Most people suffer from foot pain sometime in life. Foot pain indicates something is wrong with the internal structures of the foot, or with how the foot is interacting with external influences.
For being so small, the human foot is one of the most complex parts of the body. Our feet are made up of 26 bones, 33 joints, and hundreds of muscles, ligaments, tendons, and nerves. By age 50, the average person will have walked or run 75,000 miles, primarily on hard surfaces. Over time, this contributes to the breakdown of the skin and protective fat pads that support the foot.
How and where foot pain occurs offers clues your pain management doctor will use to discover possible causes of the pain, and treatments to relieve the pain.
Foot pain is pain or discomfort anywhere on the foot. Although mild foot pain often responds well to home treatment, it can take time to resolve. However, people experiencing severe foot pain should have a pain management doctor evaluate their pain, especially if it follows an injury. Foot pain can affect the heel, toes, arch (underside of the foot), instep (top of foot), and the bottom of the foot (sole). Also, foot pain can be the result of overuse, an injury, a fracture, a sprain, and nerve damage. Any of these can cause inflammation and pain, and be debilitating to an active lifestyle.
What Causes Foot Pain?
There are many types of foot problems affecting various parts of the foot. In some cases, foot pain symptoms can be related to a medical condition that’s unrelated to the foot, improper foot function, or poorly fitting shoes.
Therefore, to identify the cause of foot pain, the source of the main must be determined. The source might be due to the foot structure (bone, tendons, ligaments, muscles, and nerves), as well as disease, trauma, or even daily footwear.
The bones of the foot can cause foot pain, including bone spurs and stress fractures.
Bone spurs, or osteophytes, are bony projections that can develop along the edges of the bones in the feet. Bone spurs, typically the result of arthritis, can be very irritating to surrounding nerves, and cause a significant amount of pain.
An example of a broken bone is an ankle joint fracture, which is a break in any of the three bones that make up the ankle joint. The break can be minor, causing only pain and swelling, or so severe that it is impossible to place weight on the foot. Broken bones in the foot can be the result of falling from a height and landing on the feet, or from jumping.
Tendons and Ligaments
Tendons attach muscles to other body parts, usually bone. The stretching or tearing of a tendon or muscle tissue is a “strain.” Turf toe is a common athletic injury in which the tendon under the joint at the base of the big toe is strained.
Ligaments attach bones together at the joints and stabilize the bones. The stretching or tearing of a ligament is a “sprain.” An ankle sprain is an example of a common, painful injury that occurs when one or more of the ankle ligaments are forced to stretch beyond their normal range of motion.
Muscle is tissue that can contract, producing movement in the body. The muscles and the thin sheath (fascia) that enclose it can be strained by overstretching, overuse, or overloading, which can cause foot pain.
An example of a muscle causing foot pain is hammertoe. A muscle imbalance causes the toe to bend at the middle joint so that it resembles a hammer. The second toe is most likely to be affected, but this deformity can occur in other toes as well. Sometimes, affecting more than one toe.
Morton’s neuroma is an example of foot pain that results from nerve irritation. A Morton’s neuroma is a thickening of the nerve that supplies sensation to the area between the toes. It is not cancerous but can be very painful. Most often, neuromas develop between the bones leading to the third and fourth toes; but can also occur between the second and third toes.
Infectious disease, viruses, fungi, and bacteria can also cause foot pain. Plantar warts on the bottom of the foot are the result of a virus that causes irritation and foot pain. Many systemic diseases such as diabetes, lupus, gout, and rheumatoid arthritis can also cause foot pain. A fungus causes athlete’s foot and can lead to foot irritation and pain.
Injury to the bones and joints of the foot can be from a single blow or twist to the foot. It can also be the result of repetitive trauma that causes a stress fracture. Trauma from an acute injury, or accumulative repetitive injuries, is another common cause of foot pain. Running on uneven surfaces or surfaces that are too hard can cause microtrauma injuries.
A blunt-force injury such as someone stepping on the foot may result in damage to the muscles and ligaments in the foot. Direct blows to the foot can cause bruising (contusion), as well as breaking of the skin, and fracturing of bones.
Injuries can also occur from wearing shoes that fit incorrectly. Poorly fitting shoes can cause common foot problems like blisters, bruising, and can even be a source of athlete’s foot. Over time, poorly fitting shoes (loose or tight) can cause bunions, corns, and calluses from the friction created by the foot rubbing against the shoe, sock, or another toe. Shoes that don’t fit properly can also irritate nerves and joints, and cause a misalignment of the toes.
What are the Symptoms of Foot Pain?
The symptoms of foot pain vary, depending on the cause and location of the pain. The onset of pain, whether suddenly or over time, is an important indicator of the cause of the problem.
Details a pain management doctor will want to know to help identify the cause of foot pain include:
Is there pain with movement of the affected area?
Does placing weight on the foot make the pain worse?
Does the pain force limping or otherwise alter the usual walking pattern?
Loss of function and areas of discoloration of the foot can be signs of a strain. A blow to the foot that results in pain, discoloration, swelling, and changes in the regular walking pattern may indicate more severe damage such as a fractured bone.
Here are some typical examples of foot pain symptoms:
Plantar fasciitis causes pain and tenderness in the bottom of the foot. The sensitivity is usually toward the heel, but the entire sole can be affected. A sign of abnormal tension or tightness that can lead to plantar fasciitis is a bony prominence (heel spur) that develops where the inflamed plantar fascia attaches to the heel bone (calcaneus). Plantar fasciitis usually hurts the worst in the morning upon getting out of bed.
Heel spurs hurt while walking or standing. Many people have them, but most don’t have pain. People with flat feet or high arches are more likely to experience pain from heel spurs.
Stone bruises are deep bruises of the fat pad of the heel or ball of the foot. It’s most often due to an impact injury, but it can also happen after stepping on a hard object. The pain feels like walking on a pebble.
Heel fractures are usually a high-impact injury, such as an injury resulting from a fall or an accident. In some cases, the heel bone may shatter. The symptoms are heel pain, bruising, swelling, or trouble walking.
Ball of the Foot Pain
Metatarsalgia causes pain and inflammation in the ball of the foot. Ill-fitting shoes are the usual cause, but it can also result from strenuous activity, such as running or jumping. It’s sometimes called a stone bruise as well.
Morton’s neuroma causes a thickening of the tissue around the nerves between the base of the toes (usually between the third and fourth toes). The typical pain is an odd sensation or numbness over the ball of the foot. Women have it more often than men, as a result of wearing high heels or very tight shoes.
Sesamoiditis. Just behind the big toe are two bones that are connected by tendons called sesamoids. When the tendons surrounding the bones are injured, they become inflamed. This condition is a form of tendinitis, and common with runners and ballet dancers.
Plantar fasciitis, the most common cause of arch pain can affect the heel, arch, or both. There is stiffness, and the pain can be dull or sharp. The pain may be worse in the morning when taking the first few steps, after standing or sitting for a while, or when climbing stairs.
Fallen arches (also called flat feet) occur when the arches of the feet flatten out (while standing or walking). This condition is not always painful, but people who experience pain from fallen arches feel it in the heel or arch of the foot. The condition can lead to problems with the ankles and knees.
Gout (a form of arthritis) can cause pain in the toes. Crystals collect in toe joints, causing severe pain and swelling. The big toe is most often affected.
Bunions are a bony bulge along the edge of the foot, next to the base of the big toe. It’s associated with misalignment of the first toe joint. Anyone can get them, especially those who wear ill-fitting or uncomfortable shoes. It often shows up as people age. People with bunions also tend to have hammertoes as well.
Hammertoe occurs when the first joint of the second, third, or fourth toe is cocked upward, and the middle joint bends downward, creating a hammer-like appearance and making walking difficult or painful. It can come from a muscle imbalance, but it can also be brought on by wearing ill-fitting shoes.
Claw toe occurs when the first joint is cocked upward, and both the middle joint and the tiny joint at the end of the toe are curled downward like a claw. It’s often the result of nerve damage from diseases like diabetes or alcoholism, which weakens foot muscles. Without special footwear to accommodate the claw toe, irritation and calluses may develop.
Ingrown toenail is when skin, on one or both sides of a toenail, grows over the nail. It can be painful and may lead to an infection.
Turf toe is pain at the base of the big toe. It’s an overuse injury usually caused by strain. Turf toe may also be a form of sesamoiditis or a sesamoid fracture.
Toe sprain can happen after jamming or stubbing a toe, thereby damaging the tendon or soft tissues of the toe. The condition causes both pain and swelling.
Toe fractures, or a broken bone, can happen in any of the bones of the toes. The symptoms are pain, swelling, and discoloration.
Hallux rigidus (stiff big toe) is a type of arthritis at the base of the big toe. Symptoms are pain and stiffness of the joint that worsens over time.
Corns are thick buildups of tough skin at a point of irritation or pressure on the foot or toe. They sometimes look like horns. The raised area causes tenderness or pain under the skin.
Calluses are wider areas of tough skin buildup on the toes or feet. They occur because of irritation or pressure. Sometimes the raised area is tender or can be painful.
Sesamoid fracture is a break in the small bones (sesamoids) that are embedded in tendons attached to the big toe. Pain in and around the big toe is the primary symptom.
Pain on the Foot’s Outer Edge
The outer edge of the foot (fifth metatarsal bone) is a commonly broken bone in the foot. Pain, swelling, and bruising along the outer foot edge after an injury are the primary symptoms.
Foot Pain That’s Anywhere or Everywhere
Neuropathy, or nerve damage in the feet, is most often caused by diabetes. The pain can be burning, stinging, or feel like electricity. It can happen anywhere in the feet.
Tendinitis is inflammation and irritation of tendons, which are the bands attaching muscles to bones. Tendons run along all the surfaces of the foot and, if damaged, cause a dull ache.
How is Foot Pain Diagnosed?
If foot pain lasts longer than a week, despite home treatment, it’s time to see a pain management specialist. The doctor will ask questions about the symptoms, how the foot may have been injured, about physical activity, and about any past injuries to the feet or ankles.
During a physical examination, the doctor may press on different areas of the foot to isolate the location of the pain. The exam may include having the patient walk and perform simple foot exercises to evaluate the range of motion.
If the doctor suspects a broken bone, fracture, or bone spurs, an X-ray of the foot is necessary for identifying a break or fracture. Other tests the doctor may conduct include:
Blood tests, which can detect conditions such as gout.
An MRI to look for nerve damage.
How is Foot Pain Treated?
Treatment for foot pain depends on the exact cause of the pain. Typical treatments include:
Resting by not placing weight on the affected foot.
Elevating the affected foot.
Wearing shoes that fit correctly, are comfortable, and protect the feet.
Wearing shoes with good arch support and a cushioned sole.
Wearing orthotic shoe inserts.
Removal of plantar warts, corns, or calluses.
Physical therapy to relieve tight or overused muscles.
Medications like Lyrica (pregabalin), Neurontin (gabapentin), and Cymbalta (duloxetine).
Lumbar epidural steroid injections.
Lumbar sympathetic blockade.
Neuromodulation via a TENS unit or spinal cord stimulation. This groundbreaking technology works by introducing an electrical current into the epidural space of the spine near the source of chronic pain impulses to block pain signals to the brain.
Home treatment can help with foot pain in many cases. The following are self-care treatment options that can help relieve foot pain:
Apply ice to reduce pain and swelling.
Keep the painful foot elevated as much as possible.
Wear shoes that properly fit the feet, and are the right shoe for the activity.
Use foot pads or other orthotics to prevent rubbing and irritation of the painful area.
Use an over-the-counter pain medicine, such as ibuprofen or acetaminophen.
Is It Possible to Prevent Foot Pain?
The following steps can help prevent foot pain and avoid future problems:
Wear comfortable, properly fitting shoes, with good arch support and cushioning.
Wear shoes with plenty of room around the ball of the foot and a wide toe box.
Avoid narrow-toed shoes and high heels.
Wear sneakers as often as possible, especially when walking.
Replace running shoes frequently.
Warm up and cool down when exercising. Always stretch first.
Increase the amount of exercise slowly over time to avoid excessive foot strain.
Lose weight, if overweight.
Perform exercises to strengthen the feet, and help avoid potential foot problems.
People who work in manufacturing environments, foodservice and food preparation, health care, retail, personal care and grooming, teaching and other professions that require being on the feet for extended periods of times are vulnerable to foot and lower leg fatigue. Taking proper care of the feet is important. Here are some tips for taking proactive care of the feet and helping to prevent foot injuries:
As much as is possible and practical, rotate several pairs of shoes or boots. Some components of shoes and boots are made of plastic materials that need “recovery” time. If feet sweat, the footwear may get damp. Alternating footwear each day can help it dry out, regain its shape, and provide better protection.
Consider using support or compression hosiery. Standing for extended periods without moving causes the veins in the feet and legs to work harder to return the flow of blood to the heart. Gravity works against this flow, and support or compression hosiery can assist the blood flow in the veins and help reduce the feeling of fatigue and soreness in the feet and lower legs. It is a good idea to consult a physician to make sure this type of hosiery is right for you.
If work requires standing for extended periods of time, take advantage of opportunities to sit for short periods. Try to move around and not stand still for extended periods. As much as possible, sit down for breaks and meals, and elevate your feet if possible.
Do simple foot exercises throughout the day, if possible.
Raise the heels. This exercise can help relieve cramping from standing for extended periods and can strengthen the calf muscles. In a standing position, roll up on the balls of the feet, lifting the heels. Hold this position for about ten seconds. Repeat the exercise ten times.
Point the toes. Lift one foot and plantar flex it (point it down toward the floor). Then flex the foot. Repeat with the other foot. This will help stretch the muscles in the feet to help reduce aches and enhance circulation.
Roll a tennis ball or golf ball under the forefoot and apply light pressure for several minutes.
Do a sitting stretch. Remove shoes and cross one leg over the other so that the ankle is resting on the thigh of the opposite leg. Hold the toes and bend them back toward the shin, stretching the plantar fascia.
Do a self-foot massage. Start with the toes, and massage in circular motions with the thumbs. Continue working the arch of the foot and move toward the heel, applying pressure with the fingers and palms of the hands.
Practice good posture. When standing, try to keep the back as straight as possible and the shoulders back (do not slouch forward). Keep the shoulders in line with the spine and hips.
The time to contact a medical professional is if:
There is sudden, severe foot pain.
The foot pain began following an injury, especially if the foot is bleeding, bruised, or it hurts to put weight on the foot.
There is redness or swelling of the joint, an open sore or ulcer on the foot, or the patient has a fever.
There is pain in the feet, and the patient has diabetes or a disease that affects blood flow.
The injured foot does not feel better after using at-home treatments for one week.
Novus Spine & Pain Center
Novus Spine & Pain Center is in Lakeland, Florida, and specializes in treating foot pain. By using a comprehensive approach and cutting-edge therapies, we work together with patients to restore function and regain an active lifestyle, while minimizing the need for opiates.