Foot or Toe Pain: Causes by Location

Foot pain by location

Heel pain

Plantar fasciitis is the most common cause of heel pain in adults. It causes sharp pain under the heel with the first steps in the morning or after sitting, easing as you walk and returning after long standing. It is linked to tight calves, high mileage, weight gain, flat or high-arched feet and unsupportive shoes. A heel spur seen on X-ray is common and is usually not the source of pain. See heel pain.

Pain at the back of the heel, worse when pushing off, points to Achilles tendinitis.

Ball of the foot pain

Metatarsalgia

Metatarsalgia is pain and inflammation under the metatarsal heads, the bones at the ball of the foot. It feels like a stone in your shoe and is worse barefoot on hard floors or in high heels. Causes include high-impact sports, high arches, a long second toe and thinning of the fat pad with age.

Morton's neuroma

Morton's neuroma is a thickened nerve between the toes, usually between the third and fourth. It causes burning, tingling or sharp pain radiating into those toes, eased by taking off tight shoes.

Stress fracture

A stress fracture of a metatarsal, called a march fracture, causes pain and swelling on the top or bottom of the forefoot after a sudden increase in running, walking or training. Pain is worse with activity and tender on one spot. Early X-rays can look normal.

Big toe pain

Gout

Gout is crystal arthritis caused by high uric acid. The classic attack is a big toe joint that becomes red, hot, swollen and exquisitely painful over hours, often overnight. Even a bedsheet touching it hurts. Triggers include alcohol, red meat, seafood, sugary drinks, dehydration and diuretics. Attacks settle in 1 to 2 weeks with treatment.

Bunion

A bunion (hallux valgus) is a bony bump at the base of the big toe as the toe angles toward the others. It rubs in shoes, becomes red and sore, and can push the second toe into a hammer toe. Bunions run in families and are made worse by narrow shoes.

Hallux rigidus

Arthritis of the big toe joint causes stiffness, pain when pushing off, and a bony lump on top of the joint.

Ingrown toenail

An ingrown toenail digs into the skin at the side of the nail, usually on the big toe, causing pain, redness and sometimes infection.

Smaller toe pain

• Hammer, claw and mallet toes: bent toes that rub on shoes, causing corns.
• Corns and calluses: thickened skin from pressure.
• Fractured toe: after stubbing or dropping something. Bruised, swollen, painful. Most heal with buddy taping in 4 to 6 weeks.

Pain across the whole foot

• Diabetic peripheral neuropathy: burning, tingling, pins and needles or numbness in both feet, often worse at night. Numb feet are at risk of unnoticed injury and ulcers.
• Other neuropathies: alcohol, vitamin B12 deficiency, chemotherapy, thyroid and kidney disease.
• Tarsal tunnel syndrome: a pinched nerve on the inner ankle causing burning in the sole.
• Inflammatory arthritis: rheumatoid arthritis often starts in the small joints of the feet, with morning stiffness over 30 minutes.
• Peripheral artery disease: foot or calf pain on walking that eases with rest, cold feet, and pain at night in advanced disease.

How doctors diagnose foot pain

Your doctor or podiatrist will ask where and when it hurts, what shoes and activities you do, and about diabetes, gout and arthritis. They will press on specific spots, check your walk and arches, test pulses and sensation, and examine your shoes.

Tests may include:

• X-ray: fractures, arthritis, bunion angles
• Ultrasound or MRI: neuromas, tendon problems, stress fractures not seen on X-ray
• Blood tests: uric acid, inflammatory markers, blood sugar, B12
• Joint fluid test: to confirm gout crystals or rule out infection
• Nerve tests and circulation tests when needed

Treatment and home care

First steps for most foot pain

• Rest from the activity that causes pain, and switch to low-impact exercise such as swimming or cycling.
• Ice wrapped in a cloth for 15 to 20 minutes, a few times a day.
• Supportive shoes with a cushioned sole, firm heel counter and a wide toe box. Avoid flat flip-flops and high heels.
• Pain relief: acetaminophen (paracetamol) or an NSAID such as ibuprofen, following the label dose. Avoid NSAIDs if you have kidney disease, stomach ulcers or take blood thinners.
• Stretching: calf and plantar fascia stretches twice daily for heel pain.
• Weight loss reduces load on the feet.

Cause-specific treatment

• Plantar fasciitis: stretching, heel cups, night splints, physical therapy. Most improve within 6 to 12 months. Injections or shockwave therapy for persistent cases.
• Metatarsalgia and neuroma: metatarsal pads, wider shoes, orthotics, sometimes an injection or surgery.
• Gout: anti-inflammatory medicines during an attack, and long-term uric acid-lowering treatment for recurrent attacks.
• Bunions: wider shoes, padding. Surgery if pain persists.
• Stress fractures: a walking boot and rest for 6 to 8 weeks.
• Neuropathy: blood sugar control, daily foot checks, and nerve pain medicines.

Diabetes and foot pain

If you have diabetes, check your feet every day for cuts, blisters, color changes and swelling. Never walk barefoot. See a podiatrist regularly. Report any wound promptly, because foot ulcers can become infected quickly.

Frequently asked questions

What causes pain in the ball of the foot?

Common causes are metatarsalgia from overuse or high heels, Morton's neuroma (a pinched nerve between the toes), and stress fractures after increased activity. Arthritis and thinning of the fat pad with age also contribute. Wider, cushioned shoes and metatarsal pads usually help.

Why does my big toe hurt?

A sudden red, hot, swollen, very painful big toe is usually gout. A bony bump at the side is a bunion. Stiffness and pain pushing off suggest arthritis (hallux rigidus). Redness at the nail edge is an ingrown toenail. Injury can cause turf toe or a fracture.

What causes pain on the top of the foot?

Pain on top of the foot is often a metatarsal stress fracture, extensor tendinitis from tight shoes or laces, arthritis of the midfoot, or gout. Pain after a sudden increase in walking or running suggests a stress fracture and needs assessment.

When should I see a doctor for foot pain?

See a doctor if you cannot bear weight, the foot is deformed, swollen or hot, pain lasts more than 2 weeks, or you have numbness or burning. People with diabetes should get any foot pain, wound or color change checked promptly.

What helps foot pain at home?

Rest, ice, supportive shoes with good cushioning and a wide toe box, calf and foot stretches, and over-the-counter pain relievers help most foot pain. Avoid going barefoot on hard floors. If pain continues beyond 2 weeks, get it assessed.