my feet hurt

AUTHOR: Marc Mitnick DPM

Podiatric Medical Review Board

--> My feet hurt


This is the most common statement that patients make to me. It then becomes my job to determine why their feet hurt. Unlike most other sites on the internet who seem to have a "one cure fits all" philosophy such as wearing an orthotic for any type of pain regardless of its source, the purpose of this page is an attempt by me to give you, the reader, a means to narrow down the causes of why your feet hurt.

We as foot specialists break down the foot into four systems.

VASCULAR conditions of the feet

This is the circulation coming down into the foot, known as arterial circulation and the circulation leaving the foot going back up to the heart known as venous circulation. Can circulation cause foot pain? Most definately. If too little blood is getting into the foot it will cause pain and discoloration usually most noticeable when the foot is elevated such as during rest. Putting the feet in a dependant position (standing up) will reduce the symptoms somewhat. Poor venous return on the other hand will generally cause pain, swelling and sometimes breakdown of the skin (skin ulcers) when standing too long. If sitting down and elevating your feet seems to make the pain less intense, then there is a possibility that your foot pain is from lack of adequate blood flow back to the heart.

This of course is a very broad description of circulation as the source of why your feet hurt as there are many other presentations to the feet and lower leg that will be circulatory related and need to evaluated by your doctor. Circulatory problems, unlike most bone, joint or skin problems have the potential to become very serious problems with serious implications. In general if your feet change color and swell depending on whether you are standing, sleeping or sitting, you should be evaluated for poor circulation.

See also: peripheral circulation

See also: blue toe syndrome

See also: cold feet

See also: compartment syndrome

See also: edema

See also: gangrene

DERMATOLOGICAL conditions of the feet

As the name implies are skin and nail conditions. These types of problems are probably the easiest for the patient to diagnose as there will be some kind of localized skin discoloration either in the form of redness, some sort of oozing, formation of scaling, crustiness, open wound, etc. There may also be nail issues such as thick discolored nails or ingrown nails either with or without infection.

In many cases these skin and nail problems will be the result of some sort of trauma, but in many cases the origin will be insidious either occurring very quickly or developing over time. I find that most patients will attempt to remedy the problem on their own, either by performing "bathroom surgery" where they attempt to cut away something, or by visiting the local drug store and applying some kind of ointment or cream in an effort to rid themselves of the problem. I guess I probably end up seeing those people that cannot rid themselves of their skin or nail irritation.

Some of the more serious skin and nail problems that may be present include ulcers, infections and skin cancers including melanoma. Any open wound should not be self treated but instead should be under the care of a doctor familiar with wound care. Infections as well should be medically treated as many simple infections have the potential to become very serious if improperly treated by the individual. A skin growth that does not look normal, even though there may not be any pain associated with it, should be examined by a doctor who may perform a biopsy (both skin and nail biopsies) if he or she thinks the growth is suspicious.

One of my big concerns is those individuals who have a thick dark nail and just attribute it to nail fungus. In most cases that is all it is, but in rare cases it may also indicate a melanoma of the nail bed or nail growth plate and if left untreated can have catastrophic consequences.

See also: athletes foot

See also: blisters

See also: cellulitis

See also: decubitus ulcer

See also: eczema

See also: heel fissure

See also: ingrown nail

See also: melanoma

See also: nail fungus

See also: puncture wounds

See also: venous stasis ulcer

See also: warts

ORTHOPEDIC conditions of the feet

This is the section that deals with musculo-skeletal pain either the result of injury, overuse where a particular foot structure is being over worked and eventually starts to break down. There are also metabolic diseases that can affect the joints of the body and the feet are no exception. There are numerous reasons that a foot will start to hurt and in many cases the pain can occur for no apparent reason at all.

We all get aches and pains for one reason or another and in the majority cases these pains will subside in a reasonable period of time and we then forget about them. Foot pain that persists regardless of all attempts to remedy it either by oral or topical medication, rest, change of shoes, change in activity, etc. will more than likely require medical attention. A lot of the pain seen in the foot can be simply part of the aging process as the feet tend to show arthritic changes before other parts of the body. This type of pain can be intermittant or can be an ongoing issue.

Other types of musculo-skeletal pain may be the result of trauma. Simple sprains and strains will tend to improve on their own; sometimes they will linger and they too will require medical attention. In most cases of trauma, no matter how small, if pain persists beyond a couple of days, a precautionary x-ray is always indicated as there is always the chance of a broken bone. In cases of simple fractures you cannot just look at the foot to determine if it is fractured. You would be amazed how many people have asked me that over the years.

Musculo-skeletal pain is probably the most common type of pain that brings a patient into the podiatrist's office. It is very likely that your musculo-skeletal pain, once identified, will not follow the same course of remedy as your friend, co-worker, or relative who suffered from the same problem. There are just too many variables involved, one of which is patient compliance. I have found over the years that those patients who took my advice seriously tended to get better quicker. The problem with musculo-skeletal pain in the foot, as I have mentioned numerous times on this site, is that it is very difficult to rest a foot (for minor injuries), so every time a person walks, they basically re-injure the foot and that is why foot problems can take so long to heal.

If your foot has started to hurt and there is no history of trauma, in an effort to avoid a visit to the doctor, first take a look at the shoes you are wearing. Is there one pair of shoes that seems to aggravate the problem more? Did the problem begin when wearing a certain pair of shoes? Have you been doing an activity that you are not accustomed to doing, like perhaps a new job where you are required to stand long hourts. In other words, try and think about what caused your pain in the first place; perhaps by eliminating the "cause" you will be able remedy the "problem".

Some musculo-skeletal problems cannot be remedied by conservative measures and many times it takes surgical intervention to fix the problem. Just keep in mind that surgery is not a panacea for all problems. Most foot surgery are elective procedures meaning you technically can live with your problem. I bother to mention this because sometimes surgery, although it looks and sounds good on the drawing board, does not always end with the anticipated results. The last thing you want to get involved in is then having multiple surgeries for the same problem, because no matter how good the surgeon and the surgery, mankind cannot do the same job that mother nature did.

As a closing thought many people attempt to cope with their musculo-skeletal pain by living on aspirin and other inflammation reducing, over the counter, pain medication. This type of treatment is fine for short term reduction of pain, but it is not a solution. The chronic use of this type of medication can cause stomach problems, kidney problems and liver problems all of which can have devastating affects. Just because a medication is sold without a prescription, does not make it safe to abuse.

See also: ankle pain

See also: arthritis

See also: bone spur

See also: bunion

See also: bursitis

See also: capsulitis

See also: cavus foot type

See also: flat feet

See also: fracture

See also: ganglion cyst

See also: hammertoes

See also: heel pain

See also: metatarsalgia

See also: midtarsal fault

See also: sesamoiditis

See also: surgical consideration

See also: tendonitis

NEUROLOGICAL conditions of the feet

This refers to abnormal sensations occurring in the feet as well as loss of muscle strength. Neurological problems are divided into two basic types, sensory and motor loss. In sensory deficit you may be experiencing things like numbness, tingling, burning or even hyper-sensitivity or a heightened sense of feeling in the feet. This is usually caused by damage to a sensory nerve. The damage can be any where from the lower back down to one of the local nerves in the foot. If the damage to a sensory nerve is coming from the lower back, often times it will affect both feet in similar locations. Local nerve irritation of a sensory nerve will usually only occur on one foot and it will be limited to a very specific location, which is usually the affected nerve innervates.

Motor nerve abnormalities will generally adversely affect the ability of the muscles in the foot and leg to function properly. This will result in an abnormal gait because of loss of muscle strength.

Nerve abnormalities in many instances can be of a worsening nature. This is a cause for concern when the neurolgical deficit affects a good portion of the feet and extends to the legs. Local nerve irritation also has the propensity to worsen, but the damage done is generally local and with the exception of the pain it may cause, generally will not lead to permanent disability.

See also: tarsal tunnel

See also: Mortons neuroma

See also: neuropathy

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