Foot pain • Causes, diagnosis & therapy

Foot pain usually manifests itself as a stinging or burning sensation when stepping on, running or at rest. Sometimes the whole foot is affected, often just the ball of the foot, heel, or toe. What can be behind foot pain and what measures can help against it.

The feet have to bear the full weight of the body – no wonder they are prone to overload and sometimes start to hurt. A change of footwear often helps, but pain can also be relieved with the help of simple exercises. If the symptoms persist for a long time, this should be clarified by a doctor. Swelling or deformation are also warning signs that require an orthopedic examination.

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The seven most common foot problems

How and when does the foot pain occur?

Foot pain can manifest itself in very different ways, depending on the cause. Depending on the cause, the pain either kicks in suddenly or gradually gets worse over a longer period of time. For example, the complaints can occur under the following conditions:

  • after prolonged exertion (for example after jogging)
  • after an accident
  • at the beginning of a movement, for example when getting up after sitting (starting pain)
  • when stepping on and rolling off
  • when wearing shoes that are too tight
  • at rest (chronic pain)

Sometimes foot discomfort also occurs in conjunction with other symptoms, such as redness, swelling and overheating (for example, if there is an inflammation), sensory disturbances or paralysis (if nerves or muscles are damaged).

Where does the foot pain occur?

The localization of the pain is also important for the diagnosis. In addition to the whole foot, only individual areas can be affected:

  • Metatarsus
  • Toes (e.g. big toe)
  • Ball of the toe
  • Sole of the foot
  • Ankle
  • heel
  • Instep or back of the foot
  • Inside or outside of the foot

Possible causes of foot pain

There are many causes behind foot pain. Almost everyone suffers from foot pain at some point in their life as a result of excessive stress (for example when hiking or jogging), which however disappear again relatively quickly. However, shoes that are too narrow or too big often lead to problems: In addition to painful pressure points, blisters and pressure sores, the possible consequences include incorrect stress on the joints, muscles, tendons and ligaments and permanent deformation of the foot. Foot diseases such as hallux valgus (ball of the big toe) or joint wear (osteoarthritis) can also be accompanied by pain in the foot.

All causes of foot pain at a glance:

  • Heavy load: Tendinitis, heel spur (outgrowth of the bone in the heel area)

  • Injuries: Dislocation, sprain, twist, bruise, ligament stretch, bursitis, Achilles tendon rupture, fracture of the calcaneus, toes, metatarsus or fractures of the ankle

  • Congenital or acquired foot deformities: Arched arches, splayfoot, sickle foot, flatfoot, splayfoot, equinus foot (placing the foot only with the ball of the foot), clubfoot, hallux valgus (“ball of frost”, “ball toe”: crooked position of the big toe)

  • Joint wear: Hallux rigidus, osteoarthritis of the tarsal joints

  • Inflammatory diseases: Inflammation of the bones as a result of an infection (osteomyelitis), diseases and inflammations of the skin (for example athlete’s foot)

  • Nerve damage (polyneuropathy): for example as a result of diabetes mellitus (diabetes), kidney disease, alcoholism or an infection (such as borreliosis or shingles)

  • Metabolic diseases: Gout, rheumatoid arthritis

  • Circulatory disorders: arterial occlusive disease (AVK) or atherosclerosis

  • Tumor diseases: Bone cancer (sarcomas)

Cause of pain in the heels

The most common cause of sole pain is heel spur – a painful irritation of the tendon plate on the sole of the foot. If there is permanent overuse, inflammation in the tissue and, over time, bony calcifications are the result. These are also visible in the X-ray image. The sharp pain occurs under load in the heel area. Usually the first steps in the morning or after sitting for a long time are most pronounced.

Cause of foot pain on the ball of the foot

Pain in the ball of the foot can be traced back to a variety of causes, such as poor blood circulation, pinched nerves between the toes or misalignments. Many people also suffer from a misalignment of the big toe in the metatarsophalangeal joint (hallux valgus). Typically this can be recognized by an outward kink of the big toe, mobility is often restricted. Those affected also complain of pressure pain, and the friction on the shoe can in turn promote inflammation of the bursa.

Cause of metatarsal pain

Pain in the midfoot (metatarsalgia), especially when it occurs when walking and rolling, can be a sign of Morton’s neuroma. It is an inflammatory thickening of the nerves in the metatarsal area, usually as a result of splayfeet and weight or sport-related overload. The pain is described as very severe. Relieving the foot, for example by putting it up, often brings relief.

Causes of foot pain on the inside or outside

Above all, the so-called arched arched foot is often noticeable through load-dependent foot pain on the inside. In this condition, the longitudinal arch of the foot sags due to a weakness in the tibialis posterior tendon that connects the posterior tibial muscle to the foot. The ankle becomes flattened

If there is pain on the outside of the foot, there is often a sprain or torn ligament. Often the person concerned has twisted ankle beforehand. Foot misalignments and excessive strain are also possible causes.

Diagnosing foot pain

If foot pain lasts longer than three days, if the symptoms are increasing or if the foot is severely swollen or overheated, this should definitely be clarified by a doctor. The first address for foot pain is an orthopedist. In a detailed discussion (anamnesis), initial conclusions are usually drawn about the underlying cause.

Possible questions are, for example:

  • How long have the complaints existed?
  • Has there been an accident or an injury?
  • When is the pain particularly severe?
  • What occupational and other stresses are the feet exposed to?

The feet are then tested for external signs of illness and their mobility.

Further examinations can follow, depending on the suspected cause, such as an X-ray examination of the foot, a joint reflection (arthroscopy), neurological and electrophysiological examinations such as EMG (electromyography), as well as magnetic resonance imaging (MRT). If inflammatory changes, an infection or a rheumatic disease are suspected, various blood tests (signs of inflammation, test for pathogens, rheumatoid factors) are carried out.

Therapy: this is how to get rid of foot pain

How foot pain is treated depends on the cause. If there is an overload due to too tight, uncomfortable or high shoes, switching to orthopedically suitable footwear can ease the symptoms.

Tips for the right footwear

  • For people who stand a lot at work, shoes without heels, preferably made of leather or other breathable materials, are recommended.

  • You do not have to do without high heels, but when buying a footbed, you should pay attention to the most comfortable footbed possible and change back into more comfortable shoes as soon as possible.

  • An honest look at the shoe rack helps your feet: Any pair that pinches or is uncomfortable should be sorted out immediately.

  • Special orthopedic insoles provide additional relief.

  • If children’s feet are pressed into shoes that are too small, the consequences are often only noticeable in adulthood: bent, flat and splayfoot, clawed and hammer toes, which usually last a lifetime. Parents should therefore always buy children’s shoes that are big enough with extra toes and the right width.

Help with severe foot pain

If the discomfort is pronounced, it may be necessary to immobilize the foot for a while with a splint or a plaster cast. If there is inflammation, anti-inflammatory drugs provide relief. They are taken as tablets or given as injections. Physiotherapeutic measures with heat and cold applications, shock wave therapy, muscle-strengthening exercises as well as electrical and ultrasound therapy (such as iontopheresis) can be used as support.

In some cases, such as a foot malposition or, rarely, a heel spur, surgery may be necessary to correct it. If the ankle is diseased or there is a ligament or tendon injury, an attempt is made to restore the injured structures with a jointoscopy.

Foot gymnastics for foot problems

If the feet are thick and swollen after standing for a long time or in extreme heat, foot exercises can help to counteract further foot complaints. The following tips can help:

  • Simply pick up objects from the floor with bare feet or roll your soles over something rough

  • Massages cheer up tired and heavy feet. It is best to gently stretch, bend and circle your foot with both hands. This passive movement relaxes and gets the blood circulation going.

  • Doctors and podiatrists advise as often as possible walking barefoot. This prevents many causes of foot pain. Children in particular should walk without shoes more often, as this strengthens the foot muscles.

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Source: Lifeline | Das Gesundheitsportal by

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