Causes of Foot Pain and Treatment Options

The most common cause of heel pain is plantar fasciitis, which is irritation and inflammation of the plantar fascia—a thick band of connective tissue that spans the sole of the foot.

Symptoms

The pain of plantar fasciitis is generally worse when a person first steps out of their bed in the morning, and it usually improves with movement, although a dull pain often persists. 

Causes

Experts suspect there are certain factors that increase a person's chances of developing plantar fasciitis. These factors include:

• Obesity
• Prolonged standing
• Excessive training, especially running
• Tight calf muscles
• Improper running footwear
• Flat feet
• Very high arches

Diagnosis

In order to diagnose plantar fasciitis, your doctor will ask you questions about your foot pain, like where exactly it is located and if the pain is worse in the morning after waking up.

Then, your doctor will perform a physical examination, which will include pressing on the sole of your foot while you flex it to see if he can elicit any plantar fascia tenderness.

Treatment

The treatment of plantar fasciitis involves the following simple, self-care strategies:

• Reducing activity
• Applying ice
• Taking a nonsteroidal anti-inflammatory drug (NSAID)
• Wearing a cushion-soled shoe with gel pad inserts or heel cups
• Wearing a supportive shoe, even around the house, and avoiding slippers or walking barefoot

If pain persists, your doctor may consider injecting a steroid within the tender area of your foot. Surgery, which entails releasing part of the plantar fascia from its attachment to the heel bone, is rarely performed.

Tarsal tunnel syndrome refers to compression of the posterior tibial nerve—a nerve that passes through a canal (called the tarsal tunnel) inside your ankle.

Symptoms

With tarsal tunnel syndrome, a person may experience shooting, burning, aching, numb, and/or tingling pain that radiates from the inside (big toe side) of the ankle into the arch and sole. The pain tends to be worse at night, and sometimes it travels up to the calf or higher.

Causes

Anything that leads to compression of the posterior tibial nerve can cause tarsal tunnel syndrome. For example, if you sprain your ankle, the associated swelling may irritate or squeeze the nerve.

Likewise, any structural abnormality, such as a bone spur from ankle arthritis, varicose vein, or swollen ankle tendon or joint, may lead to nerve compression within the tarsal tunnel.

People with flat feet are also more prone to developing tarsal tunnel syndrome.

Diagnosis

Diagnosis of tarsal tunnel syndrome is usually made by a medical history and physical examination. Sometimes, imaging tests are ordered to see if a structural abnormality is present in the foot. Nerve studies like electromyography (EMG) and nerve conduction velocity (NCV) may also be considered.

Treatment

A variety of non-surgical therapies are used to treat tarsal tunnel syndrome, including:

• R.I.C.E. protocol (rest, ice, compression of the nerve, and elevation of the foot above the heart)
• Taking an NSAID, like Advil (ibuprofen) or Aleve (naproxen)
• Steroid injection
• Wearing custom shoe inserts, especially if you have flat feet
• Wearing a brace or cast to immobilize the foot

Surgery is considered if the nerve pain is severe or persistent, despite conservative therapies.

Metatarsalgia refers to pain located in the area of the ball of the foot. This condition develops as a result of the loss of support provided by the ligaments that connect the metatarsal bones, the five bones that make up your forefoot.

Symptoms

The sharp pain of metatarsalgia is felt on the bottom of the ball of the foot. Sometimes the pain is felt near where the toes connect to the foot. The pain, which may equated to stepping on a stone, is usually eased by sitting down and worsened by walking barefoot.

Causes

Many different conditions can make a person more vulnerable to developing metatarsalgia—most often, abnormal foot mechanics, overuse, or wearing shoes with limited cushioning.

Older people, overweight individuals, and runners may also be at an increased risk for developing metatarsalgia.

Diagnosis

Diagnosis of metatarsalgia is made by a medical history and physical exam. Imaging tests are only utilized if other diagnoses are being considered, such as a bone fracture, tumor, or cyst.

Treatment

Wearing metatarsal pads is the primary treatment for metatarsalgia. Surgery is a last resort treatment option, as it tends to fail in the long term, although, newer techniques and improved equipment offer some promise.

Another common nerve problem within the foot is Morton's neuroma, which causes a sharp or burning pain in the ball of the foot. Many people describe an uncomfortable sensation that's akin to walking on a marble or pebble.

While a neuroma is technically a benign (non-cancerous) tumor of a nerve, Morton's neuroma more accurately refers to a thickening of the tissue that surrounds one of the small nerves between the toes (called an interdigital nerve).

Symptoms

Besides a shooting or burning pain in the ball of the foot that may spread between two toes (most commonly, between the third and fourth toes), numbness may occur, as well as pain that worsens with activity or when wearing shoes.

Causes

While the cause of Morton's neuroma has not been fully teased out, experts suspect that certain factors, like wearing tight, narrow shoes (for example, high heels) or having flat feet, lead to increased pressure and subsequent injury to the tissue surrounding an interdigital nerve.

Diagnosis

Besides a medical history and physical exam, ultrasound and magnetic resonance imaging (MRI) are sometimes used to diagnosis Morton's neuroma.

Treatment

Proper shoe inserts that decrease pressure on the toe bones may ease the pain of Morton's neuroma. A roomier and broad-toed shoe that allows the toes to spread out may also be helpful. Sometimes, if pain persists, your doctor may inject a steroid into the affected area.

The final step—if the above simple methods do not provide relief—is surgery. Surgery involves removing a small portion of the affected nerve or releasing the tissue surrounding the nerve.

Tendons are the cord-like structures that anchor muscles to bone. When they are over-stretched or over-used, tendonitis can occur. Achilles tendonitis refers to irritation or inflammation of the Achilles tendon, which connects the calf and lower leg muscles to the heel bone of the foot.

Symptoms

Achilles tendonitis causes an aching or burning pain with activity or stretching, and the affected tendon is usually painful to the touch. Mild swelling, warmth, and stiffness may also occur over the tendon.

Recurrent tendonitis may be a sign of tendon tearing and weakening, also known as tendinosis.

Causes

Several factors may contribute to the development of Achilles tendonitis, including:

• Suddenly increasing an exercise regimen
• Tight calf muscles
• Wearing improper footwear
• Training in cold weather
• Flat feet
• Leg length discrepancy

Diagnosis

A medical history and physical examination are used to diagnose Achilles tendonitis. A magnetic imaging resonance (MRI) may be ordered if your doctor suspects an Achilles tendon rupture, which occurs when there is tearing and separation of the tendon fibers.

Treatment

The treatment of Achilles tendonitis involves a combination of these at-home therapies:

• R.I.C.E. protocol (reduced activity or rest, ice, compressing the tendon with an elastic bandage or tape, elevating your ankle above your heart)
• Taking a nonsteroidal anti-inflammatory (NSAID), like ibuprofen or Aleve (naproxen)

Once the acute pain is eased, it's a good idea to talk to your doctor about heel lift orthotics and physical therapy. The Alfredson Protocol, a specialized exercise program, may be recommended.

Surgical repair is reserved for an Achilles tendon rupture.

Osteoarthritis is the breakdown of cartilage within a joint from physical wear-and-tear. The joint damage manifests as decreased joint space, worn cartilage, and bone spurs surround the joint.

The pain and lack of mobility from foot osteoarthritis are often experienced at the ankle joint, the subtalar joint, and the big toe joint.

Symptoms

Symptoms of osteoarthritis may include pain, stiffness, a vibrating or grinding sound or sensation, and swelling, which generally worsen with exercise.

Causes

With aging, the cartilage in your joint naturally wears thin and frays. Besides age, having a family history and being obese also increases your risk of developing osteoarthritis.

Diagnosis

A medical history and physical examination, along with an imaging test (usually an X-ray), are used to diagnose osteoarthritis of the foot.

Treatment

Osteoarthritis of the foot is first managed with simple measures, such as:

• Lifestyle changes (e.g., weight loss if overweight or obese and choosing activities and exercises that are gentle on the feet, like swimming or cycling)
• Taking a nonsteroidal anti-inflammatory (NSAID)
• Physical therapy
• Wearing a custom orthotic to decrease pain
• Using an assistive device to aid in mobility

Surgery—arthroscopy or joint fusion or replacement—is considered if pain persists or daily functioning is significantly affected.

An ingrown toenail occurs when the edge of a toenail grows or is pressed into the skin edge. It usually occurs at the edge of the big toenail as a result of shoe pressure. Even the smallest amount of ingrowing can be very painful.

Symptoms

Besides pain, other signs of an ingrown toenail include red or swollen skin adjacent to the nail. The ingrown piece of nail is often unseen because it is buried beneath the skin.

Causes

Some factors that increase a person's chance for developing an ingrown toenail include:

• Wearing poorly fitted shoes
• Excessively trimming the lateral edge of your toenail
• Experiencing some sort of trauma to the toenail

Diagnosis

A physical exam—simply inspecting the affected area—is all that is needed to diagnose an ingrown toenail.

Treatment

Treatment of an ingrown toenail depends on the severity of the condition. For ingrown toenails associated with minimal to mild pain, redness, and no discharge, warm soaks and placing a tiny piece of cotton underneath the nail may be all that is needed.

After a few days of these simple measures, if the pain/redness/swelling is persisting or worsening, or if a yellow, cloudy substance ("pus") is present, it's important to see your doctor. You may require an antibiotic and/or your doctor may need to remove the ingrown nail part.

Calluses are thickened areas of skin over parts of the feet where excessive amounts of pressure or friction occur.

Corns occur on the toes where they rub against the shoe. Unlike calluses, corns have a central core or spot in the middle that is surrounded by dead skin.

Symptoms

Calluses are larger than corns and typically not painful, unless they fissure, or split open. On the other hand, the central core of a corn is usually painful and tender to the touch.

Causes

Improper footwear, either shoes that are too tight or too loose, is a common culprit behind corn and callus formation. Socks that don't fit well may also contribute, as can toe deformities, like hammertoe (see below).

Diagnosis

Visual inspection of your foot is all that is generally needed to diagnose a corn or callus. Keep in mind, corns and calluses also look similar to warts, which may also cause discomfort.

Treatment

Besides wearing proper shoes, you may consider trying these simple, home remedies:

• Soak your foot in warm water and once finished (15 minutes or so), use a pumice stone or callus file to remove dead skin over the corn or callus
• Place a donut-shaped, non-medicated foam corn pad over the corn or callus
• Consider placing small bits of lamb wool (not cotton) between toes where a corn has formed.

If corns or calluses continue to remain a problem, it's time to see your doctor. Your doctor may remove the dead layers of skin with a scalpel and apply a salicylic acid plaster to help dissolve the corn or callus. He may also recommend a custom foot orthotic.

A bunion is a knobby bump on the side of the foot that is often found just below the big toe joint (although, bunions can also occur on the pinkie toe side of the foot).

Bunions can vary in size and are the result of the big toe shifting out of position over time and pressing against the second toe, which results in abnormal stress on the big toe joint and surrounding ligaments.

Symptoms

Bunion symptoms generally progress over time as the deformity becomes more significant. Besides a sore or burning pain over the big toe joint, other bunion symptoms may include redness, swelling, and stiffness.

Causes

Experts believe that people with certain foot types are more prone to developing bunions, and these foot types run in families.

Wearing high heels, which forces the big toe to be squeezed into the second toe, also contributes to bunion formation.

Diagnosis

Bunions are diagnosed by a physical exam, although, sometimes an X-ray is ordered to better access the big toe joint.

Treatment

Bunions, if symptomatic, are often managed well with conservative therapies, such as:

• Applying ice
• Foot and toe stretches
• Taking a non-steroidal anti-inflammatory (NSAID)
• Padding the bunion
• Wearing proper footwear

If bunion symptoms are severe, persistent, or debilitating, surgery may be indicated.

Hammertoe is a common condition that occurs in the second, third, or fourth toes. It occurs when the joint closest to where the toe becomes the foot (called the metatarsophalangeal joint) extends upward and the proximal interphalangeal joint (the next joint as you move up the toe) flexes downward. This makes the toe bent like a hammer.

Symptoms

Pain may be felt not only at the top of the bent toe (when being pressed on), but also in the ball of the foot at the bottom of the affected toe. In addition to pain, redness, swelling, and stiffness of the affected toe joint may occur. Corns and calluses may also form on the affected toe.

Causes

Muscle imbalance is believed to be a key contributor to hammertoe formation. Tight shoes, especially high heels, are another prime cause. A hammer toe may also arise as a result of an underlying medical condition like arthritis.

Hammertoes also tend to run in families.

Diagnosis

A doctor can diagnose hammertoe simply by inspecting your foot. Imaging, like an X-ray, may be ordered if your doctor suspects an underlying condition, like arthritis.

Treatment

Various self-care strategies are used to treat hammertoe, such as:

• Performing at-home foot and toe exercises to strengthen and stretch your toes
• Wearing a non-medicated hammertoe pad
• Wearing a loose-fitting, soft shoe with a deep toe box
• Applying ice if the hammertoe becomes inflamed (acutely painful, red, and/or swollen)
• Foot exercises

If conservative measures fail or if a rigid hammertoe develops (which is when the toe tendons become tight, making the toe immobile), surgery may be recommended. Rigid hammertoes are seen in people with severe arthritis or chronically, neglected hammertoes.

A Word From Verywell

If you are enduring foot pain, it's important to see a doctor for an evaluation. Foot pain can be very disabling, and research suggests it can affect a person's mood, risk of falls, and quality of life.

In the end, getting to the bottom of your discomfort is paramount—you deserve to feel well and get back to your usual activities, and with the right therapy plan, you can.