Foot pain

Sprains and strains

Sprains and strains are very common injuries. They affect muscles and ligaments (strong bands of tissue around joints that connect one bone to another).

They often occur if you:

• change direction or speed suddenly
• fall and land awkwardly
• collide with an object or person, such as when playing sports

A sprain means:

• one or more of your ligaments have stretched, twisted or torn
• muscle fibres have stretched or torn

As well as pain, a sprain or strain can cause swelling, bruising and tenderness. This may result in you being unable to put weight on your foot.

Most sprains and strains can be managed at home using PRICE therapy (protection, rest, ice, compression and elevation) and painkillers.

Gout

Gout is a type of arthritis caused by a build-up of uric acid (a waste product) in your joints.

It causes sudden attacks of severe pain and swelling.

Signs and symptoms of gout include:

• severe pain in one or more joints
• the joint feeling hot and very tender
• swelling in and around the affected joint
• red, shiny skin over the affected joint  

These attacks usually last a few days at a time and most often affect the big toe joint. It can sometimes be difficult to tell the difference between gout and a severely inflamed bunion (see below).

The pain caused by gout can usually be treated using ice packs and by taking non-steroidal anti-inflammatory drug (NSAID) painkillers. You may also need additional treatment to prevent further episodes.

Verrucas

Verrucas are small growths that:

• develop on the soles of the feet
• are white, often with a black dot in the centre
• tend to be flat rather than raised
• can be painful if they're on a weight-bearing part of the foot

Most verrucas will often eventually clear up by themselves. This can take a long time. There are over-the-counter verruca creams, gels and plasters that may help. Ask your pharmacist for advice.

Blisters, corns and calluses

Poorly-fitting shoes that rub on the feet can damage the skin and may cause: 

• blisters – small pockets of fluid that form in the upper layers of the skin
• corns – small circles of thick skin
• calluses – hard, rough areas of skin that are often yellowish in colour

These conditions can all result in pain and discomfort when you walk.

Most blisters heal naturally in a few days and don't require medical attention. Wearing comfortable, well-fitting shoes can help stop them returning.

Corns and calluses don't necessarily improve on their own. You may need to see a podiatrist or chiropodist. They can advise you about treatment.

Bunions

A bunion is a bony swelling at the base of the big toe. It can be painful when wearing shoes and make walking difficult.

They are a common foot problem, particularly in women. The big toe points towards the other toes and the big toe joint sticks out, forming a bony lump.

Bunions can get worse if they're left untreated. See a GP for advice.

Non-surgical treatments are usually tried first, including:

• wearing comfortable and wide shoes
• orthotics (insoles)
• painkillers
• bunion pads

Corrective surgery may sometimes be necessary.

Ingrowing toenails

Ingrowing toenails occur when the sides of the toenail grow into the surrounding skin.

The toenail pierces the skin, which can become red, swollen and tender.

It can also be painful if pressure is placed on the toe or the toe becomes infected.

Cutting your toenails straight across and gently pushing the skin away from the nail using a cotton bud may help improve an ingrowing toenail.

In some cases, a procedure to remove part or all of the affected nail may be necessary.

Plantar fasciitis

Plantar fasciitis is the result of damage to the tough band of tissue (fascia) that runs under the sole of the foot. It causes pain in the heel.

It most commonly affects people aged 40 to 60 who are overweight or on their feet for long periods of time.

The pain tends to develop gradually over time and is at its worst when you wake up in the morning and at the end of the day.

There are things that can help relieve the pain, including:

• resting your heel
• regular stretching
• applying ice packs
• taking painkillers
• wearing well-fitted shoes that support your feet

In a small number of cases, other treatments such as physiotherapy or injections may be necessary. Rarely, surgery may be required.

Morton's neuroma

Morton's neuroma is a painful foot condition that:

• affects the nerves between the toes
• fibrous tissue develops around the nerve, which becomes irritated and compressed - this causes severe burning pain on the ball of the foot and at the base of the toes
• can occur on one foot or both feet
• it usually affects the nerve between the third and fourth toes, but sometimes the second and third toes are affected

If you have Morton's neuroma, it may help to wear shoes with more room for the toes.

You can also take painkillers or have steroid injections to help ease the pain. If these treatments don't work, surgery may be needed.

Metatarsalgia

Metatarsalgia is the term for pain that occurs in the front section of the foot.

It may be felt in a small area of the foot, or across the whole width of it. One or both feet may be affected.

The pain of metatarsalgia is sometimes described as:

• a burning or aching sensation
• a shooting pain
• tingling or numbness in the toes
• a feeling like there's a small stone stuck under the foot

Metatarsalgia tends to be worse when you're standing, walking or running.

Older people are more susceptible to metatarsalgia. 

Most cases of metatarsalgia can usually be managed using PRICE therapy (protection, rest, ice, compression and elevation), painkillers, changing your footwear and using shock-absorbing insoles.

Arthritis

In older people, repeated episodes of foot pain and stiffness can suggest a sudden worsening of osteoarthritis. This is one of the most common types of arthritis.

This long-term condition caused by wear and tear results in swelling of the tissues in and around the joints, including the big toe and heel joints.

Treatments include:

• wearing suitable footwear to reduce the strain on your joints
• painkillers
• anti-inflammatory medication 
• physiotherapy
• surgery in some cases 

Less commonly, foot pain can be caused by rheumatoid arthritis. This is a type of arthritis caused by the immune system attacking the joints. It causes the joint tissues to become inflamed.

It almost always affects other joints too, so foot pain will probably not be your only symptom.

The main treatments for rheumatoid arthritis include:

• include medication to relieve symptoms and slow the progress of the condition
• physiotherapy 
• occasionally surgery

Achilles tendon injuries

Pain and stiffness along the back of your heel could be a sign of damage to your Achilles tendon.

The pain can often be relieved with rest, ice packs and painkillers at home. It may take several months to resolve completely.

If you experience sudden and severe pain in your heel, which may have been accompanied by a ’popping’ or ’snapping’ sound, you may have ruptured (torn) your Achilles tendon.

You should seek medical advice as soon as possible if you think you have ruptured your Achilles tendon.

Often this will be treated with immobilisation (wearing a plaster cast or plastic boot) for several weeks. Surgery may sometimes be required to repair the tear.

Oedema

If your whole foot is painful, heavy and swollen, it may be a sign of oedema.

This is a build-up of fluid (mainly water) in the body's tissues, causing swelling to occur in the affected area.

Oedema will usually affect your whole lower leg as well. See your GP, or if the pain and swelling is severe, go to your nearest emergency department.

An object embedded in your foot

Foot pain can sometimes be caused by an object embedded in the foot. If a small object, such as a splinter or thorn, is lodged in your skin, it's usually safe to remove it yourself. 

Wash your hands and clean the area first, and use tweezers if they help. Your pain should start to improve once the object has been removed.

If the object is more deeply embedded, don't try to remove it yourself. Seek medical help as soon as possible.

Diabetic foot problems

People with diabetes can experience a number of potentially serious problems affecting their feet, some of which can be very painful. This is because the condition can damage nerves and blood vessels in your feet.

Foot problems that can affect people with diabetes include:

• nerve damage (peripheral neuropathy) - can cause numbness and burning, stabbing or shooting pains in your feet
• poor circulation (ischaemia)- can cause your feet to become painful, cold, red and swollen
• skin ulcers – painful sores that take a very long time to heal
• skin infections – ulcers that become red and swollen, and may produce a foul-smelling odour and green discharge

Contact your GP or diabetes care team immediately if you have diabetes and think you have developed a problem with one or both of your feet.

A broken or cracked bone (fracture)

A broken or cracked (fractured) bone in your foot can occur suddenly after a severe injury, or gradually over time as a result of doing lots of high-impact sports (such as long-distance running).

Occasionally they can occur as a result of osteoporosis (weakened bones).

Any bone in and around the foot can be affected, including the:

• bones in the middle of your feet (such as the metatarsals)
• heel
• toes 
• ankle 
• bones of the lower leg 

The affected area will be very painful and tender to touch, and the skin may be bruised. You should stop all activity immediately and avoid putting weight on your foot until you see a doctor.

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