Foot pain and discomfort

Foot pain is a widespread issue that can significantly impact mobility and overall well-being.

Despite being a common complaint, foot pain is often misdiagnosed due to the complex structure of the foot itself.

About
Conditions
Treatment

The human foot and ankle contain 26 bones, making up a quarter of the body’s total bone count, along with over 100 muscles, tendons, and ligaments that work together to support movement, balance, and stability.

Many medical conditions can contribute to foot pain, ranging from genetic conditions and structural deformities to inflammatory issues. Understanding these conditions is the first step toward effective treatment and relief.

Below, we explore some of the most frequently diagnosed foot conditions, their causes, symptoms, and available treatment options.

Foot pain causes and conditions

There are many medically recognised foot conditions that can cause foot pain, including:

Pes planus (flat feet)

Flat feet are one of the most common foot conditions, affecting more than 30% of the population. It is defined by the loss of the medial longitudinal arch of the foot.

The main symptom is excessive foot pronation, also called ‘overpronation,’ this describes when the arch of the foot collapses excessively downward or inward.

Shin splints

Shin splints are the general term to describe exercise-induced pain or tenderness along the inside of the lower limb; it can also be felt centrally along the front of the shin. Shin splints are very common, amounting to over 10% of running related injuries.

The most common cause of shin splints is medial tibial stress syndrome (MTSS). MTSS is a result of frequent or intense periods of exercise when a person’s body is not necessarily used to it. Long-distance running and sports involving a lot of stopping and starting increase the risk of getting MTSS.

Although shin splints is primarily an overuse injury, it’s often related to an individual’s foot mechanics and the subsequent effect on muscles in the lower leg during stance phase.

Bunions (hallux valgus)

A bunion, medically known as hallux valgus, is a deformity of the big toe. A painful, bony lump develops on the joint at the base of the big toe. More than 15% of women in the UK suffer from bunions.

The primary symptom of a bunion is when the big toe starts pointing to the other toes on the same foot. Other symptoms include:

pain and swelling over the big toe joint
a bony lump on the outside edge of the foot
changes to the shape of the foot which make it difficult to find footwear that fits
when the big toe overlaps with the second toe, hard and callused skin will develop in the affected area

Although it’s popular to blame footwear for the reason people develop bunions, it’s more likely that they are caused by a defective biomechanical structure of the foot; they are therefore a genetic condition. However it’s true that poorly fitting footwear will aggravate the problem.

Hammer toes

Hammer toes are a painful deformity of the three middle toes where the toes are always bent. There are two types: flexible and rigid. If the toe can still be moved at the joint, it’s described as a flexible hammer toe. If the tendons in the toe become rigid, the joint will be moved out of alignment, and the toe will not be able to move. This is known as a rigid hammer toe.

A toe that looks like it is stuck in an upside-down ‘V’ position is most likely a hammer toe. Other symptoms include:

pain at the top of the bent toe when putting on footwear
difficulty in moving the toe joint with associated pain when doing so
the toe joint itself swelling
corns forming on top of the toe joint

Hammer toes have a variety of causes and have been linked to:

footwear that’s too tight in the toe box which means that the toes cannot lie flat
an injury like stubbing or breaking a toe can trigger the condition
imbalance of the toe muscles
second toe longer than big toe
some medical conditions like arthritis and diabetes can be contributory factors

Plantar fasciitis

Plantar fasciitis (known also as policeman’s heel) occurs when the plantar fascia ligament along the bottom of the foot develops tears in the tissue. It is the most common heel pain condition. Around one in 10 people will develop the condition at some time in their life.

Most people with plantar fasciitis complain of a burning, stabbing or aching pain in the heel of the foot. It seems to be particularly acute when getting up and putting pressure on the ligament. Due to heel stiffness climbing stairs can also be difficult.

There are several causes and risk factors. The plantar fascia ligament absorbs significant weight and pressure and an excess of physical activity or exercise may overload the ligament. Active men and women between the ages of 40 and 70 are most at risk of developing plantar fasciitis. Long distance runners are particularly prone.

Arthritis is another common cause as certain types of arthritis can lead to inflammation to develop in the tendons. This is most common in elderly patients. Diabetes is also a factor that can contribute to foot damage.

A person’s gait may also be a contributing factor. This is because flat feet, high arches and pronation all may cause the fascia ligament to tear and become inflamed. A tight Achilles tendon can affect one’s ability to flex the ankle making it more likely that the plantar will be damaged.

Charcot foot

Charcot foot or Charcot disease takes its name from Jean-Martin Charcot who was the first to define and describe the degeneration of the joints caused by the condition.

Charcot Foot is a progressive, degenerative condition. It develops because of neuropathy (nerve damage) which decreases sensation and the ability to feel temperature or pain. The bones in the foot can be weakened enough to fracture with the joints collapsing.

The symptoms of Charcot foot may include:

the affected foot feeling warm to the touch
redness of the foot
swelling of the foot
pain or soreness

Heel spurs

Heel spurs are tiny protruding calcium deposits that can develop near the base of the heel bone; this is a process that takes many months to develop. The heel spur itself does not cause the pain, but instead it’s the soft tissue surrounding it that becomes inflamed.

Heel spurs often have no symptoms but can be associated with both chronic and intermittent pain. The pain is often described as like a pin being stuck into the bottom of your foot when you first stand up in the morning. The pain then becomes a dull ache.

Risk factors for heel spurs include:

walking gait abnormalities which place excessive stress on the heel bone
shoes that do not provide enough arch support
running or jogging frequently on hard surfaces (road running in general)

Posterior Tibial Tendon Dysfunction (PTTD)

The posterior tibialis tendon attaches the calf muscle to the bones on the inside of the foot. Its main function is to hold up the arch and support the foot when walking. It is therefore one of the most important tendons in the leg and any dysfunction will cause problems.

If the tibialis becomes inflamed or torn the tendon may not be able to provide stability and support for the arch of the foot, resulting in flat feet.

The most common location of pain is along the course of the tendon itself which travels along the back and inside of the foot and ankle. There may be swelling, too. The pain is likely to be more severe with activities like running.

In reaction to the collapse of the foot, the heel bone may shift and this can put pressure on the outside ankle bone leading to pain in this new location.

An acute injury such as a fall can tear the posterior tibial tendon. The tendon can also tear due to overuse. High impact sports like tennis, basketball or football may cause tears due to repetitive stress.

Sesamoiditis

Sesamoiditis is a painful foot condition caused by the inflammation of the sesamoid bones which are a pair of tiny bones located in the ball of the foot, beneath the big toe joint. Their function is to act as a fulcrum to hold the tendons away from the joint in the big toe.

The most common symptom is pain experienced when walking and strongest when the body weight transfers onto the toes. Pain can be felt at the base of the big toe.

Osteoarthritis of the sesamoid bones is the most likely cause in older patients. Osteoporosis is another factor as it weakens the bones. In younger adults the condition is most likely to have been caused by a traumatic event to the sesamoid bones or repeated stress over time.

High heels can place an increased stress on the forefoot and activities like athletics and dancing can trigger the condition.

Metatarsalgia

Metatarsalgia is the name given to pain in the front part of your foot under the heads of your metatarsal bones – the ball of the foot. It is not a specific disease itself rather a symptom of other problems with the foot. It is most common in middle-aged women.

The primary symptom is pain usually made worse when standing, walking or running. It usually comes on gradually rather than suddenly. Some have described the pain as like walking bare foot on pebbles.

Treatment for foot pain

All the above medical conditions can be treated by custom-made foot orthotics or insoles.

At the London Orthotic Consultancy (LOC), we take a holistic approach to biomechanical problems, understanding that issues may not always originate in the area where symptoms occur. Factors such as poor posture, pelvic misalignment, leg length discrepancies, and muscle imbalances can contribute to foot-related discomfort.

Restore your foot's biomechanical function and reduce pain with bespoke insoles

Custom-made insoles are an effective way to treat different types of foot pain.

When combined with a thorough biomechanical assessment with an orthotist, we can help diagnose the underlying cause of your pain and help you get back to doing what you love.

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