Foot pain is very common. About 75% of people in the United States have foot pain at some time in their lives. Most foot pain is caused by shoes that do not fit properly or that force the feet into unnatural shapes (such as pointed-toe, high-heeled shoes).
The foot is a complex structure of 26 bones and 33 joints, layered with an intertwining web of more than 120 muscles, ligaments, and nerves. It serves the following functions:
- Supports weight
- Acts as a shock absorber
- Serves as a lever to propel the leg forward
- Helps maintain balance by adjusting the body to uneven surfaces
Because the feet are very small compared with the rest of the body, the impact of each step exerts tremendous force upon them. This force is about 50% greater than the person's body weight. During a typical day, people spend about 4 hours on their feet and take 8,000 - 10,000 steps. This means that the feet support a combined force equivalent to several hundred tons every day.
Foot Problems and Their Locations
Foot pain generally starts in one of three places: the toes, the forefoot, or the hindfoot.
The Toes. Toe problems most often occur because of the pressure imposed by ill-fitting shoes.
The Forefoot. The forefoot is the front of the foot. Pain originating here usually involves one of the following bone groups:
- The metatarsal bones (five long bones that extend from the front of the arch to the bones in the toe)
- The sesamoid bones (two small bones embedded at the top of the first metatarsal bone, which connects to the big toe)
The Hindfoot. The hindfoot is the back of the foot. Pain originating here can extend from the heel, across the sole (known as the plantar surface), to the ball of the foot (the metatarsophalangeal joint).
Summary of Foot Problems
Corns and calluses
Around toes, usually little toe, bottom of feet or areas exposed to friction.
Hard, dead, yellowish skin.
Wide (box-toed) shoes; soft cushions under heel or ball of foot, or customized or gel insoles for calluses. Doughnut-shaped pads for corns.
Nail curling into skin causes pain, swelling, and, in extreme cases, infection.
Sandals, open-toed shoes.
Bunions and bunionettes (tailor's bunion)
Big toe (bunions) or little toe (bunionettes).
The following can occur alone or in combination:
Metatarsus primus varus. The first (big toe) metatarsal bone shifts away from the second, and the big toe points inward.
Medial exostosis. This is a bony bump at the base of the big toe, which protrudes outward. Area next to bony bump is red, tender, and occasionally filled with fluid. Toe joint may be inflamed.
Hallux valgus. This is a deformity in which the bone and joint of the big toe shift and grow inward, so that the second toe crosses over the big toe.
Soft, wide-toed shoes or sandals. Bunion shields or splints. Thick doughnut-shaped moleskin pads, custom-made orthotics or foot slings, if necessary. Avoid shoes with stitching along the side of the "bump."
Morton's neuroma (also called interdigital neuroma)
Inflammation of the nerve, usually between the third and fourth toes and bottom of the foot near these toes.
Cramping and burning pain, or electric-shock sensation. The condition may produce a thick protective sheath around the nerve that feels like a ball. This may be detected by pressing top to bottom on the top of the foot using one hand and moving the other hand from side to side. Morton's neuroma is aggravated by prolonged standing and relieved by removal of the shoes and forefoot massage.
Wide (box-toed) shoes. Orthotic or insole with pad that reduces stress on the painful area.
Hammertoe or claw toe
Usually second toe, but may develop in any or all of the three middle toes.
Toes form hammer or claw shape. In hammertoe, the first knuckle of the toe is mainly affected. In claw toe the entire toe is deformed. No pain at first, but pain increases as tendon becomes tighter and toes stiffen.
Wide (box-toed) shoes. Toe pads or specially designed shields, splints, caps, or slings. (Splints or slings are not for people with diabetes.)
Ball of the foot.
Acute, recurrent, or chronic pain without a known cause.
Wide (box-toed) shoes. Orthotic with pad that reduces metatarsal pressure. Gel cushions. Metatarsal bandage.
Most often in the area beneath the second or third toe.
Sudden pain (which persists) when injury occurs.
Low-heeled shoes with stiff soles.
Ball of foot beneath big toe.
Pain and swelling.
Low-heeled shoe with stiff sole and soft padding inside.
Heel and Back-of-the-Foot Pain
Plantar fasciitis or heel spurs
Back of the arch right in front of heel.
At onset, some people report a tearing or popping sound. Pain is most severe with first steps after getting out of bed. Pain decreases after stretching, returns after inactivity.
Over-the-counter foot insole (cut quarter-size hole surrounding painful area). Possible night splints. Orthotics if necessary.
Bursitis of the heel
Center of the heel.
Pain, with warmth and swelling. Increases during the day.
Haglund's deformity ("pump bump")
Fleshy area on the back of the heel.
Tender swelling aggravated by shoes with stiff backs.
Soft shoes. Heel pads. Possible orthotic to support heel.
Achilles tendon: area along the back between calf muscles and heel.
Pain worsens during physical activities (particularly running), after which the tendon usually swells and stiffens. If it ruptures, popping sound may occur followed by acute pain similar to a blow at the back of the leg.
Insoles, tendon strap, heel cups.
Arch and Bottom-of-the Foot Pain
Tarsal tunnel syndrome
Anywhere along the bottom of the foot.
Numbness, tingling, or burning sensations, pain, most commonly felt at night.
Specially designed orthotics to relieve pressure.
"Flat feet" or posterior tibial tendon dysfunction (PTTD)
No arch. Often no pain or discomfort. Three stages in PTTD:
Pain and weakness in the tendon.
The arch flattens but is still flexible.
The foot becomes rigid and possibly painful at the ankle. Sometimes people report fatigue, pain, or stiffness in the feet, legs, and lower back.
For children, possible custom-made insoles.
High arches ("hollow feet")
High arches. Lower back pain, possible tendency to lower limb injuries.