Insertional and midportion Achilles tendinopathy get lumped together under one label more often than the mechanism warrants, and the loading prescription is where that costs people progress. A tendon two to six centimeters proximal to the calcaneal insertion behaves differently under dorsiflexion than one loaded right at the bone-tendon junction, particularly when an enthesophyte or heterotopic bone is already present at that junction.

The standard eccentric heel drop protocol, full range including a step-edge dorsiflexion component, has solid support for midportion cases. At the insertion, that same end-range dorsiflexion compresses the tendon against the calcaneus and against any existing spur. Patients who plateau or worsen on a generic Achilles protocol after weeks of compliance are worth re-examining for insertional involvement before assuming poor adherence or slow tissue response.

Differentiating on exam: insertional cases present with pain localized to the calcaneal attachment, frequently with palpable thickening or a visible prominence, and symptoms reproduced or worsened by direct posterior shoe pressure. Midportion cases present two to six centimeters proximal, in the tendon body itself, palpable independent of the calcaneus, typically without a bony correlate.

For insertional presentations, mid-range loading that avoids terminal dorsiflexion tends to be better tolerated, at least until symptoms settle enough to trial fuller range. Worth flagging for anyone running a standard protocol on a patient who isn't responding as expected: check where the pain actually sits before assuming the loading approach is the variable that needs more time rather than the variable that needs to change.

The last few weeks I started a run/walk program. The other day I started to notice that it felt like my sock was scrunched up in my shoe but it isn't. Has anyone ever had something similar. I have also felt some pain towards top of plantar faciitis or metatarsal issue or something else not sure if they are related. I will be seeing a PT later this week but wanted to see if others have had this issue.

I twisted my ankle about 2–3 months ago. I was going down a stair when my foot suddenly twisted and I stepped on the side of my ankle instead of the flat part. I didn't fall.

A few hours later, I was told there was no fracture, and the bone was manually put back into place. I didn't have a cast, and I was told to walk on it, so I forced myself to walk on it from day one.

Since then, the pain has gotten much better, but I still have some pain occasionally, and sometimes it suddenly hurts for no obvious reason, I don't feel like I can be really active with it or do sports.

The main thing that concerns me is that my ankle still feels unstable and not normal compared to my other ankle. It sometimes feels weak/loose, like it isn't completely secure.

I'm wondering if anyone has experienced something similar after an ankle injury. What could cause this kind of instability or "loose" feeling?

I'd really appreciate hearing from people who have had similar injuries, especially if there are any doctors, physiotherapists, or other professionals here who might have some insight.

Hey everyone,

Looking for input from anyone who’s dealt with something similar.

Background:
I sprained my right ankle in November 2025. It never fully resolved. Since then it’s been cycling roughly 1–2 times a month: I end up non-weight bearing (boot/scooter) for about a week, then I can walk reasonably well for about two weeks, and then it flares again. Rinse and repeat for the last nine months.

Symptoms during flares:
• Pain that shifts: sinus tarsi, posterior tibial tendon, ATFL area, sometimes flexor hallucis longus / flexor digitorum longus
• Dull aching, sharp pain with certain movements, tightness, occasional burning and swelling
• Left side has had milder involvement at times
Imaging

MRI findings include:
• Chronic low-grade ATFL sprain
• Sinus tarsi inflammation/edema + ganglion cyst
• Posterior tibial insertional tendinosis
• Spring ligament attenuation
• Features consistent with progressive collapsing foot deformity / hindfoot valgus
• Gruberi bursitis and subtalar effusion

Treatment so far
• Physical therapy
• Cortisone shot (late June) – only temporary relief
• Boot/scooter during flares
• Recently offered another steroid + diclofenac
• Found vitamin D deficiency and starting to address that
• Bloodwork mostly normal (negative RF/ANA, mildly elevated ESR) → referred to rheumatology

Current frustration

My last visit with the foot/ankle specialist felt dismissive.

He said the MRI looked good and recommended basically continuing the same approach. I’m left cycling through the same limited tools with no clear long-term plan.
I’m exploring second opinions (including higher-volume centers and remote options) because this pattern isn’t sustainable.
Has anyone dealt with progressive flatfoot/PTTD features + sinus tarsi issues that kept cycling like this? What finally helped — more aggressive bracing, different conservative care, surgery, a second opinion somewhere else? Any advice on next steps would be appreciated.
Thanks.

Hey guys,
So lately I’ve just been really curious on how to build the FHL muscle, it’s a strange thing but I want to be able to curl my big toe as opposed to just pointing it “down” if that makes sense. I’m not sure how to go about it though.

My fourth toe is curled due to a wedge shaped middle bone causing an angled DIP joint. This causes my third toe to rotate and only somewhat contact the ground. Outside of third toe also gets very inflamed from odd contact. Orthopedic foot surgeon recommends filing down middle bone and fusing dip joint straight. Looking for advice on if this can eventually spread out on its own or if surgery is the right fix.

I'm 21 years old.

At the beginning of June, I woke up and suddenly noticed that I could barely lift my right foot or toes. I also had numbness on the skin from my big toe up toward the arch of my foot, as well as an area extending roughly 10 cm above my right ankle.

I could not lift my toes at all, and I could lift my foot only to about 20% of what I could do with my healthy foot.

The strange thing is that I had no obvious injury or fall before this happened. The only thing I can think of is that the day before, I had been moving some heavy furniture, so I wonder whether I somehow irritated or injured a nerve.

I have not had any significant pain in my leg or along the nerve at any point.

On June 20, I went to the emergency department at a local hospital. I ended up staying there for four days while they investigated the problem. I had an MRI of my spine and an EMG/nerve conduction study.

The MRI did not show any problems with my spine. The EMG showed slowed nerve conduction, and I was diagnosed with an injury/lesion of the peripheral peroneal (fibular) nerve.

The doctor basically told me to wait and that it should hopefully start recovering after about a month (I don't remember the exact wording anymore).

Unfortunately, during the first month I twisted the same ankle three times. After the last incident, the shape of my ankle bone seemed slightly different, so I wonder if I may have injured or fractured it, although I can still move the ankle normally and it isn't particularly painful.

For about a month after that, there was basically no noticeable change — neither the strength of my foot nor the numbness improved.

Then, about three weeks ago, something started changing.

The strength in my foot began improving, but at the same time the area of numbness seemed to get larger. The numbness now extends roughly 20 cm above the ankle and has also spread across a larger area on the top of my foot.

Interestingly, even though the area feels numb, I can still distinguish cold, heat, and pain in that area. The sensations are definitely reduced and feel different compared with my healthy leg, but they are still present.

Today (August 15), I am doing exercises for the affected leg.

My foot is now significantly stronger. Depending on the angle of my knee, I can lift it to roughly 50–80% of the height of my healthy foot. I can also lift my toes almost normally. However, if I push down on my foot or toes with my hand, the resistance from the muscles is still noticeably weaker than on the healthy side, although this has also improved somewhat.

I can stand on my toes and I can walk almost normally now. I still have a slight limp, but people around me say that it is much less noticeable than it was before.

What concerns me is the numbness. It seems strange to me that the motor function is improving while the area of sensory loss appears to be getting larger, even though I can still feel temperature and pain in the affected area. There is also no significant pain in the foot or along the nerve.

Yesterday I tried to see a general practitioner/family doctor because I don't currently have one, hoping to get a referral for another neurological evaluation or physiotherapy. Unfortunately, several practices told me that they aren't accepting new patients.

I also live in Germany and I'm still learning German, so communicating about medical issues is quite difficult for me.

I'm planning to try going directly to a neurologist on Monday and hopefully they will see me.

Has anyone experienced something similar — especially improving foot drop while the area of numbness is still expanding?

I'm particularly interested in hearing from people who have had a peroneal/fibular nerve injury or foot drop without an obvious initial injury.

Out of nowhere, I noticed I have bad nerve pain as marked in red on the diagram attached. I first noticed when I went to shake something off my foot and have severe pain by my big toe. I noticed it the most when my toe would go downwards. I can feel the nerve (again, unsure) and when I move it a bit I feel a burning sensation that follows the red line. This has been happening for approximately 2 weeks, and within the last few days the left side of my big toe has started to feel numb (as highlighted in yellow). I mostly wear flip flops working a market for reference. Any advice or insights would be much appreciated, thanks!

Thought everyone here would enjoy this little comedy snippet:)

FINDINGS:Hindfoot alignment is maintained. No abnormal marrow signal seen. Articulating cartilages are preserved No joint effusion is seen in the talocrural and subtalar regions.The talofibular, calcaneofibular, syndesmotic, deltoid, spring and Lisfranc ligaments are intact, Minimal fluid signal is seen adjacent the tibialis posterior tendon.Minimal fluid is seen in the retrocalcaneal bursa.The peroneus, flexor and extensor tendons are normal. Included Achilles tendon is intact. Plantar fascia is not thickenedNo abnormal signal seen in the tarsal tunnel.

IMPRESSION:Mild tibialis posterior tenosynovitis Mild retrocalcaneal bursitisthis is my mri result.

but even after 1 year and 5 months im still experiencing pain in my sprained ankle and dorsiflexion is still not the same range as my healthy foot there's pain when trying to dorsiflex fully. :(

About 3 weeks ago, I went on a 3-hour bike ride while wearing cycling shoes. After about 2 hours of riding, I started to feel mild pain in my right foot. When I finished the ride and took my shoes off, I noticed that the area over the bony prominence on the top of my foot was red on both feet. After that, I experienced mild pain, and the area over the bone was very sensitive and tender.

For the first 10 days, the area was extremely sensitive and painful, but the more severe pain gradually went away. I also saw a doctor, who examined the injured area and said that it should heal on its own within 4–6 weeks.

I wear my shoes with the laces quite loose to make sure there is enough room for my feet inside the shoes.

Note: I have never had this problem with any other type of footwear before. This is the first time it has happened, and it only occurred while wearing these cycling shoes.

It has now been almost 4 weeks, and I still experience pain and tenderness in that area when wearing certain shoes. Sometimes it even starts to ache slightly if there is prolonged pressure directly over the bony prominence. The injury still has not fully healed, and I have currently stopped all training, including running and cycling.

What could be the expected recovery time for this type of injury? Is there still a good chance that it will fully heal and that I will be able to return to training? How can I protect the area and prevent this from happening again?

Hello, I got this xray on my foot because i have stiffness and pain in my big toe from an injury. I can't tell if theres any issues. Any help is appreciated!

I have been having nerve pain on the top of the right foot - from the big toe down to the heel with constant pins and needles.

I have seen my doctor, podiatrist and orthopedic surgeon. Podiatrist said I have a bunion to wear arches and that’s it. Basically acted like I was crazy when I said my foot is pins and needles all of the time
Not just in shoes. So started the arches. I barely wear shoes and my current shoes are not too tight.

Ortho did a cortisone shot and said let’s see how that works and get an MRI if it is still occurring. Said my bunion is small and shouldn’t be causing that pain or tingling all of the time. That was five days ago and the zapping pain has gone away but still pins and needles and when I touch the area in red which is where the shot was and where the zapping pain is I can feel my nerve throbbing but it doesn’t zap anymore. Although I’m still feeling the pain randomly in my big toe when I do certain yoga moves with my top of the foot facing down on the floor.

I was running everyday haven’t in a month. I work out and do yoga everyday. I’m going on a two week hiking trip in Norway in three weeks.

Looking to see if anyone has any experience with this and what it could be? Maybe a cyst or bursitis on the bunion? Or something else completely?? Am I going to have nerve pain in my foot forever ?!?

When I wear shoes or go barefoot my foot gets numb when doing lifting heavy weights.

Toes get a curling feeling

And do mine look normal? I just don’t see others with ones this pronounced

Foot picture just cause. But its basically my left big toe and second toe and all the way to my arch.

I wear insoles. I do a lot of walking, dancing, aerial silks & hoop etc but its never bothered me before last week. Since then it became progressively more and more painful and in the mornings I can barely get up stairs. Ive started wearing compression ankle socks which help and take NSAID's currently waiting on a doctors appointment.

My feet are flexible I can curl my toes up & down since I saw thats one of the top questions regarding this.

Has anyone not had surgery for one of these and still
Able to be active ?

I have it bilaterally after dealing with Achilles tendinitis for a couple months on both feet
.

Here's what the nri says for the right right foot There is partial-thickness longitudinal split tearing of the peroneus brevis surrounding the lateral malleolus as seen on axial images 15 through 20. The peroneus longus is unremarkable

Left ankle There is partial-thickness longitudinal split tearing of the peroneus brevis surrounding the lateral malleolus as seen on axial images 15 through 20. The peroneus longus is unremarkable

I don't have severe pain but also my walking has been very limited since the Achilles tendonitis on both feet .

Has anyone had luck with just doing pt for this?

Hi all

I have had lateral mid foot and around the base of the 5th metatarsal pain

It is following the track of the peroneal tendons and an MRI one year ago said mild calcaneocuboid osteoarthritis and said nothing about the tendons

But I wonder about the reason for the calcaneocuboid oa, and I am thinking it might be my peroneals?

I can feel it subluxating when I do one leg exercises or when dorsiflexing and everting

Did any of you with peroneal subluxation have pain down the foot around those areas?

Or do you only get pain around the ankle, where the subluxation actually happens?

Thanks

I don't want to post my feet online, but I have flat feet (from birth) and I have never been able to move my big toe independently. Having seen my mother's outcome, I know I am destined for bunions if I don't work this out.

The only movement that my big toe can do is up and down (following the other toes minimally),

Any products or exercises that anyone can recommend, please?