Why Does My Foot Hurt? The 12 Main Causes of Foot Pain

If you're reading this, you've probably Googled foot pain in the last few minutes. And you probably saw multiple articles about plantar fasciitis, alongside scary-sounding conditions like osteosarcoma and scleroderma.

Here's the rundown on the most common types of foot pain and how to tell them apart. Chances are, you'll better understand your actual diagnosis by the end of this article.

Common Causes of Foot Pain

The most important factor to consider is the exact location of your pain. Let's break this down into a few easy-to-understand categories: toe pain, mid-foot pain, heel pain, and ankle pain.

Toe Pain

I doubt you're here because you stubbed your toe or have a hangnail. You'd already know that diagnosis. More likely, there's something visibly different about your toes that wasn't there a few years ago. Here are some common conditions to consider.

 1. Osteoarthritis of the big toe. If you're over 50, you may be developing wear and tear of the joint at the base of the big toe, one of the more common areas that arthritis develops. If you feel or hear grinding, or have pain at that joint when extending your toe backward, it's worth getting an x-ray or ultrasound to confirm the diagnosis.

2. Bunion. This hereditary condition, more common in women, results in an angulated rather than straight big toe. Years of suboptimal mechanical forces from walking gradually strain, or even rupture, the ligaments that keep the main joint in place. You've probably seen ads for shoe inserts and splints for bunions. Unfortunately, these are ineffective in the majority of cases. 

3. Warts and corns. Although they can look alike at first glance, a wart resembles a small floret of cauliflower while a corn is smoother and located in an area of friction. Don't confuse either with a callus, which is typically broader and non-painful. When seeking treatment, address the root cause, or they tend to come back.

4. Medical conditions. Gout occurs when the body deposits tiny crystals of uric acid in the joints rather than eliminating them through the kidneys. The resulting inflammation can turn the big toe joint red, warm, swollen, and painful, often abruptly. Dietary changes can make a real difference in treatment and prevention. Separately, if you've had diabetes for many years, or had it severely uncontrolled for even a few years, you may be developing neuropathy in the toes, which shows up as burning, numbness, tingling, or unexplained wounds. Once neuropathy sets in, recovery is challenging at best.

Mid-Foot Pain

 For simplicity, mid-foot pain covers everything from the ball of the foot to the heel. Again, the location of your pain usually points to the diagnosis.

 1. Morton's neuroma. This is caused by thickening of the tissue surrounding a nerve that travels between the third and fourth toes, so it's technically not a true neuroma. Most people feel burning in the ball of the foot when walking or running. A simple at-home test: squeeze the ball of the foot from the sides, bringing the big toe and pinky toe closer together, to see if you reproduce your typical pain.

2. Stress fracture. This happens most commonly near the pinky toe when running distances increase too quickly over a short period. You may get temporary relief by resting, but the pain tends to return once you resume running. An x-ray can typically confirm the diagnosis if there's any doubt.

3. Athlete's foot. This fungal infection causes redness, burning, itchiness, and flaking skin on the bottom of the foot and toes. You may need to try a few different treatments before finding resolution, and once you do, it helps to address the environment that allowed it to develop in the first place, usually moist feet.

Heel Pain

About 80 percent of the time, heel pain is caused by plantar fasciitis. The other major factor to consider is Achilles tendonitis. 

Plantar fasciitis commonly causes pain at the bottom of the heel, but it can also show up through the main arch of the foot. It results from inflammation of the plantar fascia, a thick band of tissue that runs along the bottom of the foot connecting the heel bone to the toes. Chronic irritation or overuse leads to tiny tears and inflammation in that tissue.

Typically, the pain is worse with the first step onto the floor in the morning, or after prolonged sitting or activity. Most people describe a stabbing or burning sensation, sometimes along with tightness in the calf. Plantar fasciitis affects people of all ages and activity levels, and it's usually caused by a combination of factors, including:

1. Physical activity. Running, jumping, and other high-impact activities put significant stress on the plantar fascia.

2. Age. As we age, the plantar fascia becomes less elastic, and stress in the tissue accumulates over time if left unaddressed.

3. Weight. Excess body weight adds stress to the plantar fascia.

4. Foot structure. Flat feet or high arches both cause an uneven distribution of weight across the foot.

5. Shoes. Ill-fitting shoes put pressure on the wrong areas and fail to support the ones that need it. 

Achilles tendonitis is the second major cause of heel pain. The Achilles tendon connects the calf muscles to the heel. Pain, stiffness, or swelling at the back of the heel bone is common among runners and jumpers, especially those who don't adequately stretch their calves and hamstrings before exercising. Interestingly, the fascia surrounding the Achilles tendon is continuous with the plantar fascia, which is why the causes and treatments for these two conditions often overlap. 

Ankle Pain

The vast majority of ankle pain comes from sprains, missing a stair, stepping in a hole, or losing your footing on a hike, and most ankle sprains affect the outside of the ankle. A few other conditions are worth knowing about as well.

1. Ankle sprain. Several ligaments on both sides of the ankle prevent it from turning too far inward or outward. The inner ligaments are stronger, which means the outer ligaments are more likely to sprain or tear from a sudden force. You'll likely notice swelling, and possibly bruising, on the outside of the ankle. Most patients don't treat these injuries adequately, which can lead to chronic swelling and pain. An osteopathic doctor may have long-term treatment options worth exploring.

2. Tendonitis. Pain behind the ankle bone on the outside usually points to a strain, or tendonitis, of one or more of the fibularis muscles. Pain on the inside usually points to a strain of the posterior tibialis muscle. You can test for these by standing on a stair and slowly lowering your heel below the level of the step, making the exercise harder by turning your foot outward or inward to stress the opposite side.

3. Osteoarthritis. The ankle is a less common site for arthritis, but it can develop from chronic overuse, such as in long-distance hikers. If your ankle pain improves with rest and pain relievers but returns after walking or jogging, an x-ray may help confirm the diagnosis. Patients often describe this pain by forming a C-shape with the thumb and pointer finger around the top of the ankle joint.

Treatment Options For Foot and Ankle Pain

Now that you have a better sense of your diagnosis, several of the following treatment options likely apply to your condition. Doctors love it when patients have already tried a few options on their own. It means you're taking initiative, and it frees up time to discuss more advanced treatment options. If you're in severe pain or unsure about your diagnosis, don't hesitate to come in. We're happy to provide immediate clarity and relief.

1. Rest. Resting the foot and avoiding activities that aggravate the irritated tissue gives the body time to heal.

2. Ice. Applying ice, such as by rolling the foot on a frozen water bottle, can help reduce inflammation.

3. Stretching. Improving flexibility and reducing tightness in the calf muscles, which are indirectly connected to the plantar fascia, can make a real difference. An osteopathic doctor can help build a plan that combines specific exercises with the other therapies listed here.

4. Orthotics. Orthotic inserts help redistribute weight across the foot. High-quality, non-custom inserts are typically sufficient, and overnight ankle splints are rarely recommended.

5. Tape. Some patients benefit from a specific taping pattern around the foot called low-Dye taping.

6. Medications. Over-the-counter NSAIDs can help reduce pain and inflammation when taken consistently for a short time, as long as there's no medical reason to avoid them.

7. Osteopathic manipulative treatment. Hands-on techniques improve the combined mechanics of the muscles, joints, ligaments, and fascia to help restore natural positioning and function.

8. Injections. For modest, short-term relief, a steroid injection into a joint, though not a tendon, may help. Some research also supports prolotherapy, which uses concentrated dextrose (sugar-water) injections, for strong and lasting relief with minimal side effects.

9. Surgery. Thankfully, very few cases of foot and ankle pain ever require surgery.

How to Prevent Foot Pain

A few habits go a long way toward preventing foot pain in the first place.

1. Wear supportive shoes that fit well (especially in terms of width) and offer the right combination of cushioning and support.

2. Maintain a healthy weight to reduce stress on the feet.

3. Train your balance by standing on the ball of each foot for one minute per day. Interestingly, studies do not support the use of stretching to prevent ankle injuries.

4. Increase the intensity and duration of physical activity gradually rather than all at once.

If you've had plantar fasciitis before, you may be more susceptible to a future flare-up. Addressing the root cause of your initial flare is one of the best prevention strategies available.

How Does Osteopathy Help With Foot Pain?

Osteopathy is a form of manual therapy that focuses on the musculoskeletal system and aims to restore balance and function throughout the body's tissues. Osteopathic treatment can be an effective way to manage foot pain by addressing the underlying causes of the condition rather than just the symptom. Here's how it helps:

1. Identifying the root cause. Osteopaths assess the whole body, not just the affected area, looking at posture, gait, and biomechanics to identify what may be contributing to foot or ankle pain. Tightness in the calves or hamstrings, for example, can put extra strain on the plantar fascia.

2. Manual therapy. Osteopaths use a variety of hands-on techniques to relieve pain and tension. Soft tissue techniques help soften knots in muscles and fascia, while joint mobilization helps restore normal range of motion in the foot and ankle.

3. Exercise prescription. Osteopaths provide exercises to strengthen and stretch the muscles and tendons in the feet and lower leg, improving foot stability and reducing the risk of further injury.

4. Footwear and orthotics guidance. Osteopaths can advise on appropriate footwear and, when helpful, recommend orthotics to support the arch and reduce stress on the plantar fascia.

5. Lifestyle modifications. This may include guidance on weight management, stress reduction, and proper warm-up and cool-down habits for physical activity.

6. Injections. As licensed medical doctors, osteopaths are trained and equipped to provide safe, effective injections in the clinic. Many, including here at Paragon Osteopathy, use ultrasound guidance to place injections within one millimeter of the target tissue.

Next Steps

Plantar fasciitis is a common cause of heel pain, but a wide range of other conditions can cause pain elsewhere in the foot and ankle. Getting the correct diagnosis is the key first step. If you're still not sure what's going on after reading this, or if you'd simply rather talk it through with someone, I offer a free phone consultation to help you figure out your next step. 

Call or text me directly at (973) 200-3770 or click here to schedule your free consultation.