Common Causes of Foot Pain

There are many different causes of foot pain—including plantar fasciitis, bunions, arthritis, and tarsal tunnel syndrome—each of which requires different treatments. Some of these conditions affect the bones and joints of the feet, while others involve nerves and connective tissues like ligaments and tendons.

The treatment of foot pain could involve anything from physical therapy and foot orthotics to medications and foot surgery. Diagnosing the cause by a specialist like a podiatrist or orthopedic surgeon is the first step toward resolving your pain.

This article discusses the nine most common causes of foot pain, and how these conditions are treated and prevented.

Causes of Foot Pain

Different conditions cause pain in different parts of your foot. The location of the pain is arguably the first step in pinpointing the cause.

Here is an example of what your healthcare provider might consider based on the location of your foot pain:

Plantar Fasciitis

Plantar fasciitis is one of the most common causes of foot pain. It results from irritation of a thick band of tissue, called the plantar fascia, that runs across the bottom of your foot. This fascia connects your heel bone to your toes.

People with plantar fasciitis experience pain across the bottom of the foot, typically near the inner part of the heel. Discomfort with plantar fasciitis is more common in the morning after waking up and with strenuous exercise like running. Some people also feel heel pain while simply walking.

Foot Osteoarthritis

The second most common cause of foot pain is foot osteoarthritis. Often referred to as "wear-and-tear arthritis," osteoarthritis is caused by the long-term, mechanical degeneration of the cartilage in your joints. Osteoarthritis can affect any joint in the body, including the feet.

Foot osteoarthritis most commonly affects the metatarsophalangeal joints between the ball of the foot and the toes (sometimes called the "toe knuckles").

Over time, the loss of cartilage causes joint deformity and the formation of bone spurs that limit the range of motion of your toes. The pain and stiffness tend to be the worst in the morning but improve as the day goes on.

Posterior Tibial Tendonitis

Posterior tibial tendonitis, also called posterior tibial tendon dysfunction, is inflammation of the posterior tibialis tendon. This is the tendon that runs down the inner lower leg and attaches to the bottom of your foot near the inside of the arch. The tendon helps support your foot's natural arch.

As with many types of tendonitis, the condition is mainly caused by repetitive stress, such as caused by wearing high heel shoes. Inflammation of the tendon can cause pain and lead to a flatfoot deformity.

Tarsal Tunnel Syndrome

Tarsal tunnel syndrome occurs when the main nerve that goes to the foot is compressed by bone or tissue. It is similar to a condition in the wrist called carpal tunnel syndrome. Repetitive stress to the arch of the foot is a common cause.

The symptoms of tarsal tunnel syndrome are typically felt on the inner side of the foot and include burning, tingling, and shooting pains.

Bunions

A bunion is a bony protrusion at the outside of your big toe. It's caused by a misalignment in the joint of the big toe (called the metatarsophalangeal joint of the hallux).

A bunion can make your big toe point inward, even to the point that it overlaps the second toe. The lump can be painful, making it hard to wear shoes. It can even change your balance and the way that you walk.

Hammertoe

Hammertoe usually affects the second, third, or fourth toe of your foot. Like bunions, it's caused by a misaligned metatarsophalangeal joint, which ends up pushing tissue from the ball of your foot forward and underneath your toes. Eventually, this can cause your toes to take on a claw- or hammer-like shape.

Hammertoe can cause pain in the toe and ball of the foot.

Metatarsalgia

Metatarsalgia is a painful foot condition affecting the ball of the foot. It is called metatarsalgia because the bones in this region of the foot are named the metatarsals.

Rigorous jumping or running activities like basketball or spriting increase the stress load on this region of the foot. Over time, the metatarsal bones can become swollen and painful. Metatarsalgia is often a precursor to foot osteoarthritis.

Turf Toe

Turf toe is a sprain at the base of your big toe. It occurs when the big toe bends back beyond its normal range of motion. This can cause a tear in the ligaments that support it.

As per its name, turf toe often occurs when kicking a soccer ball (or missing the ball and kicking the ground). Pain with turf toe is felt mainly with walking and running. You may also experience toe cramping.

Morton's Neuroma

Morton's neuroma is a nerve-related condition that causes sharp, stabbing pains when you walk or place weight-bearing pressure on your foot. It is caused by the thickening of one of several nerves between your toes (usually the third and fourth toes). This often happens because of a traumatic injury to the foot.

Symptoms may only be occasional at first, but they may become chronic (persistent) as the condition progresses.

Treatment of Foot Pain

The treatment of foot pain may involve physical therapy, medications, and occasionally surgery. In many cases, multiple treatments are needed for sustained pain relief or to improve mobility.

Physical Therapy

Arguably, all conditions that cause chronic pain can benefit from some level of physical therapy. This may involve simple or sophisticated techniques such as:

• Cold therapy; Used to relieve pain and swelling
• Heat therapy: Used to promote circulation and healing
• Foot exercises: Including stretching, balance, and strengthening exercises
• Kinesiology tape: Strategically applied, wearable tape that helps increase awareness of proper foot alignment and gait
• Foot orthotics: Different inserts placed into shoes to support the arch or correct imbalances in foot posture
• Splints and pads: Used especially for conditions like bunions or hammertoes to ease pain and help correct the toe position
• Manual soft tissue mobilization: A physical therapy technique in which pressure is on placed certain muscles or tendons either by hand or with special instruments
• Myofascial shock wave therapy: A hand-held device that exerts concussive pressure to break up scar tissues and increase flexibility
• Dry needling: The insertion of fine needles deep into a muscle or trigger points to relieve pain

Medications

Many conditions like foot osteoarthritis, posterior tibial tendonitis, tarsal tunnel release, and Morton's neuroma are managed with medications that help relieve pain and inflammation.

These include over-the-counter (OTC) and prescription drugs include:

• Non-steroidal anti-inflammatories (NSAIDs): including OTC NSAIDs like Advil (ibuprofen) and prescription NSAIDs like Celebrex (celecoxib)
• Cortisone (steroid) injections: Delivered into the joint space to provide long-lasting pain relief
• Hyaluronic acid: An injection of synthetic lubricant into the joint space that may help with osteoarthritis
• Tricyclic antidepressants: Using drugs like Elavil (amitriptyline) to relieve chronic nerve pain associated with Morton's neuroma

Surgery

Surgery may be considered when conservative options fail to provide relief. It may sometimes be pursued as the first-line treatment if a condition is severe or there is a significant deformity or pain.

Examples include:

• Plantar fascia release: A surgery that partially cuts the fascia ligament to loosen tension
• Cheilectomy: Used to debride (scrape away) bone spurs and excess bone matter in people with foot osteoarthritis
• Tarsal tunnel release: A surgery used to increase space inside the tarsal tunnel
• Bunionectomy; The surgical removal of a bunion
• Neurectomy; The surgical removal of the nerve to ease Morton's neuroma pain
  

How to Prevent Foot Pain

Foot pain is often related to long-term, repetitive stress placed on the feet. The chief culprit is the shoes you wear, but other things can contribute. These include jobs that require heavy lifting or standing for hours.

To protect your feet and prevent long-term foot pain:

• Find properly fitting shoes (with the aid of a specialist foot retailer, if needed).
• Avoid high heels and shoes that squeeze your toes together.
• Regularly practice foot stretching exercises to maintain flexibility and avoid stiffness.
• Get your gait analyzed by a podiatrist using an instrumented gait analysis (IGA).
• Treat any foot or toe injury appropriately to reduce your long-term risk of foot osteoarthritis.
• Give your feet a break from shoes when possible.
  

When to See a Healthcare Provider

Foot pain can be a difficult thing to manage. It can prevent you from walking normally and may limit your ability to enjoy normal work and recreational activities.

If you regularly have foot pain or it seems to be getting worse or more frequent, talk to your healthcare provider. It is especially important to seek medical advice if you notice changes in the size and appearance of your joints. Ask whether a physical therapist could help you overcome foot pain and return to your normal active lifestyle.

Summary

Your foot contains dozens of structures that can be injured. Damage to these structures can cause pain and make it hard for you to walk.

Foot pain can affect the bottom of your foot, the arch of your foot, or the ball of the foot and the toes. Each type of pain and the condition that causes it is treated in a different way, but some treatment strategies include stretching and strengthening exercises, anti-inflammatory drugs, and orthotics. In severe cases, surgery may be necessary.

If you have severe or recurring pain in your foot, contact your healthcare provider. They may be able to recommend physical therapy or additional treatment to help you get back on your feet.