Foot Pain

Pain or discomfort can be felt anywhere in the foot, including the heel, toes, arch, instep, sole, or ankles. See ankle pain and heel pain for more information.

Common Causes

Foot pain can be caused by:

Bunions

A bunion is a painful enlargement at the joint of the big toe. The skin over the joint becomes swollen and is often quite tender. Bunions can be inherited as a family trait, can develop with no recognizable cause or can be caused by shoes that fit poorly.

An important part of treatment is wearing shoes that conform to the shape of the foot and do not cause pressure areas. This often alleviates the pain. In severe cases, after many years, bunions can be disabling. Several types of surgery are available that may relieve pain and improve the appearance of the foot. Surgery is usually done to relieve pain.

Hammertoes

Hammertoes are one of several types of toe deformities. Hammertoes have a permanent sideways bend in your middle toe joint. The resulting deformity can be aggravated by tight shoes and usually results in pain over the prominent bony areas on the top of the toe and at the end of the toe. A hard corn may develop over this prominence.

Treatment usually involves a shoe to better accommodate your deformed toe. Shoe inserts or pads also may help. If, after trying these treatments, you are still having marked difficulty, surgical treatment to straighten the toe or remove the prominent area of bone may be necessary.

Plantar Warts

Plantar warts occur on the sole of the foot and look like calluses. They result from an infection by a specific virus. They are like warts elsewhere, but they grow inward. The wart cannot grow outward because of weight placed on it when you stand. You may experience severe pain when walking, and can have just one or many plantar warts. Plantar warts are extremely difficult to treat, but success has been achieved with repeated applications of salicylic acid (available over the counter) to soften the overlying callus and expose the virus. Other treatments include injection of the warts with medication, freezing the warts with liquid nitrogen and, very rarely, surgery.

Fallen Arches

Also called flat feet. Ill-fitting shoes often cause these problems. Aging and being overweight also increase your chances of having foot problems.

Morton's Neuroma

Morton's neuroma is caused by a nerve being pinched. This pinching usually results in pain between the third and fourth toes. Tight shoes can squeeze foot bones together. The nerve responds by forming a neuroma, a build up of extra tissue in the nerve. The neuroma results in pain, that may radiate into the toes.

Treatment usually involves wearing wider shoes and taking oral medications to decrease the swelling around the nerve. A pad on the sole of the foot to spread the bones is often helpful. Your doctor may also inject cortisone around the nerve. If your difficulty continues, surgery to remove the neuroma may be suggested.

Heel Pain

Heel pain is extremely common. It often begins without injury and is felt under the heel, usually while standing or walking.

Inflammation of the connective tissue on the sole of the foot (plantar fascia) where it attaches to the heel bone is the most common cause of pain. It is often associated with a bony protrusion (heel spur) seen on X-ray studies.

Most cases will improve spontaneously. Medication to reduce swelling of the soft tissues in your foot and shoe inserts are quite helpful. If pain continues, steroid injections or walking casts are used. Only in the most troubling and prolonged cases is surgery recommended. See Heel Pain for more information/

Corns and Calluses

Corns and calluses are caused by pressure on the skin of your foot. They may occur when bones of the foot press against the shoe or when two foot bones press together.

Common sites for corns and calluses are on the big toe and the fifth toe. Calluses underneath the ends of the foot bones (metatarsals) are common. Soft corns can occur between the toes.

Treatment involves relieving the pressure on the skin, usually by modifying the shoe. Pads to relieve the bony pressure are helpful, but they must be positioned carefully. On occasion, surgery is necessary to remove a bony prominence that causes the corn or callus.

Other common causes of foot pain include:

• Broken bones
  
• Stress fracture
  
• Arthritis
  
• Gout -- common in the big toe, which becomes red, swollen, and very tender
  
• Plantar fasciitis (see heel pain)
  
• Bone spur (see heel pain)
  
• Sprains (see ankle pain)
  
• Bursitis (see heel pain)
  
• Tendinitis (see heel pain)
  

Home Care

Apply ice to reduce pain and swelling. Do this just after an activity that aggravates your pain.

Elevate your painful foot as much as possible.

Reduce activity until the problem improves.

Wear foot pads in areas of friction or pressure. This will prevent rubbing and irritation.

Take over-the-counter pain medicine, like ibuprofen or acetaminophen. Try this for two to three weeks (unless you have a history of an ulcer, liver disease, or other condition that does not allow you to take one of these drugs).

For plantar warts, try an over-the-counter wart removal preparation.

For calluses, soak in warm water and then rub them down with a pumice stone. DO NOT cut or burn corns or calluses.

For foot pain caused by a stress fracture, an extended rest period is often necessary. Crutches may be used for a week or so to take the pressure off, if your foot is particularly painful.

For foot pain due to plantar fasciitis, shoe inserts may help.

Call our office if:

• You have sudden, severe pain.
  
• Your pain began following an injury -- especially if there is bleeding, bruising, deformity, or you cannot bear weight.br />
• You have redness or swelling of the joint, an open sore or ulcer on your foot, or a fever. br />
• You have diabetes or peripheral vascular disease -- a condition characterized by poor circulation. br />
• You do not respond to self-care within two weeks.br />

What to expect at your health care provider's office

Your doctor will perform a physical examination, paying particular attention to your feet, legs, and back, and your stance, posture, and gait.

To help diagnose the cause of the problem, your doctor will ask medical history questions, such as:

• Are both of your feet affected? If only one, which one?
  
• Exactly what part of your foot is affected?
  
• Does the pain move from joint to joint or does it always occur in the same location?
  
• Did your pain begin suddenly and severely or slowly and mildly, gradually getting worse?
  
• How long have you had the pain?
  
• Is it worse at night or when you first wake up in the morning?
  
• Is it getting better?
  
• Does anything make your pain feel better or worse?
  
• Do you have any other symptoms?
  
• X-rays may be useful in making a diagnosis.
  

For bunions, plantar fasciitis, bone spurs, Morton's neuroma, or other conditions, your doctor may inject cortisone. This will be considered if oral medication, changing your shoes, and other measures have not helped. No more than three injections in a year should be attempted in most cases.

A broken foot will be casted. Broken toes will be taped.

Orthotics fit by a podiatrist or other specialist can help many structurally related problems. Physical therapy is also quite helpful for conditions related to over-use or tight muscles, like plantar fasciitis or achilles tendinitis.

Removal of plantar warts, corns, or calluses may be necessary. This is generally performed by a podiatrist.

Surgery may be considered for certain conditions like bunions or hammer toes if the pain interferes with walking or other activities.

Prevention

The following steps can prevent foot problems and foot pain:

• Wear comfortable, properly fitting shoes. They should have good arch support and cushioning.
  
• Wear shoes with adequate room around the ball of your foot and toe.
  
• Wear sneakers as often as possible, especially when walking.
  
• Avoid narrow-toed shoes and high heels.
  
• Replace running shoes frequently.
  
• Warm up before exercise, cool down after exercise, and stretch adequately.
  
• Increase your amount of exercise SLOWLY over time to avoid putting excessive strain on your feet.
  
• Lose weight if you need to.
  
• Learn exercises to strengthen your feet and avoid pain. This can help flat feet and other potential foot problems.
  
• Keep feet dry to avoid friction. This may help prevent corns and calluses.
  
• Avoid alcohol to prevent attacks of gout.
  

Your orthopaedist is a medical doctor with extensive training in the diagnosis and nonsurgical and surgical treatment of the musculoskeletal system, including bones, joints, ligaments, tendons, muscles and nerves.

Kay D. Morton's neuroma. Foot Ankle Clin. 2003; 8(1): 49-59.
American College of Radiology (ACR), Expert Panel on Musculoskeletal Imaging. Chronic foot pain. Reston, VA: American College of Radiology; 2002.
Update Date: 10/20/2005
Updated by: Kevin B. Freedman, MD, MSCE, Sports Medicine, Orthopaedic Specialists, Bryn Mawr, PA. Review provided by VeriMed Healthcare Network.
The American Academy of Orthopaedic Surgeons provides this public information on common foot problems.