Causes of Foot Pain and Treatment Options

Plantar Fasciitis

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

Symptoms

Pain from this condition is generally worse when a person first steps out of bed in the morning. It usually feels better once you get moving, although a dull pain often persists. 

Causes

Experts suspect there are certain factors that raise the risk of developing plantar fasciitis. These factors include:

• Obesity
• Prolonged standing
• Weak foot muscles
• Walking barefoot
• Improper running footwear
• Flat feet
• Very high arches

Diagnosis

Your healthcare provider will ask you questions about your foot pain in order to diagnose it. They will want to know exactly where it is located and if the pain is worse after you wake up.

They also will perform a physical exam. It includes pressing on the sole of your foot while you flex it, to see if your plantar fascia feels tender.

Treatment

The treatment of plantar fasciitis is based on simple self-care strategies. They include:

• Reducing activity
• Applying ice
• Stretching
• Postural support
• Physical therapy
• Taking a nonsteroidal anti-inflammatory drug (NSAID)
• Wearing a cushion-soled shoe with gel pad inserts or heel cups
• Wearing a supportive shoe, even at home, to avoid slippers or walking barefoot

If the pain persists, your healthcare provider may consider injecting a steroid into the foot where it hurts. Surgery, which is meant to release part of the plantar fascia where it attaches to the heel bone, is rarely performed.

Tarsal Tunnel Syndrome

Tarsal tunnel syndrome refers to compression of the posterior tibial nerve. This nerve passes through a space inside your ankle that's called the tarsal tunnel.

Symptoms

With this syndrome, you may feel pain described as burning, tingling, and numb. It radiates from the inside (big toe side) of the ankle and into the arch and sole. The pain tends to be worse at night, and sometimes travels up to the calf or higher.

Causes

Anything that places pressure on the posterior tibial nerve can cause tarsal tunnel syndrome. For example, if you sprain your ankle, the swelling at the site may irritate or squeeze the nerve.

A bone spur caused by ankle arthritis can lead to nerve compression within the tarsal tunnel. This is also true of other structural problems with the foot, such as a varicose vein, or a swollen ankle tendon or joint.

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

Diagnosis

A medical history and physical exam are typically used to diagnose this syndrome. Sometimes, imaging tests are ordered to see if a structural abnormality is present in the foot. Nerve studies like electromyography and nerve conduction velocity may also be done.

Treatment

A range of non-surgical therapies are used to treat tarsal tunnel syndrome. They include:

• R.I.C.E. protocol (rest, ice, compression of the nerve, elevation of the foot) if the condition follows an ankle injury
• Taking an NSAID such as 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 if it doesn't respond to other therapies.

Metatarsalgia

Metatarsalgia refers to pain found in the ball of the foot. It develops when the ligaments that connect your metatarsal bones no longer offer them enough support. These are the five bones that make up your forefoot.

Symptoms

The bottom of the ball of the foot is where people with this condition feel a sharp pain. Sometimes the pain is near where the toes connect to the foot. The pain, which may be equated to stepping on a stone, is usually eased by sitting down. It gets worse when you walk barefoot.

Causes

Many issues can make a person more vulnerable to developing this foot problem. Most often, it is due to abnormal foot mechanics, or the structure and motion of how your feet work. It also is caused by overuse, or by wearing shoes with poor cushioning.

Older people, those who are overweight, and people who run may also be at higher risk of developing metatarsalgia.

Diagnosis

A medical history and physical exam are needed to diagnose the condition. Imaging tests are only used if a second problem, such as a tumor, cyst, or bone fracture, is suspected.

Treatment

Wearing metatarsal pads is the primary treatment. Surgery may be an option if other treatments don't provide relief.

Morton's Neuroma

Another common foot problem is Morton's neuroma. It causes a sharp or burning pain in the ball of the foot. Many people describe it as akin to walking on a marble or pebble.

Technically, a neuroma is a benign (noncancerous) 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. These are called interdigital nerves.

Symptoms

The shooting or burning pain in the ball of the foot may spread between two toes. It is most common to feel this between the third and fourth toes. Your foot may be numb, with pain that gets worse with activity or when wearing shoes.

Causes

The cause of Morton's neuroma has not been fully teased out. Experts think that certain factors, like having flat feet or wearing tight, narrow shoes such as high heels, may lead to increased pressure. This may cause 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 diagnose the condition.

Treatment

Proper shoe inserts that decrease pressure on the toe bones may ease the pain of Morton's neuroma. A roomy, broad-toed shoe that allows the toes to spread out may help. Sometimes, if the pain won't go away, your healthcare provider may inject a steroid into the affected area.

If the above simple methods do not provide relief, the final option is surgery. It will mean removing a small part of the affected nerve or releasing the tissue that surrounds it.

Achilles Tendonitis

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

Symptoms

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

If tendonitis keeps recurring, it may be a sign that the tendon is tearing and weakening. This issue is also known as tendinosis.

Causes

Several factors may contribute to Achilles tendonitis. They include:

• A sudden increase in your exercise routine
• Tight calf muscles
• Wearing improper footwear
• Training in cold weather
• Flat feet
• Leg length differences

Diagnosis

A medical history and physical exam are used to diagnose the condition. An MRI may be ordered if your healthcare provider suspects an Achilles tendon rupture. This problem occurs when the tendon fibers tear and separate.

Treatment

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

• R.I.C.E. protocol (rest, ice, compression of the nerve, elevation of the foot)
• Taking an NSAID such as Advil or Aleve

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

Surgical repair may be needed for an Achilles tendon rupture.

Osteoarthritis

Osteoarthritis happens when cartilage in a joint breaks down from physical wear and tear. This causes decreased joint space, worn cartilage, and bone spurs around the joint.

Often, the pain and lack of mobility of foot osteoarthritis are found at the ankle joint, the subtalar joint, and the big toe joint.

Symptoms

Symptoms of osteoarthritis may include:

• Pain
• Stiffness
• A feeling of vibration or a grinding sound when moving the joint
• Swelling, which generally gets worse with exercise

Causes

With aging, the cartilage in your joint naturally wears thin and frays. A family history of osteoarthritis and obesity also may increase your risk.

Diagnosis

A medical history and physical exam, along with an X-ray or other imaging test, are used for diagnosis.

Treatment

Osteoarthritis of the foot is first managed with simple measures. Examples are:

• Lifestyle changes, such as weight loss and exercise
• Taking an NSAID
• Physical therapy
• Wearing a custom orthotic to reduce pain
• Using an assistive device to aid in mobility

Arthroscopy, or joint fusion or replacement surgery, is considered if the pain won't go away or it interferes with daily function.

Ingrown Toenails

An ingrown toenail occurs when the edge of a toenail grows or is pressed into the skin. Due to pressure from a shoe, it usually is found at the edge of the big toe. Even the smallest amount of ingrowing can hurt.

Symptoms

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

Causes

Some factors that increase a person's chance of having an ingrown toenail include:

• Wearing poorly fitted shoes
• Trimming the side edge of your toenail too short
• Having some sort of trauma to the toenail

Diagnosis

A physical exam—simply looking at the affected toe—is all that is needed to diagnose an ingrown toenail.

Treatment

Treatment of an ingrown toenail depends on its severity. For minimal to mild pain, redness, and no discharge, then warm soaks and a tiny piece of cotton placed beneath the nail may be all that is needed.

If symptoms continue after a few days of this simple treatment, or if any yellow, cloudy pus is present, you should see your healthcare provider. You may need an antibiotic. You also may need to have the ingrown part of the nail removed.

Corns and Calluses

A callus is a thickened area of skin found on parts of the feet that deal with excessive amounts of pressure or friction.

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. They are 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

Shoes that are either too tight or too loose are a common reason for corns and calluses. Socks that don't fit well may also contribute. So can toe deformities such as hammer toe.

Diagnosis

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

Treatment

Besides wearing proper shoes, you may consider home remedies. You can:

• Soak your foot in warm water for 15 minutes or so. Then, 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.
• Put small bits of lamb wool (not cotton) between toes where the corn is.

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

Bunions

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

Bunions vary in size. They are the result of the big toe shifting out of position over time and pressing against the second toe. This causes abnormal stress on the big toe joint and surrounding ligaments.

Symptoms

Symptoms generally progress over time as the bunion becomes more significant. Besides a sore or burning pain over the big toe joint, other 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 can cause a bunion to form.

Diagnosis

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

Treatment

If you have symptoms, bunions are often managed well with simple therapies. They include:

• Applying ice
• Foot and toe stretches
• Taking an NSAID
• Padding the bunion
• Wearing proper footwear

If bunion symptoms are severe, won't go away, and interfere with daily life, surgery may be needed.

Hammer Toe

Hammer toe is a common condition found in the second, third, or fourth toes. It happens when the joint where the toe meets the foot (the metatarsophalangeal joint) extends upward and the nearest joint as you move up the toe (the interphalangeal joint) flexes downward. This makes the toe bent like a hammer.

Symptoms

Pain may be felt when the top of the bent toe is pressed. Pain also may affect the ball of the foot at the bottom of the hammer toe. Other symptoms include redness, swelling, and stiffness of the affected toe joint. Corns and calluses may also form on the affected toe.

Causes

Muscle imbalance is believed to be a key contributor to hammer toe 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. It tends to run in families.

Diagnosis

A healthcare provider can diagnose hammer toe simply by inspecting your foot. Imaging, like an X-ray, may be ordered if they suspect an underlying condition.

Treatment

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

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

If these measures fail, or if tight tendons cause a rigid hammer toe that becomes immobile, surgery may be recommended. Rigid hammer toes are seen in people with severe arthritis or chronically neglected hammer toes.

Summary

Common causes of foot pain include plantar fasciitis, tarsal tunnel syndrome, metatarsalgia, Morton's neuroma, Achilles tendonitis, osteoarthritis, ingrown toenail, corns and calluses, bunion, and hammer toe.

Most of these problems can be managed with self-care measures like rest, ice, pain medication, wearing properly fitting shoes, and protecting the injury. However, for any problems that are persistent or that affect your quality of life, see a healthcare provider.

A Word From Verywell

If you are enduring foot pain, it's important to see a healthcare provider 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. You deserve to feel well and get back to your usual activities—and with the right therapy plan, you can.