Foot pain

 

Your foot is made up of 26 bones, 33 joints, and hundreds of muscles, nerves and ligaments. Given this complex structure and the amount of punishment feet endure every day, it’s no wonder that foot pain is so common.  Foot pain can affect any part of your foot, from your toes to the Achilles tendon at the back of your heel. Some foot pain is simply an annoyance. But foot pain can also be more serious, especially if it affects your ability to work, play sports or get around easily. Minor foot pain usually responds well to home treatment, but disabling pain is likely to need medical attention. If not treated, some types of foot pain can lead to long-term damage or disability.

Foot pain may be caused by many different things. Trauma, disease, or a combination of both are the most common causes of foot pain. Trauma is a result of forces outside of the body either directly impacting the body or forcing the body into a position where a single or combination of forces result in damage to the structures of the body. Poor biomechanical alignment may lead to foot pain.
Injuries such as ligament sprains, muscle strains, bruises, and fractures typically occur suddenly (acutely). Sprains, strains, bruises, and fractures may be the result of a single or combination of stresses to the foot. A sprain of the foot or ankle occurs when ligaments that hold the bones together are overstretched and the fibers tear. The looseness or tightness of ligaments in the joints of the foot may be a factor in foot pain.
The muscle’s bursa and fascia of the foot can be strained by overstretching, overuse, overloading, bruising, or being cut such as in stepping on a sharp object. Achilles tendonitis is a common muscle injury of the tendon that attaches at the back of the heel.
Injury to the bones and joints of the foot can be caused by a single blow or twist to the foot, or also by repetitive trauma that can result in a stress fracture. A blunt-force injury such as someone stepping on your foot may result not only in a bruise (contusion) injury but also damage to the primary and secondary structures (muscles and ligaments) of the foot. Direct blows to the foot can cause bruising, breaking of the skin, or even fracturing of bones. Metarsalgia is the irritation of the joints of the foot. An example of metarsalgia is “turf toe,” a common athletic injury in which the tendon under the joint at the base of the big toe is strained. Trauma to the toenail can cause pooling of blood under the nail and the temporary or permanent loss of a toenail. Repetitive trauma to the bones, muscles, and ligaments can result in extra bone growth known as spurs or exostosis.
Injuries to both the skin covering and the internal structures may also be caused by multiple small repetitive traumas. Micro-trauma injuries can be caused by running on uneven surfaces, surfaces that are too hard or too soft, or shoes that have poor force-absorption qualities or fit incorrectly. Repeated overstressing of the same structure of the foot may cause stress fractures, tendonitis, plantar fasciitis, and acute and chronic osteoarthritis.
The arches are the primary structures of the body that absorb and return force to and from the body to the outside world when we are on our feet. Injury to the plantar fascia is a common cause of arch pain. The plantar fascia is a tough fibrous sheath that extends the length of the bottom of the foot and lends support to the arch. When the plantar fascia is damaged, the resulting inflammatory response may become a source of arch pain. High and low arches (flat feet) may cause the foot to function biomechanically in such a way as to cause pain.
Footwear can be a contributor to foot pain. Poor fitting shoes in the short term can cause blisters, calluses, bruising and be a source of athlete’s foot. The long-term effects may be bunions, corns, irritation of nerves and joints, misalignment of the toes, and the source of microtrauma injuries to the foot.
Disease, viruses, fungi, and bacteria may also be the sources of foot pain. Diabetes, Hansen’s disease, and gout are common diseases that affect the foot. Numbness and change in sensation known as peripheral neuropathy may be a result of these diseases. Plantar warts caused by a virus can become sources of irritation. Athlete’s foot caused by a fungus has also been known to develop complications from both bacterial and viral source. A common self-inflicted cause of foot pain is the ingrown toenail. Ingrown toenails occur when the edges of the nail grow through or into the skin, resulting in irritation and sometimes leading to infection.

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 are indicators of a sprain.
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. Fractures are indicated by a focal point of pain that may be exquisitely tender on the bone. There may be a distinguishable lump or gap at the site of the fracture. A rotated toe or forefoot may also be a sign of a fracture.
Muscle and tendons move the body. 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 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 of are symptoms of a strain.
Bruises are usually the result of a direct force 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.
Pain and tenderness associated with planter fascia strains are usually felt on the bottom of the foot and may occur either as a specific or general area of tenderness. 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 “warms up,” however pain may increase as use of the foot increases. In more severe cases of plantar fasciitis, pain may increase when the arch is stressed.
A sensation of rubbing or burning on the surface of the foot is usually the first signs 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 result of an ingrown toenail.

 

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, icing should discontinue immediately.

Compression and elevation will help prevent any swelling of the affected tissues.

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 antiinflammatory such as aspirin, ibuprofen, or naproxen will help lessen the pain and as well as reduce the inflammatory response. Caution should be taken when using these drugs as dosage should not exceed the labeled directions.

Blisters occur as a result of chaffing. 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 from the side with a clean needle, and 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.

Medical treatment

Once the severity and cause of foot pain is determined, a course of corrective and rehabilitative actions can be started.

  • Qualified medical personnel may use machines and or manual therapies to reduce pain and increase circulation to the area to promote healing.
  • Maintenance of fitness levels via modification of activity may be prescribed.
    • Substitute activities that aggravate the pain and soreness. Running causes the body to have repetitive impact with the ground. The use of bicycling, elliptical trainers, step machines, swimming, or ski machines minimize impact and allow you to maintain and improve your fitness.
  • Corrective prophylactic measures
    • new shoes or the replacement of current shoe insoles
    • proper footwear fitting, including lacing and sock combinations to eliminate compression and friction issues
    • additional supports added to the shoes such as heel pads or cushions, arch supports, and various wedges to help maintain the foot in a proper position
    • Athletic shoes lose the elastic properties of the soles through usage and age. A good rule of thumb is to replace your shoes every six months or more often if there is heavier usage. The use of replacement insoles can increase energy absorption and add support to the foot.
    • Corrective and off-the-shelf orthotics may also improve the biomechanics of the foot.
  • Muscle strengthening and flexibility
    • You may be given exercises to increase the strength and stability of the affected area and to correct muscles that may not be balanced.
    • Exercises to increase flexibility will maintain or improve the length of a muscle. Flexibility helps to make a stronger muscle and less likely to be injured.
  • Appropriate medication to control inflammation or disease related symptoms
  • In some cases, surgery may be necessary.
  • Biomechanical evaluation
    • Your body will create various changes in movement when you have an injury. A therapist can evaluate these changes and help you make the appropriate corrections. Prolonged, uncorrected biomechanical changes may lead to secondary mechanical changes that are painful and difficult to correct.
  • Follow up with your doctor until you are better.

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, 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 how 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. Proper 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. Poor fitting footwear can make poor biomechanics worse, and good 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 problems with the foot. Different types of foot pain can be seen at different times of the season. Typically blisters, shin splints, and arch injuries are seen at the beginning of season.
Stress-related problems are related to the workloads. If the body is not prepared for an increase of workload that is typical in early season and with “weekend warriors,” acute shin splints and tendonitis are very common, not to mention increased muscle soreness.
A good workout program begins with a physical exam by a physician, then 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 flexibility specific to the goals of the workout program or the sport.
If pain is encountered when working out, try decreasing the intensity 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 pain often results in injury.