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Claremont Medical Practice

webGP -Foot pain

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Learn more about foot pain: introduction

Foot pain is a common problem with a wide range of possible causes. 

This page summarises some of the main causes of pain in the foot, toes or heel (heel pain is also covered in more detail separately).

Many conditions that cause foot pain can be managed yourself at home, but you should see your GP if you're concerned about any severe or persistent pain in your feet.

Common causes of foot pain

Common causes of foot pain include:

Click on these links for more information about these conditions.

Sprains and strains

Sprains and strains are very common injuries that affect muscles and ligaments (strong bands of tissue around joints that connect one bone to another). They often occur if you change direction or speed suddenly, fall and land awkwardly, or collide with an object or person, such as when playing sports.

A sprain means one or more of your ligaments have stretched, twisted or torn. A strain means muscle fibres have stretched or torn.

As well as pain, a sprain or strain can cause swelling, bruising and tenderness, and may result in you being unable to put weight on your foot.

Most sprains and strains can be managed at home using PRICE therapy (protection, rest, ice, compression and elevation) and painkillers.

Read more about treating sprains and strains.

Gout

Gout is a type of arthritis caused by a build-up of uric acid (a waste product) in your joints. It causes sudden bouts of severe pain, redness, swelling and warmth in affected joints, even when you're resting.

These attacks usually last a few days at a time and most often affect the big toe joint. It can sometimes be difficult to tell the difference between gout and a severely inflamed bunion (see below).

The pain caused by gout can usually be treated using ice packs and by taking non-steroidal anti-inflammatory drug (NSAID) painkillers. You may also need additional treatment to prevent further episodes.

Read more about treating gout.

Verrucas

Verrucas are small growths that usually develop on the soles of the feet. They can be painful if you put weight on them when you stand up or walk.

Verrucas are fairly easy to identify. They look like small, flat white circles of skin that often have black dots in the centre.

Most verrucas will often eventually clear up by themselves, but this can take a long time. There are over-the-counter verruca creams, gels and plasters that may help.

Read more about treating verrucas

Blisters, corns and calluses

Poorly-fitting shoes that rub on the feet can damage the skin and may cause: 

  • blisters – small pockets of fluid that form in the upper layers of the skin
  • corns – small circles of thick skin
  • calluses – hard, rough areas of skin that are often yellowish in colour

These conditions can all result in pain and discomfort when you walk.

Most blisters heal naturally in a few days and don't require medical attention. Wearing comfortable, well-fitting shoes can help stop them returning. Read more about treating blisters and preventing blisters.

Corns and calluses don't necessarily improve on their own and you may need to see a podiatrist or chiropodist, who can advise you about appropriate treatment. Read more about treating corns and calluses.

Bunions

bunion is a bony swelling at the base of the big toe that can be painful when wearing shoes and make walking difficult.

Bunions are a common foot problem, particularly in women. The big toe points towards the other toes and the big toe joint sticks out, forming a bony lump.

Bunions can get worse if they're left untreated, so it's best to see a GP for advice. Non-surgical treatments are usually tried first, including wearing comfortable and wide shoes, orthotics (insoles), painkillers and bunion pads. Corrective surgery may sometimes be necessary.

Read more about treating bunions.

Ingrowing toenails

Ingrowing toenails occur when the sides of the toenail grow into the surrounding skin.

The toenail pierces the skin, which can become red, swollen and tender. It can also be painful if pressure is placed on the toe or the toe becomes infected.

Cutting your toenails straight across and gently pushing the skin away from the nail using a cotton bud may help improve an ingrowing toenail. In some cases, a procedure to remove part or all of the affected nail may be necessary.

Plantar fasciitis

Plantar fasciitis is the result of damage to the tough band of tissue (fascia) that runs under the sole of the foot, which causes pain in the heel. It most commonly affects people aged 40 to 60 who are overweight or on their feet for long periods of time.

The pain tends to develop gradually over time and is at its worst when you wake up in the morning and at the end of the day.

Resting your heel, regular stretching, applying ice packs, taking painkillers and wearing well-fitted, supportive shoes can often help relieve the pain. In a small number of cases, other treatments such as physiotherapy or injections may be necessary. Rarely, surgery may be required.

Read more about treating plantar fasciitis.

Morton's neuroma

Morton's neuroma is a condition that affects the nerves between the toes.

Fibrous tissue develops around the nerve, which becomes irritated and compressed. This causes severe burning pain on the ball of the foot and at the base of the toes.

Morton's neuroma can occur on one foot or both feet. It usually affects the nerve between the third and fourth toes, but sometimes the second and third toes are affected.

If you have Morton's neuroma, it may help to wear shoes with more room for the toes. You can also take painkillers or have steroid injections to help ease the pain. If these treatments don't work, surgery may be needed.

Metatarsalgia

Metatarsalgia is the term for pain that occurs in the front section of the foot.

It's is often described as a burning or aching pain that ranges from mild to severe and gets worse when walking. It can affect one or several toes near the ball of your foot, or sometimes the entire foot.

Anything that puts extra strain or pressure on the ball of your foot can bring on the pain – for example, wearing tight-fitting shoes for a long period of time, high impact sports, or being overweight. Older people are more susceptible to metatarsalgia. 

Most cases of metatarsalgia can be managed using PRICE therapy (protection, rest, ice, compression and elevation), painkillers, changing your footwear and using shock-absorbing insoles. In rare cases, surgery may be required to repair underlying damage to the foot.

Read more about treating metatarsalgia.

Arthritis

In older people, repeated episodes of foot pain and stiffness can indicate a sudden worsening of osteoarthritis, which is the most common type of arthritis in the UK. This long-term condition caused by wear and tear results in swelling of the tissues in and around the joints, including the big toe and heel joints.

Treatments include wearing suitable footwear to reduce the strain on your joints, painkillers, anti-inflammatory medication, physiotherapy and surgery in some cases. Read more about treating osteoarthritis.

Less commonly, foot pain can be caused by rheumatoid arthritis, which is a type of arthritis caused by the immune system attacking the joints and causing the joint tissues to become inflamed. It almost always affects other joints too, so foot pain will probably not be your only symptom.

The main treatments include medication to relieve symptoms and slow the progress of the condition, physiotherapy, and occasionally surgery. Read more about treating rheumatoid arthritis.

Achilles tendon injuries

Pain and stiffness along the back of your heel could be a sign of damage to your Achilles tendon. This is known as Achilles tendinopathy.

The pain can often be relieved with rest, ice packs and painkillers at home, although it may take several months to resolve completely.

If you experience sudden and severe pain in your heel, which may have been accompanied by a "popping" or "snapping" sound, you may have ruptured (torn) your Achilles tendon.

You should seek medical advice as soon as possible if you think you have ruptured your Achilles tendon. Often this will be treated with immobilisation (wearing a plaster cast or plastic boot) for several weeks. Surgery may sometimes be required to repair the tear.

Read more about treating tendon injuries.

Oedema

If your whole foot is painful, heavy and swollen, it may be a sign of oedema.

This is a build-up of fluid (mainly water) in the body's tissues, causing swelling to occur in the affected area.

Oedema will usually affect your whole lower leg as well. See your GP, or if the pain and swelling is severe, go to your nearest accident and emergency (A&E) department.

An object embedded in your foot

Foot pain can sometimes be caused by an object embedded in the foot. It may therefore be worth considering whether you have stepped on something sharp with bare feet and examining your foot for a wound.

If a small object, such as a splinter or thorn, is lodged in your skin, it's usually safe to remove it yourself. Wash your hands and clean the area first, and use tweezers if they help. Your pain should start to improve once the object has been removed.

If the object is more deeply embedded, don't try to remove it yourself. Seek medical help as soon as possible.

Diabetic foot problems

People with diabetes can experience a number of potentially serious problems affecting their feet, some of which can be very painful. This is because the condition can damage nerves and blood vessels in your feet.

Foot problems that can affect people with diabetes include:

  • nerve damage (peripheral neuropathy), which can cause numbness and burning, stabbing or shooting pains in your feet
  • poor circulation (ischaemia), which can cause your feet to become painful, cold, red and swollen
  • skin ulcers – painful sores that take a very long time to heal
  • skin infections – ulcers that become red and swollen, and may produce a foul-smelling odour and green discharge

Contact your GP or diabetes care team immediately if you have diabetes and think you have developed a problem with one or both of your feet.

Read more about feet and diabetes.

A broken or cracked bone (fracture)

A broken or cracked (fractured) bone in your foot can occur suddenly after a severe injury, or gradually over time as a result of doing lots of high-impact sports (such as long-distance running). Occasionally they can occur as a result of osteoporosis (weakened bones).

Any bone in and around the foot can be affected, including the:

  • bones in the middle of your feet (such as the metatarsals)
  • heel
  • toes – read more about a broken toe
  • ankle – read more about a broken ankle
  • bones of the lower leg – read more about a broken leg

The affected area will be very painful and tender to touch, and the skin may be bruised. You should stop all activity immediately and avoid putting weight on your foot until you see a doctor.



Content Supplied by NHS Choices

Learn more about foot pain: treatment

Most sprains and strains can be managed at home using over-the-counter painkillers to ease any pain.

If the injury is minor, you can look after yourself by using "PRICE therapy" and "avoiding HARM". These are described below.

PRICE therapy

PRICE stands for:

  • Protection  protect the affected area from further injury by using a support or, in the case of an ankle injury, wearing shoes that enclose and support your feet, such as lace-ups.
  • Rest  stop the activity that caused the injury and rest the affected joint or muscle. Avoid activity for the first 48 to 72 hours after injuring yourself. Your GP may recommend you use crutches.
  • Ice  for the first 48 to 72 hours after the injury; apply ice wrapped in a damp towel to the injured area for 15 to 20 minutes every two to three hours during the day. Don't leave the ice on while you're asleep, and don't allow the ice to touch your skin directly because it could cause a cold burn.
  • Compression  compress or bandage the injured area to limit any swelling and movement that could damage it further. You can use a simple elastic bandage or an elasticated tubular bandage available from a pharmacy. It should be wrapped snuggly around the affected area, but not so tightly that it restricts blood flow. Remove the bandage before you go to sleep.
  • Elevation  keep the injured area raised and supported on a pillow to help reduce swelling. If your leg is injured, avoid long periods of time where your leg isn't raised.

Avoiding HARM

For the first 72 hours after a sprain or muscle strain, you should avoid HARM. This means you should avoid:

  • Heat  such as hot baths, saunas or heat packs.
  • Alcohol  drinking alcohol will increase bleeding and swelling, and slow healing.
  • Running  or any other form of exercise that could cause more damage.
  • Massage  which may increase bleeding and swelling.

Moving sprained joints

Most healthcare professionals recommend you don't stop using a sprained joint. The injury will heal quicker if you begin to move the joint as soon as you're able to do so without experiencing significant pain.

Your doctor may be able to teach you a number of exercises that will help you improve the joint's functionality.

If you have a severe ankle sprain, you may be advised not to use it for a while, or even have it put into a cast for a week or so.

Immobilising strained muscles

Depending on your injury, the advice for muscle strains can vary. You may be advised to keep your injured muscle still for the first few days. Your doctor may recommend using a brace, cast or splint to help keep it as still as possible.

The aim of immobilising the muscle is to allow it to start healing, so you can move it without tearing or pulling it again in the same place. After a few days, you'll probably be advised to start using the muscle again.

Treating pain

Paracetamol is usually recommended for painful sprains or strains. If it doesn't help, you may need an additional stronger painkiller  such as codeine  that's only available on prescription.

Your GP may also prescribe a non-steroidal anti-inflammatory drug (NSAID) cream or gel, such as ibuprofen or ketoprofen, to help treat pain. Gently apply the cream or gel to the injured area and wash your hands immediately afterwards.

Ketoprofen can make your skin sensitive to light (photophobia). You should avoid exposing treated areas of skin to direct sunlight or artificial sources of light, such as sunlamps or sun beds, during treatment and for two weeks afterwards.

Oral NSAIDs, such as ibuprofen tablets, can also help reduce swelling and inflammation. However, they shouldn't be used in the first 48 hours after the injury because they may delay healing.

Physiotherapy

For more severe injuries, particularly muscle strains, your doctor may consider referring you for physiotherapy.

Physiotherapy aims to restore movement and function to an injured area of the body. The physiotherapist may show you exercises to help improve the range of motion and return normal function to the injured area.

This may reduce your risk of experiencing long-term problems or injuring the area again.

Recovery

The length of time it takes to recover from a sprain or strain depends on how severe it is. 

Generally, after an ankle sprain you'll probably be able to walk a week or two after the injury. You may be able to use your ankle fully after six to eight weeks, and you'll probably be able to return to sporting activities after eight to 12 weeks.

For muscle strains, the time it can take to recover can vary considerably. Some people recover within a few weeks, whereas others may not be able to return to their normal activities for several months.

Some people may experience continued problems, such as pain, intermittent swelling or instability, for months, or even years, after the original sprain or strain.

Contact your GP if your injury doesn't improve as expected or your symptoms get worse. They may consider referring you to an orthopaedic specialist for further assessment and treatment.


Content Supplied by NHS Choices