Foot Pain

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Risk Factors and Causes

Risk factors for foot pain include the following:

• Age (children and the elderly are at increased risk)
• Heredity (many structural foot problems are inherited)
• Overweight/obesity
• Prolonged periods of standing (especially on hard surfaces)
• Repetitive jumping and running (especially on hard surfaces)
• Wearing ill-fitting, high-heeled, or narrow shoes regularly

Certain medical conditions also increase the risk for developing foot pain. These conditions include diabetes, arthritis, and inflammatory conditions (e.g., ankylosing spondylitis, tendonitis, bursitis).

Causes for foot pain include the following:

• Forefoot, including toe pain and ball of foot pain
  • Blisters
  • Bone bruise
  • Bruised, sprained, or broken toe
  • Bunions
  • Calluses
  • Corns
  • Frostbite (damage to the skin and/or underlying tissue caused by extreme cold)
  • Gout
  • Hammertoes/claw toes
  • Ingrown toenail
  • Morton's neuroma

• Midfoot, including foot arch pain, bottom of foot pain, top of foot pain
  • Abnormalities in foot structure, such as flatfeet (excessive pronation) or high arches (supination)
  • Gait abnormalities (unusual and uncontrollable walking patterns)
  • Plantar fasciitis (inflammation of the fibrous connective tissue on the sole of the foot)
  • Plantar warts
  • Soft-tissue sarcoma of the foot (cancer that originates in fat, muscle, nerve, fibrous tissue, blood vessels, or deep skin tissue of the foot; rare)
  • Tarsal tunnel syndrome (nerve entrapment that may cause pain on the sole of the foot)

• Hindfoot, including heel pain and ankle pain
  • Achilles tendonitis
  • Ankle injuries (e.g., sprain, fracture)
  • Haglund's deformity (bony growth at the back of the heel that usually occurs when shoes repeatedly aggravate tissue and underlying bone)
  • Heel spurs (bony growths)
  • Plantar fasciitis
  • Sever's disease (relatively common condition in active growing children and adolescents)
  • Stress fractures (crack in the outer shell of the bone)

Signs and Symptoms

Foot pain can occur in the toes, the ball of the foot, the heel, the arch, the instep, the sole (bottom of the foot), the top of the foot, or the ankle. The onset of pain may be sudden, or may develop slowly over time. Foot pain can vary from a mild ache, to a severe stabbing, throbbing, and burning pain.

Depending on the cause, symptoms that may accompany foot pain include the following:

• Bruising
• Numbness
• Redness
• Swelling
• Tingling

Complications that can occur include infection (e.g., fever, redness, severe pain, warmth, swelling), an inability to bear weight, and deformities (e.g., hammertoes/claw toes, bunions). Patients who have diabetes are at increased risk for foot complications, such as sores (ulcers), Charcot foot, and diabetic neuropathy.

Diagnosis

A personal and family medical history, physical examination, and diagnostic tests (e.g., imaging tests, blood tests) may be used to help diagnose foot pain. A family history includes information about structural foot problems and other medical conditions, such as diabetes, gout, and arthritis in the patient's family.

A medical history includes information about the following:

• Additional symptoms (e.g., swelling, redness, numbness, warmth)
• Circumstances surrounding the pain's onset (e.g., sudden or gradual, whether an injury occurred)
• Exact location of the pain
• Severity of the pain
• Whether pain worsens or improves with rest or with activity

During a physical examination, the physician assesses the feet, legs, and back. The position of the body as a whole (posture), the position of the body while standing (stance), and the manner of walking (gait) are also evaluated.

X-rays can be used to rule out fractures and other conditions (e.g., arthritis) and to determine bone density. Blood tests may be performed to detect conditions such as rheumatoid arthritis).

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