Foot Pain and Problems

The foot is one of the most complex parts of the body. It is made up of 26 bones connected by many joints, muscles, tendons and ligaments. The foot is at risk of many stresses. Foot problems can cause pain, inflammation or injury. These problems can result in limited movement and mobility.

Foot pain is often caused by incorrect foot function. Shoes that don't fit well can worsen and, in some cases, cause foot problems. Shoes that fit correctly and give good support can prevent irritation to the foot joints and skin. There are many types of foot problems that affect the heels, toes, nerves, tendons, ligaments and joints of the foot.

The symptoms of foot problems may look like other health conditions and problems. Always see your healthcare provider for a diagnosis.

A heel spur is a bone growth on the heel bone. It is often located on the underside of the heel bone where it attaches to the plantar fascia. This is a long band of connective tissue running from the heel to the ball of the foot. This connective tissue holds the arch together and acts as a shock absorber during activity. The plantar fascia can be overstretched from running, wearing poor-fitting shoes or being overweight. Then pain can result from the stress and inflammation of the tissue pulling on the bone. Over time, the body builds extra bone in response to this stress, causing heel spurs. Treatment options may include:

• Rest.

• Cold packs.

• Anti-inflammatory medicine, such as ibuprofen.

• Correct stretching before activity.

• Correct footwear or shoe inserts.

• Achilles stretching.

• Corticosteroid shots (injections).

• Surgery (for more severe, prolonged conditions).

Corns are yellowish, callus growths that occur on top of the toes. Corns develop because of irritation or stress. Often, a corn develops where a toe rubs against a shoe or another toe. Corns can cause extreme discomfort and pain. Treatment may include:

• Trimming the corn by shaving the layers of dead skin.

• Applying pads around the corn area.

• Wearing larger shoes to comfortably fit your foot without rubbing.

• Surgery.

To avoid corns, always buy shoes that fit correctly.

A bunion is a bulge of bone or tissue around the joint of the big toe or small toe. Bunions may occur at the base of the big toe or at the base of the little toe. They often occur when the joint is stressed over a period of time. Women get bunions more often than men do because they may wear tight, pointed and confining shoes. Bunions can also be a result of arthritis, which often affects the big toe joint.

Treatment of bunions may vary depending on the pain and deformity. Treatment may include:

• Wearing comfortable, well-fitting shoes (particularly shoes that conform to the shape of the foot and don’t cause pressure areas).

• Surgery (for pain, not for cosmetic reasons).

• Applying pads to the affected area.

• Medicine, such as ibuprofen.

Morton’s neuroma is a buildup of noncancerous (benign) tissue in the nerves running between the long bones of the foot. Morton’s neuroma occurs when 2 bones rub together and squeeze the nerve between them. Most often, neuromas develop between the bones leading to the third and fourth toes. Morton’s neuroma often causes swelling, tenderness and pain. If the pain becomes severe, it may cause tingling, numbness and burning in the toes. It often occurs after standing or walking for a long period of time. Treatment for this condition may involve rest or a change in footwear that does not restrict the foot. If the problem persists, cortisone injections or surgery may be considered.

A hammertoe is when the toe bends or curls downward. This causes the middle joint of the affected toe to poke out. Tight-fitting shoes that put pressure on the hammertoe often make this condition worse. Often a corn develops at this site. Treatment for hammertoes may include:

• Applying a toe pad specially placed over the bony protrusion.

• Changing your footwear to accommodate the deformed toe.

• Surgical removal.

An ankle sprain is an injury to the ligaments in the ankle. Ligaments are tough bands of elastic tissue that connect bones to each other. Ankle sprains may occur if the ankle rolls, turns or twists beyond its normal range of motion. Ankle sprains may be caused by awkward foot placement, irregular surfaces, weak muscles, loose ligaments or wearing shoes with spiked heels. The symptoms of a sprain will depend on how severely the ligaments are stretched or torn but usually include swelling, pain or bruising. Treatment will depend on the severity of the sprain but may include:

• Resting the ankle.

• Wrapping the ankle with elastic bandage or tape.

• Using an ice pack application (to reduce inflammation).

• Keeping the ankle raised.

• Taking over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen to help reduce pain and inflammation. 

• Returning slowly to walking and exercise.

• Using a walking cast (for moderate sprains).

• Having surgery (rarely for severe sprains).

• Getting physical therapy.

With 26 bones in a single foot, almost any of them can be broken. Many breaks or fractures don't need surgery or even a cast. They will heal on their own with some support. When a foot is fractured, the site of the fracture usually is painful and swollen. The site of the fracture will determine the course of treatment, if needed, including:

• Ankle joint fractures. These fractures may be serious and require medical care right away. Ankle fractures usually require a cast. Some require surgery if the bones are too separated or misaligned.

• Metatarsal bone fractures. Fractures of the metatarsal bones, located in the middle of the foot, often don't require a cast. A stiff-soled shoe may be all that is needed for support as the foot heals. Sometimes surgery is needed to correct misaligned bones or displaced segments.

• Sesamoid bone fractures. The sesamoid bones are two small, round bones at the end of the metatarsal bone of the big toe. Usually, padded soles can help relieve pain, but sometimes the sesamoid bone may have to be surgically removed.

• Toe fractures. Fractures of the toes often can heal with or without a supportive hard shoe.

Foot pain can get in the way of an active lifestyle. Foot pain can have many sources, from fractures and sprains to nerve damage. Listed below are three common areas of pain in the foot and their causes:

• Pain in the ball of the foot. Pain in the ball of the foot, located on the bottom of the foot behind the toes, may be caused by nerve or joint damage in that area. In addition, a benign (noncancerous) growth, such as Morton's neuroma, may cause the pain. Corticosteroid injections and wearing supportive shoe inserts may help relieve the pain. Sometimes, surgery is needed.

• Plantar fasciitis. Plantar fasciitis is characterized by pain in the heel of the foot, especially when standing up after resting. The condition is due to an overuse injury of the sole surface (plantar) of the foot. It causes inflammation of the fascia, a tough, fibrous band of tissue that connects the heel bone to the base of the toes.
  Plantar fasciitis is more common in women, people who are overweight, people with jobs that require a lot of walking or standing on hard surfaces, people with flat feet and people with high arches. Walking or running, especially with tight calf muscles, may also cause the condition.
  Treatment may include:

  • Rest.

  • Ice packs.

  • Nonsteroidal anti-inflammatory medicines (NSAIDs), such as ibuprofen.

  • Stretching exercises of the Achilles tendons and plantar fascia.

• Achilles tendon injury. The Achilles tendon is the largest tendon in the human body. It connects the calf muscle to the heel bone. However, this tendon is also a common site of rupture or tendonitis, an inflammation of the tendon due to overuse.
  Achilles tendonitis is caused by overuse of the tendon and calf muscles. Symptoms may include mild pain after exercise that worsens gradually, stiffness that improves after the tendon warms up and swelling. Treatment may include:

  • Rest.

  • Nonsteroidal anti-inflammatory medicine.

  • Supportive devices or bandages for the muscle and tendon.

  • Stretching.

  • Massage.

  • Ultrasound.

  • Strengthening exercises.

  • Surgery.

Diabetes affects the nerves, blood vessels and blood flow throughout the whole body, including the legs and feet. People with diabetes need to check their feet regularly to identify sores or wounds on their feet before complications develop. To help manage diabetes-related foot problems, they may need to see a healthcare provider and orthopaedic doctor and sometimes occasionally a vascular doctor.