Foot Pain

With 26 bones, 33 joints and a complex mesh of muscles, nerves and ligaments, the  foot is one of the most complex parts of the body; so complex, in fact, that a medical and surgical specialty -- podiatry -- is devoted solely to treating and studying foot problems.

Problems causing foot pain

Problems affecting the bones, ligaments and muscles of the foot cause foot pain. Medical conditions such as arthritis and diabetes can cause foot pain. Howerver, the main source of most foot pain involves improper foot function or biomechanics. Each step exerts a force that is about 50 percent greater than your body weight on each foot. Poorly fitting shoes and high heel shoes can aggravate, or possibly cause, foot pain by altering the way weight is distributed on the foot or by irritating areas of the foot.  

Flatfoot or High Arches

Flatfoot (no arch) or high arches can contribute to painful problems in the feet, knees, back and 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.

• Flatfoot comes in flexible and rigid versions.  About 25 percent of the population has some degree of flatfoot, but it causes no problems in most cases. 

• Flexible flatfoot is more common, may be hereditary and usually causes no problem. When there are symptoms, they are usually pain or fatigue. Frequently, no treatment is recommended. 

• Rigid flatfoot is rarer, usually secondary to another conditions such as tarsal coalition or arthritis, and is usually is marked by stiffness, pain and a limp. 

• High arches (pes cavus) cause more pain than flatfoot (pes planus). It also causes stiffness in the feet, legs and lower back.

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. The condition may also be a harbinger of other problems such as inflammatory arthritis (rheumatoid, gout) or may be associated with a tight (shortened) heel cord.

Plantar fasciitis is marked by a dull ache in the arch or pain in the heel. The pain is usually worse when just beginning to walk after getting out of bed, or walking after a short period of inactivity. 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 (overuse). Switching from high heels or cowboy boots (with tall heels) to flat shoes or athletic shoes can increase the tension on the Achilles tendon and plantar fascia, causing inflammation and discomfort.  Gaining 10 to 20 pounds can have the same effect.

Self-care and rest sometimes relieves plantar fasciitis. Soft heel pads or other orthotics may help.  Exercises that stretch the Achilles tendon and plantar fascia may also help in some cases.  Stretching should not be done if the pain is acute. 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 or third metatarsal (below the second or third toe). 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 one 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 be needed for six weeks to several months. In some cases, surgery may be needed.

Morton's Neuroma

Morton's neuroma is a noncancerous inflammation and 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 impact or pressure. 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 is described as cramping, or severe and burning, or electric-shock. It 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 painful swelling on the side of the foot at the base of a toe (usually the big toe) with an associated deformity in which the toe to points away from the midline. Bunions are more common in women, may have a hereditary basis and are often associated with the long-time wearing of tight shoes and high heels.  A bony painful growth (exostosis) develops on the end of the metartarsal near 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. The bunion may also become inflamed and sore, especially if chaffed by the material of the 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. Generally, the second toe is affected, but hammertoe may develop in any or all of the middle toes. 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. Proper-fitting shoes are a must, as the condition is often cause by tight shoes and can’t be corrected unless the cause is first corrected.

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.

Self-Care Steps

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 three to six weeks.

• Switch to low-impact activities, such as walking, biking or swimming. Walking is particularly good.

• Gentle stretching may be helpful. Do not stretch during acute periods of pain.

• 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 three to six 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.

For Morton's Neuroma:

• Avoid the original activity that caused the pain, and other high-impact activities, for three to six weeks. Resume the original activity only after pain is gone.

• Try wearing shoes with a wider toe box to prevent pressure on the nerve.

For Hammertoe:

• Wear shoes with a toe box large enough to accommodate the hammertoe.

For Bunions:

• Choose shoes with a larger toe box (squared or rounded toe).

• Put a piece of foam or cotton between the affected toes to see if it eases the pressure.

• Place padding around the bunion to relieve pressure and rubbing from shoes. Moleskin and bunion pads are available at most drugstores.

• Try using an arch support to stop the jamming of the long bone and the big toe.

• See your doctor if pain interferes with walking, or is not relieved with self-care.

For Plantar Warts:

• Soak foot for 10 minutes in a solution of two tablespoons mild household detergent (such as dish soap) and half a gallon warm water. Cut a piece of 40-percent salicylic acid plaster (available at drugstores) the size of the wart and apply it to the wart. Cover with tape or a bandage. Remove the plaster in two days. Brush the wart with a toothbrush soaked in soap and water. Repeat this procedure for two weeks until the wart is gone.

• If warts remain despite self-care or if they interfere with walking, see your doctor.

• Do not try to cut out warts.

Preventive Care for 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 1/2 and 1-1/2 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 one to two 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.