Foot pain

Definition

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

Common Causes

Foot pain can be caused by:

• Bunions -- a protrusion at the base of the big toe, which can become inflamed. Bunions often develop over time from wearing narrow-toed shoes.
• Hammer toes -- toes that curl downward into a claw-like position.
• Calluses and corns -- thickened skin from friction or pressure. Calluses are on the balls of the feet or heels. Corns appear on your toes.
• Plantar warts -- from pressure on the soles of your feet.
• 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, caused by two bones on the sole of your foot rubbing together, leads to a sharp or burning pain in the ball of your foot (and sometimes toes). It is less common, but can be related to wearing tight-fitting shoes.

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 of the heel -- 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 2 to 3 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 your health care provider if

Call your doctor if:

• You have sudden, severe pain.
• Your pain began following an injury -- especially if there is bleeding, bruising, deformity, or you cannot bear weight.
• You have redness or swelling of the joint, an open sore or ulcer on your foot, or a fever.
• You have diabetes or peripheral vascular disease -- a condition characterized by poor circulation.
• You do not respond to self-care within 1 to 2 weeks.

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.

References

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.

Illustrations

Normal foot X-ray

Leg skeletal anatomy

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