Common Causes of Foot Pain

As shock absorbers, your feet cushion up to one million pounds of pressure during a single hour of strenuous exercise. They also support 1.2 times your body weight during walking, and two to three times that during running activities. It is not hard to see why feet are highly susceptible to injury. 

If you wake up and suddenly feel pain in your feet, what is going on? You probably want answers as well as information on how you can get better, such as whether a physical therapist can help treat your foot pain.

Foot pain is a frequent cause of visits to podiatrists and orthopedic physicians. With more than 26 bones, 33 joints, and five ligaments, many structures in the foot can be injured. When these structures become injured or overstressed, it can cause pain, and that can limit your ability to walk.

This article discusses some of the most common causes of foot pain, and how these conditions can be treated and prevented.

Types of Foot Pain

Pain can strike in different areas of your foot. Certain conditions are commonly associated with these areas. They include:

• Bottom of the foot: Plantar fasciitis
• Arch of the foot: Posterior tibial tendonitis, tarsal tunnel syndrome
• Ball of the foot/toes: Bunions, hammertoe, metatarsalgia, turf toe, Morton's neuroma

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 the heel pain while simply walking.

Treatment

Physical therapy for plantar fasciitis involves treatments that decrease inflammation and improve the function of your foot, ankle, and leg. Exercises for plantar fasciitis may include:

• Stretching
• Strengthening exercises
• Balance exercises

These exercises may also help prevent the condition from reoccurring.

Posterior Tibial Tendonitis

The posterior tibialis tendon runs down your 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. Irritation of the tendon may cause pain, limited walking ability, and flatfoot deformity. Posterior tibial tendonitis is also called posterior tibial tendon dysfunction.

Treatment

Treatment for posterior tibial tendonitis may include exercises for:

• Flexibility
• Strength
• Balance
• Reducing inflammation

Your physical therapist (PT) or healthcare provider may also recommend orthotics, medical devices that are worn inside the shoe. 

Your PT can examine you and determine the best treatment for your posterior tibial tendonitis. Continuing with exercises and orthotics can help keep it from coming back, as can surgery.

Tarsal Tunnel Syndrome

Tarsal tunnel syndrome occurs when the main nerve that goes to the foot is compressed by bone or tissue. You may be more familiar with a similar condition in the wrist called carpal tunnel syndrome. The symptoms of tarsal tunnel syndrome are typically felt on the inner side of the foot and include burning, tingling, and shooting pains.

Treatment

Treatments for tarsal tunnel syndrome includes:

• Anti-inflammatory drugs
• Orthotics
• Changes in footwear

If these fail, a surgical procedure called tarsal tunnel release may be an option. You may be able to prevent tarsal tunnel syndrome by warming up before strenuous activity and keeping the muscles in the area strong and flexible.

Bunions

A bunion is a bony protrusion at the base of your big toe, on the inside of your foot. It's caused by a misalignment in the joint. It can make your big toe point inward, even to the point that it overlaps the second toe. The lump can be painful, make your shoes uncomfortable, and change your balance and the way you walk.

Treatment

Non-steroidal anti-inflammatories (NSAIDs) are common for treating bunion pain. Your healthcare provider may also recommend corticosteroid injections. Other things that might help include:

• Bunion pads
• Splints
• Orthotics

Physical therapy exercises for bunions include muscle strengthening to improve joint alignment and range-of-motion exercises to keep the joint moving. Surgery may be an option if physical therapy isn't effective.

Many bunions can be prevented by:

• Wearing properly fitting shoes
• Avoiding high heels
• Giving your feet a break from shoes when possible
  

Keeping your feet strong can also help prevent bunions.

Hammertoe

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

Treatment

Hammertoe can be treated by:

• Wearing loose-fitting shoes
• Wearing hammertoe pads
• Icing
• Strengthening and stretching exercises
• In severe cases, surgery

Hammertoe can be prevented by avoiding:

• High heels
• Narrow shoes
• Shoes that crowd your longest toe

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.

A lot of jumping or running activities increase the stress load on this region, and over time, the metatarsal bones can become swollen and painful. Some types of arthritis can also contribute to this condition.

Treatment

Metatarsalgia treatment often involves:

• NSAIDs
• Proper footwear
• Metatarsal pads
• Orthotics

Shoes with a wide toe box and good support can both help treat and prevent metatarsalgia.

Turf Toe

Turf toe is a sprain at the base of the 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.

Turf toe often occurs when kicking a soccer ball, or missing the ball and kicking the ground. Pain with turf toe is experienced during walking and running activities. You may also experience toe cramping.

Treatment

Physical therapy for turf toe involves managing inflammation around your foot and toe and gently restoring normal mobility to the affected toe or toes. To prevent turf toe, you can learn proper running mechanics and wear hard-soled shoes during exercise.

Morton's Neuroma

Morton's neuroma causes a sharp, stabbing pain when you walk or put pressure on your foot. It's caused by thickening of a nerve between your toes, usually between the third and fourth toes. This often happens because of an injury. At first, symptoms may only be occasional, but they may become more common or even constant as the condition develops.

Treatment

Morton's neuroma is treated with:

• NSAIDs
• Cortisone injections
• Resting the foot
• Wearing wide-toed shoes and metatarsal pads
• Physical therapy
• Sometimes surgery

You can help prevent it from developing by staying away from high-heeled or pointy-toed shoes.

Physical Therapy for Foot Pain

Physical therapy is one of the main ways to treat the symptoms of foot pain from many different causes. Gentle stretching of the foot often helps to alleviate the discomfort felt due to the above disorders.

Your physical therapist can also offer strategies to help treat your pain and improve your foot function. For example, an ice bottle massage may help control pain and inflammation. A PT may also be able to help you correct walking and running mechanics. This can help alleviate and prevent foot problems.

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 to 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.