball, soccer, or tennis.

Hyperpronation, also referred to as flat feet, occurs when the arch loses support and “falls.” Flat feet can lead to pain in the arch, heel, Achilles, knee, hip and even the back and neck.

Pronation refers to the inward roll of the foot during normal motion and occurs as the outer edge of the heel strikes the ground and the foot rolls inward and flattens out in preparation for propelling the body forward by lifting the heel and pushing off the toes. A moderate amount of pronation is required for the foot to function properly, however excessive pronation stretches out the muscles, tendons and ligaments underneath the foot leading to the loss of the support structure of the arch. When the arch falls, the body loses an effective shock absorber which results in an increase in stress placed on the joints of the feet, legs, hips, and back.