Foot Pain

Foot Pain

Causes of Foot Pain

Pain in the foot can be due to a problem in any part of the foot. Bones, ligaments, tendons, muscles, fascia, toenail beds, nerves, blood vessels, or skin can be the source of foot pain. The cause of foot pain can be narrowed down by location and by considering some of the most common causes of foot pain.


Heel Pain

Plantar fasciitis is the most common cause of heel pain. The plantar fascia, a band of tough tissue connecting the heel bone to the toes, becomes irritated or inflamed. Heel pain which is often worst in the morning when getting out of bed or getting up from rest, is the most common symptom. Arch pain may also be present in some individuals. 

Treatment for plantar fasciitis includes:

  • Rest / activity modification
  • Calf and foot muscle stretches and exercises
  • Medication recommended by your physician
  • Shoes with a good shank and a cushioned sole 
  • Arch supports or if required custom foot orthotics
  • Tape for support or pain relief such as Kinesio tape
  • Physiotherapy

Heel spurs are abnormal growths of bone on the bottom of the heel bone that may be caused by an abnormal gait, posture or walking, inappropriate shoes, or certain activities. Spurs may cause foot pain while walking or standing. Although many people may have heel spurs, only a few these people will present with foot pain. Heel spurs can occur in people with plantar fasciitis, but they do not cause plantar fasciitis. People with flat feet or high arches are more likely to have foot pain from heel spurs.

Treatment for heel spurs include: 

  • Cutout heel pad
  • Custom-made insert (orthotic) worn in the shoe
  • Medication recommended by your Physician
  • Rest
  • Physiotherapy
  • Surgery (rarely)

A bruised heel is a bruise of the fat pad of the heel. It can occur after stepping on a rock or other hard object or jumping / falling from a height.

Treatment for a bruised heel includes:

  • rest
  • cushioned athletic shoes
  • gel or foam heel pads
  • Activity modification

A fracture of the heel bone (calcaneus) is usually trauma related. It is most often caused by high impact to the heel -- for example, when a person has fallen from a height or been in a car accident. Injuries can range from a bone crack from a new vigorous exercise plan to a shattered bone from a high fall.  Heel pain, bruising, swelling, limping, or difficulty walking are the main symptoms. 

Calcaneous fracture treatment includes: 

  • Rest from weight bearing, often with crutches
  • Thorough padding of the heel
  • Splinting or casting  or Robo boot to protect the heel bone
  • Medication recommended by your physician
  • Surgery
  • Physical therapy

Ball of Foot Pain - Metatarsalgia

Symptoms may include:

  • Pain and/or burning sensation in the ball of your foot when standing, walking or running – which improves upon resting

  • Sharp or shooting pain in your toes,

  • Numbness or tingling in your toes.

Causes of Metatarsalgia:

Metatarsalgia is pain and inflammation in the ball of the foot. Strenuous activity or ill-fitting shoes are common causes.

  • Intense activities
  • Foot trauma
  • Certain foot types such as high arches
  • Foot deformities
  • Arthritis
  • Fat pad deterioration (a thinning of the protective fat pads that cushion the balls of the foot)
  • Bunions
  • Excessive weight
  • Improper fitting footwear

Treatment for Metatarsalgia includes:

  • Change to more comfortable footwear
  • Arch supports to relieve pressure on the ball of the foot
  • Custom Orthotics to reduce pressure to the effected area
  • Metatarsal Pads
  • Activity Modification

Other Common Forefoot Conditions

Examples of common types of painful forefoot conditions include:

Bunion / Bunionette

A bunion is a bony enlargement or bump located on the side of the big toe joint. This area is often irritated and made more painful by tight fitting shoes causing pressure and friction on the area. A bunionette is an enlargement of the 5th Mtp (baby toe) joint.
Symptoms:
• The bunion or bunionette will often be red, swollen and painful
• Often a bunion may also have a corresponding shift of the big toe toward the smaller toes. This is called hallux valgus. The 2nd toe may rest over the big toe.


Hallux Valgus Deformity

This is a shift of the big toe toward the smaller toes. It is often improperly identified as a bunion, but frequently co-exists with a bunion.
Symptoms:
• Not always symptomatic, but pain is often present with forced movement of the big toe joint
• The 2nd toe often overrides the big toe (called crossover toe deformity) as the big toe shifts under the 2nd toe


Hallux Limitus (HL) / Hallux Rigidus (HR)

Hallux limitus is limited or reduced motion in the big toe joint possibly due to bony changes in the joint.

Hallux rigidus occurs when the big toe joint motion ceases to occur as arthritic changes have caused pronounced degeneration of the joint.
Symptoms:
• General enlargement of the big toe joint that is tender along the top of the joint line
• Pain is aggravated with increased weight-bearing activity
• A bony prominence on top of the big toe joint (called an osteophyte) may be seen on examination
• Pain during walking, especially as the foot pushes off


Morton’s Neuroma (interdigital neuroma)

A Morton’s Neuroma develops in response to irritation, pressure or injury to one of the nerves that lead to the toes. A neuroma is most often found between the 3rd and 4th toes but can also occur between the 2nd and 3rd
Symptoms:
• Pain, tingling, burning, and/or numbness is reported beginning at the ball of the foot and often radiating into the toes
• Tenderness is found in the web space between the toes and there may be a palpable click when squeezing the metatarsals (long bones of the forefoot) together.


Metatarsal Phalangeal Joint Capsulitis

This refers to a local inflammation under the metatarsal head (ball of the foot) sometimes due to degeneration of the ligaments that stabilize the metatarsal head.
Symptoms:
• Tenderness, which is localized to the area under the metatarsal head
• Patients often report it feels like a stone under the foot and it is worse when barefoot or in thin-soled shoes


Metatarsal Stress Fractures (march fractures)

A Stress fracture is a small break in the bone caused by repetitive stress.
Symptoms:
• Local point tenderness of the involved metatarsal is evident initially during activity and by squeezing the affected bone between the thumb and finger; may progress to pain at rest if left untreated
• Diffuse swelling and pain will increase as the injury progresses


Freiberg’s Disease

This condition occurs from a lack of blood supply (avascular), which results in permanent damage to the bone tissue at the 2nd metatarsal head. The avascularity leads to eventual collapse and deformity of the metatarsal head.
Symptoms:
• The dorsal aspect (top) of the metatarsal phalangeal joint (where the second toe joins the foot) is sore with examination and worsens with activity

Forefoot Pain Treatment

To alleviate the pain caused by forefoot conditions, Canadian Certified Pedorthists recommend selecting footwear with:

  • Wide, square toe box to allow proper room for toes and avoid friction with sensitive areas
  • Low heeled shoes (less than 1″ or 2.5cm) to reduce stress put on the ball of the foot
  • No stitching over areas where bones and joints are more prominent
  • Thicker soles help to absorb shock
  • Stiff, rocker bottom soles to help off-load the ball of the foot by reducing how much it bends during the push-off phase of gait
  • Strong heel counters to aid in control of foot motion

If you are experiencing foot pain or discomfort, you should consult your physician for a proper diagnosis and an appropriate treatment plan. Your doctor may refer you to  OKAPED's to see a Canadian Certified Pedorthist for Pedorthic management of your foot pain. This may include orthopaedic footwear, shoe selection guidance, orthotics and/or foot related products such as a metatarsal pad.