Why Do the Bottoms of My Feet Hurt So Bad?

Numerous conditions may cause foot pain, including tendon or bone injury, nerve pain or arthritis.

There are numerous causes of pain on the bottoms of the feet. Some common causes of pain on the soles of the feet include: 

• Plantar fasciitis
  • Causes pain beneath the heel and sole of the foot
  • Results from strain on a ligament that extends from the heel bone and fans out along the bottom of the foot to the toes. The fascia provides support to the arch of the foot and acts as a shock absorber.
  • Plantar fasciitis is caused by repetitive impact to the heel and plantar fascia by activities such as running, marching, jumping, dancing, or standing for long periods 
• Metatarsalgia
  • Causes pain in the ball of the foot
  • Results from inflammation in the metatarsals, the foot bones closest to the toes 
  • May occur from running or other activities that put a lot of pressure on the feet, wearing tight-fitting shoes a lot, or certain foot problems
• Arthritis
  • Causes pain and stiffness in the small joints of the foot and ankle 
  • Arthritis is inflammation of the joints
  • There are more than 100 forms of arthritis
• Fractures/stress fractures
  • A fracture is a break in the bone that may be caused by direct injury to the foot, twisting of the foot, and conditions that can make the bones weak such as osteoporosis or certain medications
  • Stress fractures are overuse injuries in which the repetitive stress of the foot striking the ground can cause trauma
  • Stress fractures are common in people who participate in tennis, running, gymnastics, and basketball
• Posterior tibial tendonitis
  • Causes pain just under the inner ankle
  • The posterior tibial tendon attaches the calf muscle to the bones on the inside of the foot and functions to hold up the arch and support the foot when walking
  • Acute injury, such as a fall, cause posterior tibial tendon inflammation
  • Inflammation may result from high-impact sports, such as basketball, tennis, or soccer
• Turf toe (hyperextended great toe)
  • Causes pain in the big toe area and the big toe joint
  • A sprain of the main joint of the big toe, caused by forced hyperextension of the great toe as it strikes the ground or another player
  • American football running backs and quarterbacks are at increased risk, especially from playing on artificial turf
  • Tarsal tunnel syndrome
  • Causes aching, burning, numbness, and tingling in the sole of the foot, toes, and heel
  • The foot equivalent of “carpal tunnel syndrome” 
  • A result of compression of the tibial nerve in the region of the ankles 
  • Commonly caused by a fracture or dislocation involving the bones of the rear foot or ankle (talus, calcaneus, or medial malleolus)
  • May also be caused by rheumatoid arthritis, other causes of inflammation, and tumors

Treatment for pain on the soles of the feet depends on the cause. 

• Plantar fasciitis
  • Rest
  • Ice
  • Stretching
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) for pain
  • Protective footwear
  • Shoe inserts
  • Tape support 
  • Steroid injections for pain, though the effects usually only last a few weeks
  • Walking cast 
  • Shockwave therapy
  • Surgery (usually a last resort)
• Metatarsalgia
  • Rest
  • Ice
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) for pain
  • Wearing sturdy shoes with a metatarsal insert 
  • Wearing arch supports or orthotics 
  • Surgery to correct the position of the foot bones
• Arthritis
  • Minimize activities that worsen pain
  • Do low impact exercises such as swimming or cycling instead of high impact activities such as running
  • Weight loss
  • Physical therapy
  • Assistive devices such as braces, shoe inserts (orthotics), or custom-made shoes with stiff soles and rocker bottoms 
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) for pain
  • Steroid injections for pain, though the effects usually only last a few weeks
  • Surgery, for cases that do not respond to non-surgical treatment
• Fractures/stress fractures
  • Fractures are treated with immobilization of the injured area with a cast, splint, brace, walking cast, or healing boot 
  • Stress fractures are treated with rest and shoe inserts or braces 
• Posterior tibial tendonitis
  • Rest
  • Ice
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) for pain
  • Immobilization with a short leg cast or walking boot for 6 to 8 weeks
  • Orthotics
  • Braces
  • Physical therapy
  • Steroid injection
  • Surgery, only if pain does not resolve after 6 months of non-surgical treatment
• Turf toe
  • RICE: 
    • Rest
    • Ice
    • Compression
    • Elevation
  • Taping the big toe to the smaller toes to restrict motion
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) for pain and swelling
  • Immobilization for several weeks with a walking boot or cast
  • Physical therapy 
  • Surgery, if symptoms persist or the level of athletic play is affected
  • Tarsal tunnel syndrome
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) 
  • Shoe modification
  • Orthotics
  • Corticosteroid injection 
  • Surgery to decompress the tibial nerve at the ankle for those who do not respond to conservative therapy