Foot Pain: Top Causes & Treatment

Every day, we rely completely on the 28 bones, 33 joints, 112 ligaments, and the 34 intrinsic and extrinsic muscles that control our feet to be able to take us anywhere we want to go, cover as many miles as we need to, and stay stable over a range of challenging terrain. More than that, we expect our feet to stay comfortable and painless while:

• Supporting our entire body weight on one foot during parts of the gait cycle, which is estimated to increase to up to three times our body weight during running
• Helping to keep our entire bodies balanced and upright
• Absorbing shock and transferring ground reaction forces
• Adapting to any kind of shoe we put our feet in

Simply put, the demands that we place on our feet without realising are large, and so it’s no surprise that at times, injury and pain may result. As physiotherapists that treat a wide range of foot problems, we’ve put together a list of some of the common causes of foot pain depending on which area of the foot you’re experiencing pain, and how to successfully rehabilitate your foot pain.

Causes Of Pain On The Outside Of The Foot

• Peroneal tendonitis: Your peroneal tendons run down the outside of your leg, crossing your outer ankle and moving down to the outer border of your foot. When the tendons are strained, whether it’s a one-off event like an ankle sprain or repetitively over time due to the structure and function of the feet and legs, the tendons become irritated, leading to pain. Pain is often felt around the outer ankle, especially when twisting the foot inwards. Pain may also be felt when you place your fingers behind the bony bump on the outside of your ankle called your lateral malleolus.
• Cuboid syndrome: When the ligaments and tissues around your cuboid bone are over-stressed or damaged, this can adjust the alignment of the bone in a way that produces pain. The pain may radiate up or down the foot, and can be worse when walking without good support from shoes or orthotics, especially over uneven ground. We often see this condition occurring together with ankle sprains.
• Sinus tarsi syndrome: The sinus tarsi is a small canal on the outside of the ankle that can be injured by overusing or injuring the ankle like in an ankle sprain. The pain you feel isn’t so much on the border of the midfoot or forefoot as it is between the heel and ankle. If you’ve had repeated ankle sprain, you are more likely to have sinus tarsi syndrome.
• Stress or avulsion fracture: Stress fractures occur when a bone is repetitively overloaded, forming micro-cracks that grow bigger as the pressure isn’t managed and offloaded. This pain tends to be gradual at first, feeling more like a niggle or dull ache, and progressing to a sharper and more intense pain as the injury worsens. In avulsion fractures, a small piece of bone is pulled off and separated due to the strain of an attaching tendon or ligament. The most common site for this to happen in the foot is at the fifth metatarsal, which is the bony bump you feel when you move your fingers along the outer border of your foot. These often occur alongside sprains and other traumatic injuries.

Causes Of Pain On The Inside Of The Foot

• Plantar fasciitis or fasciopathy: Your plantar fascia is a thick connective tissue band that starts at your heel and then spreads across your foot like a fan to connect to all five toes. The plantar fascia helps support the function of the foot, while helping it maintain its shape, strength and flexibility. When the plantar fascia is overloaded, it can sustain micro-tears and become damaged, inflamed and painful. This is known as plantar fasciitis.
• Posterior tibial tendon dysfunction (PTTD): PTTD describes the dysfunction to a tendon called the posterior tibial tendon, which travels down the side of our lower leg, crosses the inside of our ankle, and attaches to the underside of the foot. The posterior tibial tendon plays a very important role in the structure of our foot and arch, as well as helping support healthy and pain-free movement every time we take a step. When the tendon is repetitively overloaded and strained, the tendon can become unable to carry out its role.
• Tarsal tunnel syndrome: Tarsal tunnel syndrome produces pain, numbness, tingling or burning sensations on the bottom of the foot, often around the heel. It occurs when a prominent nerve (the posterior tibial nerve) is compressed when it passes through a dedicated space near the inside of the ankle called the tarsal tunnel, named after the tarsal bones of the foot where the tunnel is located.

Causes Of Pain At The Back Of The Heel

• Achilles tendinopathy: Your cord-like Achilles tendon is the strongest and largest tendon in your body, attaching to the back of your heel. When the Achilles is overloaded, overused or strained, pain can occur either at the mid-portion of the tendon or at its insertion. This can be during walking, running, and movements like standing on tip-toes.
• Bursitis: Bursitis is the inflammation of a bursa - a small, fluid-filled sac that sits between structures in the body to help prevent painful friction and rubbing, while promoting lubrication and healthy movement. When the bursa is overloaded, like from excess pressure from tendons or other structures, it can become swollen and painful. There are two bursae positioned at the back of the heel that can cause your heel pain - retrocalcaneal bursitis (the bursa between the Achilles tendon and the heel bone) and superficial calcaneal bursitis (sits just beneath the skin, at the back of the heel where the Achilles tendon inserts).
• Posterior ankle impingement: A posterior ankle impingement is felt when the forefoot and toes are pointed down, which narrows the space at the back of the ankle and can impinge the structures there - often an accessory bone. The cause of the impingement will need to be identified with imaging studies so that the best treatment plan can be created.
• Sever’s disease: Sever’s disease is a type of growing pain that only presents in children, often between ages 7-15 years. Sever’s disease occurs when the growth plate at the back of the heel is overloaded and consequently irritated, most often from tension from the Achilles tendon. The result is pain at the back of the heel.

Arthritis In The Feet

• Osteoarthritis: Osteoarthritis is the wear and tear arthritis that develops slowly over time as the cartilage that covers your bone ends wears down. The cause is largely from natural use over many years, though injuries, alignment issues within the joint and other diseases may result in it developing at a faster rate.
• Rheumatoid arthritis: Rheumatoid arthritis is an autoimmune disease that affects the joints. It occurs when your body’s immune system attacks the joints and causes damage, inflammation and pain. If the effects of rheumatoid arthritis remain uncontrolled, it can cause permanent changes in the appearance of the joints, especially at the feet and hands.
• Gout: Gout is an inflammatory arthritis that results from a high concentration of uric acid in the blood. It is associated with a high intake of purine-containing foods like red meats and shellfish. Gout feels like sharp, painful crystals in the joints. Often, this is in the big toe or the joints of the feet.

Treating Foot Pain

Treating foot pain can often be made harder by the fact that we spend the majority of the day on our feet, but we’re proud to have a team of highly regarded, experienced and trusted physiotherapists who are very knowledgeable about the best approaches to foot pain. Every assessment starts with a comprehensive exam that will help your physio get to know everything from your medical history, to the what’s, how’s and why's of your pain, to your lifestyle and personal circumstances - like whether you’re on your feet all day at work - to be able create a customised plan that you can gain the best results from.

We have a range of evidence-based treatments and rehabilitation approaches, and our team goes above and beyond to explain everything you need to know to continue to make the best decisions for your injury at home, in the workplace, and in light of your existing physical activity commitments.

As part of your care, we also have a dedicated Pilates studio that helps our clients excel in their rehab, and get the best long-term outcomes.

You can book in with any of our three clinics available in Hong Kong Central and Wong Chuk Hang through either booking online, or calling us on +852 2801.4801