Foot Pain Causes and Treatments

Toe Pain	Heel and Arch Pain	Ball of Foot Pain	General Foot Pain
Ingrown toenail	Plantar fasciitis	Bunions	Fracture
Hammer toe	Achilles tendinitis	Metatarsalgia	Sinus tarsi syndrome
Corns and calluses	Tarsal tunnel syndrome	Morton’s neuroma	Osteoarthritis
Gout			Diabetes
			Heart disease
			Pregnancy

Fracture

One of the most common causes of foot pain is trauma, such as a foot fracture. A Lisfranc injury, found at the bridge where the toes connect to the top of the foot, is an example a fracture that’s often sports-related.

It can be hard to tell the difference between a fracture and a bruise, but if your foot is broken, you are more likely to have the following symptoms:

• Swelling around the fractured area
• Severe bruising and pain
• Inability or limited ability to move your foot
• Inability to stand on your foot
• A grinding sensation

Foot fractures are usually diagnosed with an imaging test such as an X-ray, magnetic resonance imaging (MRI), or computed tomography (CT) scan. 

The following can help the bone mend faster:

• Avoid walking on the foot. Your healthcare provider may give you a cast, boot, and/or crutches to help stabilize your foot and keep weight off of it while it heals.
• Use the RICE protocol: rest, ice, compression, and elevation

These injuries will often heal without surgery, but severe breaks may require surgery to repair the bone and any ligaments, muscles, or tendons that might have also been damaged.

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.

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

Foot 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. 

The treatment of plantar fasciitis is based on simple self-care strategies you can practice at home. They include:

If the pain persists, your healthcare provider may consider injecting a steroid into the foot where it hurts. Shock wave therapy also can help.

Surgery, which is meant to release part of the plantar fascia where it attaches to the heel bone, is rarely performed. If surgery is performed, large heel spurs may also be removed at this time.

Toe Disorders

Issues with one or more toes can cause local pain in that area of the foot. These can affect mobility and cause further complications

Ingrown Toenail

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.

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.

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

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

If an infection develops, you may need an antibiotic. You also may need to have the ingrown part of the nail removed.

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.

Muscle imbalance is believed to be a key contributor to hammer toe formation. Tight shoes, an underlying medical condition, and heredity are other common causes.

Hammer toe pain is characterized by the following:

• Foot pain when the top of the bent toe is pressed
• Pain in the ball of the foot at the bottom of the hammer toe
• Redness, swelling, and stiffness of the affected toe joint
• Corns and calluses on the affected toe

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, surgery may be recommended.

Achilles Tendonitis

Tendons are 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.

This condition causes an aching or burning foot 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.

Achilles tendonitis is rarely caused by an injury. Rather, common factors that may contribute to the condition include:

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

Treatment involves following the RICE protocol (rest, ice, compression of the nerve, elevation of the foot) and taking non-steroid anti-inflammatory drugs (NSAIDs).

Once the acute foot pain is eased, 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.

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.

Common causes of corns and calluses include:

• Shoes that are either too tight or too loose
• Socks that don’t fit well
• Toe deformities such as hammer toe

Besides wearing proper shoes, home remedies can ease the foot pain caused by corns and calluses:

• 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 the toes where the corn is.

If corns or calluses remain a problem, contact your healthcare provider. They may remove the corn 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. They result from 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.

Bunions vary in size and are often found just below the big toe joint but can occur on the pinkie toe side of the foot too.

Certain foot types may be more prone to developing bunions, including people who have a very high arch. Wearing high heels, which forces the big toe to be squeezed into the second toe, also can cause a bunion.

Symptoms generally become more severe over time causing:

• A sore or burning pain over the big toe joint
• Redness
• Swelling
• Stiffness

Bunion-related foot pain is often managed well with simple therapies such as applying ice, taking NSAID, padding the bunion, and wearing proper footwear.

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.

Anything that places pressure on the posterior tibial nerve can cause tarsal tunnel syndrome, including:

• An ankle sprain that causes swelling
• A bone spur, or abnormal bone growth caused by ankle arthritis
• A varicose vein
• Swollen ankle tendon or joint

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

With this syndrome, you may feel foot pain described as burning, tingling, and numbness. 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.

To diagnose tarsal tunnel syndrome, imaging tests may be ordered to see if a structural abnormality is present in the foot. Nerve studies like electromyography and nerve conduction velocity may also be done.

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

• Following the RICE protocol if the condition follows an ankle injury
• Taking an NSAID
• 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.

Sinus Tarsi Syndrome

Sinus tarsi syndrome can cause the top of your foot to hurt in the area between the ankle and the heel. Ankle sprains are the most common cause.

An injury to the extensor digitorum brevis muscle, on the top of the foot, can lead to sinus tarsi syndrome. Between 70% and 80% of the time, the cause is an ankle sprain that rolls the foot outward.

Symptoms include pain near the ankle, especially with the foot turned in or turned out. The foot may feel unstable, and it’s difficult to walk on uneven surfaces.

Your provider may order images, including X-rays and MRI, to diagnose the syndrome. Ankle arthroscopy may be needed to assess tissue damage. Tests also may be needed to rule out other possible conditions.

Surgical treatment may be required in some cases of sinus tarsi syndrome. Generally, however, treatment can include:

• Medication (anti-inflammatory drugs, steroid injections)
• Physical therapy
• Support from bracing, taping, or walking boots
• Orthopedic shoes or custom foot orthotics 

Metatarsalgia

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

With metatarsalgia, you may feel a sharp pain in the ball of the foot. Sometimes the pain is near where the toes connect to the foot. This foot pain is compared to stepping on a stone. It’s usually eased by sitting down but gets worse when you walk barefoot.

Issues that put you at risk for metatarsalgia include:

• Deformities of the foot
• Overuse
• Wearing shoes that don’t have proper support or cushioning
• Increased intensity in physical activity

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

Morton’s Neuroma

Morton’s neuroma is another common cause of foot pain. It causes shooting or burning pain in the ball of the foot. Pain may spread between two toes (most often between the third and fourth toes). Your foot may be numb, or pain may get worse with activity or when wearing shoes. Many people say it feels like walking on a marble.

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.

While it’s not clear why certain people develop Morton’s neuroma, experts think that having flat feet or wearing tight, narrow shoes such as high heels may lead to increased pressure. This causes injury to the tissue surrounding an interdigital nerve increases your risk.

Treatment options include:

• Placing proper inserts in your shoe to reduce pressure on the toe bones
• Wearing roomy, broad-toed shoes that allow the toes to spread out
• Injecting a steroid into the affected area
• Surgically removing a small part of the affected nerve or releasing the surrounding tissue

Underlying Medical Conditions

Several common medical conditions can affect your feet. These may cause issues with the joint or impede circulation, leaving you at risk for a variety of problems that lead to foot pain.

Osteoarthritis 

Osteoarthritis occurs when cartilage in a joint breaks down from physical wear and tear, causing decreased joint space, worn cartilage, and other symptoms. Often, the pain and lack of mobility of foot osteoarthritis are found at the ankle joint, the subtalar joint, and the big toe joint.

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

• 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.

Diabetes

Foot problems are a common complication of diabetes, especially if your blood sugar isn’t well-managed. This results in hard-to-heal wounds and a type of nerve damage called diabetic neuropathy, which leads to loss of sensation and other symptoms in your feet. 

The first step in treating diabetes-related foot problems is to make sure your blood sugar is controlled. These tips may also help:

• Make sure your feet are clean and dry.
• Wear moisture-wicking socks and breathable, well-fitting shoes.
• Notify your healthcare provider if you find any cuts, sores, blisters, or other lesions on your feet. 
• Don’t walk barefoot.
• Keep your feet elevated when sitting.

Heart Disease

When you have heart disease, your heart has a more difficult time moving blood to the rest of your body, especially the more distant parts such as your feet. High blood pressure can also lead to poor circulation.

Complications from these conditions can cause pain and other problems with your feet such as:

• Swelling (edema)
• Sores
• Cramping
• Pain or fatigue in your feet, especially when walking

If you’re diagnosed with heart disease, your healthcare provider may recommend lifestyle changes like losing weight, exercising, and quitting smoking or alcohol consumption. They may also prescribe medications or suggest dietary changes to help treat your blood pressure or reduce cholesterol. 

Gout

Gout is a type of arthritis that can cause pain in your feet, especially your big toe. Gout is caused by a buildup of uric acid crystals in your joints. These crystals can cause inflammation and pain in the affected joints.

Gout can be triggered by certain foods, alcohol consumption, illness, or injury. 

Symptoms of gout can come on suddenly. They can include:

• Intense pain in the affected joint
• Swelling
• Redness
• Changes in the joint’s mobility

A gout flare will usually get better over the course of one or two weeks. When gout is untreated, however, the flares can get worse and/or more frequent.

The goals of treatment are to reduce pain and prevent flares. Some of these treatments include:

• Over-the-counter NSAID medications
• Prescription pain relievers
• Prescription medication to help lower urate levels

Pregnancy

Your body experiences many changes during pregnancy. Several of these can affect your feet and cause pain that may be temporary, but in some cases can continue to affect you after you give birth.

Foot-related issued during pregnancy include:

• Flat feet caused by the relaxation of ligaments (a result of the body producing hormones to help relax your ligaments for childbirth)
• Plantar fasciitis caused by added weight stressing your arches
• Edema or swelling in your feet and ankles resulting from an increase in blood volume or the production of hormones

In addition to causing pain, you may have problems staying balanced on your feet. Even after giving birth, you may find that you have gone up a full shoe size due to the changes experienced during pregnacy.

When to See a Healthcare Provider

Soaking, resting, and elevating feet may help with a wide range of soreness and pain, However, if you’re not able to control discomfort with at-home treatment, you should see a healthcare provider.

Any sign that an ingrown toenail or foot sore is infected requires antibiotic medical treatment. This includes oozing pus or discharge, redness, and inflammation around a wound.

If you have experienced Achilles pain and notice sudden, severe pain at the back of the leg or trouble bearing weight on your foot, it could be a sign of an Achilles tendon rupture. If this happens, seek immediate medical care.

Also, call your healthcare provider anytime you have pain from osteoarthritis, gout, or neuropathy that won’t go away or interferes with daily function.

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.