Causes of Foot Pain

The main source of most foot pain involves improper foot function or biomechanics. Shoes rarely cause foot deformities but may irritate them.

Flat Feet or High Arches

Flat feet or high arches can contribute to painful problems in the feet, knees, and even hips. When the arch is too high or low, other structures in the foot and leg have to work longer and harder than intended. The added stress, weight, and poor motion can cause fatigue, pain, and inflammation. Arch supports (orthotics) and exercises to stretch and strengthen the arch and lower leg help relieve many problems related to weak arches. Fortunately, many people who have flat feet or high arches never have any problems.

Plantar Fasciitis

Plantar fasciitis is a common source of pain in the heel and arch of the foot. It involves the heel bone and the plantar fascia, a strong band of connective tissue at the bottom of the foot that runs from the heel to the base of the toes. This band of tissue helps maintain or hold the arch together and serves as a shock absorber during activity. Overstretching of this band of tissue can result in strain and inflammation where it’s attached to the heel bone.

Plantar fasciitis is marked by a dull ache in the arch or pain in the heel. The pain is worse when you wake or after resting. Walking may hurt at first, but once the plantar fascia is warmed up, the pain may decrease. Plantar fasciitis most often occurs when activity suddenly increases, or it results from wearing shoes with poor support. Switching from high heels or cowboy boots to flat shoes or athletic shoes can irritate the fascia, causing pain. Gaining 10 to 20 pounds can have the same effect. Working out or standing and walking on hard surfaces, such as concrete, or wearing shoes that do not have good arch support can also lead to the problem.

Self-care and rest sometimes relieves  plantar fasciitis. If symptoms continue despite these measures or if pain is severe, see your doctor. Your doctor may recommend physical therapy or steroid injections. Surgery is a last resort and used only in severe and prolonged cases.
 
Stress Fractures

Stress fractures of the foot occur most often in the second metatarsal. The metatarsals are the long bones that connect the ankle bones to the toes. High-impact activities such as running, basketball, or aerobics pose particular risk for stress fractures of the foot. Postmenopausal women with lower bone density, women with absent or infrequent periods, or anyone on long-term steroid or hormone therapy may be more likely to have stress fractures.

Stress fractures most often appear several weeks into a new or more intense training schedule, after changing from running on a track to running on concrete or asphalt, or after landing wrong following a jump. At first, pain may be mild enough that it can be ignored. After time, however, the mild pain gives way to sudden, intense pain. Both the top and bottom of the foot may be tender to the touch.

Treating stress fractures in the foot mostly involves time—usually at least 1 month—to allow the bone to heal. With the exception of fractures in the fifth metatarsal, a cast is usually not needed. A wooden shoe or postoperative shoe is usually worn to allow the fracture to heal. A stress fracture in the fifth metatarsal can be serious because it often resists healing. Fractures may need a cast, and crutches may have to be used for 6 weeks to several months. In some cases, surgery may be needed.

Morton’s Neuroma

Morton’s neuroma is a noncancerous enlargement of one of the nerves running between the metatarsal bones (long bones of the foot). The enlargement occurs when the nerve is squeezed between the bones, sometimes from narrow, tight shoes or stress from repeated motions. Most often, neuromas develop between the metatarsal bones leading to the third and fourth toes (called the third intermetatarsal space). Occasionally they may develop between the second and third metatarsals.
 
Morton’s neuroma causes local swelling and tenderness. A person with this condition may feel as though he or she is walking on a lump, especially when barefoot. Pain may spread to the toes or toward the heel. Pressure makes the pain worse and, if constant, may cause numbness, burning, and tingling in the toes, between the toes, or at the ball of the foot.
 
Bunion

A bunion is a swelling on the side of the foot. Usually bunions show the foot
isn’t working properly, often because of flat-footedness. Instability and muscle imbalance can also cause the big toe to slant in toward the other toes. The joint where the big toe connects to the foot (the end of the first metatarsal) then pokes out on the inner side of the foot. This is caused by poor alignment and is not a growth of bone. The bunion may also become inflamed and sore, especially if rubbed by a shoe. A similar problem, called a “tailor’s bunion,” may develop on the opposite side of the foot, where the little toe meets the fifth metatarsal. For bunions that cause persistent pain despite self-care, steroid injections or surgery may provide relief.

Hammertoe

Hammertoe is a deformity in which the toe buckles and bends, causing the middle joint of the affected toe to poke above the other toes. The deformity may also cause the toe to become bent at the middle joint, so it turns in toward the toe next to it. Tight shoes can rub and put pressure on the raised portion of the hammertoe, often causing a corn to form. Hammertoes may cause no problems at all, or they can be a source of pain, especially if the person wears tight or ill-fitting shoes. If self-care fails to relieve the symptoms, surgery may be needed to straighten the toe or to remove the bony protrusion.

Plantar Warts

Plantar warts, like warts in other areas of the body, are caused by a virus. The weight of the body on the foot causes plantar warts to grow inward. The result is a painful lump on the bottom of the foot that feels like you are walking on a pebble. Children and teens are more likely than adults to get plantar warts. Plantar warts are often difficult to treat, but a slow approach is best. If plantar warts interfere with walking, you should see your doctor or a podiatrist to have them removed.

Preventing Foot Pain

• Have your feet measured when you buy shoes. Your feet can change size.
• Don’t wear shoes that pinch your feet or toes. Don’t wear shoes that are too big. Your feet should not slide around in them. Loose shoes can rub and cause blisters and other problems.
• Look for shoes that have a low heel. Heels between ½ and 1½ inches are the best height. Higher heels can strain the feet and legs.
• If your shoes need extra support or cushioning, buy arch supports or cushioning for soles.
• Break in new shoes. For the first few days, wear new shoes for 1 to 2 hours at a time.
• Do not walk around barefoot. Wear shoes around the house and yard to prevent injury. Even at the beach, wear sandals, thongs, or “beach socks.” Broken glass, shells, hot sand, and other objects can injure your feet.

Caring for Foot Pain

How you care for foot pain depends on what is causing it.

For heel spurs and plantar fasciitis:

• Rest the foot, avoiding high-impact activities, such as running, for 3 to
  6 weeks.
• Switch to low-impact activities, such as walking, biking, or swimming. Walking is particularly good.
• Apply ice to the heel two to three times daily.
• Support the arches of your feet to protect them from further stretching and tearing. Place arch supports even in your slippers and put them on first thing when getting out of bed.
• See your doctor if pain is not relieved with self-care within 3 to 6 weeks.

For stress fractures:

• See your doctor if pain continues or worsens.
• Avoid high-impact activities, such as running or playing basketball. Switch to weight-bearing, low-impact, or nonimpact activities, such as walking or low-impact aerobics. Weight-bearing exercises strengthen bones and prevent bone loss. Resume your regular workout or other activities slowly after pain eases and the fracture heals.