Foot pain: causes, diagnosis and treatment options

When walking, the human foot has to bear the entire weight of the body on a very small surface - a real top performance. So it's no wonder that sooner or later almost everyone suffers from foot pain at some point.

In order for you to learn to assess foot pain correctly and get a feeling for when you should definitely see a foot specialist, we would like to inform you about the following topics in this article:

Foot pain can have many different causes. In the most harmless case, it is triggered by standing for a long time or wearing bad shoes. But foot malpositions, injuries or metabolic diseases can also be the cause. In case of persistent or increasing pain in the foot, visible swellings or bruises, it is advisable to seek a foot specialist's opinion.

The triggers of foot pain can be, for example:

• (Sports) accidents: ankle injury, torn ligament
• Overload: tendonitis, heel spur
• Foot deformities: Hallux valgus, bent foot, flat foot, splay foot
• Arthrosis: hallux rigidus, ankle joint arthrosis, tarsal arthrosis
• Nerve compression: Morton neuroma (metatarsal pain), tarsal tunnel syndrome (nerve constriction)
• Metabolic diseases: Gout, rheumatism

Dr Gottlieb, the specialised foot surgeon in Berlin, advises:

"Basically, any foot can cause pain. Let's assume you walk the Way of St. James barefoot. Then even completely healthy feet would hurt afterwards - because the feet were overloaded. If pain occurs, I always first distinguish whether the load on the foot was too high or whether the load-bearing capacity of the foot is not high enough. Appropriate examinations provide clarity here.”

Acute foot pain can occur, for example, directly after an accident or injury. One of the most common accidents in everyday life is twisting your ankle while running, jogging or other sporting activities.

However, pain in the feet can also develop slowly and get worse over time. They can also become noticeable not only with exertion, but also at rest or after lying down for a long time in the morning (start-up pain).

Additional accompanying symptoms and warning signals are swelling, haematoma, overheating of certain areas of the foot or an external, clearly visible deformation of the foot. In these cases, you should consult a specialised foot doctor to clarify the underlying causes of the foot pain.

Foot pain can be so different:

• Sudden pain, e.g. after long periods of exertion
• Pain after an accident
• Pain always recurs after a certain walking distance
• Start-up pain in the foot that disappears after a few metres
• Start-up pain after rest (e.g. in the morning)
• Pain on emergence
• Pain after jogging
• Pain due to shoes that are too tight

Pain on loading the foot

Our feet are a true masterpiece of nature. They are highly complex, made up of a multitude of bones, muscles, tendons and ligaments that have to work together perfectly so that the foot can do its daily hard work. When humans walk upright on two legs, the entire force of the body's weight is distributed over the very small surface of the feet, creating an enormously high pressure. In addition, the feet have to cushion every step, compensate for uneven ground and maintain balance.

So it's no wonder that foot pain often becomes noticeable when the foot is strained - for example after standing for a long time, walking, jogging or during certain movements. Very often, the foot hurts when stepping or rolling. Then every step can become a torture. In the case of osteoarthritis, for example, typical symptoms include pain when starting to walk in the morning, which improves with prolonged walking.

Complaints can also occur at rest

Relapsing foot pain, which also occurs in a resting position, is most often due to inflammation of the joints - for example in rheumatoid arthritis. If pain in the metatarsus or toes occurs mainly at night, this could indicate tarsal tunnel syndrome (pain due to pressure on the tibial nerves).

Foot pain often occurs in the morning after lying down for a long time. If, for example, you feel a stabbing pain in the sole of your foot after getting up, which subsides after a short time, the tendon plate of the sole of your foot could be inflamed (plantar fasciitis).

Common accompanying symptoms of foot pain

Sometimes foot pain occurs in conjunction with other symptoms. These include swelling, redness or overheating of the foot, which can occur, for example, in the case of inflammation or ligament injury of the foot. Damage to nerves or muscles can lead to sensory disturbances. Possible accompanying symptoms are radiating knee, hip or back pain. Deformities of the foot (e.g. a bent, flat or splay foot) can even lead to a pelvic obliquity in the long term.

If you are also a pain patient, the foot surgeon Dr Tonio Gottlieb is the right person to contact. He examines you with the utmost care and always has the entire body statics in mind. Whether you need an initial diagnosis or a second opinion - arrange a private consultation with Dr. Gottlieb now!

Let Dr. Gottlieb advise you personally!

The anatomy of the human foot is divided into three areas:

• Forefoot (antetarsus): The front area is formed by the five toes. The big toe consists of two bones and the other four toes of three bones each.
• Metatarsus: The area between the tarsus and the toes is called the metatarsus. It consists of five bones.
• Tarsus: The tarsus is located at the back of the foot. It consists of a total of seven bones. These include the calcaneus and the talus, which rests on the calcaneus.

Pain can arise in all of these areas of the foot, which must be clarified in a comprehensive diagnosis by the foot specialist. Even the localisation of the pain gives the expert clues to possible causes.

Pain in the heel

The most common cause of heel pain is plantar fasciitis, which can develop into ossification at the base of the plantar fascia - colloquially known as a heel spur. This is a thorny, bony process that forms on the heel bone and is very visible on an X-ray.

A distinction is made between two variants: The lower (dorsal) and the upper (plantar) heel spur. In both cases, the body forms ossifications at the base of the Achilles tendon and at the base of the plantar fascia due to permanent inflammation caused by overuse. A bony spur forms here after a long period of time. The surrounding region becomes irritated and inflamed.

Symptoms of a heel spur are foot pain in the area of the heel, which occurs either with the first steps after getting up or also after prolonged exertion.

Pain in the metatarsus can be an indication of metatarsalgia

Metatarsalgia (from the Greek metatarsus "metatarsus" and algos "pain") is the medical collective term for metatarsal pain affecting the second to fifth toes and the associated metatarsal bones. The typical pain on the outside of the foot can occur due to overloading, foot malpositions or injuries.

A stabbing pain between the third and fourth toe is typical of morton's neuroma (morton's neuralgia)

Morton's neuroma (Morton's neuralgia or Morton's metatarsalgia) is a painful condition of the plantar nerve located between the third and fourth toes in the midfoot. Compression can cause this nerve to swell severely and become a nerve growth (Morton's neuroma). The stabbing, electrifying pain in the foot can be aggravated by further pressure - for example, by shoes that are too tight.

Tarsal tunnel syndrome causes complaints in the sole of the foot

The tarsal tunnel is located in the area of the inner ankle. The tibial nerve runs through it and supplies the sole of the foot. In tarsal tunnel syndrome, this nerve becomes pinched due to increased pressure, which can lead to paraesthesia and sensory disturbances such as tingling, numbness or a furry feeling. Pain in the sole of the foot, the inside of the foot, the heel or the toes are also typical symptoms.

The cause of tarsal tunnel syndrome can, for example, be a foot malposition (e.g. a flatfoot).

If you have persistent foot pain, it is advisable to consult a foot specialist such as the foot surgeon Dr Tonio Gottlieb. He will address your individual complaints in a personal consultation and then conduct a careful physical examination. This way he can make a clear diagnosis and recommend the ideal form of therapy for you.

Among other things, the examination takes place on a special, transparent foot platform, which offers numerous advantages. On the platform, Dr Gottlieb can examine the foot at eye level and examine the footprint analogously from below. At the same time, he also has an overview of the entire leg axis and statics. The feet are examined both under load, i.e. standing, and unloaded. Afterwards, Dr. Gottlieb will discuss the causes and therapy options with you and also give you a stringent recommendation.

In the case of sudden or persistent foot pain, the cause of the pain must first be clarified. Only then can various therapy methods be considered. Basically, one always differentiates between conservative (non-surgical) or surgical treatment.

Options for conservative therapy

Conservative treatments of the foot include all non-surgical therapy methods. On the one hand, they serve to reduce the load and, on the other hand, to increase the load-bearing capacity of the foot.

Anyone suffering from foot pain should always avoid overloading the foot by walking or standing for too long. It is advisable to wear comfortable, well-fitting shoes and orthopaedic insoles. Regular foot exercises also have a positive effect and can strengthen the muscles. Depending on the cause and severity of the foot pain, good results can be achieved with conservative treatment methods such as foot gymnastics, special splints and insoles or medication.

The most important conservative therapies, especially for foot pain, are

• individual inserts and
• orthopaedic shoes to reduce the load,
• Physiotherapy and
• special foot gymnastics to increase weight-bearing capacity.

When does surgery make sense?

In some cases, the causes of foot pain can only be eliminated by surgery. If it is an obvious bone fracture, surgery to restore the integrity of the bones is usually unavoidable.

In the case of persistent pain or significant deformities of the foot that cannot or can no longer be corrected conservatively, surgical intervention should be considered - also to avoid consequential damage, for example progressive joint wear. The most common surgical interventions include foot operations on the ankle joint (in case of arthrosis, incorrect strain or torn ligaments), in the tarsal (in case of flat feet) as well as on the metatarsus and forefoot (on the big toe and the small toes - especially hallux valgus surgery and corrections of small toe deformities).

Foot pain is hard to ignore and quickly affects our everyday lives. After all, most people are "on their feet" all day. The most normal daily activities such as walking, standing, climbing stairs or even sports can then quickly become an arduous and painful challenge. Causes of foot pain are common:

• Injuries
• Incorrect footwear
• Overload
• Chronic diseases
• Joint wear and tear
• Malpositions
• Growth (in children and adolescents)

A previous injury

Foot pain often occurs as a result of a previous injury. Ankle injuries are among the most common accidents that can occur in everyday life. In the worst case, twisting the ankle can happen while simply taking a walk, but it is also considered a typical sports injury that can occur, for example, when running on uneven ground or abruptly changing direction. A fall is also a possible cause.

The most common foot injuries in everyday life are:

• Ankle sprains
• Ankle fracture (ankle joint fracture)
• Fatigue fracture of the ankle
• Achilles tendon rupture

Pain due to incorrect footwear

One of the most common reasons for foot pain is wearing the wrong shoes. Not only high heels can cause acute pain or permanent damage. Shoes that are too tight, too small or too big also promote malpositions and foot problems.

The shoe, which is harmless to health, leaves enough room for the toes, encloses the heel for a perfect fit and allows the foot to roll naturally when walking.

Basically, shoes should support the foot and make walking easier. If you only have discomfort in the shoe, you have most likely chosen the wrong footwear.

If you want to do your feet some additional good, you should go barefoot more often. Barefoot walking on hard ground is the greatest strain you can put on your feet, but it is a very good fitness exercise when pain-free. Barefoot walking on soft ground is even a recommended wellness programme for some foot malpositions.

If the foot is well trained, wearing high shoes on special occasions is no problem.

Dr Gottlieb advises:

"Basically, the footwear should adapt to the foot and not the other way round. Then many foot complaints or pain can be avoided in advance. Those who cannot avoid this, for example because they have to wear shoes with higher heels as part of a professional uniform or because business attire demands it, should compensate for this in their leisure time with flat and comfortable footwear."

Fatigue fracture due to excessive load on the foot

Sharp pain when stepping on, which starts suddenly without injury or accident, is a typical symptom of overloading the foot. Often it is a so-called fatigue fracture, the causes of which can be excessive sports training, too much strain or osteoporosis.

A fatigue fracture is not a bone fracture in the strict sense. It refers to a significant disturbance of the bone structure that occurs due to uniform and permanent stress. This first results in a change in the arrangement of the bone's small bones and then in a reaction of the neighbouring periosteum in the form of oedema, which causes pain.

Pain as a concomitant of chronic diseases

Foot pain is often accompanied by chronic diseases such as rheumatism, gout or arthrosis. In so-called inflammatory rheumatism (rheumatoid arthritis), the cause of the pain is a chronic inflammation of the joint, which affects the inner skin of the ankle.

Gout can also cause painful joint inflammation. In this metabolic disease, uric acid crystals accumulate in the joints and cause pain. In age-related arthrosis of the foot, on the other hand, the pain is caused by wear and tear of the joint cartilage.

Foot pain in old age can be an indication of joint wear and tear

If foot pain occurs with increasing age, the cause is often primary arthrosis in the foot. This degenerative wear and tear of the joints in particularly stressed areas of the foot is one of the typical diseases of old age.

In the over-60 age group, about 50% of all women and one third of all men are affected. In the over 70s, about 80% of all women and men suffer from arthritic joint changes. In the course of foot arthrosis, bone outgrowths can develop, causing inflammation and pain. Very typical are pulling or stabbing pains in the foot, pain when starting or when straining.

What can be the causes of pain in the foot area in children and adolescents?

Children and adolescents have foot pain for various reasons. Small accidents or injuries in everyday life can be the trigger - from bumping toes to twisting an ankle. If the child has acute pain and can no longer put weight on the foot, it must be clarified whether a bone fracture is present.

Shoes that have become too small are often the problem. Children's feet sometimes grow in stages and the shoe size can change very quickly. Foot pain in children and adolescents is also often due to growth in length.

Growing pains can occur when the bones grow very quickly and the musculature is still too short compared to the particularly rapid bone growth. During the period of readjustment, when the musculature adapts to the grown bone, pain can occur, for example, in the Achilles tendon insertion.

Other typical causes are overuse pain during popular sports activities, such as football or ballet. To prevent foot injuries and overuse injuries during sports activities in the growth phase, attention should be paid to regular sports orthopaedic examinations.

Rather rarely, foot pain in childhood or adolescence is caused by so-called tarsal coalitions. This is a firm bridge of connective tissue that is cartilaginous or bony in the place where a movable joint is normally located. Such a tarsal coalition can exist between two or more bones of the hindfoot and midfoot. This is a rare growth problem in which bone nuclei that have not previously separated from each other suddenly cause pain.

Foot pain is a clear warning signal from the body that you should pay attention to. Untreated injuries to the foot or malpositions can cause further health problems in the long run. That is why you should consult a foot specialist in good time if you have foot pain. Only he or she, as an expert in this field, can give you the most accurate diagnoses and the best possible treatment options that less specialised colleagues may not be able to offer.

In his private practice for foot surgery and foot therapy, Dr Tonio Gottlieb takes the time to get to the bottom of the causes of your foot pain. Together with you, he will develop an individual treatment concept and accompany you from consultation and diagnostics to possible surgery and follow-up treatment. His proven expertise will help you to be pain-free again in the future - regardless of whether an operation has to be performed or not.

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