About foot pain

What is foot pain?

Your feet bear weight when you’re standing and when you walk to where you need to go. Because of this, foot pain is common. Foot pain refers to any pain or discomfort in one or more parts of the foot, such as the following:

  • toes
  • heels
  • arches
  • soles

What are the symptoms for foot pain?

Intense burning pain symptom was found in the foot pain condition

Pain and point tenderness is the immediate indicators that something is wrong in a specific area. Swelling, Redness (erythema), bruising (ecchymosis), numbness/tingling, and shooting pains may also present localized to the injured area. The onset of pain, whether suddenly or over time, is an important indicator of the cause of the problem. The following questions are also important.

  • Is there Pain with the movement of the affected area?
  • Is it affected by weight-bearing?
  • Does it change your walking motion?

The bones of the foot are joined together by ligaments. A sprain occurs when the ligaments that hold the bones together are overstretched and the fibers tear. Point tenderness and looseness of a joint can be indicators of a sprain.  Ligament injury is often accompanied by a sense of instability when walking or exercising.

Injury to the bones of the foot can be caused by a single blow or twist to the arch or also by repetitive trauma that can result in a stress fracture. There may be a distinguishable lump or gap at the site of a fracture. The fracture can be accompanied by dislocation of involved joints.  In such circumstances, the joint alignments are disrupted in addition to a break in the bone. Fracture and dislocation are common causes of post-traumatic arthritis. This is due to additional injury to joint cartilage.

Muscles and tendons allow movement of the foot in various directions. A strain occurs when a muscle or group of muscles are stressed to the point where there is tearing of the muscle fibers. The muscles and tendons of the foot may be strained by overstretching, overuse, overloading, bruising, or even being lacerated. Weakness in the contraction of a joint, difficulty in stabilizing body parts, and Pain working against resistance are signs of muscle problems. Swelling, tenderness, loss of function, and discoloration over and around the injury can be symptoms and signs of a strain.

Bruises (contusions) are most commonly the result of a direct impact injury to the body. A bruise can occur to the foot by a variety of causes, such as having your foot stepped on or by stepping on a rock. Blows to the foot that result in pain, discoloration, swelling, and changes in how you walk may indicate more serious damage such as fractured bone.

Pain and tenderness associated with plantar fascia strains are usually felt on the bottom of the foot between the heel and the base of the toes. Plantar fascia Pain may be increased or decreased by stretching of the arch. In mild cases of plantar fasciitis, the Pain will decrease as the soft tissues of the foot "warm-up," however, Pain may increase as the use of the foot increases. In more severe cases of plantar fasciitis, Pain may increase when the arch is stressed. Often the sufferer of plantar fasciitis will feel Pain in the morning until the plantar fascia warms up. Foot Pain at night may be a sign of plantar fasciitis, as well as other possible problems. Plantar fasciitis can cause a shift in the weight-bearing surface in order to avoid pain, which may cause compensation Pain in the other areas of the heel.

A sensation of rubbing or Burning on the surface of the foot is usually the first sign of a blister. Itching and Burning sensations between the toes or around the foot indicate a skin infection or athlete's foot. Pain and Redness at the edge of a toenail are usually the results of an ingrown toenail.

What are the causes for foot pain?

Foot pain may be caused by many different diseases, deformities, biomechanical conditions, improper footwear, or injuries.

  • Infectious diseases, viruses, fungi, and bacteria can cause foot pain. Plantar warts on the bottom of the foot are caused by a virus and can cause irritation and pain. Athlete's foot, which is caused by a fungus, can lead to foot irritation and pain. A common cause of foot pain is an ingrown toenail. Ingrown toenails occur when the edges of the nail grow through or into the skin, resulting in pain and often leading to infection. Patients with diabetes are more prone to infection since their immune system is compromised.
  • Many systemic diseases such as diabetes, lupus, gout, and rheumatoid arthritis can cause foot pain. Rheumatoid arthritis can cause painful inflammation in the joints of the foot, accompanied by alignment changes that lead to foot deformities.
  • Deformities, such as tarsal coalitions, calcaneal varus, calcaneal valgus, bunions, claw toes, mallet toes, hammertoes, and bone spurs, are common causes of foot pain.
  • Biomechanical abnormalities from muscle and tendon tightness or laxity, flat feet, or high arched feet often lead to muscle imbalances, deformities, and foot pain.
  • Trauma from an acute injury or from accumulative repetitive injury is a very common cause of foot pain, as well.  An example of such an injury is Achilles tendonitis or rupture.  The tendon can rupture from an acute, sudden injury or it can become inflamed (tendinitis) from repetitive insult to the structure.  Injuries to the skin and internal structures may also be caused by small repetitive traumas or pressures. Micro-trauma injuries can be caused by running on uneven surfaces or surfaces that are too hard or too soft, or by wearing shoes that have poor force-absorption qualities, are not activity-specific, or fit incorrectly.
  • Wearing shoes that are too tight or high heels can cause pain in the forefoot. Shoes that are tied too tightly can cause pain and bruise on the top of the foot. Improper, non-sport-specific shoes for running or cycling can lead to foot pain with activities. Poorly fitting shoes in the short term can cause blisters, bruising, and be a source of an athlete's foot. The long-term effects of poorly fitting shoes may be bunions, corns, calluses, irritation of nerves and joints, and misalignment of the toes. Morton's neuroma caused by the thickening of tissue around a nerve between the toes can cause toe numbness and pain and may also be aggravated by ill-fitting shoes as can many foot deformities such as hammertoes, mallet toes, and bunions.

What are the treatments for foot pain?

Treatments are optimally directed toward the specific cause of the pain.

  • When you first begin to notice discomfort or pain in the area, you can treat yourself with rest, ice, compression, and elevation (RICE).
    • Over-the-counter medications may also be used to reduce discomfort and pain.
  • Rest will allow the tissues to heal by preventing any further stress to the affected area.
    • Crutches should be used if you have difficulty putting weight on the foot.
    • Appropriate use of commercially available ankle and foot supports may provide rest, comfort, and support to the affected area.
  • Ice should be applied no longer than 20 minutes. The ice may be put in a plastic bag or wrapped in a towel. Commercial ice packs are not recommended because they are usually too cold. If extreme discomfort occurs, the icing should discontinue immediately.
    • Alternatively, one can soak the affected limb in cool water mixed with Epsom salt.
  • Compression and elevation will help prevent any swelling of the affected tissues.  Excessive swelling can cause stretching of the nerve fibers in the affected area, which can cause more pain.  Therefore, decreasing swelling often provides some degree of pain relief.  
  • There are two types of over-the-counter medications that may help with the pain and swelling of foot pain.
    • Acetaminophen (Tylenol) will help reduce the pain, while a nonsteroidal anti-inflammatory.
    • (NSAID) such as aspirin, ibuprofen (Motrin), or naproxen (Naprosyn) can help lessen the pain and as well as reduce the inflammatory response.
    • Caution should be taken when using these anti-inflammatory medications as the dosage should not exceed the labeled directions. In addition, individuals with a history of acid reflux or stomach ulcer and kidney problems should consult a medical doctor prior to using them. 
  • A popular home remedy for the relief of plantar fasciitis is rolling a frozen water bottle on the ground with the bottom of the foot. 
    • Various stretching exercises are known to be beneficial. 
    • Proper shoe gear with a supportive insert is also beneficial, as well as avoiding going barefoot. 
    • A corticosteroid injection can be helpful.
  • Blisters occur as a result of chafing. These "hot spots" should be attended to immediately with padding or friction reducers. If these spots progress to a blister and are unbroken, the doctor can drain them by puncturing them from the side with a clean needle, and once drained, the skin will act as a natural bandage and should not be trimmed away. If the skin over the blister is broken, the loose skin should be peeled back and the area should be treated as an open wound.
    • Blisters should be covered and padded before returning to activity; in simple cases, a Band-Aid may solve the problem.
    • If the blister is bigger, donut pads, gel pads, or commercially available blister pads may be more appropriate.
    • To avoid blistering in the future, a generous application of petroleum jelly or anti-chafing topical cream to the affected area can be helpful.
    • Shoe sizing should be assessed as well as sock construct and material.
    • Synthetic cotton combinations can provide a wicking effect to reduce moisture and friction. 
    • It is also possible to sustain blisters from contact-related allergies. In such cases, it is important to identify the causative agent and to avoid contact with the agent in the future.  The topical or oral steroids may be necessary to relieve pain and itching caused by these allergic blisters.

What are the risk factors for foot pain?

To prevent injuries and pain, the following issues should be addressed before starting an exercise routine. Are you in good health? A general physical exam by a physician will help to evaluate your cardiovascular function, the possibility of disease, or any other general medical problems that you may have. Before beginning activities, diseases such as gout, diabetes, certain types of arthritis, and neuropathies should be treated.

Physicians with sports medicine, physical medicine, podiatric, or orthopedic backgrounds may also help you choose an appropriate activity. After choosing the sport or activity that you wish to participate in, proper preparation will help minimize the initial aches and pains of that activity. Proper technique in any activity will help you to properly and safely perform your chosen activity and avoid injury. Good coaching can help you develop good biomechanics that can prevent foot pain.

Shoes and socks appropriate to your activity will also be a deterrent to foot pain. Properly fitting shoes and proper foot hygiene can prevent blisters, ingrown toenails, corns, calluses, bunions, stress fractures, metatarsalgia, Morton's neuroma, mallet toes, and plantar fasciitis. Poorly fitting footwear can make poor biomechanics worse, and properly fitting footwear can help to minimize the effect of bad biomechanics.

A plan for a gradual return to play should be started once the pain is reduced and muscle strength and flexibility are restored. Returning to participation and prevention of foot pain are governed by the same factors as preparing for participation. Foot pain can be caused by doing too much of a particular activity too fast. Ignoring pain can also lead to further foot problems. Different types of foot pain can be seen at different times of the season. Typically, blisters, shin splints, Charley horse (muscle spasms/cramps), and arch injuries occur at the beginning of the sports season.

Stress-related foot problems are related to the workloads. If the body is not prepared for an increase of workload that is typical early in the season and with "weekend warriors," acute shin splints and tendonitis are very common, in addition to increased muscle soreness.  A stress fracture can result from a sudden increase in workload. 

After foot pain has been successfully treated, an optimal workout program begins with a physical exam by a physician, followed by a gradual, consistent workout plan. A good example of this type of program is a running program that starts with a good warm-up, such as walking five to 10 minutes, then alternating sets of jogging and walking. An example of such a program would be 20 sets of jogging for two minutes, then walking one minute, with jogging time increased until you can run continuously for 40 minutes. Good surfaces and proper equipment used in your workout will lower the risk of foot pain.

Components of a good exercise program should include core strengthening, muscle strengthening, and stretching specific to the goals of the workout program or the sport.

If pain is encountered when working out, try decreasing the intensity or duration of the workout. If the pain persists, then you should immediately stop and seek medical advice to discover the source of the pain. Pushing through the pain often results in injury.

Is there a cure/medications for foot pain?

Medications and therapies can help reduce foot pain. Common choices include:

  • Physical therapy: Physical therapy is an important part of foot pain management. For pain caused by inflammation following a physical injury to the foot, an ice pack applied immediately after the incident can help, as it brings down the inflammation. Heat packs can be used to reduce swelling and pain for patients with arthritis and similar conditions.
  • Podiatry care: As specialists in the health of feet, a podiatrist often plays a central role in the management of foot pain. For some patients, orthotics can help to support the feet properly.
  • Medications: There are various types of medications that may be used to relieve the pain and inflammation of the feet, or to address a specific cause that may be causing the pain.
  • Oral analgesic medications such as acetaminophen (paracetamol) or aspirin are often the first-line choice for quick relief of foot pain.
  • Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen are also often recommended and can help to reduce inflammation at the same time.
  • Topical formulations of some NSAIDs, such as diclofenac may be preferred in some cases, as they help to reduce inflammation with a lowered risk of systemic side effects.
  • A local corticosteroid injection into the foot can help to control inflammation that is causing foot pain.
  • For patients with foot pain due to arthritis, disease-modifying anti-rheumatic drugs (DMARDs) may be recommended.
  • Alternatively, biologic response modifiers are a newer class of medication that can help to slow the disease progression by inhibiting the immune system, which is involved in causing rheumatoid arthritis.
  • For patients with foot pain due to gout, preventative medications such as allopurinol can control the concentration of uric acid in the body.
  • Surgery: Surgical procedures that may be recommended include:

Fracture repair, Arthroscopic debridement, Joint fusion
and Osteotomy.

Intense burning pain,Numbness or tingling
Peripheral neuropathy
Acetaminophen (paracetamol) or aspirin,Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen

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