Child Health Library
Our Health Library information does not replace the advice of a doctor. Please be advised that this information is made available to assist our patients to learn more about their health. Our providers may not see and/or treat all topics found herein.
- Swelling and Bruising of the Ankle
- Puncture Wound
- Ankle With Ligament Tear
- Achilles Tendon
- Stress fracture of the foot
- How to Stop Bleeding From a Skin Wound
- Removing a Ring From a Finger or Toe
- Buddy Tape
- Applying a Compression Wrap for a Sprained Ankle
- How to Drain Blood From Under a Nail
- Range-of-Motion Exercises for Ankle Sprains
- Towel Curl
- Towel Stretch
- Calf Stretch
- Balance and Control Exercises for Ankle Sprains
Toe, Foot, and Ankle Injuries
At one 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 activities.
- Work-related tasks.
- Work or projects around the home.
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 evaluated.
Certain athletes, such as dancers, gymnasts, or soccer or basketball players, have an increased risk of toe, foot, or ankle injuries.
Older adults are at higher risk for injuries and fractures because they lose muscle mass and bone strength as they age. They also have more problems with vision and balance, which increases their risk of injury.
Most minor injuries will heal on their own, and home treatment is usually all that is needed to relieve your symptoms and promote healing.
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 include:
- 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 ligaments that support your joints.
- 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 persistent symptoms.
- Pulled muscles (strains). Muscles of the foot and ankle can be strained and can also rupture.
- Broken bones (fractures), such as a broken toe.
- A bone moving out of place (dislocation).
- A crushing injury, which can lead to compartment syndrome.
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 include:
- 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.
- Achilles tendinitis or tendinosis (tendinopathy), which is the breakdown of soft tissues in and around the Achilles tendon that connects the calf muscles to the heel bone.
- Stress fracture, which is a hairline crack in a bone.
- 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 the foot.
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 injury.
- When the injury occurred.
- Your age, your overall health condition, and your activities (such as work, sports, or hobbies).
Check your symptoms to decide if and when you should see a doctor.
Check Your Symptoms
Many things can affect how your body responds to a symptom and what kind of care you may need. These include:
- Your age. Babies and older adults tend to get sicker quicker.
- Your overall health. If you have a condition such as diabetes, HIV, cancer, or heart disease, you may need to pay closer attention to certain symptoms and seek care sooner.
- Medicines you take. Certain medicines, herbal remedies, and supplements can cause symptoms or make them worse.
- Recent health events, such as surgery or injury. These kinds of events can cause symptoms afterwards or make them more serious.
- Your health habits and lifestyle, such as eating and exercise habits, smoking, alcohol or drug use, sexual history, and travel.
Try Home Treatment
You have answered all the questions. Based on your answers, you may be able to take care of this problem at home.
- Try home treatment to relieve the symptoms.
- Call your doctor if symptoms get worse or you have any concerns (for example, if symptoms are not getting better as you would expect). You may need care sooner.
Pain in adults and older children
- 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 there.
- 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 than10 ft (3.1 m) [more than5 ft (1.5 m) for children under 2 years and adults over 65].
- A car crash in which any vehicle involved was going more than20 miles (32 km) per hour.
- Any event that causes severe bleeding that you cannot control.
- 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 grimace.
- 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 trouble standing.
- 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.
- Acting confused. The child may not know where he or she is.
With severe bleeding, any of these may be true:
- Blood is pumping from the wound.
- The bleeding does not stop or slow down with pressure.
- Blood is quickly soaking through bandage after bandage.
With moderate bleeding, any of these may be true:
- 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 true:
- The bleeding stops on its own or with pressure.
- 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 include:
- Increased pain, swelling, warmth, or redness in or around the area.
- Red streaks leading from the area.
- Pus draining from the area.
- A fever.
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, and HIV/AIDS.
- Long-term alcohol and drug problems.
- Steroid medicines, which may be used to treat a variety of conditions.
- Chemotherapy and radiation therapy for cancer.
- Other medicines used to treat autoimmune disease.
- Medicines taken after organ transplant.
- Not 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 years.
- 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 years.
- 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.
- If the symptoms get worse, seek care sooner.
Seek Care Now
Based on your answers, you may need care right away. The problem is likely to get worse without medical care.
- Call your doctor now to discuss the symptoms and arrange for care.
- If you cannot reach your doctor or you don't have one, seek care in the next hour.
- You do not need to call an ambulance unless:
- You cannot travel safely either by driving yourself or by having someone else drive you.
- You are in an area where heavy traffic or other problems may slow you down.
Call 911 Now
Based on your answers, you need emergency care.
Call 911 or other emergency services now.
Call 911 Now
Based on your answers, you need emergency care.
Call 911 or other emergency services now.
Put direct, steady pressure on the wound until help arrives. Keep the area raised if you can.
Make an Appointment
Based on your answers, the problem may not improve without medical care.
- Make an appointment to see your doctor in the next 1 to 2 weeks.
- If appropriate, try home treatment while you are waiting for the appointment.
- If symptoms get worse or you have any concerns, call your doctor. You may need care sooner.
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 doctor.
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.
- It is important to control bleeding from your injury.
- Be sure 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.
- Try to free your trapped toe or foot if it is stuck in an object, such as a pipe, toy, or jar.
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.
Home treatment for a sore or sprained toe
- Use rest, ice, compression, and elevation (RICE) for pain and swelling.
- 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
If you have a minor injury, try home treatment measures to relieve pain, swelling, and stiffness.
- 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 increases.
- Use 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.
- For 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 beverages.
- 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 activities.
- 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 other exercises.
Begin 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.
Try the following simple range-of-motion exercises:
- 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 maintain flexibility.
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.
Next, 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 open.
- Across your chest with your eyes open.
- Out to the side and close your eyes.
- Across your chest and close your eyes.
Do six repetitions, holding each for 60 seconds, once a day.
Take good care of your feet
- Wear supportive footwear to prevent re-injuring your foot or ankle.
- Wear roomy footwear, especially if the front of your foot hurts.
- Consider using an orthotic shoe device, such as an arch support, to help relieve foot pain.
- Treat blisters to prevent an infection.
Do not smoke or use other tobacco products. Smoking slows healing because it decreases blood supply and delays tissue repair. For more information, see the topic Quitting Smoking.
Try a nonprescription medicine to help treat your pain:
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:
Symptoms to watch for during home treatment
Call your doctor if any of the following occur during home treatment:
- Pain or swelling develops.
- Signs of infection develop.
- Numbness; tingling; or cool, pale skin develops.
- Symptoms do not improve with home treatment.
- Symptoms become more severe or more frequent.
The following tips may prevent toe, foot, or ankle injuries.
Toe, foot, and ankle tips
- Avoid problems by wearing good footwear. Wear comfortable, supportive shoes.
- Do not walk barefoot in areas such as streets and parks where you have an increased risk of stepping on an object.
- Use a rubber mat to stand on if your work requires you to stand on hard surfaces. This will help to reduce stress on your feet.
- Buy new running shoes often. Experts recommend getting new athletic shoes every 3 months or after 500 miles of wear. Overworn shoes may not absorb shock well or provide traction or protection.
- Reduce your risk of reinjury by wrapping your foot or ankle or wearing a supportive brace during activities or exercises where injury is a risk.
- Prevent blisters caused by poorly fitting shoes or socks.
- Do exercises for heel pain and tightness. This is especially important for athletes before they participate in sports. It is also helpful for people who are not involved with sports.
- To help prevent foot injuries and problems:
- 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.
- Be 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).
- Never cut calluses and corns with a razor or a pocketknife.
- Avoid foot problems or injuries, especially if you have diabetes.
- Take steps to prevent falls and injuries in adults, such as removing any obstacles from your walking path.
- Take steps to prevent falls and injuries in babies and toddlers, such as not leaving your baby unattended in any infant seat or "sitting" toy.
General prevention tips
- 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 your height.
- 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 muscles.
- 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 assignments.
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 foods.
- Exercise and stay active. It is best to do weight-bearing exercise, such as walking, jogging, stair climbing, dancing, or lifting weights, for 2½ 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.
Preparing For Your Appointment
To prepare for your appointment, see the topic Making the Most of Your Appointment.
You can help your doctor diagnose and treat your condition by being prepared to answer the following questions:
- What are your main symptoms?
- How long have you had your symptoms?
- How and when did an injury occur? How was it treated?
- Can you walk, or is walking difficult?
- Have you had any injuries in the past to the same area? Do you have any continuing problems because of the previous injury?
- What activities related to sports, work, or your lifestyle make your symptoms better or worse?
- What home treatment measures have you tried? Did they help?
- What nonprescription medicines have you taken. Did they help?
- Do you have any health risks?
Current as ofSeptember 23, 2018
Author: Healthwise Staff
Medical Review: William H. Blahd Jr. MD, FACEP - Emergency Medicine
Kathleen Romito MD - Family Medicine
Adam Husney MD - Family Medicine
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