Causes of Bottom of Foot Pain and Treatments

Our feet are vital shock-absorbers. Your feet support your body weight as you walk and navigate your day, so foot pain can disrupt your life. In fact, 77% of adults have struggled with foot pain that has slowed them down (metaphorically or literally). 

What causes pain on the bottom of your foot? Knowing more about your foot’s anatomy can help you learn how to cope with problems like plantar fasciitis, metatarsalgia, and neuropathy. 

Possible Causes

Your feet are fairly complex: 26 bones, 30 joints, and almost 100 muscles and ligaments. Each of these anatomical elements, from your toes to your Achilles tendon, help you stand upright and balanced.

In a healthy foot, these numerous bones, joints, and tendons work together to absorb pressure from your steps. But a foot injury or complication can become quite painful because your feet hold all of your body weight, which can irritate your foot any time you stand.

 Plantar Fasciitis

One of the most common culprits of foot pain is plantar fasciitis. If you have plantar fasciitis, the tissue along the arch of your foot (between your heel and your toes) becomes inflamed. This inflammation can cause sharp, stabbing pains in your heel or in the bottom of your foot.

People who wear shoes with poor arch support, who walk or stand for long periods of time on hard surfaces, or who walk barefoot are especially prone to developing plantar fasciitis.

Plantar fasciitis symptoms are often most severe in the morning or during long periods of rest. When you wake up and step out of bed, you may feel a sharp pain in your heel or elsewhere on the bottom of your foot. Gentle stretching, ice or heat packs, and low-impact exercises like walking can help reduce pain. 

Metatarsalgia

Metatarsalgia is another potential cause of your foot pain. Patients with metatarsalgia often report pain and inflammation in the ball of their foot, right behind their toes. What causes this discomfort? Metatarsalgia can develop from high-impact activities that can stress the bottoms of your feet, like jumping or running.

A medical study found that 80% of people have experienced metatarsalgia at some point in their lives.  Many patients report that their mild-to-moderate metatarsalgia pains resolve after resting their feet and using orthopedic shoe inserts.

Peripheral Neuropathy

Foot pain can also be attributed to your nervous system. While tissue inflammation causes metatarsalgia and plantar fasciitis, millions of people experience nerve pain in their feet.

Nerve pain, or neuropathy, can be more complicated to treat and identify than other foot conditions. In neuropathy, a patient’s nervous system is either damaged or is misfiring.

Our nervous system connects our feet and toes to our brain, carrying signals throughout our body that allow us to move and feel our toes. Sometimes, an injury or an illness can complicate these signals, resulting in pain.

Peripheral nerve pain can feel like tingles, burning, or stabbing sensations.

Neuroma

Neuroma is due to inflammation or enlargement of the digital nerves. These nerves travel along the bottom of the foot and give sensation to the toes. The same activities that leads one to suffer from metatarsalgia can also cause a neuroma to form. This includes overuse activities like running, wear shoes without proper support, or wearing very high heels often. Patients may feel as though there is a pebble or foreign object along the bottom of the foot usually between the second and third toes or third and fourth. This is usually associated with numbness/tingling/ burning of the two adjacent toes.

Sesamoiditis or Sesamoid Stress Fracture

The sesamoids are two small bones beneath the ball of the big toe. They help support the function of the tendon that flexes the great toe. These bones can become overloaded and inflamed causing pain and swelling. If the overload is severe, a stress fracture may occur in them. Injury to these bones causes pain directly at the bottom of the big toe.

When to See a Healthcare Provider

For some people, their foot pain resolves, untreated, in days. But other people cope with chronic foot pain. Any kind of foot pain that prevents you from being able to go about your daily life is a potential cause for medical concern.

You should especially consider consulting a healthcare provider if you experience any of the following: 

• New pain that lasts longer than several days
• Pain that prevents you from walking
• Dizziness or nausea related to your foot pain (which could indicate a bone fracture)
• Fever or swelling related to your foot pain (which could indicate an infection)
• An accident or injury that could have caused your foot pain
• Your existing chronic foot pains have worsened

Diagnosis

Your healthcare provider will likely begin with a physical exam to identify the cause of your foot pain. During a physical exam, your healthcare provider will try to pinpoint any sensitivity or tenderness.

They may touch your feet, ask you to stretch your toes, and observe you walking. The healthcare provider will also look for inflammation or swelling, bruising, ingrown toenails, or other injuries that might contribute to your pain. 

After a physical exam, your healthcare provider may refer you to a foot and ankle specialist such as a podiatrist or an orthopedist. Podiatrists specialize in diagnosing and treating foot pain. Your general healthcare provider or podiatrist might order an imaging test like an X-ray if they suspect that you might have a bone fracture or other skeletal issue.

Treatment

To treat your foot pain, your healthcare provider may recommend several lifestyle changes, medications, or therapies. 

While some foods have been touted as miracle cures to inflammatory disorders like plantar fasciitis, no food has been proven as a sure treatment for foot pain. Nonetheless, a healthy, anti-inflammatory diet can supplement your healthcare provider's medical routine.

Foods with turmeric, lemon water, and antioxidants may help reduce the body inflammation, such as swelling in your feet.

Some patients find that complementary or alternative treatments like acupuncture provide temporary pain relief to their feet. Medical researchers have found that electro-acupuncture, in particular, can help alleviate plantar fasciitis pains.

To prevent future foot injury and strain, patients can buy orthopedic inserts or supportive and comfortable shoes. Careful walking and stretching can strengthen the feet after an injury, but patients should avoid excessive running, jumping, or high-impact activities that might add to their pain. 

A healthcare provider may recommend that you use over-the-counter pain relievers like Tylenol (acetaminophen). Holding a cold or hot compress to your foot may also help reduce swelling. However, if you have chronic, moderate-to-severe foot pain, you may need a more powerful medication to help you cope.

For patients with more serious foot complications, a healthcare provider may recommend an opioid drug such as oxycodone or hydrocodone. Use opioids only as prescribed to avoid addiction, and always consult your healthcare provider before trying a new treatment or diet.

Cortisone injections would be recommend after failed conservative treatments for plantar fasciitis, sesamoiditis, and neuromas.

If any of these conditions are severe, your healthcare provider may recommend offloading the foot with a short CAM boot or surgical shoe for a period of several weeks.

A Word From Verywell

At its best, foot pain can be frustrating. At its worst, your pain may feel debilitating. However, you’re not alone. Millions of people experience some degree of foot pain. Fortunately, there are options to find relief. Whether you are living with metatarsalgia, neuropathy, plantar fasciitis, or another foot condition, your healthcare provider can help you come up with a treatment plan that’s right for you.