Bottom of Foot Pain

It's a common experience to wonder why the bottom of your foot hurts. In fact, 77% of adults say that foot pain has affected their life in one way or another.

Whether your foot pain is near the toes or at the heel, the pain may affect you with every footfall. Depending on the injury or condition, you may feel symptoms that range from a shooting pain to a constant ache.

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.

Causes

Your feet are fairly complex, and so are the reasons for why the bottom of your foot hurts. For example, plantar fasciitis can lead to pain at the heel. A neuroma can cause pain at the toes.

This complexity is due to the elements that make up the structure of your foot. Each foot has 26 bones, 30 joints, and almost 100 muscles and ligaments to connect them.

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.

With this complex structure, you may feel different kinds of pain as well. For instance, it might hurt in certain circumstances like when you put pressure on it or only at night.

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 foot pain in the middle along the sole.

Factors that increase your chances of developing plantar fasciitis include:

• Having flat feet or a very high arch
• Being overweight or obese
• Wearing shoes with poor arch support
• Walking, running, or standing a lot on hard surfaces
• Walking barefoot
• Being pregnant
• Having pronated feet, meaning that your feet roll a bit inward with each 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

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, and is the cause of foot pain for many people living with a chronic illness.

These conditions damage the peripheral nerves, and include diabetes, severe alcohol misuse, Lyme disease, or autoimmune diseases like lupus. Other causes include 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.

Females are more likely than males 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, with pain 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 tennis
• Having high arches
• Frequently wearing high heels
  

Rare Causes of Bottom-of-Foot Pain

Though less common, additional causes of foot pain 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.

As many as 40% of Guillain-Barré syndrome cases are triggered by a bacteria called Campylobacter jejuni, which causes diarrhea. It's often found in undercooked poultry, putting people who eat it at an increased risk of campylobacter infection. GBS tends to set in a few weeks after the infection took place.

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 males and adults older than 50. Your risk is also higher if you have had a recent surgery or have a preexisting autoimmune disorder.

When to See a Healthcare Provider

Sometimes, bottom-of-foot pain goes away on its own in a few days. Other times, it becomes a chronic condition that impacts your quality of life. It's important to have an accurate diagnosis and begin treatment and any lifestyle changes to relieve pain on the bottom of your foot.

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 do 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 specialist) or orthopedist (bone specialist).

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.

When to Seek Emergency Care

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 swelling
• You are unable to put any weight on your foot or walk
• You have numbness or loss of sensation
• The pain or tingling comes on suddenly
• You feel burning or tingling in your feet after being exposed to toxins
• You had a flu or other infection in the days or weeks before your pain began, which could indicate Guillain-Barré syndrome
• You 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 to see how the bottom of your foot hurts when 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 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.

Imaging

Depending on what your healthcare provider finds during the physical examination, they may order special imaging tests to diagnose bottom-of-foot pain and rule out other causes.

Possible imaging studies include:

• 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, sesamoiditis, tarsal tunnel syndrome, and changes in soft tissues and bones due to arthritis, fractures, and infections
  

Differential Diagnoses

A differential diagnosis is the process in which your healthcare provider rules out all the other possible conditions that could explain your symptoms. 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 out these other conditions.

There are more than 100 causes of peripheral neuropathy. The differential diagnosis means 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 out these other conditions.

Plantar fasciitis can have some of the same symptoms as 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 out these other conditions.

With 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. 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 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.

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 fasciitis
• Sesamoiditis
• Neuromas

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, so 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 lifestyle changes you can make to reduce your risk of discomfort. You can:

• Wear orthopedic inserts or supportive shoes
• Carefully walk and stretch after an injury
• Avoid excessive running, jumping, or high-impact activities 
• Strive to maintain a healthy weight
• Avoid foods that trigger inflammation, such as sugar and highly processed foods
• Work on having great posture if you don't already
• Listen 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.