Bottom of Foot Pain

Pain on the bottom of your foot can be caused by many things from ill-fitting shoes to activities like long-distance running or walking. For jobs that require long hours on your feet, bottom-of-the-foot pain is an occupational hazard.

The pain may arise from problems with the bones, nerves, cartilage, tendons, or ligaments of your foot. Some people are predisposed to pain due to structural foot problems, such as having very high arches or flat feet. Depending on the condition, you may feel shoooting pain or a constant ache.

This article covers some of the more common causes of bottom-of-the-foot pain. It also describes some treatments that can help and when it is time to see a healthcare provider

What Causes Pain in the Bottom of the Foot?

Your foot is a complex, highly articulated structure made up of 26 bones, 30 joints, and almost 100 muscles and ligaments. An injury of any of these structures by injury, infection, or disease can lead to foot instability and pain.

Here are some of the more common causes of bottom-of-the-foot pain, also known as plantalgia.

Plantar Fasciitis

One of the most common causes of foot pain is plantar fasciitis. This is the inflammation of the band of tissue called the plantar fascia that stretches from the heel bone to the base of your toes.

Plantar fasciitis causes sharp, stabbing pains in your heel and/or foot pain in your arch. Symptoms tend to be most severe in the morning when taking your first steps out of bed.

Risk factors for plantar fasciitis include:

• Having flat feet or a very high arch
• Being overweight or having obesity
• Overpronation (when feet roll inward with each step)
• Wearing shoes with poor arch support
• Walking, running, or standing a lot on hard surfaces
• Walking barefoot
• Being pregnant
  

Metatarsalgia

Metatarsalgia describes pain in the ball of your foot where the five metatarsal bones are situated. These long bones in your forefoot connect your ankle to each of your five toes. The metatarsals help form the arch of the foot, which are essential for walking and weight-bearing activities.

Metatarsalgia pain is often described as being sharp, aching, or burning. It can worsen when you stand, run, walk, or flex your feet.

Metatarsalgia is common in people who do high-impact activities, like running or jumping. Older adults are more likely to develop metatarsalgia due to long-term repetitive stress.

Other risk factors include:

• Having high arches
• Having especially long bones in your feet
• Having hammertoes
• Being overweight or having obesity
• Wearing high heels or ill-fitting shoes
• Having problems with blood circulation
• Having gout
• Having diabetes
  

Peripheral Neuropathy

Peripheral neuropathy is pain caused by damage to nerves situated outside of the brain and spinal cord (called the peripheral nerves). This condition can cause pain and other abnormal sensations in the hands and feet. 

Neuropathy pain is often described as tingling, burning, shocking, or stabbing. The pain often gets worse with walking or standing.

Damage to the peripheral nerves can be caused by many things, including diabetes, alcohol abuse, Lyme disease, autoimmune diseases like lupus, and certain medications.

Neuroma

A neuroma is an abnormal clump of nerve cells that can form between the toes (usually after an injury). Symptoms include burning pain in the ball of the foot. There may also be numbness and tingling that radiates to your toes.

The neuroma can feel like a pebble in your shoe. It is most common between the second and third toes or the third and fourth ones.

People who are assigned female at birth are more likely to be affected.

Other risk factors include:

• Playing high-impact sports that involve running or jumping
• Wearing shoes without proper support
• Wearing high heels, tight shoes, or restrictive footwear like work boots
• Having hammertoe or a bunion
  

Sesamoiditis

Sesamoiditis is the inflammation of the two small bones situated beneath the pad of the big toe, called the sesamoids. These bones help support the tendon that flexes this toe.

Symptoms of sesamoiditis include dull pain and swelling at the base of the big toe. A stress fracture can develop if excessive weight-bearing stress is placed on these bones.

Risk factors include:

• Activities that place pressure on the ball of the foot, like running, ballet, or tennis
• Having high arches
• Wearing high heels
  

Tarsal Tunnel Syndrome

Tarsal tunnel syndrome occurs when the nerve that services parts of the calf and foot, called the posterior tibial nerve, gets compressed in a narrow space inside the ankle, called the tarsal tunnel. This causes pain, numbness, and tingling in the foot.

Risk factors for tarsal tunnel syndrome include:

• Having flat feet
• Swelling in your ankle due to an ankle sprain
• Having diabetes, arthritis, or other diseases that cause nerve compression

Guillain-Barré Syndrome (GBS)

Guillain-Barré syndrome (GBS) is a rare disorder that causes your immune system to attack your peripheral nerves. It is often triggered by a respiratory or digestive infection and occasionally by certain vaccines.

For many people, the first signs of GBS are pain, weakness, or tingling in their toes, feet, or legs. These sensations tend to progress over the coming hours, days, or weeks and gradually spread to the arms and upper body. In rare cases, GBS can cause permanent nerve damage, paralysis, or death.

Anyone can get GBS, but it is more common in adults over 50. Your risk is also higher if you've had a recent surgery or have a preexisting autoimmune disease.

When to See a Healthcare Provider

Sometimes, bottom-of-the-foot pain goes away on its own in a few days. At other times, it becomes a chronic condition that impacts your quality of life.

See a healthcare provider if you have: 

• New pain that lasts more than a few days
• Loss of sensation or abnormal sensations like tingling or burning
• Chronic foot pain that suddenly gets worse
• Pain that makes it difficult to walk or do everyday activities
• An injury that causes foot pain
• Fever, chills, and swelling of the foot (indicative of an infection)

Based on your symptoms, your healthcare provider may refer you to a podiatrist (foot specialist), orthopedist (bone specialist), or neurologist (nerve specialist).

How is Pain in the Bottom of the Foot Diagnosed?

To identify the cause of your foot pain, your healthcare provider will first examine your foot for signs of pain, tenderness, infection, or a loss of range of motion. They will also check for any abnormal sensations or signs of deformity (including bunions, overpronation, or flat feet).

Based on the findings, the healthcare provider may order imaging tests to check the structure of your foot and other procedures that measure nerve activity.

These include:

• X-ray: This imaging study is well-suited to check for changes in the bones due to fractures, infections, or arthritis.
• Computed tomography (CT): This is an imaging test that composites multiple X-ray images to check for bone fractures, arthritis, and structural deformities.
• Ultrasound: This is an imaging test that uses reflected sound waves to check for neuromas, metatarsalgia, tarsal tunnel syndrome, plantar fasciitis, and other soft tissue problems.
• Magnetic resonance imaging (MRI): This imaging study uses powerful magnetic and radio waves to create highly detailed images of soft tissue conditions like plantar fasciitis, metatarsalgia, neuroma, sesamoiditis, and tarsal tunnel syndrome.
• Nerve conduction studies (NCS): This involves the placement of electrodes on the skin to measure nerve response if Guillain-Barré syndrome or peripheral neuropathy is suspected.
• Electromyography (EMG): This involves the insertion of the needle through the skin to measure nerve activity to determine if your pain is related to your muscles, nerves, or some other cause.

Differential Diagnoses

A differential diagnosis is a process in which your healthcare provider rules out all the other possible conditions that could explain your symptoms. This is important to make a definitive diagnosis of your bottom-of-the-foot pain.

Conditions similar to sesamoiditis include:

• Osteoarthritis of the big toe
• Tenosynovitis or tendinosis of the big toe joint
• Gout

Conditions that mimic neuroma include:

• Bursitis of the bones at the base of the toes
• Instability in the metatarsophalangeal (MTP) joint
• A tear in the ligament in the ball of your foot

Conditions with similar symptoms to metatarsalgia include:

• Morton's neuroma
• Bursitis of the bones at the base of the toes
• Stress fractures in the metatarsals

How is Pain in the Bottom of the Foot Treated?

Treatment for foot pain depends on your diagnosis. Healthcare providers usually recommend starting with conservative options and moving to other treatments as needed.

Lifestyle

The more significant your pain is, the more you might think that lifestyle won't have much of an effect. That's simply not true. There are many effective strategies that can help.

Shoe Inserts

Supportive shoes or inserts can help relieve some foot pain, particularly for conditions like plantar fasciitis, metatarsalgia, and neuroma.

In some cases, your healthcare provider may prescribe custom orthotic shoe inserts designed to fit and support your foot's distinct curves.

Diet

Starting an anti-inflammatory diet is ideal for anyone experiencing pain. It focuses on fruits and vegetables, fish, nuts, and whole grains. Foods with turmeric, lemon water, and antioxidants may help reduce foot inflammation.

Weight Loss

Being overweight or obese is linked to an increased risk of pain, inflammation, and other problems in your feet. Losing weight, if needed, can reduce the stress on your feet.

Losing weight is especially important if you also have diabetes, which is a risk factor for peripheral neuropathy, metatarsalgia, tarsal tunnel syndrome, and more.

Posture

Many people find that improving their posture evens out the stress on their feet and improves their pain. Even if you have had poor posture for years, you can still improve it by making sure that your shoulders are pushed back and your weight is balanced evenly on both feet.

If you tend to slouch, you can try wearing a posture brace to pull your shoulders back. You might find it helpful to set a frequent alarm to remind you to correct your posture too.

Last but not least, stretches and strength-building exercises are a must for correcting posture. Stretching will release tension in your back, hips, and glutes and help you stand more evenly. Exercises that strengthen your core, back, and shoulders will help you stand taller and align your spine.

Medications

Over-the-counter pain relievers are commonly used to ease foot pain, including:

• Tylenol (acetaminophen)
• Advil/Motrin (ibuprofen)
• Aleve (naproxen)
• Aspirin

If conservative treatments fail, a cortisone injection can quickly ease inflammation in people with plantar fasciitis, sesamoiditis, or neuromas.

For severe pain, you may be given a prescription opioid painkiller like:

• Tylenol with Codeine (acetaminophen/codeine)
• Vicodin (hydrocodone/acetaminophen)
• OxyContin (oxycodone)

Opioids can be highly addictive and are only intended for short-term use.

Peripheral neuropathy can be harder to treat. It is generally managed with medications such as anti-seizure drugs and antidepressants. These change how your nervous system functions.

Complementary and Alternative Therapies

Certain complementary or alternative treatments may help relieve foot pain, including:

• Acupuncture
• Foot and ankle massage
• Movement therapies like yoga or tai chi to improve muscle strength, flexibility, and balance

You can also try applying a cold or hot compress to your foot to reduce pain. Use ice for only 20 minutes at a time up to three times a day. Don't place ice packs directly against your skin.

Physical Therapy

Your healthcare provider may refer you to a physical therapist if your foot pain interferes with your daily life, activities, or mobility. The goal of physical therapy is to reduce your symptoms and the effect they have on your quality of life.

To accomplish this, your physical therapist will put together a program that rehabilitates your foot so that you can walk and stand without pain. Your rehab program may involve stretches and exercises that improve your foot and ankle strength, balance, and range of motion.

Physical therapy can help you manage your plantar fasciitis, metatarsalgia, neuroma, or sesamoiditis. In some cases, it may help with peripheral neuropathy.

Surgery

Surgery is typically a last resort when all other treatment options fail to reduce your pain and other symptoms.

A surgical procedure called a sesamoidectomy may be necessary for very severe cases of sesamoiditis that do not respond to physical therapy. This surgery involves removing the sesamoid bone.

Surgery for plantar fasciitis is uncommon, but it may be necessary if your pain persists despite six to 12 months of physical therapy. The surgery involves cutting part of the plantar fascia to release tension and ease swelling.

Severe neuromas that don't get better with therapy can be treated with a minimally-invasive procedure called a neurectomy. A small incision is made in the foot and the affected nerve is removed.

Several possible surgeries can be done for severe metatarsalgia, depending on what has caused it. If a deformity is to blame, a metatarsal osteotomy can be done to realign the metatarsal bone(s).

Surgery may be done for peripheral neuropathy, also depending on the cause. The minimally-invasive procedure involves dividing the affected nerve to relieve pressure. It can be done in an outpatient setting.

How to Prevent Bottom-of-Foot Pain

You can't always prevent a foot injury or an illness that leads to foot pain. But there are lifestyle changes you can make to reduce your risk of discomfort. You can:

• Wear orthopedic inserts or supportive shoes
• Carefully walk and stretch after an injury
• Avoid excessive running, jumping, or high-impact activities 
• Strive to maintain a healthy weight
• Avoid foods that trigger inflammation, such as sugar and highly processed foods
• Work on having great posture if you don't already
• Listen to your body and take pressure off your foot when you need it

Taking care of your overall health goes a long way in preventing foot pain. In addition to eating a healthy diet and exercising regularly, carefully managing any chronic conditions you have is key.

If you smoke cigarettes, do all you can to quit. Cigarette smoking promotes chronic inflammation.

Similarly, if you think you may be dependent on alcohol, consult with your healthcare provider. Resolving an alcohol dependence can reduce your risk of peripheral neuropathy along with many other health conditions.

Summary

There are several possible causes of bottom-of-the-foot pain. Symptoms can vary depending on what's to blame.

For example, plantar fasciitis causes sharp pain in the heel or sole. Metatarsalgia causes pain in the ball of the foot. Peripheral neuropathy can cause pain on the bottom of the foot paired with tingling or burning, and so on.

Finding the cause of bottom-of-the-foot pain may include a physical exam and X-rays or other imaging. Treatment may involve pain relief, lifestyle changes, physical therapy, and in severe cases, surgery.