Understanding and Managing Foot Pain

Dr. James - Orthopaedic Surgeon in Singapore

Medically reviewed by Dr. James Tan

If you’re hobbling around with pain in the bottom of your foot that just won’t quit, you’re not alone. Heel pain, arch pain, and general foot discomfort plague millions of people — but not all foot pain is created equal! The specific location of your discomfort offers clues to the underlying cause. Finding the source of that problem is key to finding the right solutions. 

In this expert guide, we’ll explore some of the most common culprits behind bottom-of-the-foot pain, including plantar fasciitis, heel spurs, metatarsalgia, and nerve problems. You will learn how to pinpoint the location of your pain and what it might mean. We’ll discuss both orthopaedic treatments as well as at-home care and lifestyle remedies for plantar foot pain.

With the right insights, you can get on the road to relief and get back to pain-free walking and activity. Read on to give your foot pain the boot once and for all!

What Causes Foot Pain?

There are several potential causes of pain on the bottom of the foot, including the following:

  • Plantar fasciitis: This is inflammation of the plantar fascia, the thick band of tissue that runs along the bottom of the foot. It causes stabbing pain near the heel that is often worse with the first steps after getting up. It’s caused by overuse, strain, or injury to the plantar fascia.
  • Heel spurs: These are calcium deposits that form on your heel bone, causing localised pain and tenderness under your heel. These spurs develop because of tension and pulling on your plantar fascia.
  • Metatarsalgia: This refers to pain in the ball of the foot. It is caused by repetitive stress to your metatarsal bones or inflammation of the surrounding tissues.
  • Arthritis: Osteoarthritis of rheumatoid arthritis can affect your midfoot joints, causing stiffness and achiness on the bottom of the foot.
  • Stress fractures: Tiny cracks or fractures in your metatarsal or navicular bones from repetitive impacts lead to pain that worsens when it is bearing weight.
  • Nerve compression: Entrapment of your medial calcaneal nerve under your heel can cause chronic pain in that area.
  • Posterior tibial tendon dysfunction: Injury to the tendon supporting your arch can lead to pain along the inner side of your foot.
  • Tarsal tunnel syndrome: Compression of the posterior tibial nerve as it passes through your ankle into your foot can be very painful.
  • Ganglion cysts: Fluid-filled lumps (associated with a previous injury or joint damage) can put pressure on your nerves which causes pain.
  • Improper footwear: Poorly fitted shoes, lack of support, or inadequate cushioning while walking or running can lead to several types of plantar foot pain. Improper footwear also affects your walking posture, which may also lead to lower back pain if worn long-term.
types of foot pain
Image Credit: foot.com

How Is Foot Pain Diagnosed?

There are several methods doctors use to diagnose the cause of foot pain, including the following:

  • Medical history: The doctor will ask about your symptoms when the pain started, your injury history, any existing medical conditions, and your regular activities. This provides clues to the cause of the pain.
  • Physical exam: Your foot may be palpated to pinpoint areas of tenderness. Your doctor might check the range of motion, alignment, and arch structure, and look for signs of swelling or redness. 
  • Gait analysis: You could be asked to walk so your doctor can observe abnormalities in your gait that could contribute to foot pain.

What Tests Can Be Done on Feet?

There are several methods doctors use to diagnose the cause of foot pain, such as the following:

  • X-rays: These help detect fractures, arthritis, heel spurs, and other bone abnormalities.
  • MRI: This provides a detailed view of your soft tissues like ligaments, tendons, and cartilage. It can detect plantar fasciitis, neuromas, and other conditions.
  • Ultrasound: This test is used to evaluate tendons, ligaments and soft tissue inflammation, such as plantar fasciitis.
  • CT Scan: Doing this scan provides cross-sectional images that can assess your bone anatomy and fractures.
  • Bone scan: Radioactive dye injected into your bloodstream safely detects areas of increased bone metabolism from stress fractures or arthritis.
  • Laboratory tests: Blood work can check for inflammation markers associated with arthritis or infection.
  • Nerve conduction studies: These are able to measure how well your nerves transmit signals and are able to detect nerve compression. 
  • Biopsy: Removing a small sample of tissue for analysis under a microscope can confirm conditions like neuropathy.

After considering all aspects of your medical history, physical exam, and test results, your doctor will diagnose the specific cause of foot pain and tailor treatment accordingly. This careful evaluation is vital to getting the right treatment and ensuring optimal recovery.

Check out this article to learn more about X-rays, MRIs and CT Scans.

What Is Plantar Fasciitis?

Plantar fasciitis is the most common cause of heel pain and arch pain in the foot. It involves inflammation of the plantar fascia, which is a thick band of fibrous connective tissue that runs along the bottom of the foot from the heel bone (calcaneus) to the base of the toes.

What Causes Plantar Fasciitis?

Several factors can contribute to developing plantar fasciitis, such as the following:

  • Overuse: Repeated microtrauma from excessive running, sports injuries, walking, jumping, or standing causes tiny tears in the plantar fascia over time. This is especially common in athletes and people who are on their feet a lot.
  • Foot structure: Having high arches or flat feet increases strain on the plantar fascia and can predispose you to plantar fasciitis.
  • Tight calf muscles: Tightness in your calf muscle and Achilles tendon leads to tension on the plantar fascia when your ankle flexes, resulting in inflammation and pain.
  • Obesity: Excess weight puts additional strain and compression forces on the plantar fascia, making it more prone to injury.
  • Improper footwear: Shoes with inadequate arch support or cushioning increase stress on the plantar fascia and don’t absorb shock adequately.
  • Sudden increases in activity: Quickly ramping up exercise, running long distances, or standing on hard surfaces can overwhelm your plantar fascia and lead to micro-tearing.
  • Age: Plantar fasciitis is most common between ages 40 to 60. The plantar fascia loses elasticity with age and this creates issues for those trying to stay active
  • Foot mechanics: Excessive pronation causes the arch to flatten and elongate the plantar fascia, contributing to tearing.
  • Heel spurs: These calcium deposits that form due to plantar fascia tension can become a source of irritation.
  • Occupation: Jobs that require prolonged standing like nursing or factory work increase risk.

The most common factor is overuse and repetitive strain to the plantar fascia. Reducing risk factors like tight calves, high arches, and obesity can help prevent plantar fasciitis. Transitioning slowly to new activities and wearing proper shoes are also key preventive strategies.

How Is Plantar Fasciitis Treated?

There are several conservative treatment options for plantar fasciitis, such as:

  • Rest: Reducing activities that exacerbate pain allows the inflammation to settle down.
  • Ice: Use ice therapy on your heel for 15-20 minutes several times a day to decrease inflammation and pain.
  • Stretching: Stretching the plantar fascia and Achilles tendon loosens tightness and relieves tension.
  • Footwear modifications: Wearing shoes with good arch support and cushioning helps reduce stress on the plantar fascia.
  • Inserts or orthotics: Custom orthotics or over-the-counter inserts support the arch and heel to improve foot mechanics.
  • Night splints: Wearing a splint at night keeps the plantar fascia stretched gently during sleep.
  • NSAIDs: Nonsteroidal anti-inflammatory drugs like ibuprofen help relieve pain and reduce inflammation.
  • Arch taping: Taping the arch can provide temporary symptom relief and support.
  • Calf strengthening: Strengthening exercises for the calf and foot intrinsic muscles provide stability.
  • Cortisone injections: Injections of steroid medication into the plantar fascia decrease inflammation. Alternatively, you might consider PRP injections.
  • Shockwave therapy: Pulses of high-energy acoustic waves stimulate the healing of the plantar fascia.
  • Surgery: Only used in severe, chronic cases, orthopaedic surgery releases tightness or tension in the plantar fascia.

The majority of patients see improvement in symptoms with conservative treatments over six months to one year. However, recurrence is common if risk factors are not addressed, which highlights the importance of prevention. Check out this video below for stretching exercises to relieve Plantar Fasciitis.

What Are the Best Shoes for Plantar Fasciitis?

Here are some features to look for in shoes that are beneficial for plantar fasciitis:

  • Arch support: Shoes should have adequate arch support to reduce strain on the plantar fascia. Look for shoes advertised as having high arch support or stability.
  • Cushioning: Cushioning in the heel and forefoot helps absorb shock and impact, protecting the plantar fascia from excessive force. A thick, supportive midsole is ideal.
  • Firm heel counter: The back part of the shoe should have a firm heel counter to cup the heel and provide stability, without digging into the Achilles area.
  • Flexible sole: The shoe should bend with the foot for a smooth transition through the gait cycle. Avoid shoes with stiff, inflexible soles.
  • Deep toe box: A toe box that allows the toes to spread out comfortably reduces repetitive squeezing of the metatarsals at push-off.
  • Rocker bottom sole: The curved sole mimics the natural shape of the foot through the stride, reducing plantar fascia strain.
  • Orthotic friendly: A removable insole will accommodate custom orthotics if prescribed by a podiatrist.

Consult with a podiatrist for recommendations tailored to your foot type and activities. Transition gradually to any new shoe to allow your feet to adapt.

Getting Help for Foot Pain in Singapore 

Foot pain can make every step painful and stop you from doing the things that you want to do in life. When you understand the causes, know the symptoms to look out for, and are getting proper treatment, you can alleviate pain and get back out there again. 

When you’re in pain, it is crucial to get professional proper medical care to receive an accurate diagnosis and get started with a treatment plan. With the right care, you can go back to living pain-free in no time! 

Looking for an orthopaeidc doctor in Singapore who can help you get rid of foot pain? Our team of experts is here to help with a wide range of treatments like knee pain management and also shoulder pain treatment.

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Dr. James - Orthopaedic Surgeon in Singapore

About the Author

Dr James Tan is a highly skilled orthopaedic surgeon who has more than 10 years of experience in sports surgery and exercise medicine. He is a member of the elite Asian Shoulder and Elbow Group and a founding member of the Singapore Shoulder and Elbow Surgery Society.

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