Pain in the Bottom of Foot | Galleria Podiatry

bottom of foot pain diagram

A. Heel Spur

A heel spur is a bony growth that forms on the underside of the heel bone. It often develops over many months and is frequently associated with plantar fasciitis, a condition involving inflammation of the plantar fascia. This connective tissue stretches from the heel to the front of your foot, and strain or overuse can lead to both conditions.

Pain Caused by Heel Spurs

  • Sharp, stabbing pain – typically felt with the first few steps in the morning or after a period of rest. The pain may decrease as you move more, but it can return after prolonged periods of standing or when you stand up after sitting.
  • Chronic, dull ache – throughout the day, especially when walking or standing for long periods.

The pain from heel spurs can be quite debilitating, affecting daily activities and mobility. Treatment often involves rest, physical therapy, orthotic inserts, and, in some cases, medications or surgery if conservative measures fail to relieve symptoms.

B. Plantar Fasciitis

Plantar fasciitis is a common condition that involves inflammation of the plantar fascia, the thick band of tissue that runs along the bottom of your foot, connecting your heel bone to your toes. It’s particularly prevalent among runners, overweight individuals, and those who wear shoes with inadequate support.

Types of Pain Caused by Plantar Fasciitis

  • Sharp, stabbing pain – most commonly felt in the heel, this pain is typically most intense with the first steps after waking up or after long periods of sitting or standing. It may decrease after a few minutes of walking but can return after prolonged standing or when standing up after sitting.
  • Chronic, dull ache – it can persist throughout the day, especially after extended periods of activity.
  • Burning or throbbing sensation – this can occur along the arch or the bottom of the foot.

The pain from plantar fasciitis can be quite severe, making it difficult to walk or stand for long periods. Treatment options include rest, ice, anti-inflammatory medications, physical therapy, orthotics, and stretching exercises. In more persistent cases, more invasive treatments such as corticosteroid injections or surgery may be considered.

Q. How to tell the difference between heel spur and plantar fasciitis?

Telling the difference between heel spur and plantar fasciitis can be challenging because they often occur together and share similar symptoms. Heel spur pain originates from a bony growth on the heel bone, causing a sharp, poking sensation that might not always be present and can vary with the location and size of the spur. In contrast, plantar fasciitis pain is caused by inflammation of the plantar fascia, a band of tissue running along the bottom of the foot. This results in a sharp, intense pain typically felt in the heel and along the arch, most severe upon taking the first steps after waking or after rest periods.

heel spur vs plantar fasciitis pain bottom of foot
Heel Spur vs Plantar Fasciitis –  Pain in the Bottom of Foot

The pain characteristics for each also differ; heel spur pain is localised and can feel like walking on a pebble, whereas plantar fasciitis spreads along the arch and bottom of the foot and is often described as a stabbing pain.

C. Metatarsalgia

Metatarsalgia is a condition characterised by pain and inflammation in the ball of the foot, specifically in the area of the metatarsals, which are the bones leading up to the toes. This common foot disorder can affect anyone but is often seen in athletes who participate in high-impact sports that involve running and jumping. It can also be caused by footwear that does not fit properly or lacks adequate cushioning, as well as by abnormal foot mechanics and excess weight, which can increase pressure on the metatarsals.

Types of Pain Caused by Metatarsalgia

  • Sharp, aching, or burning pain in the ball of the foot — the part of the sole just behind the toes. This pain typically worsens when standing, walking, or running, especially on hard surfaces, and might improve when resting.
  • Pain intensifies when the feet are flexed, and it might feel like there’s a pebble in the shoe.
  • Numbness or tingling in the toes can also occur alongside the pain.
  • Increased pain when walking barefoot, particularly on hard surfaces.

The pain from metatarsalgia can make it difficult to carry out everyday activities and can severely affect mobility if left untreated. Treatment generally involves resting the foot, using proper footwear with shock-absorbing insoles or arch supports, and in some cases, losing weight. Ice and over-the-counter pain relievers may help reduce pain and inflammation. In some cases may require custom orthotics, physical therapy, or surgery to correct the underlying foot deformities.

D. Morton’s Neuroma

Morton’s neuroma is a painful condition that affects the foot, typically between the third and fourth toes. It involves the thickening of the tissue around one of the nerves leading to the toes. This thickening can cause compression and irritation of the nerve, leading to inflammation.

Types of Pain Caused by Morton’s Neuroma

  • Sharp, burning pain in the ball of the foot, often described as feeling like standing on a pebble in the shoe or a fold in the sock.
  • Tingling or numbness in the toes can also accompany the pain, as the nerve compression affects sensory perception in the area.
  • Pain that worsens with activity or wearing tight, narrow shoes that further compress the affected area might be alleviated when the shoe is removed or the foot is massaged.

Morton’s neuroma can cause severe pain, which can have a significant impact on daily activities and mobility. The treatment options for this condition include changing footwear to those that provide more space for the toes, using orthotic pads or arch supports to reduce pressure on the nerve, and taking anti-inflammatory medicines to manage pain and swelling. In cases where conservative treatments fail to provide relief, injections or surgery may be considered to relieve pressure on the nerve or remove the affected tissue.

Q. How to tell the difference between Metatarsalgia and Morton’s neuroma?

Differentiating between Metatarsalgia and Morton’s neuroma involves recognising where the pain is located and how it feels. Metatarsalgia generally causes a sharp, aching, or burning sensation across the broader area of the ball of the foot, often exacerbated by activities like standing, walking, or running that put pressure on the front of the foot. In contrast, Morton’s neuroma typically presents localised sharp, burning pain between the third and fourth toes, accompanied by feelings of standing on a pebble and possibly tingling or numbness in the adjacent toes due to nerve compression.

Metatarsalgia often improves with the use of well-cushioned shoes that help distribute pressure away from the ball of the foot, whereas Morton’s neuroma benefits from shoes with a wider toe box and lower heels to reduce nerve compression.

E. Turf Toe

Turf toe is a sprain of the main joint of the big toe, occurring typically due to hyperextension of the toe. This injury is common in sports played on artificial surfaces, where the foot can stick to the ground, causing an upward force on the toe joint, which leads to injury. Turf toe is particularly prevalent among football and soccer players.

Pain Caused by Turf Toe

  • Sharp, sudden pain at the base of the big toe, particularly when pushing off during walking, running, or jumping.
  • Swelling and tenderness around the joint area of the big toe.
  • Limited joint movement in the toe makes it difficult to bend and walk, and the injury can worsen if it is not properly rested.
  • Ongoing discomfort that persists if the toe is not allowed to heal completely or if repetitive injury occurs.

The pain from turf toe can vary in intensity depending on the severity of the sprain. Minor cases might cause discomfort but still allow for some activity, whereas more severe sprains can lead to significant pain and immobility, requiring a longer period of rest and rehabilitation. Treatment typically includes rest, ice, compression, elevation (RICE), and in some cases, physical therapy to strengthen the joint and restore flexibility.

F. Gout

Gout is a form of inflammatory arthritis that results from the accumulation of uric acid crystals in the joints. When it affects the toe, it most commonly impacts the joint at the base of the big toe, known as the metatarsophalangeal (MTP) joint. This condition is characterised by sudden, severe attacks of pain, swelling, redness, and tenderness in the joints, typically occurring suddenly at night.

Pain Caused by Gout in the Toe

  • Severe, intense pain that often strikes without warning, usually at night. The pain is typically described as throbbing, crushing, or excruciating.
  • Swelling and redness around the affected joint, making it hot and very tender to the touch, to the point that even the weight of a sheet or blanket may feel intolerable.
  • Limited mobility in the affected toe during an acute gout attack, as the pain and swelling can significantly restrict movement.

The pain from a gout attack can be debilitating and is often described as one of the most painful forms of arthritis. Initial attacks typically resolve within a week or two without treatment, but over time, if gout is not managed, the attacks can last longer and occur more frequently.

Management of gout typically involves medications to reduce uric acid levels in the blood, prevent future flare-ups, and address acute pain with anti-inflammatory drugs. Lifestyle changes, such as dietary modifications, adequate hydration, and reduced alcohol intake, also play a crucial role in managing and preventing gout attacks.

Q. What is the difference between turf toe pain and gout pain?

Turf toe and gout pain differ significantly in their causes, locations, and characteristics. Turf toe arises from a hyperextension injury at the big toe’s metatarsophalangeal joint, often occurring in athletes who play on hard surfaces. The pain is sharp, localised around the base of the big toe, and worsens with activities that involve extending or pushing off the toe. There is also associated swelling and movement limitation. In contrast, gout is caused by the buildup of uric acid crystals in joints, leading to severe inflammation. It commonly affects the big toe but can impact other joints as well. Gout pain is intense, starts suddenly—often overnight—and the affected joint becomes red, swollen, and extremely tender, to the point where even light contact is painful.

gout vs turf toe pain on the bottom of foot
Gout vs Turf Toe

G. Sesamoiditis

Sesamoiditis is an inflammatory condition affecting the sesamoid bones, which are two small, pea-shaped bones located in the ball of the foot beneath the big toe joint. These bones are embedded within the tendons that run to the big toe, and they help absorb impact and assist in the foot’s movement, particularly when pushing off during walking or running.

Pain Caused by Sesamoiditis

  • Gradual onset of pain – unlike acute injuries that cause sudden pain, sesamoiditis usually develops gradually as the inflammation around the sesamoid bones increases.
  • Pain beneath the big toe joint – the pain is typically focused under the big toe on the ball of the foot. It can feel dull or sharp depending on the movement and activity level.
  • Swelling and bruising – there might be visible swelling and sometimes bruising around the area of the sesamoid bones.
  • Difficulty and pain when walking or running – the pain increases with activities that put pressure on the ball of the foot, especially when pushing off with the toes. Walking barefoot or in thin-soled shoes can be particularly painful.
  • Increased pain with direct pressure – directly pressing on the sesamoid bones can exacerbate the pain, making certain types of footwear uncomfortable.

The treatment for sesamoiditis typically involves reducing pressure on the affected bones, which can be achieved through rest, ice, and the use of cushioned pads or orthotics to offload weight from the area. Anti-inflammatory medications may also help reduce pain and inflammation. In some cases, physical therapy might be recommended to strengthen surrounding muscles and correct biomechanical issues contributing to the problem. Recovery time can vary, depending on the severity of the inflammation and the effectiveness of conservative treatment methods.

Q. How does Sesamoiditis pain differ from Metatarsal pain?

Sesamoiditis and metatarsalgia affect the forefoot differently. Sesamoiditis causes pain beneath the big toe at the sesamoid bones, while metatarsalgia impacts a broader area under the metatarsal heads. Sesamoiditis pain worsens with direct pressure, while metatarsalgia pain worsens with standing, walking, or running on hard surfaces. Both conditions can cause swelling and inflammation.

Q. How does Sesamoiditis pain differ from Turf Toe or Gout?

Sesamoiditis, turf toe, and gout are three distinct foot conditions with unique causes and symptoms. Sesamoiditis is characterised by gradually developing pain around the sesamoid bones under the big toe, while turf toe involves sudden, sharp pain at the base of the big toe due to a specific injury. Gout causes intense, throbbing pain in the big toe joint due to the buildup of uric acid crystals.

Achilles tendinitis (H) and Achilles rupture (I) can cause pain at the back of the foot above the heel. Read what causes pain at the back of the foot…

Learn more about what is your foot pain telling you here, or book an appointment with one of our podiatrists in Perth

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