11 Most Common Reasons Your Feet Hurt [and how to fix them!]

Do your feet hurt too?

Do they hurt right when you step out of bed?

Do they hurt after a long day of work?

Do they hurt only when you’re laying down?

If only you knew why they hurt maybe you could do something about it. This article will show you the 11 most common reasons why your feet hurt AND show you how to fix them!

Lets get to it!

1. Are your shoes sabotaging you?

This is going to anger some people… high heels and flip flops are not your friends. There… I said it.

  • Heels that are higher then roughly 2 inches will:
    • put unnatural stress on the pads of your feet,
    • will cause excessive shearing forces on the ankle and foot joints, and…
    • can lead to the dreaded ‘pump bump’ on the back of your heel.
  • Flip flops offer little to no support and will lead to flattened arches. Additionally, most flip flops cause you to tense your foot to avoid them ‘flopping’ off. This leads to unnatural footfalls that will cause pain over time.

How do I fix this?

Try to find a shoe that is comfortable, fits well, and (most importantly) supports your arches. Don’t be afraid to ask a Physical Therapist for guidance when it comes to using orthotics if you need to, your feet will thank you. Keep reading to #11 – Plantar Fasciitis to see my personal recommendation for the best orthotics.

2. Has ‘Uncle Arthur’ come calling?

Reasons-Why-Feet-Hurt
The dreaded ‘A-Word’… Arthritis! (Courtesy of CDC.gov)

Arthritis is commonly seen after the age of 65, but can occur in people as young as 20 and even in children! Usually, an earlier onset is associated with an underlying cause:

  • Repetitive stress (Irritation of the joint cartilage will eventually cause break-down)
  • Obesity (Increased pressure on the joints leads to accelerated inflammation)
  • Inflammatory conditions (pre-disposition to overactive inflammatory responses)

Basically, arthritis works like this:

Reasons-Why-Feet-Hurt
  1. The cartilage/padding between joints is worn down from the above-mentioned reasons.
  2. This leads to decreased joint space and increased likelihood that your bones start to rub together (‘eww’).
  3. This friction leads to a pain signal sent to your brain and an inflammatory response in which your body delivers increased blood flow in an attempt to deal with the ‘injury’.
  4. The increased blood flow leads to increased intra-articular (in-the-joint) swelling, which leads to more pressure on the already irritated joint.

How do I fix this?

  • 1.) Lose excess weight to reduce excess pressure.
  • 2.) Modify your daily repetitive stresses to decrease irritation.
  • 3.) Exercise to increase muscular support of joint and reduce the stresses it has to take.
  • 4.) Control the inflammation with ice or heat (See: Is It Better To Use Ice or Heat?)

3. Is your Bunion so big you’ve named it Paul?

Reasons-Why-Feet-Hurt

Bunions are hereditary. So don’t blame ya pumps, blame ya mom.

A Bunion is a painful lump right where your big toe meets your foot. It develops as the big toe pushes inward and stretches out the medial ligaments (which leads to inflammation and pain).

Contrary to popular belief, narrow shoes and high heels do not cause bunions, but they certainly make them worse.

How do I fix this?

Ice, bunion pads, and roomy shoes can all decrease the amount of inflammation, irritation, and friction (respectively) at the joint. If the bunion gets bad enough, the only real solution is surgery.

4. Do I Have Bursitis (the Arthritis Imposter)?

The main difference between arthritis and bursitis is the anatomical structures that each affect. While arthritis is a degenerative and chronic condition that affects bones and cartilage, bursitis is (usually) temporary and affects the bursa around certain joints.

A bursa is a small fluid filled sack located in many locations throughout the body. It’s function is to prevent friction and provide cushioning to bones and tendons.

In our foot we have one near the toes and one on the heel. When these get inflamed you’ll notice painful swelling and sometimes redness at the site.

How do I fix this?

Like all swelling and inflammation, ice is usually your number-one weapon. Other conservative treatments are orthotic padding, over-the-counter pain meds like tylenol or ibuprofen, and even corticosteroid injections.

Additionally, you could consult with a physical therapist to learn how to correct muscle imbalances and tight connective tissue that could be contributing to extra friction on the bursae.

5. Do you have a Stress Fracture?

Repetitive stress from running, walking up and down stairs, and weight lifting can cause small fractures in the long bones of your foot. There is usually not a significant event that you can determine as the cause. You’ll notice swelling and pain, especially with weight bearing.

There are some conditions that predispose you to this malady: Age, weight, sex (sorry ladies), osteoporosis, low vitamin D levels, and presence of other foot problems.

How do I fix this?

Usually a stress fracture will heal when you allow it to. This means changing your activity level for the next 6-8 weeks (typical bone healing time1). Additionally, you should be icing when you can and providing cushioning in the form of comfortable shoes.

6. Sprains/strains

Unlike a stress fracture, there is almost always a significant event that causes a sprain or strain of your foot/ankle. First lets examine the difference between the two.

Reasons-Why-Feet-Hurt
Courtesy of braceability.com
  • Sprains refer to the stretching or tearing of ligaments (between two bones). They are usually sustained when you fall or get hit.
  • Strains refer to the stretching or tearing of tendons (between a muscle and a bone). They are usually sustained when you roll your ankle or step awkwardly.

The most common spot for strains is the ankle but can also occur at the great toe and at the arch of your foot. These injuries can be mistaken for plantar fasciitis but have one tell-tale sign: bruising. When you get small tears in a ligament or in a tendon, it will bleed. That bleeding is visible in the form of bruising.

How do I fix this?

The ‘old standby’… RICE. (Rest/Ice/Compression/Elevation).

  • The foot will probably be swollen and definitely hard to walk on. If you can, stay off of it for 1-2 days while providing consistent ice in 10-15 minute intervals.
  • Compression wrapping can be beneficial to control the swelling and to provide comfort, but you have to take care not to wrap too tightly or create a tourniquet effect.
  • Elevate the foot to reduce swelling, ideally above the level of your heart.

After this initial period, you can usually begin some light range of motion and experiment with switching to heat to promote healing and reduction of swelling. If the foot still hurts so badly that you can’t walk on it, consult your physician.

*NOTE: Sprains and strains involve tearing, but not complete tearing, of the structural tissues. Surgery is usually not required unless a tendon or ligament is completely ruptured.

7. “Is it broken?”

Reasons-Why-Feet-Hurt

There are many small bones in the foot. Aside from your toes there are:

  • 5 metatarsals
  • 5 tarsal bones
  • 2 bones that make up your heel
  • and the distal end of your ankle bones

The design of your foot allows it to be subtly flexible in many different ways. This is an evolutionary adaption from a time when we didn’t have shoes and had to walk, run, and travel on uneven terrain to survive. The multiple bones and multiple articulation points give your foot amazing flexibility… but also many places to sustain a fracture or break!

How do I Fix This?

Broken bones can and will be confirmed with an x-ray, after which your doctor will likely recommend a cast to protect the break and allow it to heal.

Standard bone healing time is 6-8 weeks1 (assuming no other confounding factors). Depending on the severity and which bone is broken, sometimes you’ll be given a Walking Boot or Offloading Shoe and allowed to bear weight.

8. Are you having Achilles Problems?

Your Achilles Tendon is the thick band that runs down from your calf muscle and attaches to the heel and bottom of foot. It is the conduit that transmits the power of the calf muscle across the ankle joint and allows you to rise up on your toes.

As thick and as strong as this tendon is, it is still susceptible to overuse injuries that result in inflammation and pain. You’ll know something is wrong if your calf feels tight, the back of the ankle is tender, and if it hurts to stand up on your toes.

A jump, fall, or strong push-off (like performed in sporting activities) can even rupture the tendon. Oftentimes you’ll feel or hear a pop, accompanied by sudden and sharp pain. This will need immediate attention and likely surgical repair.

Kobe Bryant was one of many athletes to tear his Achilles. RIP Mamba.

What are the common signs of Achilles Tendon injury?

  • Pain down the back of your leg
  • Pain worsens during and after activity
  • Stiffness in the Achilles upon waking
  • Difficulty flexing the foot
  • Swelling and tenderness behind the ankle
  • Feelings of the tendon “thickening”

How do I Fix This?

Wait for it…

Wait for it…

  • Rest and Ice. This is tried-and-true and by now you know how and why it works. The key is to control the inflammation and allow time to heal without adding stress to the injury site.
  • Other viable options are to use NSAIDs, or Non-Steroidal Anti-Inflammatories. Ibuprofen is the most common.
  • A Physical Therapist can show you how to gently stretch the muscle and maintain range of motion. When appropriate, eccentric exercises can be performed. Although the mechanisms aren’t completely understood yet, there is evidence that eccentric exercises will help to build the strength and function of tendons better than concentric2,3.

9. Tarsal Tunnel Syndrome

Most of us have heard of Carpal Tunnel Syndrome (affecting our wrists and hands) and up to 5% of the general population has experienced it. It is a nerve entrapment syndrome that pinches on the median nerve and results in pain, numbness, and tingling.

Reasons-Why-Feet-Hurt

As it turns out, we can also experience Tarsal Tunnel Syndrome in our feet.

In Tarsal Tunnel Syndrome, the Tibial Nerve gets entrapped as it passes through the ‘tunnel’ formed by your ankle bone and a group of ligaments (flexor retinaculum) in the foot. The

Tibial Nerve is responsible for your sense of feeling in the bottom of your foot.

Symptoms of Tarsal Tunnel Syndrome:

  • Numbness
  • Tingling
  • Sharp shooting pains/ ‘pins and needles’ / burning pain (usually at the bottom of the foot)

How do I Fix This?

  • RICE: If there is swelling, you know what to do. Rest it, Ice it, apply light compression, and elevate it.
  • Stretch your calves: That Tibial Nerve runs down the back of your leg. If your calf is tight it will put pressure on the nerve and could be the source of your problems.
  • Wear arch support: People with fallen arches or ‘flat feet’ will pronate their feet with every step. This pronation will put repetitive stress and stretching on that Tibial Nerve as it crosses the flexor retinaculum.
    • Arch support like these will prevent that:
  • Cross Friction Massage: Applied properly, this gentle massage technique can re-align and relax any bunched up ligaments at the flexor retinaculum and release the pressure through the Tarsal Tunnel. To perform, gently rub across the flexor retinaculum like you were strumming a guitar. DO NOT rub along the length of the ligaments, this will be counter-productive.
    • Notice the orientation of the ligament and remember to rub across:

10. Is Bad knee Alignment causing your feet to ache?

I had a patient earlier this year who was referred with chronic foot pain. I walked into his home (I’m a Home Health Physical Therapist) and he started telling me that he didn’t know why his doctor was recommending physical therapy again. He’s tried therapy before, he’s done the exercises, he’s had massages, but nothing helps and the pain keeps getting worse.

I asked him to walk for me and he looked exactly like this:

Reasons-Why-Feet-Hurt

I spent the next few minutes convincing him that we were going to fix his foot pain by spending most of our time on his hips and knees. Can you guess why?

As the picture above shows, he had knock-knees or what we call genu valgum ‘in the biz’. Imbalanced hip and knee musculature was creating that abnormal knee angle, which was in turn causing his feet to excessively pronate (flat feet). This was stretching out his ligaments, putting pressure on his Tibial nerve, and inflaming his plantar fascia.

How do I Fix This?

We spent the next couple of weeks stretching out tight hip and knee muscles, strengthening and toning their counterparts, and working on the mechanics of this man’s gait. We then got his podiatrist to prescribe custom orthotic inserts for his shoes. By the time I discharged him from my care, his foot pain was gone and I had a new raving fan.

Here’s what you can do:

  • Stretch and foam roll your hip adductors.
    • Tight adductors can lead to internal rotation
  • Stretch and foam roll your IT band.
    • Tight Tensor Fascia Lata/IT band complex can lead to internal rotation
  • Stretch hip flexors
    • Tight hip flexors can lead to internal rotation (are you sensing a pattern yet?)
  • Strengthen glutes (strongest external rotators)
  • Strengthen the piriformis (external rotator)
  • Strengthen quadratus femorus (external rotator… another pattern here.)
  • Purchase orthotic arch support (Again, I’m a huge fan of these.)These will set a proper base from the ground and support correct knee alignment all the way up your leg.
  • Consult (the best) Physical Therapy for guidance.

11. How do you know if you have Plantar Fasciitis?

Plantar Fasciitis is a very common cause of foot pain and one that is difficult to prevent. The plantar fascia is a ligament that runs lengthwise and connects the front and back of your foot, supporting your arch.

At it’s most basic, plantar fasciitis is a repetitive stress injury.

The hallmark signs of plantar fasciitis are:

  • Pain on the bottom of the foot.
  • Pain worse in the morning, specifically when first standing up out of bed.
  • Get worse with increased weight bearing or long-distance walking/running.
  • Feels much better when resting.

The plantar fascia can be irritated if:

Reasons-Why-Feet-Hurt
  • Your arches are too high.
  • Your arches are too low.
  • Your calves are too tight.
  • You have a bone spur in your heel.
  • You subject it to repeated impact (running).
  • You start a new sport/activity.

(Image Courtesy of VeryWellHealth)

As you can see, your plantar fascia is a ‘sensitive flower’ that will require some TLC to prevent and heal injuries.

Here are the 4 ways you can fix your Plantar Fasciitis:

  1. Ice: Like all other inflammation, ice can ease the pain and reduce the swelling when your foot is especially irritated.
  2. Stretch: The targets of your stretching will be the actual plantar fascia (duh.) and the calf muscle. Dr. Jo does an excellent job of demonstrating in this quick and informative video…
  1. Night Splints: When we sleep our foot falls naturally into a position of plantar flexion (toes pointed down). This shortens the plantar fascia and lets it stay that way for hours until you wake up. This is the reason that your plantar fasciitis pain is worse in the morning. Night splints like this one help you to avoid that shortened position and can even eliminate that morning pain.
  2. Orthotics: Off the shelf orthotics can usually do the trick and support that tender fascia, but I advise you to consult with a Physical Therapist to choose the right one depending on your foot. Physicians can also order custom fitting orthotics in certain situations. There are lots of options, but I can personally vouch for Walk Hero. I switched to them early in 2020 and I’ll never stray.

Pssst… They also make Orthotic Flip Flops that completely negate the first point in this post.


So there you have it, folks. These are the MOST COMMON causes of Foot Pain and a few ideas on how you can take charge and fix yourself.

I encourage you to join the 1149 other people who make up the Rehab Revolution by entering your email below to receive Life-Changing Rehab Tips and Tricks.

rehab-revolution-consult-with-therapist

Dan Kristoff PT, DPT is recognized as one of the Top Physical Therapists in Ohio. In his 10+ yrs as a physical therapist, he has helped thousands of patients recover from illness and debility. His company, Rehab Revolution, is less than a year old and has already helped hundreds of clients take back control of their health.


References:

  1. “Stress Fractures of the Foot and Ankle – OrthoInfo – AAOS.” OrthoInfo, 2015, orthoinfo.aaos.org/en/diseases–conditions/stress-fractures-of-the-foot-and-ankle/.
  2. N. Maffulli, U. G. Longo, How do eccentric exercises work in tendinopathy?, Rheumatology, Volume 47, Issue 10, October 2008, Pages 1444–1445, https://doi.org/10.1093/rheumatology/ken337
  3. O’Neill S, Watson PJ, Barry S. WHY ARE ECCENTRIC EXERCISES EFFECTIVE FOR ACHILLES TENDINOPATHY?. Int J Sports Phys Ther. 2015;10(4):552-562.

Published by Dan Kristoff PT, DPT

President of Rehab Revolution Creator of CleBD Topical and Doctor of Physical Therapy

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