Common Causes of Foot Pain

Common Causes of Foot Pain

As shock absorbers, our feet cushion up to one million pounds of pressure during a single hour of strenuous exercise. They also support 1.2 times our body weight during walking and two to three times that during running activities.1 It is not hard to see why our feet are highly susceptible to injury. If you wake up and suddenly feel pain in your feet, what is going on? You probably want answers as well as information on how you can get better, such as whether a physical therapist can help treat your foot pain.

Foot pain is a frequent cause of visits to podiatrists and orthopedic physicians. With more than 26 bones, 33 joints, and five ligaments, many structures in the foot can be injured. When these structures become injured or overstressed, it can cause pain, and that can limit your ability to walk.

Types of Foot Pain
Pain can strike in different areas of your foot, and certain conditions are commonly associated with these areas. They include:

Bottom of the foot: Plantar fasciitis
Arch of the foot: Posterior tibial tendonitis, tarsal tunnel syndrome
Ball of the foot/toes: Bunions, hammertoe, metatarsalgia, turf toe, Morton's neuroma
Plantar Fasciitis
Plantar fasciitis is one of the most common causes of foot pain.2 It results from irritation of a thick band of tissue, called the plantar fascia, that runs across the bottom of your foot. This fascia connects your heel bone to your toes.

People with plantar fasciitis experience pain across the bottom of the foot, typically near the inner part of the heel. Discomfort with plantar fasciitis is more common in the morning after waking up and with strenuous exercise like running, although you may feel the heel pain while simply walking.3

Physical therapy for plantar fasciitis involves treatments that decrease inflammation and improve the biomechanics of your foot, ankle, and entire lower extremity. Exercises for plantar fasciitis may include stretching, strengthening, and balance exercises. The same exercises may help prevent the condition from reoccurring.4

Plantar Fasciitis: Overview and More
Posterior Tibial Tendonitis
The posterior tibialis tendon courses down your inner lower leg and attaches to the bottom of your foot near the inside of the arch. The tendon helps support your foot's natural arch, and irritation here may cause pain, limited walking ability, and flatfoot deformity.

Treatment for posterior tibial tendonitis (also called posterior tibial tendon dysfunction) may include exercises for flexibility, strength, and balance, reducing inflammation, and orthotics.5 Your physical therapist (PT) can examine you and determine the best treatment for your posterior tibial tendonitis. Continuing with exercises and orthotics can help keep it from coming back, as can surgery.6

Posterior Tibial Tendonitis: Overview and More
Tarsal Tunnel Syndrome
Tarsal tunnel syndrome occurs when the main nerve that goes to the foot is compressed by bone or tissue. You may be more familiar with a similar condition in the wrist called carpal tunnel syndrome. The symptoms of tarsal tunnel syndrome are typically felt on the inner side of the foot and include burning, tingling, and shooting pains.7

Treatments for tarsal tunnel syndrome include anti-inflammatory drugs, orthotics, and changes in footwear. If those fail, a surgical procedure called tarsal tunnel release may be an option.8 You may be able to prevent tarsal tunnel syndrome by warming up before strenuous activity and keeping the muscles in the area strong and flexible.9

Tarsal Tunnel Syndrome: Overview and More
A bunion is a bony protrusion at the base of your big toe, on the inside of your foot, that's caused by a misalignment in the joint. It can make your big toe point inward, even to the point that it overlaps the second toe. The lump can be painful, make your shoes uncomfortable, and change your balance and the way you walk.10

Non-steroidal anti-inflammatories (NSAIDs) are common for treating bunion pain, as are corticosteroid injections.11 Bunion pads, splints, and orthotics can help when combined with other treatments.12 Physical therapy exercises for bunions include muscle strengthening to improve joint alignment and range-of-motion exercises to keep the joint moving.10 Surgery may be an option if physical therapy isn't effective.

Many bunions can be prevented by wearing properly fitting shoes, avoiding high heels, and giving your feet a break from shoes when possible. Keeping your feet strong can also help prevent bunions.13

Getting Rid of Bunion Pain
Hammertoe usually affects the second, third, or fourth toe. Like bunions, it's caused by a misaligned joint that pushes tissue from the ball of your foot forward and underneath your toes.14 Eventually, it can cause your toe to take on a claw-like or hammer-like shape and lead to pain in the toe and ball of the foot.

Hammertoe can be treated by wearing loose-fitting shoes, wearing hammertoe pads, icing, strengthening and stretching exercises, and, in severe cases, surgery. Hammertoe can be prevented by avoiding high heels, narrow shoes, and shoes that crowd your longest toe.15

Surgery for Hammertoe
Metatarsalgia is a painful foot condition affecting the ball of the foot. It is called metatarsalgia because the bones in this region of the foot are named the metatarsals. A lot of jumping or running activities increase the stress load on this region, and over time, the metatarsal bones can become swollen and painful. Some types of arthritis can also contribute to this condition.16

Metatarsalgia treatment often involves NSAIDs, proper footwear, metatarsal pads, and orthotics. Shoes with a wide toe box and good support can both help treat and prevent metatarsalgia.17

Metatarsalgia: Overview and More
Turf Toe
Turf toe is a sprain at the base of the big toe. It occurs when the big toe bends back beyond its normal range of motion, which can cause a tear in the ligaments that support it.18 This often occurs when kicking a soccer ball (or missing the ball and chunking the ground). Pain with turf toe is experienced during walking and running activities. You may also experience toe cramping.

Physical therapy for turf toe involves managing inflammation around your foot and toe and gently restoring normal mobility to the affected toe or toes. To prevent turf toe, you can learn proper running mechanics and wear hard-soled shoes during exercise.19

Turf Toe: Overview and More
Morton's Neuroma
Morton's neuroma causes a sharp, stabbing pain when you walk or put pressure on your foot. It's caused by thickening of a nerve between your toes, usually between the third and fourth toes, possibly due to injury.20 At first, symptoms may only be occasional, but they may become more common or even constant as the condition develops.

Morton's neuroma is treated with NSAIDs, cortisone injections, resting the foot, wearing wide-toed shoes and metatarsal pads, physical therapy, and sometimes surgery.20 You can help prevent it from developing by staying away from high-heeled or pointy-toed shoes.

Morton's Neuroma and How to Treat It
Physical Therapy for Foot Pain
Physical therapy is often one of the main ways to treat the symptoms of foot pain from many different causes.4 Gentle stretching of the foot often helps to alleviate the discomfort felt due to the above disorders.

Your physical therapist can also offer strategies to help treat your pain and improve your foot function. For example, an ice bottle massage may help control pain and inflammation. A PT may also be able to help you correct walking and running mechanics that can alleviate and prevent foot problems.

When to See a Doctor
Foot pain can be a difficult thing to manage. It can prevent you from walking normally and may limit your ability to enjoy normal work and recreational activities. If you regularly have foot pain or it seems to be getting worse or more frequent, and especially if you notice changes to the size and appearance of joints, make an appointment with your doctor. Ask whether a physical therapist could help you overcome foot pain and return to your normal active lifestyle.

Frequently Asked Questions
Why do my feet hurt when it's cold outside?
Cold temperatures can aggravate foot pain caused by certain conditions. Plantar fasciitis and arch and heel pain are some conditions that may be exacerbated by colder temperatures, and additional foot problems such as frostbite can occur with extreme cold.

Can you get arthritis in your feet?
The short answer is yes. Arthritis can affect any joint in the body, including those joints in the foot and ankle, causing inflammation and pain. While there is no cure for arthritis, there are treatment options to help manage discomfort, including physical therapy, medications, and some surgical options

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