Foot pain is characterized by discomfort in any part of the foot, including the ankle, heel, sole, arch and toes. Foot pain can result from a number of conditions and can affect people regardless of their level of activity.
The feet support the body and move it throughout the lifetime. The foot’s complex anatomy includes more than one-fourth of the bones in the body, in addition to many joints, muscles, ligaments and tendons. All these parts must interact smoothly to function. Despite the complexity of the foot’s interior, many soures of foot pain originate elsewhere. For example, a herniated disc in the back can cause nerve pain running down the leg into the foot.
Footwear that compresses the feet or toes or is not adequate for a given activity causes many of the pressure-related problems in the feet, such as corns, calluses and bunions. Lack of hygiene exposes the feet to fungal infections, which can flourish in the warm, moist environment inside most shoes.
People with certain diseases are especially prone to foot pain. Individuals with arthritis can have inflamed joints in the feet, which can lead to pain in the toes and ankles. Diabetic complications of the nervous and circulatory systems can also affect the feet and increase the likelihood of foot ulcers. When diabetic foot problems are not treated promptly, they may eventually progress to the point where amputation is the only treatment.
Other sources of foot pain include injuries, such as fractures and tendon ruptures. Some strains, such as plantar fasciitis , may affect athletes or sedentary people. Connective tissue (fascia) on the bottom of the foot may become inflamed and cause heel pain when standing or moving. Nerves in the feet may be compressed or irritated by bony growths that cause pain or burning sensations.
The source of most foot pain can be identified with a physical examination from a physician or podiatrist (foot doctor). X-rays or other imaging studies may be needed to confirm other conditions.
Although traumatic injuries and strains may require casts or even surgery, most foot pain can be alleviated with simpler measures. These may include:
Proper foot hygiene
Wearing properly fitting shoes
Cushions or pads in shoes for comfort
Orthotics (specially designed inserts for shoes)
Stretching exercises before and after an activity
Physical therapy
Medications
About foot pain
The foot is a complex body part that handles stress daily. Each foot contains 26 bones, 33 joints and more than 100 muscles, tendons and ligaments.
The anatomy of the foot is designed to support the tremendous impact and absorb the shock of the body’s weight. The foot also has the flexibility to move that weight for a lifetime.
The bones of the lower leg (tibia and fibula) connect to the foot at the ankle bone (talus) and ankle joint. The heel bone (calcaneus) is below the ankle bone and is the largest bone in the foot. In front of the heel bone are five tarsal bones that form the arch of the foot. The tarsal bones connect to the five metatarsals, the long bones that give the foot much of its length. In front of the metatarsals, more bones (phalanges) and joints form each of the toes. The big toe (hallux) has two joints and the other toes have three. The metatarsal-phalangeal joint at the base of the big toe is the largest joint in the foot and forms the ball of the foot.
Many muscles, ligaments and tendons surround the bones of the foot. Ligaments are strong connective tissues that join bones. Muscles help the foot move and provide padding, especially along the sole (bottom) of the foot. Many of the foot muscles are in four layers along the sole of the foot.
Tendons are similar to ligaments but connect muscles to bones. The largest tendon in the foot is the Achilles tendon, which connects the muscles of the calf to the heel bone. Each joint is surrounded by a joint capsule or bursa, a fluid–filled sac surrounded by ligaments and other soft tissue.
When all the parts of the foot work properly, they can support the body’s weight and move it through near-constant activity. If there is damage or injury to any part of the foot, it can quickly affect other parts of the foot or leg and disrupt foot function, making it painful to walk or even stand. Gait disturbances can result.
Many common causes of foot pain can be traced to shoes that do not fit properly. Ill-fitting shoes can cause pressure on certain points and lead to the formation of blisters, corns, calluses and bunions.
Other pain areas related to foot pain
Many systemic diseases have symptoms that are first observed in the feet and may cause pain elsewhere. For example, the joint inflammation of arthritis may be felt in the feet, knees, hips and arms. Gout, a form of arthritis, usually attacks the big toe joint first but may later strike other joints as well.
Some pain that originates in other parts of the body is perceived in the feet. This type of pain is known as referred pain. A person experiencing foot pain may also experience:
Knee pain
Hip pain, calf pain or other leg pain
Back pain
Potential causes of foot pain
Pain can affect any part of the foot, including the ankle, heel, sole, arch and toes. Potential causes of foot pain include:
Problems caused by pressure. The feet withstand enormous pressure while standing and walking. Pressure on the feet from ill-fitting shoes causes skin to rub and can shift the bones. This may result in numerous foot conditions, including:
Callus. Area of hard skin that forms on the foot from excess pressure.
Corn. Area of hard skin that forms on the toes.
Bunion. Occurs when compression forces the big toe joint to enlarge and turns the big toe toward the other toes. A painful, reddened area forms near the joint. Bunions can be caused by tight or high-heeled shoes that compress the toes. Other foot problems, such as flat feet, may contribute to bunions. The tendency to develop bunions may appear to be inherited, although the structure of the foot (e.g., flat feet) is inherited, not the bunion.
Hammertoe. Occurs when compression forces the lesser toes to bend over in a claw shape, shortening their tendons. They are usually caused by shoes that compress the toes. Conditions that affect the muscles and nerves, such as diabetes and arthritis, may contribute to the development of hammertoe.
Metatarsalgia. Pain in the ball of the foot, which may be caused by bunions, hammertoes, poorly fitting shoes or high-impact athletics such as running.
Plantar warts. These warts grow from a virus on the sole (plantar surface) of the foot. A wart on a finger will grow outward, but because of the pressure of standing, plantar warts grow inward. They become painful and may spread to form other warts.
Trauma. The feet and ankles are susceptible to breaks or stress fractures of the bones, joint dislocations, and strains and tears of the ligaments and tendons. The most common tendon injury in the foot is to the Achilles tendon, which connects the calf muscle to the heel. Although most of the tendon is in the calf and ankle, the injury usually causes heel pain. Jumping, running or abrupt movements can strain, tear or even rupture the tendon.
Common ankle injuries include stretching, partial tear (sprain) or complete tear to a talofibular ligament or calcaneofibular ligament. Ankle impingement syndrome involves acute trauma or chronic strain (e.g., stepping in a hole, playing sports) that causes bony or soft-tissue compression in the ankle.
Arthritis. Arthritis is inflammation of the joints. Each foot has 33 joints and bears enormous weight, so it is quite susceptible to arthritis. Arthritis in the foot may cause pain, swelling, stiffness and limited range of motion. Of the many forms of arthritis, those that often involve foot pain include:
Osteoarthritis (OA). A gradual breakdown of cartilage in the joints. This is the most common form of arthritis, but it tends to affect the hands, knees, hips and spine more than the feet.
Gout. A type of arthritis where deposits of uric acid build up in joints. The metatarsal-phalangeal joint (big toe joint) is the most common site for gout attacks, which can cause acute pain, swelling and redness.
Rheumatoid arthritis (RA). A debilitating autoimmune disease that can deform bones and tendons. The foot joints are among the first affected by RA.
Reiter’s syndrome. A form of infectious arthritis that can involve heel spurs or other abnormal growths in bones of the feet.
Ankylosing spondylitis. A form of arthritis that often begins in the sacroiliac joints between the lower back and pelvis, and that can also affect the hips, knees, ankles and shoulders.
Diabetes. People with diabetes may have long-term damage to their nervous and circulatory systems that affect the feet. Diabetic neuropathy is a type of nerve disease. When nerves in the legs and feet are damaged, a person may not feel pain or pressure. Consequently, patients may not notice an ulcer or problem that develops in their feet. These patients are thus more susceptible to injury due to numbness. Some types of neuropathy can also cause pain in the feet, characterized by tingling or burning sensations. Many diabetes patients with neuropathy have overly sensitive feet and even the slightest touch results in pain (allodynia).
Diabetes patients frequently have impaired circulation, such as peripheral arterial disease, particularly in their legs. Without good blood flow, a cut or infection in the foot heals more slowly. Diabetic foot ulcers can worsen and infect the foot and leg. Eventually, an untreated ulcer may require amputation of the foot. Diabetic patients with impaired sensation may also develop Charcot foot, in which minor trauma goes unnoticed, worsens and leads to deformity.
Heel conditions. Pressure on the heel causes specific types of pain:
Plantar fasciitis. The plantar fascia is a connective tissue that runs along the bottom of the foot from the heel to the ball of the foot. When the fascia is overstretched, tiny tears may cause inflammation or degeneration over time. The condition causes pain in the heel and just in front of it, usually after getting out of bed or after standing for long periods of time. It is common in athletes and people with flat feet.
Heel spurs. Small outgrowths on the heel bone.
Haglund’s deformity. A painful bump on the back of the heel caused by shoes with rigid backs.
Inflammation. The soft tissues and sacs (bursae) of the foot are subject to pain from inflammation. Inflammation can occur in the bursae as bursitis and in the tendons as tendinitis. Both may cause pain in the heel and it may be difficult to distinguish between the two. Enthesitis, inflammation of entheses, the sites where tendons or ligaments attach to bone, may be more common in people with other musculoskeletal conditions such as plantar fasciitis, Achilles’ tendinitis or arthritis.
Athlete’s foot (tinea pedis). A fungal skin infection that usually occurs between the toes. The fungus grows in warm, moist places such as showers or locker rooms and can spread on the feet because shoes also provide an environment that encourages fungal growth. Athlete’s foot involves itchy, scaly skin, followed by inflammation and blisters that can be swollen and painful.
Nerve problems. A pinched nerve in the leg or back – for example, sciatica resulting from a herniated disc, spinal stenosis or degenerative disc disease – can cause pain radiating to the foot. Other causes of nerve pain in the foot can include:
Neuroma. An abnormal swelling or growth on a nerve. It may cause a burning sensation in the foot, pain between the toes or a sensation of a stone in the shoe.
Tarsal tunnel syndrome. Similar to the carpal tunnel syndrome that affects the wrist, but it is caused by compression of a nerve in the foot and may cause pain along the bottom of the foot.
Complex regional pain syndrome. A chronic pain condition in a leg (or arm) that usually occurs after significant trauma to the limb.
Congenital conditions. Many patients are born with flat plantar arches or high-arched feet, which themselves may not cause pain but predispose to a number of other conditions that can cause pain. Inherited diseases such as Charcot-Marie-Tooth disease, which damages the peripheral nerves, can cause foot pain and weakness.
High cholesterol. A painful Achilles tendon may signal a common but little-known inherited condition involving excess cholesterol, familial hypercholesterolemia. This condition involves deposits of cholesterol in the tendons as well as the arteries.
Common tests performed for foot pain
A physical examination performed by a physician or podiatrist (foot specialist) can help identify the source of foot pain. A physician can identify many foot problems by sight and may be able to detect the source of others with palpation (feeling).
The physician may ask the patient to walk and flex the foot to identify the source of pain and assess the patient’s ability to move the foot. Shoes may also be examined for adequate support and correct fit. The physician may assess sensation with a filament or other device.
Certain tests are commonly used to investigate foot pain. Some of these include:
X-rays. An image of the foot is produced on special film or a fluorescent screen, using low doses of radiation. X-rays are useful for identifying bone fractures and misalignments.
MRI (magnetic resonance imaging). This noninvasive or minimally invasive test uses powerful magnets to produce images on a computer screen. MRIs are used for bone and soft tissue problems, especially for slight fractures called stress fractures that may not be immediately visible on an x-ray.
Synovial fluid analysis. A needle is used to take a sample of fluid from a joint. It can be used to detect some forms of arthritis, such as rheumatoid arthritis and gout.
Bone scan. This type of radionuclide imaging identifies areas of breakdown, infection or abnormal growth.
Blood tests. A cholesterol test can reveal whether Achilles tendon pain is due to familial hypercholesterolemia.
Electromyography. This is seldom needed to diagnose neuropathy but can be used if needed.
Relief and prevention options for foot pain
Most painful foot conditions may be relieved or even avoided with some simple hygiene measures. People should wash and dry their feet every day and inspect them for any irregularities such as cuts or calluses. They should wear shower shoes in public showers, locker rooms or near swimming pools and avoid going barefoot in these areas.
Properly fitting shoes may alleviate many foot problems. Shoes should support the heel and arch and have adequate room for the toes without compressing them. Foot size can change even for adults, so people are advised to have their feet measured once a year. If the feet are different sizes, shoes should be bought to fit the bigger foot. A person should not wear the same shoes every day, but should alternate them to allow the shoes to air out. The use of high-heeled shoes should be minimized in duration and frequency.
Many foot injuries and sprains may be treated with the RICE principles:
Rest the foot.
Ice the foot.
Compress the foot.
Elevate the foot.
Other common treatments include:
Medications. Minor foot pain from strain or arthritis may be treated with medications such as nonsteroidal anti-inflammatory drugs (NSAIDs). For more severe pain, prescription NSAIDs may be given. Antifungal medications are typically used for athlete’s foot and nail infections. Corticosteroids, either in pill form or injections, may help reduce inflammation associated with conditions such as with plantar fasciitis or arthritis. People with gout need to reduce the amount of uric acid in their systems, either by adjusting their diets or with prescription medication.
Foot products. Over-the-counter products such as pads, inserts and moleskin can help painful conditions such as corns, calluses and plantar warts. Arch supports may help the pain of plantar fasciitis by redistributing the weight along the foot. Prescriptions are also used for more specialized shoe inserts called orthotics to alleviate some foot problems.
Stretching before exercise. Proper stretching may also alleviate and prevent foot pain. People should warm up the feet and legs with stretching before exercise. People with plantar fasciitis may experience some relief if they stretch their foot muscles before getting out of bed in the morning, the time when their pain is most severe.
Diabetic foot care. People with diabetes must be especially vigilant with foot care. They should regularly have their feet checked by a physician or podiatrist. They should also seek trained salespeople when buying shoes to obtain a proper fit. Diabetes patients with problems such as foot ulcers should seek treatment immediately. Physicians treat foot ulcers by removing dead skin and tissue (debriding) and applying medications or dressings. Left untreated, foot ulcers can worsen with an infection that may eventually require amputation. Diabetic patients are also more prone to infections because of impairment in the immune system.
Immobilization. Sometimes foot fractures and sprains must be immobilized with a cast or splint. The cast immobilizes the foot and the person uses crutches to walk to keep weight off the foot, usually for several weeks or months. Achilles tendon sprains may require a cast.
Surgery. Some tendon tears require surgery to reconnect the tendon, followed by casting. Bunions and hammertoes may also require surgery. Bunion surgery may involve removal of any protruding bone and realignment of the toe joint. For hammertoes, a surgeon may realign the toes to help rebalance the tendons and joints. Ankle joint replacement (arthroplasty) is sometimes performed in cases of severe arthritis. After any foot surgery, a patient may need physical therapy to help restore function.
A new approach to treating plantar fascitis, shockwave therapy, which has long been used for conditions such as kidney stones, has demonstrated effectiveness in reducing heel pain.
Questions for your doctor regarding foot pain
Preparing questions in advance can help patients have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following questions about foot pain:
What condition is causing my foot pain?
Can my foot pain be related to other pain I am experiencing?
Are there exercises to alleviate my foot pain?
Will medications help my pain?
What kind of shoes should I wear to help my foot pain?
Will orthotics help me?
Will my bunions, corns, calluses or hammertoes get worse without treatment?
Will physical therapy help my condition?
Could surgery be necessary if noninvasive treatments don’t help me? Can my condition return after surgery?
