Common Foot Problems

Pain in the Foot Overview

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.

Following are 12 of the most common foot problems. Find out about the symptoms and suggested treatments. Be sure to see your doctor if you suspect you have a problem.

• Irritation and inflammation of the tendon that attaches to the back of the heel bone.
• Can be caused by improper warm up or over-training.
• Can be treated with ice, rest, aspirin or anti-inflammatory medications.
• Should be evaluated by your health care professional.

• Misaligned big toe joints that can become swollen and tender. Painful enlargement at the joint of big toe. Also occurs on the little toe from sitting cross-legged for long periods of time (tailor's bunion).
• First joint of the big toe may slant outward. The second joint may slant toward the other toes.
• Condition tends to be hereditary but can be aggravated by shoes that are too narrow in the forefoot and toe.
• Foot surgery is frequently recommended to correct the problem.
• After age 65, there is a 200 percent greater risk of developing a bunion.

• Areas of thick, dead layers of skin. (Serves as padding over skin tissue under excessive pressure: a reaction to foot abuse and stress.)
• Usually results from repeated wearing of tight, ill-fitting shoes (high heels, ill-fitting shoes, etc.). Most common on big toe and fifth toe. Calluses also are found underneath ends of foot bones. Soft corns may also develop between the toes.
• May be caused by obesity, problems with walking motion, flat feet, loss of fat pad on foot bottom, bony prominences and other problems.
• See your foot doctor for a thorough examination of your feet.
• Get both feet properly fitted for shoes. Wear thick socks for sports activities and recreational walking. Pads and orthotics may be prescribed. Foot surgery is the last resort.
• Avoid temptation to remove corns and calluses with razors/knives.

Foot Warts (see also Plantar Warts)

• Foot warts (Verruca Plantaris) are caused by a virus and are contagious. They may grow singularly or in groups.
• They are painful and appear particularly on the bottom of the feet.
• Conservative treatments include topical medicines and patches. If these treatments fail, your foot doctor may use a series of freezing methods (Histofreeze) for wart removal.
• If the foot warts still persist after several treatments, wart removal may be done surgically. The wart is scooped out with a curette, a special surgical instrument. The base is then laser cauterized to discourage regrowth.
• Since warts are caused by a virus, they can recur

• Most fungi are harmless until they penetrate the skin.
• A fungus can invade through minor cuts, causing the nail to separate from the bed.
• The fungus can cause the nail to thicken and become yellow or brownish.
• Pressure from a thickened nail or the buildup of debris may cause the toe to become painful. Treatment and foot pain relief can consist of filing the nail plate down with a surgical burr, in addition to oral or topical medications.
• Fungal foot problems are painful infections.
• A synthetic antifungal agent such as Penlac® (ciclopirox) inhibits the growth of dermatophytes, a type of fungus that grow on the skin, hair and toenails.
• These infected nails can become white, thick and brittle, causing pain in the foot while walking or doing people when they walk or do other simple activities

• A condition, usually stemming from muscle imbalance, in which the toe is bent in a claw-like position.
• Most frequently occurs with the second toe, often when a foot bunion slants the big toe toward and under it.
• Selecting shoes and socks that do not cramp the toes will help alleviate aggravation and provide foot pain relief. .
• Shoe inserts or pads may help. If no improvement, surgical treatment many be necessary.

• Growths of bone on the underside, forepart of the heel bone.
• Can be inflammation of connective tissue on the sole of the foot.
• Occurs when the plantar tendon pulls at its attachment to the heel bone. Can later calcify to form a heel spur.
• Strain to the ligament can be reduced with proper warm-up and the use of appropriate athletic shoes.
• May improve spontaneously. Medication and shoe inserts may be helpful in providing foot pain relief.
• Steroid injections and walking casts may be prescribed if heel pain continues. Surgery is only recommended in the most troublesome cases.

• Toenails whose corners or sides dig painfully into the skin.
• Ingrown Toenails are frequently caused by improper nail trimming. May also be caused by shoe pressure, injury, fungus infection, heredity and/or poor foot structure.
• Can be prevented by trimming toenails straight across, selecting proper shoe style and size, and paying attention to foot pain.
• Because of shoe styles, women are 50 percent more likely than men to have Ingrown Toenails.

(Forefoot Pain or Ball of Foot Pain)
• Refers to pain in the balls of the feet (the area between the toes and the arch).
• The most important structures in the balls of the feet are the five metatarsal heads (the ends of the metatarsal bones that connect to the toes) and the protective fatty pad that cushions the ball of the foot.
• Each time we take a step forward, we push-off with our toes and the ball of the foot, forcing ourselves forward. To do this, we force 100% of our body weight on these structures.
• If they are not aligned perfectly, or if we have insufficient fatty padding, we experience ball of foot pain.

• Enlarged benign growths of nerves, most common between the third and fourth toes.
• Caused by tissue rubbing against and irritating the nerves, or "pinched nerve." Ill-fitting shoes (usually tight) or abnormal bone structure also can create the condition.
• Pain in foot may radiate from tissue buildup through toes.
• Treatments include shoe inserts (orthotics) and/or cortisone injections, but surgical removal of the growth is sometimes necessary.

• Pain on the bottom of the feet -- very irritating, but rarely serious.
• Commonly traced to an inflammation of the plantar fascia, the tissue that connects your heel bone and toes.
• A podiatrist or physician can evaluate and may prescribe customized shoe inserts to help alleviate the pain. According to the Mayo Clinic, there is no quick cure to this condition. It can take six months or longer before your heel is back to normal. Custom orthotic devices, ultrasound, corticosteroids, night splints, or surgery may be recommended.

• Foot wart which Occur on the sole of the foot and may look like calluses. Grows inward. May be one or many.
• Caused from an infection of a virus.
• May cause severe pain in the foot when walking.
• Difficult to treat but often improves with salicylic acid (available at drug stores without prescription).
• Other treatments by physicians may include injecting with medication, freezing with liquid nitrogen, and on very rare occasions, surgery.

• Problems with two small bones (the sesamoids, known as the "ball bearings of the foot") found beneath the first metatarsal bones.
• May inflame or rupture under the stress of exercise.
• Proper shoe selection and orthotics can provide foot pain relief.

• Leg pain to either side of the leg bone.
• Caused by muscle or tendon inflammation.
• Commonly related to collapsing arch (excessive foot pronation) but may be related to muscle imbalance in the leg.
• Proper stretching and corrective shoe inserts can help prevent Shin Splintss and leg pain relief.

• Incomplete cracks in bone.
• Caused by overuse.
• Heal quickly with complete rest. Extra padding in shoes helps prevent them.
• Left untreated, they may become complete fractures that require a cast and immobilization