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Causes/Symptoms
Nearly all causes of foot pain can be categorized under one or more of the following conditions:
• Shoes. The causes of most foot pain are poorly fitting shoes. High-heeled shoes concentrate pressure on the toes and are major culprits for aggravating, if not causing, problems with the toes.
Of interest, however, was a British study, in which 83% of older women experienced some foot pain. In the study, 92% of them had worn 2-inch heels at some point in their lives. Foot problems, however,
were significant even in women who regularly wore lower heels.
• Temporary Changes in Foot Size and Shape. Temperature, and therefore weather, affects the feet: they contract with cold and expand with heat. Feet can change in shape and increase in size by
as much as 5% depending on whether a person is walking, sitting, or standing.
• Poor Posture. Improper walking due to poor posture can cause foot pain.
Medical Conditions. Any medical condition that causes imbalance or poor circulation can contribute to foot pain.
Inherited Conditions. Inherited abnormalities in the back, legs, or feet can cause pain. For example, one leg may be shorter than the other, causing an imbalance.
• High-Impact Exercising. High-impact exercising, such as jogging or strenuous aerobics, can injure the feet. Common injuries include corns, calluses, blisters, muscle cramps, acute knee and ankle
injuries, plantar fasciitis, and metatarsalgia.
• Industrial Cumulative Stress. Because of the effects of work-related repetitive stress on the hand, there has been considerable interest in the effect of work-stress on foot pain. According to
one 2000 analysis, there is very little evidence for any significant impact of work on various foot disorders, including hallux valgus, neuroma, tarsal tunnel syndrome, toe deformity, heel pain,
adult acquired flatfoot, or foot and ankle osteoarthritis. In general, the foot is designed for repetitive stress, and few jobs pose the same stress on the feet as many do on the hands. Nevertheless,
certain professions, such as police work, are associated with significant foot pain. More research is needed.
• Arthritic Conditions. Arthritic conditions, particularly osteoarthritis and gout, can cause foot pain. Although rheumatoid arthritis almost always develops in the hand, the ball of the foot can
also be affected.
• Diabetes. Diabetes is an important cause of serious foot disorders.
Diseases That Affect Muscle and Motor Control. Diseases that affect muscle and motor control, such as Parkinson's disease, can cause foot problems.
High Blood Pressure. High blood pressure can cause fluid buildup and swollen feet. The effects of high blood pressure on the nervous and circulatory systems can cause pain, loss of sensation, and
tingling in the feet, and can increase the susceptibility for infection and foot ulcers.
• Obesity. Weight gain can cause foot and ankle problems. According to survey data presented at the 2005 annual meeting of the American Academy of Orthopaedic Surgeons, an increased body mass index
(BMI) raised the risk for foot and ankle pain.
• Osteoporosis. Osteoporosis, in which bone loss occurs, can cause foot pain.
Pregnancy. Pregnancy can cause fluid buildup and swollen feet. The increased weight and imbalance of pregnancy contributes to foot stress.
• Other Diseases. Diseases that affect the nervous and circulatory systems, such as anorexia, can cause pain, loss of sensation, and tingling in the feet, as well as increase the susceptibility
for infection and foot ulcers. Several conditions -- including heart failure, kidney disease, and hypothyroidism -- can cause fluid buildup and swollen feet.
• Medications. Some medications, such as calcitonin and drugs used for high blood pressure, can cause foot swelling.
Risk Factors
Nearly everyone who wears shoes has foot problems at some point in their lives. Some people are at particular risk for certain types of pain.
The Elderly. Elderly people are at very high risk for foot problems. In one study, 87% of older people reported at least one foot problem. Feet widen and flatten, and the fat padding on the sole
of the foot wears down as people age. Older people's skin is also dryer. Foot pain, in fact, can be the first sign of trouble in many illnesses related to aging, such as arthritis, diabetes, and
circulatory disease. Foot problems can also impair balance and function in this age group.
Children. Foot pain is fairly common even in children. Heel pain is common in very active children ages 8 - 13, when high-impact exercise can irritate growth centers of the heel.
Women are at higher risk than men for severe foot pain, probably because of high-heeled shoes.
Older Women. Severe foot pain appears to be a major cause of general disability in older women. In a British study of women ages 50 - 70, 83% reported foot problems. In another study, 14% of older
disabled women reported chronic, severe foot pain, which played a major role in requiring assistance in walking and in daily activities.
Pregnant Women. Pregnant women have special foot problems from weight gain, swelling in their feet and ankles, and the release of certain hormones that cause ligaments to relax. These hormones
help when bearing the child but can weaken feet.
An estimated 120,000 job-related foot injuries occur every year, about a third of them involving the toes. A number of foot problems -- including arthritis of the foot and ankle, toe deformities,
pinched nerves between the toes, plantar fasciitis, adult acquired flat foot, and tarsal tunnel syndrome -- have been attributed to repetitive use at work.
For example, in a study of New York police officers who walked an average of 3 miles a day, 20% experienced foot pain at the end of their workday. (Insoles can relieve much of this pain.) No studies,
however, have scientifically distinguished between injuries due to work versus those due to regular use. This is an important issue because of its potential impact on disability claims.
People who engage in regular high-impact aerobic exercise are at risk for plantar fasciitis, heel spurs, sesamoiditis, shin splints, Achilles tendon, and stress fractures. In one study of aerobic
dance instructors, for example, nearly one-third reported injuries in the feet and ankles. Even young athletes are at risk for stress fracture, particularly if they exercise 6 or 7 days a week.
Women are at higher risk for stress fractures than men are.
Excess Weight. Anyone who is overweight puts increased stress on the feet and is at risk for foot or ankle injuries.
Diabetes. People with diabetes are at particular risk for severe foot infections and must take special precautions.
Other Medical Conditions. Many other medical conditions, such as osteoarthritis, rheumatoid arthritis, and gout, predispose people to foot problems, as do inherited abnormalities.
A 2000 study reported that smokers are at higher risk for blisters, bruises, sprains, and fractures, most likely because they tend to be less fit than nonsmokers. They also may heal less quickly,
which, some evidence suggests, affects some foot surgeries.
Other common causes of foot pain include:
• Bunions -- a protrusion at the base of the big toe, which can become inflamed. Bunions often develop over time from wearing narrow-toed shoes.
• Hammer toes -- toes that curl downward into a claw-like position
• Calluses and corns -- thickened skin from friction or pressure. Calluses are on the balls of the feet or heels. Corns appear on your toes.
• Plantar warts -- from pressure on the soles of your feet
• Fallen arches -- also called flat feet
• Morton's neuroma -- usually centered between third and fourth toes and causes tingling and sharp shooting, or burning pains in the ball of your foot and sometimes toes, especially when wearing
shoes or pressing on the area. Pain grows worse over time and is more common in women.
• Broken bones
• Stress fracture
• Arthritis
• Gout -- common in the big toe, which becomes red, swollen, and very tender
• Pseudogout -- calcium deposits in on or more of your joints cause pain, redness and swelling
• Plantar fasciitis -- inflammation of the thick connective tissue on the sole of your foot that attaches to your heel. The pain is usually felt at the bottom of your heel and is often worse in
the morning because of stiffness that occurs overnight.
• Bone spur
• Sprains
Bursitis of the heel -- inflammation of the back of the heel can be caused by landing hard or awkwardly on the heel or by pressure from shoes.
• Achilles Tendinitis -- inflammation of the large tendon that connects your calf muscle to your heel. This can be caused by running, tightness and lack of flexibility in your calf muscles, shoes
with inadequate stability of shock absorption or sudden inward or outward turning of your heel when hitting the ground
Reviewed By: Andrew L. Chen, M.D., M.S., Orthopedist, The Alpine Clinic, Littleton, NH. Review provided by VeriMed Healthcare Network.
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