Pain in the foot instep

Introduction

Not only soccer players and competitive athletes are affected, but often also hobby athletes who have overexerted themselves in training. We are talking about pain in the instep, more precisely called “foot instep”. The back of the foot is – similar to the hand – a complicated structure of many bones, muscles, tendons and nerve tracts.

Some of them lie very superficially at this point and are therefore particularly exposed to external influences. In addition, the foot and the arch of the foot is a structure of the human body that is exposed to great forces throughout its life. After all, the entire body weight is on them every day.

It is therefore no wonder that our feet hurt from time to time. Especially the instep, also called instep in sports, or foot instep, often causes pain. The various causes and forms of therapy are discussed below.

Causes

There are many causes of pain in the foot instep, which are almost always related to overloading or incorrect loading of the foot. This is often the case with track and field athletes or marathon runners. Often a change of shoes is enough to cause sudden pain.

For the shoe industry, it is not easy to produce the “perfect” shoe, because every back of the foot is different. For example, some runners have a particularly high, strong foot instep, while others have a relatively low, blunt back. However, one and the same shoe should fit both, which is not always possible.

So athletes often have to try on several shoes before they find one that really fits. A skin rash on the back of the foot can also cause pain. It is therefore advisable to try on shoes in a specialist store instead of buying them over the Internet.

Often, however, the pain does not appear until after some training. It is not for nothing that a really fitting shoe is considered a real blessing by track and field athletes. In addition to sports, there are also other causes of pain in the instep: for example, obesity (overweight) can promote pain.

This is due to the fact that, on the one hand, more tissue surrounds the foot. As a result, the foot is permanently enlarged and “no longer fits in any shoes”. On the other hand, of course, a much heavier weight weighs on the foot and puts additional strain on it.

Small inaccuracies in fit, which a person with a normal constitution would still tolerate, become painful pressure points in obese patients. The pressure points can lead to nerve compressions at the foot instep, since the nerves in this area run very superficially over the bone. Nerve compressions always lead to pain and numbness up to complete muscular and sensory failure.

The overweight can also lead to a so-called peripheral arterial occlusive disease (pAVK for short). In this case, peripheral arteries of the body – as they also supply the feet – are blocked by deposits and prevent the foot from being supplied with fresh, oxygen-rich blood. This results in cold, pale, pulseless feet, which become extremely painful.

Furthermore, there is a large group of chronic or systemic diseases, such as gout, diabetes, rheumatism and arthritis, which can cause pain throughout the foot. However, pain that occurs selectively at the foot instep is more typical of tendonitis in the foot or trauma. Inflammation of tendons can simply occur as a result of constant, excessive strain and manifests itself as a stabbing pain that diminishes slightly with continued movement.

This is also the deceptive thing about tendonitis, one is inclined to ignore it, but this makes the problem even worse. Traumas – i.e. fractures or torn ligaments – do not always have to be related to a direct event and can also occur over weeks or months. Fragmentation of small pieces of bone is often not even noticed and only becomes a problem after a long period of time.

Ligament attachments can slowly tear out of the bone over long periods of time, so that they are not directly associated with a specific movement. The pain often makes itself felt gradually over months until it becomes too strong at some point. Unfortunately, the pain often goes only as slowly as it has come.

The only thing that usually helps here is to pause and take it easy – a patience exercise when you are in preparation for a competition.Sudden swellings of the foot instep are, however, more a sign of an acute process: swellings – also called oedemas – are caused by an increased fluid permeability of the finest blood vessels. Through the capillaries, more fluid escapes from the vessel into the tissue and settles there. This results in water in the feet.

As a result, the affected body part swells. Edema can be the result of an inflammatory reaction as described above. But injuries can also lead to ruptured vessels and consecutive blood leakage into the tissue.

The tissue usually appears reddish, later black. A torn ligament in the foot becomes noticeable by discoloration of the surrounding tissue and sudden, severe pain. The tissue turns reddish due to the escaping blood.

After 2-3 days, the coagulated blood settles near the sole of the foot, following the force of gravity, and now appears bluish-black. This also causes a swelling within hours, which usually disappears again after a good week. Torn ligaments usually affect the lateral ligaments in the foot area, after a classic “bending over” with the foot.

But the foot instep can also be affected. Tendons are structures that connect the muscles with bones. There are a large number of different muscles in the foot, each of which has its tendon attached to certain bones.

Especially if there is a localized pain at the foot instep, it should be discussed whether an inflammation of the tendon (tendinitis) or an inflammation of the tendon sheath (tendovaginitis) could be the cause of the complaints. These inflammations are often caused by chronic overloading or friction of the tendon. This overloading of the foot instep can be caused by unsuitable footwear and excessive training.

Typical for pain that occurs in the context of tendon inflammation is that it is very strong at the beginning of the movement and then slowly gets better (starting pain). It is also typical that the pain is perceived as weak at the beginning of the disease and then increases during the course of the disease. A detailed anamnesis (doctor-patient conversation) as well as a physical examination can often already clarify whether the individual pain is the symptom of tendonitis.

Further examinations with ultrasound, X-ray or MRI (magnetic resonance imaging) are usually used to rule out other diseases that may also be responsible for the symptoms. Immobilization of the tendon and the intake of anti-inflammatory and pain-relieving medication is usually sufficient to completely heal the tendon inflammation. Pain in the foot instep occasionally occurs not only depending on the situation but also on the time of day.

The question is often asked why the pain occurs especially after getting up or at night. If the pain occurs for a short time after getting up and then disappears again, it is called “tarnishing pain”. Every athletically active person has experienced this at least once in their life when the training on the lecture was very intensive and demanding.

The training is still “in your bones”. However, if the starting pain after getting up becomes a habit and is not related to heavy training, this can be a sign of a joint disease. The two main types are arthrosis and arthritis.

While arthritic pain usually resolves within 15 minutes, arthritic pain lasts longer than half an hour. Arthrosis refers to a degenerative change in the joint (usually age-related) as a result of excessive wear and tear. Arthritis is an inflammatory process associated with swelling, redness, and pain.

If the pain occurs at night, so that the affected person wakes up, it is more likely to be a traumatic event. After the injury itself, the body releases adrenaline, which constricts the vessels, but also suppresses pain. It is only in the course of the evening that the full effect of the pain is felt.

After sports injuries the PECH rule should always be followed: P stands for pause, E for ice, C for (K) compression and H for high bearing. This reduces swelling, protects the body part and prevents further strain. If the pain becomes too severe, a doctor or an emergency clinic should be consulted.

Injuries to the foot instep are rarely life-threatening, but some operations can only be performed immediately after the injury or weeks later after the swelling has completely subsided.So if severe pain occurs at night, after a previous injury, a hospital presentation should always be considered. Pain in the outer area of the foot instep can be caused by different diseases, depending on the quality of the pain and relevant accompanying symptoms. Very often pain on the outside of the instep is caused by injuries and accidents.

Especially when “bending over” inwards, injuries of the ankle joint are very common, which then lead to pain in the area of the outer foot instep. Almost always, one or more ligaments are torn or torn off, which are located on the outside of the foot instep when the ankle is bent inwards. If pain occurs in the inner area of the foot instep, different diseases can be responsible for this.

First of all, it is important to find out whether a specific event can be made responsible for the occurrence of the pain. For example, if the pain occurred directly after an accident or a specific sporting activity, different diseases are shortlisted. Injuries to the foot can cause complaints on the inside of the instep.

Particularly strains and injuries of certain ligaments are to be mentioned here. When the foot is bent outwards, ligaments on the inside of the back of the foot are strained and can tear in the worst case. In addition to the severe pain, there is usually also a bruise in this case.

Accidents can also cause bone fractures with similar symptoms. However, the inside of the back of the foot can also cause pain due to sporting overloading. The cause is often incorrect footwear.

Irritation of muscles and tendons causes a painful inflammation. There can also be systemic diseases, which, in addition to the complaints on the foot, usually also cause other complaints on the body. Last but not least, older people in particular should be examined to see whether signs of wear and tear of the joints are the cause of the complaints.

The type of pain can be described not only by its quality (sensation of pain – burning, stabbing etc. ), but also by its temporal occurrence. Specific pain in the foot instep, which occurs immediately after getting up, gives an indication of which disease could be the cause of the complaints.

In particular, joint diseases such as arthrosis, rheumatism or, in rare cases, other systemic diseases such as lupus erythematosus are suspected of causing pain directly after getting up. Inflammation of blood vessels can also cause complaints of this kind. However, complaints caused by inflammation and overstrain can also be particularly prominent after getting up.