Foot pain: causes and treatment

This guide helps you narrow down what may be behind your foot pain and points you to our detailed page for each area. Dr. Efe Ozturk, a Foot and Ankle Surgeon and podiatrist, treats foot and ankle pain at our offices in Lyndhurst, Paramus and Millburn, NJ.

Foot pain by location

The regions overlap, so use the chart as a starting point, not a diagnosis.

1. 1Heel — plantar fasciitis, a stress fracture of the heel bone, a fat-pad problem
2. 2Arch and midfoot — strain of the plantar fascia, flatfoot, midfoot arthritis
3. 3Ball of the foot — overload of the forefoot, problems of the toe joints, stress fractures, nerve irritation
4. 4Big toe — a bunion, or arthritis of the big toe joint (hallux rigidus)
5. 5Lesser toes — hammertoes, mallet toes, claw toes, corns
6. 6Top of the midfoot — a Lisfranc injury, a stress fracture, midfoot arthritis
7. 7Outer edge — a fifth metatarsal fracture, a stress fracture

• Under the heel: usually plantar fasciitis, worst with the first steps after rest. A stress fracture of the heel bone, an irritated nerve or a bruised fat pad can feel similar.^[2] See heel pain and plantar fasciitis.
• Back of the heel: often the Achilles tendon, with pain that worsens with activity and stiffness in the morning.^[6] See Achilles tendon problems.
• Arch: pain along the inside of the arch and ankle, sometimes with a flattening arch, can come from a strained posterior tibial tendon.^[7] See arch pain and flat feet.
• Ball of the foot: overload under the metatarsal bones, a stress fracture, or Morton’s neuroma, a pinched nerve that can feel like a pebble underfoot.^[8,9,10] See ball of foot pain.
• Big toe: a bunion (a bony bump at the joint), hallux rigidus (arthritis that makes the joint stiff and sore), or gout, which often flares first in the big toe.^[11,12,13] See big toe pain.
• Smaller toes: hammertoes, corns and calluses, all linked with shoes that don’t fit.^[14] See hammertoes.
• Top of the foot: a stress fracture, arthritis of the midfoot, or, after a twisting injury, a Lisfranc injury, which is easily mistaken for a sprain.^[8,15,16] See top of foot pain.
• Outer edge: a fracture of the fifth metatarsal, often after rolling the ankle, or the peroneal tendons behind the outer ankle bone.^[17,18] See outside of foot pain.
• Ankle: sprains are the most familiar cause. A severe sprain can hurt as much as a fracture, and repeated sprains can leave the ankle painful and unstable.^[19] See ankle pain.

Burning, tingling, numbness or electric-shock pain often points to a nerve instead, and diabetes is the most common cause of peripheral neuropathy (nerve damage) in the U.S.^[20]

When it hurts: clues from the pattern

• First steps in the morning: typical of plantar fasciitis, which usually eases after a few minutes of walking.^[3]
• When walking: pain that builds with weight-bearing and eases with rest suggests a stress fracture, especially with a tender spot on the bone.^[8]
• After running or sport: a sudden jump in training is the most common cause of stress fractures and a common trigger for Achilles pain. Plantar fasciitis often hurts more after exercise than during it.^[8,6,3]
• At night: nerve pain is sometimes worse at night,^[20] and gout flares often start suddenly at night with a swollen, red, warm joint.^[13]
• With no injury: a joint that suddenly turns red, hot and swollen may be gout, but an infection can look just the same, especially with a fever, so have it checked that day.^[13,21] With diabetes, redness, warmth and swelling can also be an infection or the start of Charcot foot.^[5]

When foot pain needs prompt care

Book an evaluation if foot pain lasts more than a few weeks despite rest and better shoes, keeps coming back, or changes the way you walk. Being unable to put weight on the foot after an injury can mean a fracture.^[4]

What kind of doctor treats foot pain?

Foot pain is the everyday work of Foot and Ankle Surgeons and podiatrists, and of orthopedic surgeons who focus on the foot and ankle. A Doctor of Podiatric Medicine (DPM) is a physician and surgeon for the foot, ankle and related structures of the leg, trained through four years of podiatric medical school and three years of hospital-based surgical residency.^[22] Orthopedic surgeons (MD or DO) train in the whole musculoskeletal system. Either can be a good choice. What matters most is a doctor who concentrates on the foot and ankle and offers both non-surgical care and surgery. See podiatrist or orthopedic surgeon?

Dr. Ozturk is double board certified, by the American Board of Podiatric Medicine and as a Fellow of the Academy of Physicians in Wound Healing. See about Dr. Ozturk.

How we evaluate foot pain

We ask where and when it hurts and what you’ve already tried, then examine the whole foot and leg: alignment, motion, strength, skin, circulation and sensation. We also watch how you stand and walk. This gait analysis helps explain pain that keeps coming back; see what a gait analysis can tell you.

X-ray and ultrasound are available at the practice. X-rays quickly show fractures and arthritis but little of muscles and tendons.^[23] Ultrasound shows tendons, ligaments, muscles and nerves, without radiation.^[24] An early stress fracture is often hard to see on X-ray, so an MRI or bone scan is sometimes needed.^[8] See X-ray, ultrasound or MRI?

Treatments we offer

Most treatment starts without surgery. With plantar fasciitis, for example, more than 9 in 10 people improve within 10 months of starting simple treatment.^[3]

• Shoes, inserts and custom orthotics. Custom orthotics, made from a 3D scan of your feet, have the strongest evidence for painful high-arched feet, and some evidence for foot pain from rheumatoid arthritis and for painful bunions.^[25] For heel pain, they are a later step that helps some people who haven’t improved with stretching and other simple care.^[26] See custom orthotics.
• Stretching and advice. Stretching, taping, and advice on shoes and activity are the core of care for heel pain.^[26]
• Shockwave therapy (ESWT), done in the office with no incision or injection. In a large review of plantar fasciitis treatments, shockwave was the only one that improved pain in the medium and long term.^[27] See shockwave therapy.
• Class IV laser therapy, short in-office sessions for heel and tendon pain. In five small trials comparing the two for plantar fasciitis, pain scores did not differ clearly between laser and shockwave, though foot function improved somewhat more with shockwave and the evidence is limited.^[28] See laser therapy.
• Injections. A cortisone (steroid) injection can calm a painful joint for several weeks. Doctors usually limit how many you get in a year, and steroid shots are generally avoided for tendon problems such as Achilles tendinitis.^[29] For plantar fasciitis, platelet-rich plasma (PRP) relieved pain better than a steroid from three months on, but most of the studies had a high risk of bias, so the result is uncertain.^[30] See regenerative medicine.
• Surgery, when good non-surgical care hasn’t helped enough, or when an injury needs it.

Common questions

Why does my foot hurt when I walk?

Usually something is overloaded: the plantar fascia, a tendon, an arthritic joint, or a bone with a stress fracture. In studies, about two in three people wore shoes that didn’t match the length or width of their feet, and poor fit is linked with foot pain.^[14] Use the chart above to narrow it down, and get a tender spot on a bone checked for a stress fracture.^[8]

Why does my foot hurt in the morning?

Sharp heel pain with the first steps out of bed is the classic sign of plantar fasciitis.^[3] See morning heel pain for why it happens and what helps.

My X-ray was normal. Why does my foot still hurt?

X-rays show little of muscles and tendons, and an early stress fracture often doesn’t show at first.^[23,8] An examination, ultrasound or MRI can find what the X-ray missed, and burning or tingling suggests a nerve.^[2]

How can I ease foot pain from standing all day?

Wear supportive, cushioned shoes that fit the length and width of your feet, and replace them when worn. Stretch your calves and arches, take sitting breaks, and consider inserts. Long hours standing on hard surfaces raise the risk of plantar fasciitis, so heel pain that lasts more than a few weeks is worth checking.^[3]