Orthopedics Leg, Foot & Ankle Causes of Pain Causes of Bottom-of-Foot Pain and Treatment Options Everything you need to know about pain in the bottom of your foot By Laken Brooks Laken Brooks Laken Brooks (she/hers) is a freelance writer with bylines in CNN, Inside Higher Ed, Good Housekeeping, and Refinery29. She writes about accessibility, folk medicine, and technology. She served as a Fulbright Scholar at the University of Szczecin, Poland and has worked with various museums and nonprofits. Learn about our editorial process Updated on March 17, 2022 Medically reviewed Verywell Health articles are reviewed by board-certified physicians and healthcare professionals. These medical reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Eva Umoh Asomugha, M.D. Medically reviewed by Eva Umoh Asomugha, M.D. LinkedIn Eva Umoh Asomugha, MD, is a board-certified orthopedic surgeon who specializes in all conditions involving the foot and ankle region. She is based in northern Virginia. Learn about our Medical Expert Board Print Table of Contents View All Table of Contents Causes When to See a Healthcare Provider Diagnosis Treatment Prevention Frequently Asked Questions The bottom of your foot strikes the ground with every step. So when it hurts, the pain can really disrupt your life. In fact, 77% of adults say that foot pain has affected their life in one way or another. Pain in the bottom of your foot can begin suddenly due to an injury. It can also develop gradually over time due to chronic stress on your feet. Depending on the cause, you may feel a burning sensation, shooting pain, a constant ache, or something else. This article explains your foot's anatomy and common causes of pain. It also covers when to see your healthcare provider and a few possible treatments that may help ease bottom-of-foot pain. Verywell / Theresa Chiechi Causes Your feet are fairly complex. Each foot has: 26 bones30 jointsAlmost 100 muscles and ligaments All of these parts, from your toes to your Achilles tendons, help you stand upright, balance, and walk. Given this, a problem with your feet can cause irritation and pain any time you stand or take a step. The following foot conditions can cause pain specifically in the bottom of your foot. Common Given the many parts of the foot, it's perhaps no surprise that there are several common problems that can cause bottom-of-the-foot pain. Plantar Fasciitis The plantar fascia is a band of tissue that stretches from your heel bone, through the arch of your foot, and to the base of your toes. One of the most common causes of foot pain is plantar fasciitis, or inflammation of the plantar fascia. This causes sharp, stabbing pains in your heel or sole.Factors that increase your chances of developing plantar fasciitis include: Having flat feet or a very high archBeing overweight or obeseWearing shoes with poor arch supportWalking, running, or standing a lot on hard surfacesWalking barefootBeing pregnantHaving pronated feet, meaning that your feet roll a bit inward with each step Plantar fasciitis symptoms are often most severe in the morning or after inactivity. When you get out of bed, you may feel a sharp pain with the first step. Metatarsalgia There are five metatarsal bones in each foot (one for each toe). These long bones in your forefoot connect your ankle to your toes. The metatarsals help form the arch of the foot, which are essential for weight-bearing and walking. Metatarsalgia is the term for pain and inflammation in the ball of the foot. This is the area between the arch and the base of your toes, under your metatarsal bones. The pain is often described as sharp, aching, or burning pain in the ball of the foot. It may worsen when you stand, run, walk, or flex your feet. A study suggests that 80% of people experience metatarsalgia at some point. It is more common in people who do high-impact activities that stress the bottoms of the feet, like running or jumping. Older adults are more likely to develop metatarsalgia. Other factors that increase your chances of developing it include: Having high arches Having especially long bones in your feet Having hammertoes—a deformity in your second, third, or fourth toes, in which the toe's middle joint bends down instead of lying flat Playing high-impact sports that involve running or jumping Being overweight or obese Frequently wearing high heels or shoes that don't fit right Having problems with blood flow Having gout Having diabetes Peripheral Neuropathy For millions of people, foot pain comes from the nervous system. Peripheral neuropathy is nerve pain that stems from nerves that are away from the spinal cord and on the outer edges of your body. It is caused by damaged or misfiring nerves. Certain chronic illnesses that damage your peripheral nerves can trigger this condition, such as diabetes, severe alcohol misuse, Lyme disease, or autoimmune diseases like lupus. It can also be caused by an injury to your peripheral nerves, such as a gunshot wound, an electrical injury, or a drug injection injury. The pain is often described as tingling, burning, or stabbing sensations in the feet or hands that may spread upward into your legs or arms. Neuroma A neuroma is an abnormal clump of nerve cells. It forms between the toes, usually after an injury. Women are more likely than men to have a neuroma. Other factors that increase your chances of developing a neuroma include: Playing high-impact sports that involve running or jumping Wearing shoes without proper support Frequently wearing high heels Frequently wearing tight shoes or restrictive footwear, such as the shoes worn in ballet or for rock climbing Having hammertoe or a bunion, a bony bump that forms on the outside of the big toe A neuroma may feel like a pebble in your shoe. It's most common between the second and third toes, or the third and fourth ones. Symptoms include burning pain in the ball of the foot, as well as numbness and tingling that radiates into your toes. Sesamoiditis or Sesamoid Stress Fracture The sesamoids are two small bones beneath the pad of the big toe. They help support the tendon that flexes this toe. These bones can get overloaded. That causes sesamoiditis—dull pain and inflammation at the base of the big toe. If the overload is severe, you may develop a stress fracture. Factors that increase your chances of developing sesamoiditis include: Playing a sport that puts a lot of pressure on the ball of the foot, like running, ballet, or tennisHaving high archesFrequently wearing high heels Rarer Though less common, these additional causes must also be considered. Tarsal Tunnel Syndrome The tarsal tunnel is a narrow space on the inside of the ankle. Many arteries, veins, tendons, and nerves that allow the foot to move in different directions run through the tarsal tunnel. One of these nerves is the posterior tibial nerve, which is responsible for the sensations you feel on the bottom of your foot and in your toes. Tarsal tunnel syndrome occurs when the posterior tibial nerve gets compressed (squeezed) in the tarsal tunnel. This causes pain, numbness, and tingling in the foot. Factors that increase your chances of developing tarsal tunnel syndrome include: Having flat feet Swelling in your ankle due to an ankle sprain Having diabetes, arthritis, or another disease that causes swelling and nerve compression Having a varicose vein (a twisted and enlarged vein), a ganglion cyst (a noncancerous cyst over a joint or tendon), a swollen tendon, or a bone spur that presses on the posterior tibial nerve Guillain-Barré Syndrome (GBS) This rare autoimmune disorder can come in several different forms. The most common form in the United States is acute inflammatory demyelinating polyradiculoneuropathy (AIDP). AIDP is often triggered by an infection, such as the flu or a respiratory illness. It can also be triggered by an immunization, but this is extremely rare. Around 40% of Guillain-Barré syndrome cases are triggered by a bacteria called Campylobacter jejuni, which causes diarrhea. GBS tends to set in a few weeks after the infection took place. In GBS, your immune system attacks your body's peripheral nerves, causing muscle weakness. In some cases, it can result in permanent nerve damage, paralysis, or death. For many people, the first sign of GBS is pain, weakness, or tingling in their toes, feet, or legs. These sensations tend to progress over the coming hours, days, to weeks, gradually spreading upwards into the arms and upper body. The symptoms may worsen until the person cannot use their muscles at all. Anyone can develop GBS, but it is more common in men and adults older than 50. Your risk is also higher if you have had a recent surgery or have a preexisting autoimmune disorder. Note that campylobacter is often found in undercooked poultry. Eating raw or undercooked chicken (such as in chicken tartare or chicken sashimi) places you at an increased risk of campylobacter infection. When to See a Healthcare Provider Sometimes foot pain goes away on its own in a few days. Other times, it becomes chronic. That can have a big impact on your life. See a healthcare provider if you have: New pain that lasts more than a few days Loss of sensation or tingling Existing chronic foot pain that gets worse Pain that makes it uncomfortable and difficult to walk or doing other activities An injury that causes foot pain Dizziness or nausea related to foot pain (which could indicate a bone fracture) Fever or swelling with foot pain (which could indicate an infection) Diabetes or another condition that affects your nerves In general, your primary care provider (PCP) should be the first person you see for any foot pain, injury, or other condition you are experiencing. Based on their assessment, they may point you to a podiatrist (foot doctor) or orthopedist (bone doctor). Your PCP may point you to a neurologist if they suspect your foot pain is due to a nerve condition like peripheral neuropathy or Guillain-Barré syndrome. There are some instances in which you should go straight to the emergency room. Don't hesitate to go to the ER if: You have severe pain or swellingYou are unable to put any weight on your foot or walkYou have numbness or loss of sensationThe pain or tingling comes on suddenlyYou feel burning or tingling in your feet after being exposed to toxinsYou had a flu or other infection in the days or weeks before your pain began, which could indicate Guillain-Barré syndromeYou have an open wound, or your wound has signs of infection, such as pus, redness, or red streaks leading from it Diagnosis To identify the cause of your foot pain, your healthcare provider will likely examine your foot. They'll look for areas of pain or tenderness. They'll also check for inflammation, bruising, or other injuries. They may watch you walk and ask you to stretch your toes. If your provider suspects you have peripheral neuropathy, Guillain-Barré syndrome, or another condition related to your nerves, they may perform nerve conduction studies (NCS). With this, your provider attaches small metal wires (electrodes) to your skin. The wires release tiny shocks that trigger your nerves. The electrodes then measure the speed and strength of your nerve response. During the NCS, your provider may also do an electromyography (EMG). Your provider inserts a small needle through your skin and into your muscle. This allows them to measure the electrical activity in your muscles. Your provider may diagnose and treat you or refer you to a foot and ankle specialist. That may be a podiatrist or orthopedist. Imaging Depending on what your healthcare provider sees during the physical examination, they may order special imaging to diagnose the above conditions and/or rule out other issues. Possible imaging includes: X-ray to check for changes in the bones due to fractures, infections, or arthritis Computed tomography (CT) scan to check for changes in bones due to fractures, infections, arthritis, and deformities, along with soft tissue problems Ultrasound to check for neuroma, metatarsalgia, tarsal tunnel syndrome, plantar fasciitis, injuries in ligaments, tendons, and cartilage, and other soft tissue problems Magnetic resonance imaging (MRI) to check for plantar fasciitis, metatarsalgia, neuroma, and sesamoiditis, tarsal tunnel syndrome, and changes in soft tissues and bones due to arthritis, fractures, and infections X-rays and CT scans both involve radiation, which can harm an unborn child. If you are pregnant, make sure to let your healthcare provider know so that you can avoid these types of imaging. Differential Diagnoses A differential diagnoses (DDx) is the process in which your healthcare provider rules out all the other possible conditions that could explain your symptoms. During the DDx process, your provider may do several tests based on each possibility. For example, if your provider suspects you have sesamoiditis, they may also order medical imaging to rule out osteoarthritis, a dislocated sesamoid bone, or a compressed nerve near the sesamoid bones. That's because each of these conditions can result in the same kind of symptoms you are experiencing. Conditions that cause similar symptoms to neuroma include intermetatarsal bursitis (inflammation of the bursa sacs between the metatarsals), instability in the metatarsophalangeal (MTP) joint, and a tear in the plantar plate ligament. Medical imaging, such as an ultrasound or MRI, can help your provider rule these other conditions out. There are more than 100 causes of peripheral neuropathy. The DDx in this case involves identifying the cause of the nerve damage. The most common causes include diabetes and chronic alcohol abuse. If you have never been tested for diabetes, your provider will check your glucose (blood sugar) level with a blood test. Conditions that cause similar symptoms to metatarsalgia include Morton's neuroma, intermetatarsal bursitis, or stress fractures in the metatarsals. An MRI or ultrasound can help your provider rule these other conditions out. The DDx for plantar fasciitis includes osteoarthritis, a bruised heel, and a ruptured plantar fascia. It could also be tarsal tunnel syndrome. An MRI or ultrasound can help your provider rule these other conditions out. During the DDx for Guillain-Barré syndrome, your provider will likely consider the possibility of other conditions that can affect your peripheral nerves. This may include hypothyroidism (underactive thyroid) or a vitamin B deficiency. Treatment Treatment for foot pain depends on your diagnosis. You have several options. Healthcare providers usually recommend starting with conservative options and moving to other treatments as needed. Lifestyle The more significant your pain is, the more you might think that lifestyle won't have much of an effect. That's simply not true. There are many very effective strategies that can help. Shoe Inserts Supportive shoes or inserts can help relieve some foot pain, particularly for conditions like plantar fasciitis, metatarsalgia, and neuroma. In some cases, your healthcare provider may prescribe custom orthotic shoe inserts designed to fit and support your foot's distinct curves. Diet Starting an anti-inflammatory diet is ideal for anyone experiencing pain. It focuses on fruits and vegetables, fish, nuts, and whole grains. Foods with turmeric, lemon water, and antioxidants may help reduce foot inflammation. Weight Loss Being overweight or obese is linked to an increased risk of pain, inflammation, and other problems in your feet. Losing weight, if needed, can reduce the stress on your feet. Losing weight is especially important if you also have diabetes, which is a risk factor for peripheral neuropathy, metatarsalgia, tarsal tunnel syndrome, and more. Posture Many people find that improving their posture evens out the stress on their feet and improves their pain. Even if you have had poor posture for years, you can still improve it by making sure that your shoulders are pushed back and your weight is balanced evenly on both feet. If you tend to slouch, you can try wearing a posture brace to pull your shoulders back. You might find it helpful to set a frequent alarm to remind you to correct your posture too. Last but not least, stretches and strength-building exercises are a must for correcting posture. Stretching will release tension in your back, hips, and glutes and help you stand more evenly. Exercises that strengthen your core, back, and shoulders will help you stand taller and align your spine. Diabetes care involves regular exercise and keeping blood sugar under control. High-impact activities like running might add to your foot pain, though. In that case, low-impact activities like swimming, rowing, or Tai Chi might be a better option. 6 Simple Tricks to Sit With Optimum Posture Medications Over-the-counter pain relievers may help, too. They include: Tylenol (acetaminophen) Advil/Motrin (ibuprofen) Aleve (naproxen) Aspirin (acetylsalicylic acid) If conservative treatments fail, cortisone injections may work for: Plantar fasciitisSesamoiditisNeuromas Are Cortisone Injections Bad for You? For severe pain, you may be given an opioid (narcotic) drug such as: Tylenol with Codeine (acetaminophen/codeine) Vicodin (hydrocodone/acetaminophen) OxyContin (oxycodone) These drugs can be addictive. They aren't intended for long-term use. Use them only as prescribed. Peripheral neuropathy can be harder to treat than other foot conditions. It's generally treated with medications such as anti-seizure drugs and antidepressants. These change how your nervous system functions. Complementary and Alternative Therapies Complementary or alternative treatments may relieve foot pain, at least temporarily. These include: Acupuncture Electro-acupuncture (especially for plantar fasciitis) Massage Movement therapies like yoga or tai chi may help with muscle strength, flexibility, and balance. You can also try applying a cold or hot compress to reduce pain. Use ice for only 20 minutes at a time, up to three times a day. Don't put ice or gel packs directly against your skin. Physical Therapy Your healthcare provider may refer you to a physical therapist if your foot pain interferes with your daily life, activities, or mobility. The goal of physical therapy is to reduce your symptoms and the effect they have on your quality of life. To accomplish this, your physical therapist will put together a program that rehabilitates your foot so that you can walk and stand without pain. Your rehab program may involve stretches and exercises that improve your foot and ankle strength, balance, and range of motion. Physical therapy can help you manage your plantar fasciitis, metatarsalgia, neuroma, or sesamoiditis. In some cases, it may help with peripheral neuropathy. Surgery Surgery is typically a last resort for when all other treatment options fail to reduce your pain and other symptoms. A surgical procedure called a sesamoidectomy may be necessary for very severe cases of sesamoiditis that do not respond to physical therapy. This surgery involves removing the sesamoid bone. Surgery for plantar fasciitis is uncommon, but it may be necessary if your pain persists despite six to 12 months of physical therapy. The surgery involves cutting part of the plantar fascia to release tension and ease swelling. Severe neuromas that don't get better with therapy can be treated with a minimally-invasive procedure called a neurectomy. A small incision is made in the foot and the affected nerve is removed. Several possible surgeries can be done for severe metatarsalgia, depending on what has caused it. If a deformity is to blame, a metatarsal osteotomy can be done to realign the metatarsal bone(s). Surgery may be done for peripheral neuropathy, also depending on the cause. The minimally-invasive procedure involves dividing the affected nerve to relieve pressure. It can be done in an outpatient setting. Prevention You can't always prevent a foot injury or an illness that leads to foot pain. But there are things you can do in your everyday life to reduce your risk of discomfort: Wear orthopedic inserts or supportive shoesCarefully walk and stretch after an injuryAvoid excessive running, jumping, or high-impact activities Strive to maintain a healthy weightAvoid foods that trigger inflammation, such as sugar and highly processed foodsWork on having great posture if you don't alreadyListen to your body and take pressure off your foot when you need it Taking care of your overall health goes a long way in preventing foot pain. In addition to eating a healthy diet and exercising regularly, carefully managing any chronic conditions you have is key. If you smoke cigarettes, do all you can to quit. Cigarette smoking promotes chronic inflammation. Similarly, if you think you may be dependent on alcohol, consult with your healthcare provider. Resolving an alcohol dependence can reduce your risk of peripheral neuropathy along with many other health conditions. Summary There are several possible causes of bottom-of-the-foot pain. Symptoms can vary depending on what's to blame. For example, plantar fasciitis causes sharp pain in the heel or sole. Metatarsalgia causes pain in the ball of the foot. Peripheral neuropathy can cause pain on the bottom of the foot paired with tingling or burning, and so on. Finding the cause of bottom-of-the-foot pain may include a physical exam and X-rays or other imaging. Treatment may involve pain relief, lifestyle changes, physical therapy, and in severe cases, surgery. A Word From Verywell Foot pain can impose a lot of limits. Luckily, many problems that commonly affect the feet are treatable. Work with your healthcare provider to figure out what's going on, then follow the treatment plan. You don't need to "just live with" foot pain. Frequently Asked Questions What causes peripheral neuropathy in the feet? Neuropathy can be caused by:InfectionCertain medications, like chemotherapyCertain cancers and benign tumorsAlcohol use disorderExposure to toxinsVitamin imbalancesKidney and liver disordersHormonal imbalancesAutoimmune diseases that attack nervesVascular (vein) and blood problemsDiabetesInjuries that cause nerve compression How common is peripheral neuropathy? At least 20 million Americans have some form of peripheral neuropathy. Symptoms of peripheral neuropathy vary widely, so it is often misdiagnosed. What causes a sesamoid stress fracture? Sesamoid stress fractures are caused by overusing the tendons around the sesamoid bones. This injury is common in athletes. It can also be caused by high foot arches, flat feet, or feet that roll inward when walking. Was this page helpful? Thanks for your feedback! Dealing with joint pain can cause major disruptions to your day. Sign up and learn how to better take care of your body. Click below and just hit send! Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit 28 Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. American Podiatric Medical Association. 2014 podiatric practice survey. Trojian T, Tucker A. Plantar fasciitis. Am Fam Physician. 2019 Jun;99(12):744-750. Ramachandra P, Kumar P, Kamath A, et al. Do structural changes of the foot influence plantar pressure patterns during various stages of pregnancy and postpartum?. Foot & Ankle Specialist. 2016 Dec;10(6):513-519. doi:10.1177/1938640016685150 Arie EK, Moreira NS, Freire GS, Dos Santos BS, Yi LC. Study of the metatarsal formula in patient with primary metatarsalgia. Rev Bras Ortop. 2015 Jul;50(4):438-444. doi:10.1016/j.rboe.2015.06.018 Winchester Hospital. Metatarsalgia. Johns Hopkins Medicine. Peripheral nerve injury. Ruiz Santiago F, Tomás Muñoz P, Pryest P, Martinez Martínez A, Olleta Prados N. Role of imaging methods in diagnosis and treatment of Morton's neuroma. World J Radiol. 2018 Sep;10(9):91-99. doi:10.4329/wjr.v10.i9.91 American College of Foot and Ankle Surgeons. Sesamoid injuries in the foot. Johns Hopkins Medicine. Tarsal tunnel syndrome. Centers for Disease Control and Prevention. Guillain-Barré syndrome. Reviewed December 2019. Hocker S, Nagarajan E, Rubin M, Wijdicks EFM. Clinical factors associated with Guillain-Barré syndrome following surgery. Neurol Clin Pract. 2018;8(3):201-206. doi:10.1212/CPJ.0000000000000451 Florida Podiatric Medical Association. What is podiatric medicine? Sims AL, Kurup HV. Painful sesamoid of the great toe. World J Orthop. 2014 Apr;5(2):146-150. doi:10.5312/wjo.v5.i2.146 Ganguly A, Warner J, Aniq H. Central metatarsalgia and walking on pebbles: Beyond Morton nueroma. AJR. 2018 Apr;210(4):821-833. doi:10.2214/AJR.17.18460 Lehmann H, Wunderlich G, Fink G, Sommer C. Diagnosis of peripheral neuropathy. Neurol Res Pract. 2020 Jul;2(1):1-7. doi:10.1186/s42466-020-00064-2 Turchin O, Lyabakh A. The differential diagnosis of metatarsalgia. 2019;4(1):48-52. doi:10.15674/0030-59872018448-52 Lurati A. Flat feet and a diagnosis of plantar fasciitis in a Marine Corps recruit. WHS. 2015 Apr;63(4):136-138. doi:10.1177/2165079915576923 Leonhard SE, Mandarakas MR, Gondim FAA, et al. Diagnosis and management of Guillain-Barré syndrome in ten steps. Nat Rev Neurol. 2019 Sep;15(11):671-683. doi:10.1038/s41582-019-0250-9 De Gregori M, Muscoli C, Schatman ME, et al. Combining pain therapy with lifestyle: the role of personalized nutrition and nutritional supplements according to the SIMPAR Feed Your Destiny approach. J Pain Res. 2016;9:1179-1189. doi:10.2147/JPR.S115068 Thiagarajah AG. How effective is acupuncture for reducing pain due to plantar fasciitis? Singapore Med J. 2017;58(2):92-97. doi:10.11622/smedj.2016143 Pearson JM, Moraes LVM, Paul KD, et al. Is fibular sesamoidectomy a viable option for sesamoiditis? A retrospective study. Cureus. 2019;11(6):1-12. doi:10.7759/cureus.4939 University of Michigan Health. Plantar fasciitis: Should I have surgery for heel pain?. Updated November 2020. Penn Medicine. Morton's neuroma treatment. Kaiser Permanente. Metatarsalgia. University of Michigan Health. Peripheral nerve surgery. Lee J, Taneja V, Vassallo R. Cigarette smoking and inflammation: cellular and molecular mechanisms. J Dent Res. 2012 Feb;91(2):142-149. doi:10.1177/0022034511421200 National Institute of Neurological Disorders and Stroke. Peripheral neuropathy fact sheet. Updated November 2021. Kaiser P, Guss D, DiGiovanni C. Stress fractures of the foot and ankle in athletes. Foot & Ankle Ortho. 2018 Aug;3(3):1-11. doi:10.1177/2473011418790078 Additional Reading Franettovich Smith MM, Collins NJ, Mellor R, et al. Foot exercise plus education versus wait and see for the treatment of plantar heel pain (FEET trial): a protocol for a feasibility study. J Foot Ankle Res. 2020;13(1):20. doi:10.1186/s13047-020-00384-1 Menz HB, Dufour AB, Casey VA, et al. Foot pain and mobility limitations in older adults: the Framingham Foot Study. J Gerontol A Biol Sci Med Sci. 2013;68(10):1281-1285. doi:10.1093/gerona/glt048 Menz HB, Dufour AB, Katz P, Hannan MT. Foot pain and pronated foot type are associated with self-reported mobility limitations in older adults: The Framingham foot study. Gerontology. 2016;62(3):289-295. doi:10.1159/000442089 Riskowski JL, Dufour AB, Hagedorn TJ, Hillstrom HJ, Casey VA, Hannan MT. Associations of foot posture and function to lower extremity pain: results from a population-based foot study. Arthritis Care Res (Hoboken). 2013;65(11):1804-1812. doi:10.1002/acr.22049