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Common Causes of Foot Pain

Cause | TypesRisk FactorsSymptoms | Diagnosis | Treatment | Talking to Your Doctor

Cause

The foot is a complex structure of 26 bones, 33 joints, and 126 muscles, ligaments, and nerves. Only a small percentage of Americans are born with foot problems. Most problems are due to neglect and improper care, including ill-fitting shoes. With age, changes occur in the feet. Some disorders begin early in life and are affected by heredity, gait patterns, and terrain. About 75% of Americans will experience foot pain at some point in their lives.

Common causes of foot pain include:

  • Poor-fitting shoes
  • High-heeled shoes
  • Poor posture
  • High impact exercise (eg, running)
  • Poor balance

Foot pain may also be caused by systemic disease. For example:

  • Arthritis-Arthritis ( osteoarthritis and  rheumatoid arthritis) can cause stiffness and reduced range of motion.
  • Peripheral Vascular Disease-This condition affects the legs and feet by causing reduced circulation, swelling, and increased risk of infection.
  • Diabetes-A common complication of diabetes is reduced circulation, which causes a number of problems in the legs and feet including abnormal sensation, swelling, and increased risk of infection.
  • Gout-Gout may cause pain and swelling in the great toe.

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Types of Foot Pain

Foot pain may occur in any part of your foot including:

  • Toes
  • Forefoot
  • Midfoot
  • Heel
  • Arch and bottom of foot

Toe Pain


Corns and Calluses

Corns and calluses are thickened layers of skin that are caused by irritation. The skin is usually cone-shaped and has a knobby core, which points inward. This core can put pressure on the underlying thin skin and cause sharp pain. Corns can develop on top of or between your toes. Soft corns develop between your toes, where they are kept pliable by the moisture from perspiration. Calluses develop on the bottom of your foot. Corns and calluses develop as a result of friction from the toes rubbing together or against the shoe.

Corns are a result of:

  • Shoes, socks, or stockings that fit too tightly around the toes
  • Pressure on the toes from high-heeled shoes
  • Shoes that are too loose
  • Deformed and crooked toes

Calluses are a result of:

  • Poorly fitting shoes
  • Walking regularly on hard surfaces
  • Flat feet

Note: If you have diabetes, the presence of calluses is a strong predictor of ulceration, particularly if you have a history of foot ulcers. Contact your doctor.

Bursitis of the Toe

Bursitis is an inflammation of the fluid filled sacs that protect your toe joints, particularly the big toe. It often occurs as a result of irritation from rubbing.

Ingrown Toenails

Ingrown toenails can occur on any toe, but are most common on the big toe. They usually develop when tight-fitting or narrow shoes put too much pressure on the outside of your big toe. This forces the nail to grow into the flesh of your toe. Incorrect toenail trimming can also contribute to the risk of developing an ingrown toenail. Other conditions that can lead to ingrown toenails include:

  • Fungal infections
  • Injury to the toe
  • Abnormalities in the structure of the foot
  • Repeated impact on the toenail from the shoe during high-impact exercise

Bunions

bunion is a painful swelling that usually occurs at the head of one of the long bones (metatarsal bones) of the big or little toe, which extend from the arch of the foot and connect to the toes. A bunion begins to form when the big or little toe is forced in toward the rest of the toes. This causes the head of the metatarsal bone to jut out and rub against the side of your shoe. The underlying tissue becomes inflamed, and a painful swelling forms. Bone growth may occur at the site of irritation. The toe grows towards the rest of your toes at an increasing angle.

Bunions can be caused by a number of conditions:

  • Narrow high-heeled shoes with pointed toes, which can put enormous pressure on the front of your foot
  • Injury in the joint
  • Genetics, which may play a role in 10 to 15 percent of all bunions
  • Other causes, including:
    • Flat feet
    • Gout 
    • Arthritis 
    • Occupations (such as ballet) that place unnatural stress on the feet

Hammertoes

hammertoe is a permanent deformity of your toe joint. With hammertoe, your toe bends up slightly and then curls downward, resting on its tip. When forced into this position long enough, the tendons of your toe contract and it stiffens into a hammer, or claw-like, shape.

A hammertoe is most common in the second toe. However, it may develop in any or all of your three middle toes if they are pushed forward in a shoe and do not have enough room to lie flat.

The risk of developing a hammertoe is increased if your toes are already crowded by the pressure of a bunion. Your chances also increase if you have diabetes or other diseases that affect the nerves and muscles of your feet.

Forefoot


Interdigital (Between the Toes) Neuromas

Neuromas occur when a nerve, or the tissue surrounding the nerve, becomes enlarged and inflamed. Symptoms are a burning or tingling sensation and cramping in the front of your foot. This condition can be caused by:

  • Tight, poorly fitting shoes
  • Injury
  • Arthritis
  • Abnormal bone structure

Morton's neuroma is the most common neuroma of the foot. It develops when the second and third or the third and fourth metatarsal bones (foot bones that lead to the toes) pinch the nerve that runs between them.

Stress Fracture

stress fracture in your foot usually occurs in one of the five metatarsal bones (mostly the second or third). These fractures are caused by overuse during strenuous exercise, particularly running and high-impact aerobics.

A fracture in the first metatarsal bone, which leads to the big toe, is uncommon because of the thickness of this bone. If it occurs, however, it is more serious than a fracture in any of the other metatarsal bones because it dramatically changes your pattern of normal walking and weight-bearing. Stress fractures do occur in other foot bones but are much less common than in the metatarsals.

Sesamoiditis

Sesamoiditis is a condition involving the sesamoid bones, which are small bones underneath the head of the first metatarsal bone (the bone that leads to the big toe). The sesamoid bones bear considerable weight, and sometimes a stress fracture occurs within the bone. Sometimes a part of the sesamoid actually dies due to high repetitive stress, and the bone may fragment. Often there is no clear-cut cause, but sesamoid injuries are common among people who participate in high-impact activities, such as ballet dancing, running, and aerobic exercise.

Metatarsalgia

When a cause cannot be determined, any pain on the ball of the foot is generally referred to as metatarsalgia. It is most likely caused by improper footwear, particularly high heels, or by high-impact activities. People with a high arched foot are prone to develop metatarsalgia.

Midfoot


Tarsal Tunnel Syndrome

Tarsal tunnel syndrome results from compression of a nerve that runs through a narrow passage behind your inner anklebone down to your heel. It may be caused by injury to your ankle, such as a sprain or fracture, or by a growth that presses against the nerve.

Excessive Pronation

Pronation is the normal motion that allows your foot to adapt to uneven walking surfaces and to absorb shock. Excessive pronation occurs when your foot has a tendency to turn outward, flattening the longitudinal arch, and stretching and pulling the fascia. It can cause not only foot pain, but since it may affect the gait, it may cause secondary problems in the hip, knee, and lower back.

Heel Pain

The heel is the largest bone in the foot. Heel pain is the most common foot problem and affects two million Americans every year. It can occur in the front, back, or bottom of the heel.

Plantar Fasciitis

Plantar fasciitis occurs from small tears and inflammation in the plantar fascia, a ligament-like structure that stretches from the heel to the ball of your foot. This band, much like the tensed string in a bow, supports the arch of your foot and helps to serve as a shock absorber.

Plantar fasciitis is usually a result of overuse during high-impact exercise and sports, especially running. Because the condition often occurs in only one foot, factors other than overuse may be responsible in some cases. Other causes of this injury include poorly fitting shoes or an uneven stride that causes a stressful impact on the foot.

Pain often occurs suddenly and mainly around the undersurface of the heel, although it often spreads to your arch. The condition can be temporary, but may become chronic if you ignore it. Resting usually provides relief, but the pain may return.

Heel Spurs

Heel spurs are bony growths that protrude from the bottom of the heel bone, and they are parallel to the ground. They are not like a needle sticking down into the foot. The spur occurs where the plantar fascia attaches, and the pain in that area is really due to the plantar fascia attachment being irritated. There is a nerve that runs very close to this area and may contribute to the pain which occurs. However, there are many people with heel spurs who have no symptoms at all.

Haglund's Deformity (Pump Bump)

Haglund's deformity is a bony growth on the back of the heel bone, which then irritates the bursa and the skin lying behind the heel bone. It is commonly called a "pump bump." It develops when the back of your shoe repeatedly rubs against the back of the heel, irritating the bursa and skin overlying the bone.

Achilles Tendinopathy

Achilles tendinopathy is degeneration of the tendon that connects your calf muscles to your heel bone. There are two common types of tendinopathy, tendinosis and tendinitis. Tendinitis is an inflammation of the tendon. Although the term tendinitis is used more often, tendinopathies are actually more likely to be a tendinosis, with no inflammation. The tendon suffers excessive stress and then internal injury; a small area undergoes degeneration. Small internal tears may even develop. Achilles tendinopathy occurs primarily in those who engage in high-impact exercise, particularly running, racquetball, and tennis.

People at highest risk of this disorder are those with a shortened Achilles tendon. Such people tend to roll their feet too far inward when walking and tend to bounce when they walk. A shortened tendon can be due to an inborn structural abnormality, but is more likely to be acquired after wearing high heels regularly.

Stress Fracture

A stress fracture can occur in the heel and is caused by overuse during strenuous exercise, particularly running and high-impact aerobics. Stress fractures are common in military training.

Arch and Bottom-of-the-Foot Pain


Flat Foot

Flat foot is a defect of your foot that eliminates the arch. The condition is most often inherited. Arches, however, can also "fall" in adulthood. This condition is sometimes referred to as posterior tibial tendon dysfunction (PTTD). This occurs most often in women over 50, but it can occur in anyone. Overall, normally occurring flat feet in adults do not cause many functional problems, and many great athletes have done very well with this condition.

Abnormally High Arches

An  overly high arch (cavus foot) can cause problems. Army studies have found that recruits with the highest arches have the greatest tendency to lower limb injuries, while flat-footed recruits have the least. The cavus foot is much less common than the flat foot.

Clawfoot

Clawfoot is a deformity of the foot marked by very high arches and very long toes that tend to curl downwards. Clawfoot is a hereditary condition, but in rare cases can occur when muscles in your foot contract or become unbalanced due to nerve or muscle disorders.

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Risk Factors

A risk factor is something that increases your likelihood of getting a disease or condition.

It is possible to develop foot pain with or without the risk factors listed below. However, the more risk factors you have, the greater your likelihood of developing foot pain. If you have a number of risk factors, ask your health care provider what you can do to reduce your risk.

Risk factors for foot pain include the following:

Age

Nearly everyone who wears shoes has foot problems at some point in their lives. Those who are at a slightly greater risk, though, include children and the elderly.

  • Children-Foot pain is fairly common in children. Heel pain is common in very active children between the ages of 8-13, when high-impact exercise can irritate growth centers of the heel.
  • The Elderly-Elderly people are at very high risk for foot problems. With age, feet widen and flatten, and the fat padding on the sole of the foot wears down. Older people's skin is also drier and thinner and may have less blood supply. Foot pain can be the first sign of trouble in many illnesses related to aging, such as  arthritis, diabetes, and circulatory disease.

Gender

Women are at higher risk than men for severe foot pain, probably because of wearing high-heeled shoes, and possibly because of wearing shoes that may be too narrow.

  • Older Women-Severe foot pain appears to be a major cause of general disability in older women. In one study, 14% of older disabled women reported chronic, severe foot pain, which played a major role in requiring assistance for walking and doing daily activities.
  • Pregnant Women-Pregnant women have special foot problems from weight gain, swelling in their feet and ankles, and the release of certain hormones during pregnancy that cause ligaments to relax. These hormones help with childbearing, but can weaken the soft tissue structure of the feet.

Occupational Risk Factors

An estimated 120,000 job-related foot injuries occur every year, and about one-third of them involve the toes. A number of foot problems have been attributed to repetitive use at work. These include:
  • Arthritis of the foot and ankle
  • Toe deformities
  • Pinched nerves between the toes
  • Plantar fasciitis
  • Adult acquired flat foot
  • Tarsal tunnel syndrome

No studies, however, have scientifically distinguished between injuries due to work and those due to regular use.

Sports

People who engage in regular high-impact aerobic exercise are at risk for plantar fasciitis, heel spurs, sesamoiditis, shin splints, Achilles tendinopathy, and stress fractures.

Medical Conditions

Certain conditions increase the risk of having foot pain, these include:

  • Diabetes -People with diabetes are at particular risk for severe foot infections, due to impaired circulation, and must take special precautions.
  • Excess Weight -Anyone who is overweight puts increased stress on his or her feet and is at risk for foot or ankle injuries.
  • Other Medical Conditions-Many other medical conditions, such as osteoarthritis, rheumatoid arthritis, and gout, predispose people to foot problems, as do some inherited abnormalities.

Smoking

A 2000 study reported that  smokers are at higher risk for blisters, bruises, sprains, and fractures, most likely because they tend to be less fit than nonsmokers. Smokers may also heal less quickly, which affects some foot surgeries.

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Symptoms

There are different types of foot pain, each with different symptoms.  View a chart listing the symptoms and recommended footwear or orthotics for each type of foot pain.

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Diagnosis

If you have foot pain and/or suspect that a bone in your toe or foot has been broken (fractured), call your doctor. You may be able to walk even if a foot bone has been fractured, particularly if it is a chipped bone or a toe fracture.

Diagnosis of foot pain may include the following:

  • Initial Evaluation-Your doctor will review your medical history and will ask questions about your foot pain, your daily activities, and any present or previous injuries.
  • Physical Exam-Your doctor will examine your feet. Many foot problems are obvious from a simple exam.
  • X-rays-You may have  x-rays of your foot. X-rays can identify problems, such as arthritis, bone spurs, fractures, bone tumors, and metallic foreign bodies.

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Treatment

The management of foot pain is varied, since there are many conditions that can afflict your feet. If you are generally healthy, proper shoes and over-the-counter foot products are usually all you need for most foot problems. Seek professional care if the problem persists or worsens.

If you have diabetes, you need to take scrupulous care of your feet on a daily basis. Half of all lower limb amputations in the United States are done on people with diabetes. Most of them can be prevented with vigilant foot care.

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Talking to Your Doctor

You have a unique medical history. Therefore, it is essential to talk with your doctor about your personal risk factors and/or your experience with foot pain. By talking openly and regularly with your doctor, you can take an active role in your care.

General Tips for Gathering Information

Here are some tips that will make it easier for you to talk to your doctor:
  • Bring someone else with you. It helps to have another person hear what is said and think of questions to ask.
  • Write out your questions ahead of time, so you don't forget them.
  • Write down the answers you get, and make sure you understand what you are hearing. Ask for clarification, if necessary.
  • Don't be afraid to ask your questions or ask where you can find more information about what you are discussing. You have a right to know.

Specific Questions to Ask Your Doctor


About Your Feet and Specific Foot Problem:

  • What sort of footwear do you recommend for me?
  • Is there any such thing as a comfortable shoe that is attractive?
  • In my case, what caused the pain I'm having?

About Your Risk of Developing Foot Problems:

  • Given my anatomy and activities, what are my risks for foot problems, and how can I best prevent trouble?
  • Should I see a foot specialist, such as an orthopedic surgeon or a podiatrist?

About Treatment Options:

  • What treatment options are available for this condition?
  • Is there a way I can avoid surgery?
  • Should I see a different sort of specialist for this problem?
  • Should I check this out with my diabetes doctor?

About Lifestyle Changes:

  • Is there an activity I should avoid because of my foot condition?
    • Will I be able to return to it later on?
  • Do I need a walking aid of some kind?
  • How can I prevent further pain?

About Outlook:

  • Will this progressively limit my activities, or is it only temporary?
  • Do I need to be concerned about this condition recurring?

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Above content provided Beth Israel Deaconess Medical Center. For advice about your medical care, consult your doctor.

Posted March 2011