Well-Connected What Is Foot Pain?

The foot is a complex structure of 26 bones and 33 joints layered with an intertwining web of 126 muscles, ligaments, and nerves. The average person spends four hours on their feet and takes between 8,000 and 10,000 steps each day. The feet are very small relative to the rest of the body, and the impact of every step exerts tremendous force upon them -- about 50% greater than the person's body weight. During an average day the feet support a combined force equivalent to several hundred tons. In addition to supporting weight, the foot acts as a shock absorber and as a lever to propel the leg forward, and it serves to balance and adjusts the body to uneven surfaces. It is not surprising, then, that about 75% of Americans experience foot pain at some point in their lives. According to a recent study, chronic and severe foot pain is a serious burden for one in seven older disabled women. To compound problems, the lower back is often affected by injuries or abnormalities in the feet.

Foot pain is generally defined by one of three sites of origin: the toes; the front of the foot (forefoot); or back of the foot (hind foot). Toe problems most often occur because of the pressure imposed by ill-fitting shoes. Pain originating in the front of the foot usually involves the metatarsal bones (five long bones that extend from the front of the arch to the bones in the toe) and the sesamoid bones (two small bones imbedded at the top of the first metatarsal bone, which connects to the big toe). Pain originating in the back of the foot can affect parts of the foot extending from the heel, across the sole (known as the plantar) to the ball of the foot.

What Causes Foot Pain?

General Conditions Causing Foot Pain The causes of most incidents of foot pain are poorly fitting shoes. High-heeled shoes are major culprits for aggravating, if not causing, problems in the toes, where the most pressure is exerted. Other conditions can also cause or exacerbate foot pain. Weather affects the feet; they contract in cold and expand in hot weather. Foot size can also increase by 5% over the day and change shape and size depending on whether a person is walking, sitting, or standing. Improper walking due to poor posture or inherited or medical conditions that cause imbalance or poor circulation can contribute to foot pain. Often one leg is shorter than the other, causing an imbalance. 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.

Medical Conditions Causing Foot Pain

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. Osteoporosis, in which bone loss occurs, can also cause foot pain. Diabetes is a particularly serious cause of foot pain, infection, and ulcers, and, without proper foot care, can result in amputation. Diabetics with foot deformities, such as claw toes, or bunions are at particular risk. Anorexia, high blood pressure, and other diseases that affect the nervous and circulatory systems can cause pain, loss of sensation, and tingling in the feet, as well as increase the susceptibility for infection and foot ulcers. A number of conditions, including pregnancy, heart failure, kidney disease, and hypothyroidism, can cause fluid build-up and swollen feet. The increased weight and imbalance of pregnancy contributes to foot stress. Diseases that affect muscle and motor control, such as Parkinson's disease, also cause foot problems. Some medications, such as calcitonin and drugs used for high blood pressure, can cause foot swelling.

Causes of Toe Pain Corns. A corn is actually a form of a callus -- a protective layer of dead skin cells composed of a tough protein called keratin. A corn itself is cone-shaped and usually develops if a shoe rubs against the toes for a prolonged period. As the skin thickens, the corn forms a knobby core that points inward. Hard corns develop on toe joints, usually on the little toe. A shoe that squeezes the front of the foot may cause one toe to rub against another forming a corn between the toes, which is usually soft. These corns can be painful, however, if they harden and rub against each other.

Ingrown Toenails. Ingrown toenails can occur in any toe but are most common in the big toes. They usually develop when tight fitting or narrow shoes put too much pressure on the toenail and force the nail to grow down into the flesh of the toe. Incorrect toenail trimming can also contribute to the risk of developing an ingrown toenail (see How Is Foot Pain Prevented, in this report). Fungal infections, injuries, abnormalities in the structure of the foot, and repeated pressure to the toenail from high impact aerobic exercise can also produce ingrown toenails. Bunions. A bunion is a deformity that usually occurs at the head of the first of five long bones (the metatarsal bones) that extend from the arch and connect to the toes. The first metatarsal bone is the one that attaches to the big toe. The big toe is forced in toward the rest of the toes, causing the head of the first metatarsal bone to jut out and rub against the side of the shoe; the underlying tissue becomes inflamed and a painful bump forms. As this bony growth develops, the bunion is formed as the big toe is forced to grow at an increasing angle towards the rest of the toes. A bunion may also develop in the bone that joins the little toe to the foot (the fifth metatarsal bone), in which case it is known as a bunionette or tailor's bunion. Bunions often develop from wearing narrow, high-heeled shoes with pointed toes, which puts enormous pressure on the front of the foot and causes the foot and toes to rest at unnatural angles. Injury in the joint may also cause a bunion to develop over time. Genetics play a factor in 10% to 15% of all bunion problems; one inherited deformity, hallux valgus, causes the bone and joint of the big toe to shift and grow inward, so that the second toe crosses over it. Flat feet, gout, and arthritis increase the risk for bunions.

Hammertoes. A hammertoe is a permanent deformity of the toe joint in which the toe bends up slightly and then curls downward, resting on its tip; when forced into this position long enough, the tendons of the toe contract and it stiffens into a hammer- or claw-like shape. Hammertoe is most common in the second toe but may develop in any or all of the three middle toes if they are pushed forward and do not have enough room to lie flat in the shoe. The risk is increased when the toes are already crowded by the pressure of a bunion. Lying down for long periods, diabetes, and various diseases that affect the nerves and muscles put people at risk.

What Are The Treatments For Specific Foot Problems?

Treatment for Acute Pain and Injury Over-the-Counter Pain Relievers. Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used to treat mild pain caused by inflammation of muscles. There are dozens of these drugs, but aspirin is the most common of them. Others include ibuprofen (Motrin, Advil, Nuprin, Rufen), ketoprofen (Actron, Orudis KT), naproxen (Aleve, Naprelan), and tolmetin (Tolectin). It is important to note that high doses or long-term use of any NSAID can cause gastrointestinal disturbances, with sometimes serious consequences, including dangerous bleeding. No one should take NSAIDs for chronic pain without consulting a physician. A gel containing ibuprofen can be applied to sore joints. Acetaminophen (e.g., Tylenol) is not an NSAID, and although it is a mild pain reliever, it will not reduce inflammation. RICE. The acronym RICE (rest, ice, compression, elevation) is used to remind people of the four basic elements of immediate treatment for an injured foot. People should get off injured feet as soon as possible (Rest). Ice is particularly important to reduce swelling and promote recovery during the first forty-eight hours. A bag or towel containing ice should be wrapped around the injured area on a repetitive cycle of 20 minutes on, 40 minutes off (Ice). An ace bandage should be lightly wrapped around the area (Compression). The foot should be elevated on several pillows (Elevation). X-Rays. If people suspect that bones in a toe or foot have been broken or fractured, they should call a physician, who will probably order x-rays. It should be noted that often a person is able to walk even if a foot bone has been fractured, particularly if it is a chipped bone or a toe fracture.