Foot Pain

Foot pain

Foot pain can be acute (sudden onset) as in fractures or sprains or may develop gradually over time (chronic foot pain). Here we explain the common causes of pain in the foot, including heel, forefoot, midfoot and top of the foot.


Heel pain

Bruised Heel

Plantar fasciitis – probably the most common cause of pain under the heel. Symptoms develop gradually over time, are worse first thing in the morning and may radiate into the arch of your foot.

Bruised heel – (fat pad contusion), also known as Policeman’s heel is an overuse injury. It also has symptoms of gradual onset pain under the heel, but will not radiate into the arch of the foot.

Sever’s disease – affects children, usually between the ages of 8 and 15. It causes pain at the back of the heel which gets worse the more active the child is.

View all causes of heel pain.


Pain in the arch of the foot

Plantar fasciitis – is the most common cause of pain in the arch of the foot. Pain under the heel develops gradually, is worse in the morning and eases as your foot warms up.

Plantar fascia strain – is a tear to the arch ligament under your foot. It can occur suddenly or may develop over time through repetitive strain.

View all causes of foot arch pain.


Pain on top of the foot

pain on top of the foot

Extensor tendonitis – (also known as extensor tendinopathy is the most common cause of gradual onset pain over the top of the foot. It is inflammation or more likely degeneration of the extensor tendons which run along the top of your foot. Overuse is the most likely cause.

Metatarsal stress fracture – is a hairline fracture of one of the long metatarsal bones in the foot. Pain develops gradually over time and is located towards the middle or front of your foot.

Navicular stress fracture – is a stress fracture to the navicular bone. Caused by overuse, the navicular is one of the tarsal bones found in the middle of your foot. Symptoms include a vague aching pain in the midfoot which gets worse with exercise.

Midtarsal joint sprain – is a sprain or tear of a ligament which holds the tarsal bones together in the midfoot. Symptoms will depend on which ligament is sprained, but will usually consist of pain over the outside middle of your foot. Swelling over the top of your foot is also likely.

Lisfranc’s injury – is a dislocation or fracture in the midfoot area which is rare, but can cause serious long term complications if it goes undiagnosed.

View all causes of pain on top of the foot.


Forefoot pain/Ball of the foot pain

Forefoot pain ball of the foot pain

Bunion – (also called Hallux valgus) is a painful swelling of the tissue on the inside of the ball of your foot. It develops gradually over time. Eventually, a deformity occurs where your big toe points inwards.

Sesamoiditis – is inflammation of the Sesamoid bones under the ball of the foot. Pain develops gradually over time and is worse when weight-bearing.

Morton’s neuroma – is caused by compression of a nerve in the forefoot resulting in pain between the third and fourth toes.

Turf toe – is a sprain of the ligament under the base of the big toe. It is caused by a sudden bending or forcing the big toe upwards.

View all causes of forefoot pain.


Pain on the outside of the foot

pain on outside of foot

Peroneus Brevis tendon injury – is a strain of the peroneal tendon at the point it inserts into the outside of the forefoot (the 5th metatarsal bone).

Midtarsal Joint Sprain – causes pain in the outside of the midfoot. The exact location of pain will depend on which particular ligament is torn. You may also see swelling over the point of injury.

Jones fracture – is a fracture of the 5th metatarsal bone on the outside of the foot. It is caused by overuse or may occur from an ankle sprain

Cuboid Syndrome – occurs gradually over time. It is caused by the peroneus longus muscle pulling too hard on the cuboid bone, causing it to partially dislocate.

View all causes of outside foot pain.


Pain on the inside of the foot

pain on inside of foot

Bunion – is painful swelling over the inside of the big toe. It is a common cause of pain and deformity on the inside of the foot.

Navicular Stress Fracture – has symptoms of a vague ache in the midfoot, which may radiate along the inside arch of the foot.

Tibialis posterior tendinopathy – is another overuse injury, causing pain on the inside of the ankle and under the foot.

View all causes of inside foot pain.


Toe pain

Toe pain

Broken toe – is a fracture, or break to any of the smaller phalanges bones which make up the toe.

Dislocated toe – is an even more severe toe injury where the bones is displaced, tearing ligaments and other soft tissue as well. It may occur at the same time as a toe fracture.

Black toenail – also known as a Subungual Hematoma occurs gradually through overuse. It is more common in long-distance runners or soldiers. Eventually, the nail may fall off completely.

Ingrown toenail – occurs when the sides of your toe grow downwards into the skin. The toe will be painful, sore and inflamed.

Hallux rigidus (stiff big toe) – causes pain and stiffness of the joint at the base of the big toe. Pain is worse when walking or running. Your toe may also appear swollen.

Hammer toe – is a deformity of the smaller toes which curl up, or bend upwards at the joint. The top of your toe may rub on your shoe, possibly causing blisters or corns.

Blisters – are caused by friction over the skin. The best cure for a blister is to prevent it from occurring in the first place.

Corns & Calluses – also commonly affect the toes of sportsmen and women.

View all causes of toe pain.


Midfoot pain

midfoot pain

Midtarsal joint sprain – is a sprain to any of the ligaments which hold the tarsal bones together in the midfoot area.

Stress fracture of the navicular – is also common and should not be missed.

Lisfranc joint sprain – should be considered as long term complications will result if this is missed.

Sprained ankle – may also cause pain in the midfoot as well as the ankle.

View all causes of midfoot pain.


Skin conditions

skin conditions

Athlete’s foot – commonly causes itching between the toes.

Corns & Calluses – develop where there is pressure or thickening of the skin.

Blisters – occur anywhere on the foot but are most common between the toes and at the back of the heel.

View all foot skin conditions.


Immediate first aid for foot injuries

cold therapy foot

The PRICE principles (protection, rest, ice, compression, and elevation) are the gold standard set for treating acute foot and heel injuries. PRICE should be applied as early as possible and continued for at least the first 24-72 hours.

Protection

  • Protection of the damaged tissue is vital to prevent further damage and enable the healing process to start efficiently and effectively.
  • There are a number of ways to protect the injured area all with the same aim of limiting further movement and use of the joint/muscle/ligament/tendon.
  • One way this can be achieved is by using a support or splint.

Rest

  • Rest in the early stages, rest is one of the most important components of the P.R.I.C.E principle but is often neglected or ignored.
  • It does not only refer to the prolonged period of time that the athlete will be out of action but also to the immediate period after the injury.

Ice

Cold therapy, also known as cryotherapy, is one of the most widely known and used treatments for acute sports injuries. It is cheap, easy to use and requires very little time to or expertise to prepare. The application of ice to an injury:

  • Decreases the amount of bleeding by closing down the blood vessels (called vasoconstriction).
  • Reduces pain (pain gate theory)
  • Decreases muscle spasm
  • Reduces the risk of cell death (also called necrosis) by decreasing the rate of metabolism

A cold therapy and compression wrap is a convenient way to apply cold therapy. Ice should not be applied directly to the skin as it may cause ice burns.

Compression

  • Compression is applied to minimize the amount of swelling that forms after an injury and should be applied for the first 24 to 72 hours from the onset of injury.
  • The most effective method is by using a compression bandage which is an elasticated bandage that simply fits around the affected limb.

Elevation

  • Elevating the injured limb is the final PRICE principle but is equally as important as the other 4.
  • Elevation uses gravity to drain the fluid away from the injured site, therefore swelling and pain.


When should I see a doctor?

When should you see a doctor with your foot pain? If you have any of the following symptoms you should seek medical assistance.

  • Severe pain, especially when walking
  • Severe swelling (oedema)
  • A changed sensation in the foot – such as a feeling of “pins and needles” (paresthesia) or a “loss of feeling” (anesthesia) in the foot.
  • Inability to complete normal daily activities after the initial 72 hours.

Further medical help can be sought through either your local GP or a private clinician such as a podiatrist, physiotherapist, sports therapist, osteopath, or chiropractor. If you have followed the P.R.I.C.E. principles (see above) and are still unable to walk after 72 hours, or still have severe pain that is not subsiding, you should visit your local A&E department.

If you have applied the P.R.I.C.E. principles and still have a weakness that lasts a long time (more than 2 weeks), or has ongoing discomfort in your foot or heel, you are highly recommended to seek advice from a specialist expert. Experts include a podiatrist or physiotherapist, osteopath, or chiropractor – who can all give you advice and an appropriate recovery and rehabilitation program.


Further reading & research papers:

This article has been written with reference to the bibliography.