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The human foot is a complex structure of bones, joints, muscles, and ligaments that work together to support the body’s weight and facilitate motion. Pain is often a sign that something is not working properly.
There are many reasons why you might be experiencing foot pain. You may have plantar fasciitis or another condition such as heel spurs or flat feet. There could be a biomechanical issue like overpronation. Or you may just need better shoes.
But you’re not alone. Studies show that up to 25% of us have pain in the feet that keeps us from our day-to-day activities.
Why do my feet hurt when I walk? A Primer on Foot Pain
When you see your doctor, podiatrist, or PA about foot pain, they may start their assessment with an anatomy-based approach. The foot can be divided into three sections: forefoot, midfoot, and hindfoot.
The hindfoot is the simplest structure comprising the heel bone (calcaneus) and the talus which sits on top of the calcaneus.
The midfoot contains 5 tarsal bones: the three cuneiforms, the navicular, and the cuboid.
The forefoot consists of all that’s left including the bones that provide length to your foot (the metatarsals) and the toes (phalanges).
After identifying where your foot hurts, you can help your doctor or PA by explaining how the pain started. Describe how the pain feels, including any numbness or tingling. Point out things that make the pain better or worse. Did you get new shoes recently or just go back to the gym? Have you gained weight lately?
A Differential Diagnosis of Foot Pain by Location
Common causes of foot pain, grouped by location, include:
- Plantar fasciitis
- Subtalar arthritis
- Tarsal tunnel syndrome
- Achilles tendonitis
- Posterior tibial tendinopathy
- Sinus tarsi syndrome
- Extensor tendinopathy
- Posterior tibial tendinopathy
- Peroneal tendinopathy
- Navicular stress fracture
- Accessory navicular syndrome
- Warts, corns, and calluses
- Hallux rigidus
- Hallux limitus
When should I be concerned about foot pain?
Pain is your body telling you that something is wrong, at least in the short term. Chronic pain, on the other hand, may have little to do with tissue damage. All pain, but especially chronic pain, needs to be interpreted within a biopsychosocial context.
What is the biopsychosocial model?
We tend to overestimate the biological when thinking about pain. “If I hurt, something is broken.” That’s not always the case. Your biology also includes your genetics which helps determine how your body processes pain.
Social factors also play a role in pain processing. Your support system and socioeconomic status also play a role in how you perceive pain. You can imagine that someone living alone without friends or family nearby and who also struggles with money may have a harder time managing pain.
Psychological factors are perhaps the most important determinant of a person’s perception of pain. Not surprisingly, studies have shown a connection between foot pain and depression.
Now imagine someone who struggles with depression, anxiety, or anger. They’ve learned to be hypervigilant and are prone to catastrophic thinking– do you think they might perceive pain differently than someone who has a healthy sense of self-esteem and plentiful coping skills?
Why do my feet hurt when I wake up?
One of the most common causes of foot pain seen in the primary care office is plantar fasciitis. Plantar fasciitis is the pain you feel on the inside of your heel as you take your first step out of bed in the morning. It is caused by an overly tight band of tissue called the plantar fascia.
The first step to treating plantar fasciitis pain is to stretch the plantar fascia before going to bed. This can be done by rolling the foot over a tennis ball or a frozen water bottle. Another commonly recommended activity in physical therapy is to point your big toe in the air and spell your name. You could also try to pick up a tissue with your toes and move it from one spot to another. Both of these activities will get that fascia moving and stretching.
If home exercises fail, the next step is often a splint worn at night. This allows the plantar fascia to stretch while you sleep making that first step much more tolerable!
How do I get my feet to stop aching?
Most issues with foot pain appear after you’ve been on your feet for a while. When your feet ache at rest, or at night, the problem could be much more serious. For example, diabetic neuropathy often bothers people the most at night. But other problems such as arthritis and stress fractures also tend to cause more pain at rest. Neuropathy is described as a burning sensation while arthritis is more of an ache.
What are the signs of arthritis in your feet?
Osteoarthritis pain tends to develop gradually. Generalized (vs focal) pain also suggests arthritis. Women over 75 are at higher risk for having arthritis pain in the feet. Obesity is also linked to foot arthritis. The large knuckle of the great toe is one of the most common locations for foot arthritis (but it’s also a common location for gout), so make sure you check it out.
Insoles: A Simple Solution
We have many tools in the primary care clinic when it comes to treating pain. We can splint a joint, inject a steroid, and prescribe medication or lifestyle changes. But one often overlooked intervention for foot pain is recommending a custom insole.
The best insoles are probably those made specifically for you by a podiatrist. But they are also the most expensive! These insoles may run well over $200. While it may be a good investment, it’s not the only solution.
Is it worth getting custom insoles?
Most people are probably aware of over-the-counter orthotics and insoles such as those made by Dr. Scholl’s. But those are about as generic as they come. The middle ground would be to use a semi-custom insole, also known as a pre-fabricated insole, such as those sold by Protalus.
How to Find the Best Custom Insoles for You
Shopping for custom, or semi-custom, insoles begins by identifying your goals:
- Support and stability
- Improved Alignment
- Cushion/Shock absorption
- Diabetic Relief
- Plantar Fasciitis Relief
Next, you’ll select your gender and shoe size. Custom insoles are available in a wide variety of sizes, even as large as size 15.5!
After choosing your shoe size, you’ll identify the type of footwear the insole will be going into. Custom insoles usually fit any kind of footwear from gym shoes to work boots. It’s essential to check if the original insole is removable, however.
How do you know if your current shoes have removable insoles? Simply give it a tug to see if it slips out easily. Some shoes have insoles that are cemented or sewn in and won’t be easily removed.
How Custom Insoles Work to Support Your Feet
Insoles provide comfort and support to the feet. It also helps to keep the bones of the foot properly aligned. Custom insoles do this by creating a stable base for the foot and ankle to rest on. A stable base allows the muscles of the legs and hips to function correctly. This means that the body can move more efficiently and with as little discomfort as possible.
Even complex neurological problems such as diabetic neuropathy can benefit from prefabricated insoles. One study found that by improving arch support, pressure on the forefoot was relieved which may lead to fewer injuries and diabetic foot ulcers.
Give This a Try Before You See a Podiatrist
Your feet shouldn’t hurt when resting, walking, or running. Having foot pain doesn’t mean you’re going to have to spend hundreds on custom insoles. Pre-fabricated, semi-custom insoles may really help reduce your pain and you don’t have to see a podiatrist to get a decent pair.
This article was written by PA Doctor staff and medically reviewed by Brandi Blevins, DMSc, MBA, PA-C, AT-C.