Made of 26 bones, 33 joints and over 100 muscles, tendons and ligaments, the foot is amazingly complex, capable of withstanding a lifetime of activity. But feet aren't exactly free from injury. Rather, quite the opposite.
Under the right conditions, any part of the foot is susceptible to injury, whether it's due to a fall, years of wear and tear or even poor-fitting shoes. Plus, certain factors — like age — can make an injury more likely to occur. However, there are things you can do to benefit your feet and ankles and help prevent injury and pain from occurring.
We spoke with Dr. Travis Hanson, a foot and ankle surgeon at Houston Methodist, to better understand these contributing factors, along with some of the most common conditions that affect the foot and ankle. Plus, he gives his tips for reducing the likelihood of injury in the future.
Factors that may contribute to foot and ankle pain
Age
"People of all ages can develop foot pain and certain foot conditions," says Dr. Hanson. "However, the older you get, the more wear and tear we tend to have on our bodies."
"When you're 22 years old, the tendons around your foot and ankle may be pristine, but once you get over 45, those tendons might have some baseline partial tears and scar tissue, basically degenerative changes, that may increase your likelihood of developing some pain," he adds.
"Wear and tear" is a phrase typically associated with osteoarthritis, the degenerative joint disease. But Dr. Hanson notes that this gradual breakdown can also happen to other soft tissues in the foot, including the ligaments, tendons and muscles that support our bones.
Joint stiffness
A separate but related factor to age is joint stiffness, which can add additional strain to certain parts of the foot and ankle and increase a predisposition to pain, says Dr. Hanson.
Stiff joints are common in conditions such as arthritis and other inflammatory conditions, but they can also be associated with others such as bursitis, tendinitis or fibromyalgia.
"Joint stiffness is something we work on a lot for many foot pain conditions, and stretching is often a key part in that treatment plan," says Dr. Hanson.
Overuse and injury
There are two main types of injury: Acute and chronic. Acute injuries happen suddenly, like when you fall and twist your ankle. Chronic injuries, on the other hand, develop over time due to repeated use of a specific area of the body, such as shin splints in runners.
"Overuse injuries are like taking a paperclip and bending it slightly," says Dr. Hanson. "It's not going to break, but if you continue bending it back and forth, it will gradually fatigue and break."
"This can happen to our bodies as well," he says. "Once you subject a structure of the foot and ankle to failure, the more likely you are to develop an injury."
Standing for long periods
"Standing for prolonged periods of time, depending on the situation, can certainly be a risk factor for developing foot and ankle pain," says Dr. Hanson. "But it's not like everyone who has a standing job will have pain. "If they constantly stand on hard surfaces, use the wrong shoes, carry some extra body weight or have joint stiffness, however, then those predisposing factors can eventually lead to foot pain."
Ill-fitting shoes
"A lot of patients come in asking what's the best shoe," Dr. Hanson says. "There really is no 'best' shoe."
"If someone has a certain painful foot condition or diagnosis, there may be some shoes that are more beneficial to that condition," he says.
For example, rather than a more minimalist, flexible shoe, patients with arthritis in their midfoot may benefit from a thicker, curved sole called a rocker bottom designed to make walking a bit easier on the foot, according to Dr. Hanson. But he recommends people without a specific condition go to the shoe store, walk around in the shoes and see what feels good — because nobody's foot is the same.
Excess weight
Along with standing for prolonged periods and poor-fitting shoes, Dr. Hanson adds that excess body weight can also be a contributing factor to foot pain. The idea is that the more weight you carry, the more pressure your joints, muscles and tendons have to endure, thus making them more prone to wear and tear, overuse and injury.
Being overweight is defined as a body mass index (BMI) greater than or equal to 25. Obesity is a BMI greater than or equal to 30.
(Related: PODCAST: When BMI Is Helpful and When It's Not)
Where does it hurt? Common foot pains by source
Feet are complicated, and pain in your ankle isn't the same as your heel or toes — different areas hurt and different reasons. Starting from the ankle downward, Dr. Hanson breaks down common conditions associated with each part of the foot.
Ankle
Common conditions associated with pain around the ankle include:
- Baseline arthritis
- Joint inflammation
- Sprains or strains
Back of the heel
Common conditions associated with pain on the back of the heel include:
- Achilles tendinitis
- Achilles tears or ruptures
- Bone spurs
"When you have pain on the back of the heel, a lot of times that suggests problems with your Achilles tendon," says Dr. Hanson.
Sudden, intense pain could indicate a ruptured or torn Achilles tendon, whereas prolonged inflammation and soreness may instead be Achilles tendinitis or a bone spur that's rubbing and irritating the Achilles tendon, says Dr. Hanson. Achilles tendinitis is a fairly common condition in which roughly one in four athletes at some point will develop. Non-athletes can experience it, too.
"Achilles tendinitis is one of the most common conditions I see," he says. "There are lots of nonsurgical options for that condition, including stretching, icing, physical therapy and sometimes anti-inflammatory medication or a walking boot."
"If none of that calms down the condition, then surgery is likely needed," he adds.
Bottom of the heel
Common conditions associated with pain on the bottom of the heel include:
- Plantar fasciitis
- Blisters
- Flat feet
- Heel spurs
"Plantar fasciitis is another incredibly common condition," says Dr. Hanson. "One of the most common complaints is pain from the first few steps out of bed or when rising from a seated position."
These patients often get tight calf muscles as a result as well. Thankfully, Dr. Hanson says the vast majority of plantar fasciitis resolve without physical therapy but not without icing, stretching and potentially an over-the-counter heel cushion for inside the shoes.
Top of the foot
Common conditions associated with pain on top of the foot include:
- Arthritis
- Sprains or strains
- Bone spurs
"We see a lot of patients with arthritis in their midfoot, and that can cause some activity related pain," says Dr. Hanson. "Specific shoe wear or steroid injections may help, but some may require surgery to actually remove the arthritis."
Toes
Common conditions associated with pain in the toes include:
- Bunions
- Hammertoes
- Gout
It used to be thought that bunions and hammertoes were mostly developed by women who wear tight-fitting shoes. However, they're largely genetic and men can also get them, says Dr. Hanson.
"We usually treat those with recommendations of what shoes to wear, and if that doesn't help, then surgical correction is fairly common" he says.
What larger conditions can present as foot pain?
"There are all sorts of conditions where we as foot and ankle surgeons might make the first diagnosis of a systemic problem across their body rather than a problem isolated in one location," says Dr. Hanson.
Gout is an example of one of those conditions that occurs when you have too much uric acid in the body, a condition known as hyperuricemia. Like salt in evaporating water, uric acid in gout patients form crystals, most commonly at the base of the big toe, causing significant pain and inflammation.
Poor circulation is another common systemic condition Dr. Hanson often diagnoses.
"A patient might come in with foot pain, but come to find out, it's due to poor arterial blood supply," he says. "We will often witness diminished pulses, which necessitate a vascular workup and potentially other tests such as an ultrasound of the arteries."
Other common diagnoses that Dr. Hanson makes include pinched nerves in the back or neuropathy — both of which can cause pain, tingling or loss of sensation in the feet.
How do I know if my foot pain is serious?
"If you have an injury to the foot and ankle, but the pain is relatively mild and you can walk on it comfortably, you might benefit from the RICE method and see how it goes," says Dr. Hanson.
RICE is a technique that stands for rest, ice, compression and elevation and aims to reduce pain and swelling and promote healing.
"If you're not back to full activity in a week or so, it's probably worth getting checked out, but minor contusions and sprains will typically go away on their own," he says.
Ultimately, if you experience an injury, and you're not able to walk on your leg, Dr. Hanson says to seek care and get an X-ray.
For more chronic conditions, Dr. Hanson says you may not need to pursue any treatment if the pain your experience doesn't affect your activity level or bother you too much. However, when that pain starts to affect your life, or you have to modify your activity to work around the pain, those conditions should be evaluated so that you can be at your highest activity level and not have to slow down to accommodate the pain, he says.
Tips for healthy feet and pain prevention
Stretching
According to Dr. Hanson, a regular stretching regimen, especially around exercise and staying flexible is a "huge benefit" not just for foot and ankle pain, but overall health in general.
Since "a lot of pain" around the foot and ankle is due to a tight calf muscle, one exercise Dr. Hanson may recommend to patients is a simple runner's stretch. This involves leading against a table, counter or desk and leaning forward with the affected foot behind you flat on the floor.
(Related: 5 Benefits of Stretching, Plus the Dos and Don'ts)
Weight management
Because excess weight adds pressure to your joints and other tissues, maintaining a reasonable body weight can help reduce any added strain and potentially prevent further foot and ankle pain, per Dr. Hanson.
(Related: How Much Should I Weigh?)
Exercise
Exercise has many benefits beyond preventing foot and ankle pain. Not only can you strengthen the muscles around the foot and ankle, providing you with increased stability to prevent injury, but by incorporating strength training and cardio workouts, you can increase your resting metabolism, improve your mental health and mood and reduce your risk of certain diseases.
(Related: Tips for Exercising with Joint Pain)
