Foot Pain
Author: Jayson Goo, ATC, MA, CKTI
Medical Editor: William C. Shiel Jr., MD, FACP, FACR
How is the foot designed?
The foot is an intricate structure of 24 bones that
form two arches. The longitudinal arch runs the length of the foot, and the
transverse arch runs the width. The ankle joint is the interaction of the foot
and the lower leg, and the toes are on the far side of the foot. The bones of
the foot are primarily held together by the shape that they fit with each other
and by a fibrous tissue known as ligaments. The muscles of the foot, along with
a tough, sinewy tissue known as the plantar fascia, provide secondary support to
the foot. The foot has internal muscles that originate and insert in the foot
and external muscles that begin in the lower leg and attach in various places on
the bones of the foot. There are also fat pads in the foot to help with weight-bearing and absorbing impact during weight-bearing.
The foot is the foundation
of most athletic movements. Pain indicates that there is something wrong with
either the interaction of internal structures of the foot or with the how the
foot is interacting with external influences. How and when the pain occurs and
the locations of the pain are the primary clues to what may be causing the pain.
When there is pain, the body reacts by changing the way it moves or functions in
an effort to reduce the pain. Biomechanical changes or disease may prevent the
normal movement and cause further injury.
What causes foot pain?
Foot pain may be caused by many different things.
Trauma, disease, or a combination of both are the most common causes of foot
pain. Trauma is a result of forces outside of the body either directly impacting
the body or forcing the body into a position where a single or combination of
forces result in damage to the structures of the body. Poor biomechanical
alignment may lead to foot pain.
Injuries such as ligament sprains, muscle
strains, bruises, and fractures typically occur suddenly (acutely). Sprains,
strains, bruises, and fractures may be the result of a single or combination of
stresses to the foot. A sprain of the foot or ankle occurs when ligaments that
hold the bones together are overstretched and the fibers tear. The looseness or
tightness of ligaments in the joints of the foot may be a factor in foot pain.
The muscle's bursa and fascia of the foot can be strained by overstretching,
overuse, overloading, bruising, or being cut such as in stepping on a sharp object.
Achilles tendonitis is a common muscle injury of the tendon that attaches at the
back of the heel.
Injury to the bones and joints of the foot can be caused by a
single blow or twist to the foot, or also by repetitive trauma that can result
in a stress fracture. A blunt-force injury such as someone stepping on your foot
may result not only in a bruise (contusion) injury but also damage to the
primary and secondary structures (muscles and ligaments) of the foot. Direct
blows to the foot can cause bruising, breaking of the skin, or even fracturing
of bones. Metarsalgia is the irritation of the joints of the foot. An example of
metarsalgia is "turf toe," a common athletic injury in which the tendon under
the joint at the base of the big toe is strained. Trauma to the toenail can
cause pooling of blood under the nail and the temporary or permanent loss of a
toenail. Repetitive trauma to the bones, muscles, and ligaments can result in
extra bone growth known as spurs or exostosis.
Injuries to both the skin
covering and the internal structures may also be caused by multiple small
repetitive traumas. Micro-trauma injuries can be caused by running on uneven
surfaces, surfaces that are too hard or too soft, or shoes that have poor force-absorption qualities or fit incorrectly. Repeated overstressing of the same
structure of the foot may cause stress fractures, tendonitis, plantar fasciitis,
and acute and chronic osteoarthritis.
The arches are the primary structures of
the body that absorb and return force to and from the body to the outside
world when we are on our feet. Injury to the plantar fascia is a common cause of
arch pain. The plantar fascia is a tough fibrous sheath that extends the length
of the bottom of the foot and lends support to the arch. When the plantar fascia
is damaged, the resulting inflammatory response may become a source of arch pain.
High and low arches (flat feet) may cause the foot to function biomechanically
in such a way as to cause pain.
Footwear can be a contributor to foot pain. Poor
fitting shoes in the short term can cause blisters, calluses, bruising and be a
source of athlete's foot. The long-term effects may be bunions, corns,
irritation of nerves and joints, misalignment of the toes, and the source of microtrauma injuries to the foot.
Disease, viruses, fungi, and bacteria may also
be the sources of foot pain. Diabetes, Hansen's disease, and gout are common
diseases that affect the foot. Numbness and change in sensation known as
peripheral neuropathy may be a result of these diseases. Plantar warts caused by
a virus can become sources of irritation. Athlete's foot caused by a fungus has
also been known to develop complications from both bacterial and viral source. A
common self-inflicted cause of foot pain is the ingrown toenail. Ingrown
toenails occur when the edges of the nail grow through or into the skin,
resulting in irritation and sometimes leading to infection.
Next: What other symptoms may accompany foot pain? »
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