The foot is one of the most important parts of the human body, having to sustain the entire body weight and also to ensure locomotion. The foot contains no less than 24 bones, not to mention tendons, ligaments and other soft tissues. The support at the level of the foot is given by the plantar fascia, with additional support being offered by fat pads (these also absorb shocks).
The pain that appears at the level of the foot is often a symptom of an underlying condition. In this article, we will talk about the different causes that stand behind such a pain, helping you make a quick diagnosis.
As you will often see in this article, the location of the pain is most important. For example, if you are experiencing pain at the level of the heel(s), a number of conditions should be suspected.
The plantar fascia is a fibrous band of tissue that runs along the entire sole, connecting the muscle tendons with the toes. A number of factors can cause the plantar fascia to become irritated and inflamed, such as excess physical training, improper weight bearing or unequal weight distribution. The pain is more intense in the morning, as one tries to walk the first steps and it improves gradually, as the day passes. It is possible that the pain is experienced not only at the level of the heel but also in the arch of the foot.
It is highly possible that a heel spur is behind the discomforting foot pain you have been experiencing, the abnormal bone growth being caused by ill-fitting shoes, inadequate posture or unequal weight distribution at the level of the soles. It is important to understand that heel spurs do not appear overnight but they rather develop in time. In general, the pain is more intense during activities such as running, walking or even standing. People with flat feet or those who present a high arch present a higher risk for heel spurs.
Note: According to a study published on Foot & Ankle International, it is possible that plantar fasciitis and heel spurs are present in the same patient, making the foot pain even more intense. The study demonstrated that the simultaneous treatment of the two conditions can significantly reduce the pain experienced and also improve the overall functioning.
If you have recently experienced an injury at the level of the foot sole or you have stepped on a hard object, your foot pain might be caused by what is known as a stone bruise. The pain, in this case, will be localized in the ball of the foot or the fat pad of the heel. Many people associate the pain with the sensation of walking on pebbles, hence the name. Keep in mind that this is a deep bruise and it requires a longer period of time, in order to heal.
The pain that results from a heel fracture is generally severe, being accompanied by other signs, such as distinct bruising or inflammation. Given the fact that heel fractures are generally caused by falls or car accidents, the person in question will most likely be unable to walk or even support himself/herself in an orthostatic position. Emergency medical care is required in such situations.
The inflammation of the metatarsal bones can cause serious pain, which will be mostly felt in the ball of the foot. A number of factors contribute to the appearance of such symptoms, including the constant wearing of ill-fitting shoes, excess physical effort and engaging in activities, such as running or jumping.
This is a serious condition, in which the tissue that surrounds the nerves of the toes begins to thicken (most commonly at the level of the third and fourth toe). Patients who suffer from Morton’s neuroma may present pain in this area, being sometimes accompanied by numbness or a pins & needles sensation. Women are more predisposed to such problems, due to the fact that they wear high heels or constrictive shoes.
Sesamoid bones are normally located at the level of the big toe or the first metatarsal. In the situation that the tendons or other soft tissues around these bones become inflamed, the patient can experience pain in that area. This condition can be caused by an acute injury but it is also present on professional athletes or artists (runners, ballerinas etc.).
As it was mentioned at the beginning of the article, it is possible that the inflammation of the plantar fascia can cause both heel and arch pain. It is essential to remember that, in this case, the pain is most intense, in the morning, when one takes the first steps.
If you have flat feet, it is quite likely to experience pain at the level of the fallen arches. This pain becomes more intense when one walks for prolonged periods of time or if he/she engages in more strenuous physical activities.
Bunions represent a common cause of foot pain, especially in those who have worn ill-fitting shoes for a prolonged period of time. Aging is considered a risk factor for such problems, as the first toe joint can become misaligned with the passing of time.
According to an article published in the Journal of Orthopaedic and Sports Physical Therapy, bunions can often lead to food pain, discouraging the person who is suffering from such problems from engaging in physical activity. The authors of the article draw attention to the fact weak muscles might be a common cause of bunions, with physical therapy being able to strengthen foot muscles and improve overall mobility.
The excess flexion of the toes can be responsible for the pain in the area. The changes occur at the level of the middle joint, the name being chosen due to the hammer-like appearance. It is important to understand that there are a number of factors that can cause such changes, including ill-fitting footwear or unequal weight distribution.
This is an inflammatory condition, which is mainly caused by the accumulation of uric acid crystals in the joints of the toes. When an inflammatory episode is present, the pain can be quite severe, preventing the patient from walking or engaging in other physical activities. The big toe is most commonly affected by gout, the pain being accompanied by other symptoms as well, such as warmth, redness or a pulsating sensation.
When a person suffers from conditions such as diabetes or alcoholism, it is possible that nerve damage occurs. If the nerves are damaged, this means that all the tissues in the area, including muscles, are going to suffer. The pain associated with the claw toe is quite intense, the patient being unable to straighten his/her toes. Apart from the pain, one might also present a burning or stinging sensation. Many patients describe such sensation, as if electricity was passing through their bodies.
Ingrown toenails can be extremely painful, preventing the patient from standing and even walking. If an infection has occurred at the same time, then the pain is going to be even more intense. In general, the pain is made worse by continuing to wear ill-fitting or constrictive footwear.
The toe sprain is a direct result of injury, a common situation being the one in which would stub his/her toe against a hard surface. The pain and inflammation can be quite severe but, upon no severe damage being caused, they will subside rapidly.
If one or several toes have been fractured, as a result of injury or trauma, the patient will present severe pain. He/she will also be unable to move the toes, experiencing numbness or other similar symptoms (suggestive of nerve damage). Immediate medical attention is required in case of such fractures.
Big toe arthritis
The inflammatory arthritic process that can occur at the level of the big toe is also known as hallux rigiditus. The pain is mostly experienced at the base of the big toe, being accompanied by a reduced range of motion and stiffness. It is important to understand that this condition can progress, becoming worse with the passing of time.
Corns and callouses
The thickened and hard skin can cause a lot of pain, especially if one continues to wear ill-fitted shoes. The pain is present in the areas of pressure or excess friction, being made worse by prolonged standing or when walks on hard or unleveled surfaces.
Even though it is quite rare, it is possible that a sesamoid fracture occurs. In such situations, the pain will be mostly experienced at the level of the big toe. Radiologic investigations are required in order to confirm such a diagnosis.
Other causes of foot pain
If the last metatarsal bone has been fractured, the patient will most likely experience pain on the outer edge of the foot. Apart from pain, there will be obvious swelling and bruising. Injuries and accidents are mainly responsible for such kind of fractures. Immediate medical intervention will be necessary.
 Relationship and classification of plantar heel spurs in patients with plantar fasciitis. Foot & Ankle International, 2016. Retrieved from: http://www.ncbi.nlm.nih.gov/pubmed/27177888
 Bunions: strengthening foot muscles to reduce pain and improve mobility. Journal of Orthopaedic and Sports Physical Therapy, 2016, 46(7). Retrieved from: http://www.ncbi.nlm.nih.gov/pubmed/27363573