Foot pain
The foot carries the whole weight of the body and takes several thousand steps a day, so it can hurt for a dozen different reasons — from unlucky shoes to an…
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Medicines commonly prescribed for Foot pain
For informational purposes only. Always consult a doctor before taking any medication.
Dosage form: GEL, 10 mg/gActive substance: diclofenacManufacturer: Faes Farma S.A.Prescription not requiredDosage form: GEL, 1%Active substance: diclofenacManufacturer: Kern Pharma S.L.Prescription not requiredDosage form: TABLET, 400 mgActive substance: ibuprofenManufacturer: Teva Pharma S.L.U.Prescription required
The foot carries the whole weight of the body and takes several thousand steps a day, so it can hurt for a dozen different reasons — from unlucky shoes to an illness that has nothing to do with the foot itself. It is easier to work through it not by diagnosis names but by three questions: where exactly it hurts, when it hurts most, and whether there is anything besides the pain. Below comes first what cannot wait, and then the common causes by area of the foot.
What must not be missed
Immediately, calling an ambulance on the single European number 112 or going to an emergency department:
- the foot is cold, pale or bluish, the skin mottled, no pulse can be felt in it, and the pain is severe and does not ease at rest. That is how a sudden blockage of an artery looks: tissue without blood flow survives only hours, and the circulation has to be restored urgently;
- after an injury the foot or ankle has changed shape or sits at an unnatural angle, there was a crack or a pop at the moment of injury, and it cannot be stood on;
- redness is spreading up the foot and leg, the skin is hot and tight, there is fever and shivering;
- the wound is deep or dirty, bone is visible, or pus is coming out of it;
- the foot has suddenly gone numb or "dropped", and the toes will not lift.
The same day, not tomorrow:
- any wound, callus, crack, darkened patch or ulcer on the foot of someone with diabetes — that has its own section below, because it is the central danger of this subject;
- a single joint that has suddenly turned red, swollen and hot, with touch unbearable. Most often this is gout, but a joint infection begins in exactly the same way, and that cannot wait even a day. All the more so with fever, shivering, a recent wound nearby, a weakened immune system or a recent injection into the joint;
- a sudden sharp pain above the heel, as though struck with a stick or kicked from behind, sometimes with an audible snap, after which you cannot rise onto the toes of that leg — that is how the Achilles tendon ruptures;
- pain after an injury that stops you taking four steps with weight on the foot;
- numbness, pins and needles or weakness in the foot that will not go;
- foot pain in someone with cancer, on treatment that suppresses the immune system, or with a fever that has no clear cause.
The foot of a person with diabetes
This is the most important section on the page. In long-standing diabetes both the nerves and the vessels of the foot suffer, and together they set a trap: the pain that ought to warn you disappears. The person does not feel the pebble in the shoe, does not notice the rubbing, walks calmly on a twisted toe, and finds the problem when what used to be a callus is already an ulcer.
From this comes a simple rule worth more than any treatment plan: in diabetes, any damage to the foot — a wound, a rub, a burst blister, an ingrowing nail, a cracked heel, a darkened patch of skin — is a reason to be seen by a doctor the same day, even if nothing hurts. Here the absence of pain is not a sign that all is well; it is a sign that sensation has been lost.
Immediately, without waiting for an appointment, if there is an ulcer that discharges or smells, a black area of skin, spreading redness and swelling or fever, or if the foot has suddenly become hot, red and swollen with no wound at all: the last of these happens in destruction of the joints of the foot, which moves fast and ends in deformity unless the foot is taken out of use in time.
What helps to keep it from getting that far:
- look at your feet every day, including the sole and between the toes, using a mirror or asking someone at home;
- wash them in warm water, testing the temperature with a hand rather than a foot, and dry carefully between the toes;
- never walk barefoot, even indoors, and run a hand inside each shoe before putting it on;
- do not cut calluses off, do not remove them with acid plasters or liquids, and do not use hot water bottles or hot foot baths;
- file nails straight across without cutting into the corners; wear wide shoes with no inner seams and break them in gradually;
- attend regular foot checks with testing of sensation and pulses, whether or not anything is troubling you.
Pain on walking that goes away when you stop
There is a separate and often unrecognised pattern: it hurts not when the foot is pressed but when the person walks. Pain or cramping comes on in the calf and foot after a certain distance — a hundred metres, two hundred — forces a halt, and disappears after a few minutes of standing, with no treatment at all, then returns at exactly the same distance. This is intermittent claudication: under load the muscle is not getting enough blood, because the artery is narrowed.
It matters for two reasons. The condition progresses: next comes pain at rest, usually at night, when the person hangs the leg out of bed for relief, and after that wounds on the toes and heel that will not heal. And more importantly, narrowing of the leg arteries is almost never isolated, so what such a person is really risking is the heart and the brain. That is why it is not just the leg vessels that get checked, but blood pressure, blood sugar and cholesterol, and smoking is discussed seriously.
Other clues point the same way: the foot feels cold, the skin is dry and shiny, hair on the lower leg has gone, the nails are thickened, and small wounds take weeks. Narrowing of the spinal canal in the lower back causes a similar pain on walking, but that one eases not by stopping but by bending forwards, and comes with numbness down the backs of the legs.
The heel: first steps in the morning, and pain at the back
Plantar fasciitis is the commonest cause of heel pain. It gives itself away by one detail: the worst pain is the first step after sleep or after sitting for a long time, sharp, like a nail driven into the heel; it eases after a dozen steps and returns by the end of the day or after long hours standing. The tender spot is on the sole at the front edge of the heel bone, towards the inner side of the foot. It turns up in runners, in people who stand all day, after weight gain, after switching to flat shoes. The bony spur so often blamed on the X-ray does not hurt in itself and is present in plenty of people with no symptoms at all.
Pain at the back, over the tendon itself, above the heel is usually inflammation and remodelling of the Achilles tendon. It is thickened and tender when pinched, the leg is stiff in the mornings, and rising onto the toes or climbing stairs hurts. Worth knowing separately: some antibiotics of the fluoroquinolone group raise the risk of tendon damage, and sudden Achilles pain during such treatment is a reason to contact a doctor straight away. And once again, a snap with inability to rise onto the toes is already a rupture, and it belongs in the first section.
Pain in the heel bone itself, building over weeks after a sharp increase in load, with tenderness when the heel is squeezed from the sides, points towards a stress fracture. In children and teenage athletes, pain at the back of the heel on running and jumping is more often related to the growth plate of the heel bone: it settles with age, but the load has to come down and the child should be examined so that nothing else is missed.
The forefoot and the toes
- Metatarsalgia — pain in the ball of the foot under the bases of the toes, with a feeling of walking on pebbles or of a rolled-up ridge under the skin. Worse barefoot on hard floors, in heeled shoes with a narrow toe box, with extra weight and after long walking.
- Morton's neuroma — thickening of the sheath of a nerve between the metatarsal heads, most often between the third and fourth toes. The pain burns and shoots into the toes, often with numbness; typically the person takes the shoe off in the middle of the street and rubs the foot, and that helps. Narrow shoes and heels bring the attack on.
- Stress fracture of a metatarsal. The pain builds gradually, is tied to load and settles at rest, with pinpoint tenderness right on the bone on top of the foot and slight swelling of the instep. It follows an increase in running mileage, long days on foot, and low bone density. In the first weeks a plain X-ray often shows nothing, and a clear X-ray does not rule the diagnosis out.
- Bunion (hallux valgus) — a bony prominence at the base of the big toe that pushes the toe itself towards the others. It hurts from shoe pressure, and the skin over it reddens and thickens. It is not bursitis: inflammation of the overlying bursa can join in on top, but that is a different thing.
- Gout. The classic is the joint at the base of the big toe turning purple, hot and so painful in the middle of the night that even the bedclothes are unbearable. The attack builds within hours. Its double, joint infection, is in the first section.
- Ingrowing toenail. The edge of the nail grows into the fold, the toe reddens and hurts, and later starts to discharge. Do not cut the corner back further and do not dig the edge out: that is how it becomes established. With diabetes or poor circulation, go straight to a doctor.
Skin, nails and other common findings
- Hard skin and corns are the skin's answer to steady pressure and therefore secondary: until the shoes and the load change, they come back. Cutting them off yourself, particularly with a blade, is not a good idea.
- A verruca is pressed into the skin and hurts when squeezed from the sides, whereas a corn hurts on direct pressure; that is how they are told apart.
- Athlete's foot and nail fungus: itching, flaking and cracks between the toes, a thickened cloudy nail. Those cracks are a common entry point for cellulitis, so they are not left to themselves.
- Symmetrical pain and numbness in both feet with night-time burning is the picture of peripheral nerve damage; the search is for diabetes, vitamin B12 deficiency, heavy drinking and the effects of medicines.
What usually helps and what is better avoided
While the cause is unclear and there are no warning signs, it makes sense to take load off the foot: less standing and less walking on hard surfaces, no running or jumping, and the leg raised when possible. Cold through a cloth in short spells reduces pain after activity. Shoes matter more than they seem to: a wide toe box, a stable sole, a low heel; and at home too, not barefoot on tiles. Off-the-shelf soft insoles or heel pads make walking easier for some people and are worth a try, but fitting custom orthoses and doing stretching exercises belongs with someone who has seen your foot, not with a picture from the internet. For pain relief, paracetamol and non-steroidal anti-inflammatory drugs are used, including as a gel on the skin; check with a doctor whether the medicine suits you, especially if you have stomach, kidney or heart problems.
What not to do: put up with pain for weeks, force the foot through severe pain, apply heat to a fresh injury, bandage tightly — that only adds to the swelling — cut calluses off, or carry on running on a stress fracture. With diabetes, none of the above is a matter for home measures.
It is worth seeing a doctor if the pain does not settle within a couple of weeks of sensible rest, if it returns every time activity resumes, if it interferes with work and sleep, if the foot is changing shape, or if you simply cannot make sense of what is happening.
Online consultation
Foot pain is exactly the subject where good questioning is worth half the investigation. A doctor will go through where precisely it hurts and how the pain behaves: morning or evening, on the first steps or after exertion, whether it stops when you stand still. From that alone they will separate plantar fasciitis from a stress fracture, a neuroma from metatarsalgia, and vascular claudication from everything else, and will check the warning signs separately: diabetes, a hot joint, a cold foot, an inability to rise onto the toes. They will say whether an X-ray or a scan is needed, which specialist to see and how urgently. They will help with footwear and with taking load off over the next few days, and advise which painkiller suits you given your other conditions. And they will name the signs that mean ending the conversation and being examined in person.
This material is for information only and does not replace medical advice.
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