Foot Pain: Causes by Location

Foot pain by location

Heel and arch pain

Plantar fasciitis

Plantar fasciitis is the most common cause of heel pain in adults. The thick band of tissue under the foot (the plantar fascia) becomes irritated where it attaches to the heel bone. Pain is sharp or stabbing in the bottom of the heel, worst with the first steps in the morning or after sitting, and eases as you walk, then returns after long standing. Risk factors are running, weight gain, flat or high arches, tight calves and long hours on hard floors. See heel pain for other heel causes.

Achilles tendinitis

Pain and stiffness at the back of the heel or just above it, worse in the morning and when starting exercise. Common in runners and middle-aged people who play sport occasionally.

Flat feet and tendon problems

Flat feet can strain the arch. Posterior tibial tendon dysfunction causes pain on the inner ankle and arch, with the arch slowly collapsing, mostly in women over 40.

Ball-of-foot and toe pain

Metatarsalgia

Metatarsalgia is pain and inflammation under the ball of the foot, often like walking on a pebble. It comes from high heels, high-impact activity, high arches, thin fat padding with age, or toe deformities.

Morton's neuroma

Morton's neuroma is a thickened nerve between the toes, usually the third and fourth. It causes burning pain, tingling or numbness in the toes, and a feeling of a fold in the sock. Tight, narrow shoes make it worse, and taking them off and rubbing the foot brings relief.

Bunions and big toe arthritis

A bunion is a bony bump at the base of the big toe as the toe angles toward the others. It rubs in shoes and can ache. Hallux rigidus is arthritis of the big toe joint, causing stiffness and pain when pushing off.

Gout

Gout causes sudden attacks of severe pain, redness, heat and swelling, classically in the big toe joint, often overnight. Even the weight of a bedsheet hurts.

Hammer toes, corns and ingrown nails

Bent toes rub on shoes, forming painful corns. Ingrown toenails cause pain, redness and sometimes infection along the edge of the nail.

Top and side of foot pain

• Stress fracture: a hairline crack from repeated stress, often in the metatarsals. Pain builds with activity, there is a tender spot on the bone, and sometimes swelling on the top of the foot. Common after a sudden increase in running or marching. See stress fracture.
• Extensor tendinitis: pain on the top of the foot from tight laces or overuse.
• Fifth metatarsal fracture: pain on the outer edge after rolling the ankle.
• Arthritis: osteoarthritis or rheumatoid arthritis in the midfoot causes aching and swelling on top of the foot.

Pain in the whole foot or both feet

• Peripheral neuropathy: burning, tingling, electric or numb feet, usually both, worse at night. Diabetes is the most common cause.
• Peripheral artery disease: cramping pain when walking, cold feet, poor nail growth, and in severe cases pain at rest.
• Inflammatory arthritis: rheumatoid and psoriatic arthritis often start in the feet, with morning stiffness.
• Complex regional pain syndrome: severe, burning pain with color and temperature changes after an injury.

Foot pain and diabetes

People with diabetes may not feel injuries because of nerve damage, and poor circulation slows healing. A small blister can become a diabetic foot ulcer and a serious infection. Check your feet every day, never walk barefoot, and see a doctor or podiatrist promptly about any wound, redness, swelling or color change.

How doctors find the cause

A doctor or podiatrist will ask where and when it hurts, about footwear, activity, injuries and other health conditions, and examine the foot standing and walking. They press on specific points, test movement, check pulses and sensation, and look at your shoes. Tests may include X-rays (fractures, arthritis, bunions), ultrasound (plantar fascia, neuroma, tendons), MRI (stress fractures and tendon tears), blood tests (uric acid, inflammation markers, blood sugar) and nerve or circulation tests.

Treatment and home care

Self-care for most foot pain

• Rest and modify activity: switch from running to cycling or swimming for a few weeks.
• Ice: 15 to 20 minutes a few times a day. Rolling the foot over a frozen water bottle helps plantar fasciitis.
• Footwear: supportive shoes with a cushioned sole, a firm heel and enough room for the toes. Avoid high heels and worn-out running shoes.
• Insoles: over-the-counter arch supports or heel cups. Metatarsal pads for ball-of-foot pain.
• Stretching: calf and plantar fascia stretches twice a day.
• Weight loss reduces load on the feet.
• Pain relief: acetaminophen (paracetamol) or ibuprofen at the label dose. Avoid NSAIDs if you have kidney disease, stomach ulcers or take blood thinners.

Medical treatment

• custom orthotics and physical therapy
• night splints for plantar fasciitis
• steroid injections for neuroma, bursitis or plantar fasciitis
• boots or casts for fractures
• medicines to treat and prevent gout
• surgery for bunions, toe deformities, neuromas or tendon tears that do not improve

Frequently asked questions

Why does the bottom of my foot hurt when I walk?

Pain under the heel when walking, especially first thing in the morning, is usually plantar fasciitis. Pain under the ball of the foot points to metatarsalgia or Morton's neuroma. A tender spot on a bone that worsens with activity could be a stress fracture.

What causes pain on the top of the foot?

Common causes are stress fractures of the metatarsals, extensor tendinitis from tight laces or overuse, arthritis in the midfoot, and gout. Pain with swelling and tenderness on a bone after increased activity should be checked with an X-ray.

When should I worry about foot pain?

See a doctor urgently if your foot is red, hot and swollen, you have a fever, you cannot bear weight after an injury, the foot is cold or pale, or you have diabetes and notice any wound or color change. Pain lasting more than two weeks also needs a check.

What shoes are best for foot pain?

Choose shoes with good arch support, a cushioned and slightly rocker-shaped sole, a firm heel counter, a heel of no more than about 2.5 cm (1 inch) and a wide toe box. Replace running shoes every 500 to 800 km (300 to 500 miles).

Can foot pain come from the back?

Yes. A pinched nerve in the lower back (sciatica) can cause pain, tingling or numbness in the foot, often with back or leg pain. Tarsal tunnel syndrome, a pinched nerve at the inner ankle, causes similar symptoms in the sole.