June 1, 2019

Causes, Symptoms, and Investigations for foot pain

Causes, Symptoms, and Investigations for foot pain

One common complaint amongst my patients is foot pain. Some weeks back, I met a young man that presented with foot pain. He said he has had no injuries recently, and he wondered why he has pain on both if his feet.

He described the pain as sharp and excruciating, stopping him for his daily activities. He was concerned about the possibility of a fracture, that is, the breakage of one or more bones in the body.

So, when he presented, he wanted an instant X-ray of both feet to be carried out. We did, there was no visible sign of a fracture, neither was there any dislocation.

But, there were signs of arthritic lesions that could be seen, So this explains the reason he could have had pain in his foot without any injuries.

There are millions of people dealing with foot issues in the world. In the United States, for example, more than 75 per cent of both male and female will have experience at least one-foot issue in their lifetime.

Moreover, pain is expected in the foot. The feet contain about 8000 nerves, and pain can easily be felt if you have an injury.

This article explains the anatomy of the foot, types of foot pain, parts of the foot and the cause of pain around that region and foot first-aid before seeing a doctor.

Basic Foot anatomy

The anatomy of the foot describes the design of the foot, the bones that make the foot, the joints and the blood supply and innervations.

The foot is the lowest part of your body. Its main function is to carry the whole weight of your body. That is, if you are obese, it means your foot is doing much work to keep you going.

Likewise, if you have a foot injury, it becomes difficult to move around easily with your foot. This is because carrying your body’s weight will cause severe foot pain.

There are 33 bones in your foot. That’s much, but an injury to any one of them will cause severe foot and ankle pain depending on which bone is affected.

Theses bone are joined together in what doctors call Joints. These joints fix one bone together. In the foot, there are 26 joints.

Now there are also ligaments in the foot. These ligaments help to hold the foot bones together. For example, imagine the bone and the joint without any band to hold them together. The foot will be weak and unstable. Right?

The band that holds bones and joints together is called Ligaments. There are about 11 ligaments in the foot, which helps for its stability.

But before we discuss the most common ligaments that are likely to cause pain the foot, it is important we decide the foot into three parts.

For ease, doctors divide the foot into three parts: the hindfoot, the midfoot, and the forefoot. The word “hind” means whats behind. That is the posterior part of the foot. The word “mid” means the middle of something, That is, the middle of the foot. Similarly, “fore” means the foremost or anterior part of the foot.

In the back of the foot, that is, the hindfoot, there is a joint right there. Its called the ankle joint made by the connection of 3 main bones. Your leg bones move downwards and attach itself to the bone of the foot forming the ankle joint.

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The long bones of the leg are the tibia and fibula bones. In the upper part of the leg, they form the knee joint. Then, lower down the form a joint with the talus bone of the foot forming the ankle joint. The talus bone posteriorly has an extension called the calcaneus, which is generally referred to as the heel bone.

At the midfoot are cuboid, cuneiform, and navicular bones. These bones form the upward curve of your foot called an arch. The essence of this arch is to maintain the stability of the foot and carry your huge body weight.

From the inside to the outside, the midfoot bones are arranged thus; The Navicular, three cuneiform bones and the Cuboid bone with is on the outside of the foot.

At the forefoot are about metatarsal and phalanges, precisely about five metatarsal bones and lower down 14 phalanges.

Next, are the ligaments and tendons of the foot. For ease, We will only discuss the common ligaments that can cause pain at the top, bottom, back, and side of the foot.

In the outer side of the foot is the Lateral ligament. These ligaments, when injured, is the most frequent cause of outside foot pain. On the inside of the foot are the medial or deltoid ligament. If you injure this ligament, you will have pain on the inside of the foot.

At the back of the foot is the Achilles tendon, this tendon is vital for movement, standing, and jumping. When it ruptures or gets torn, you will also experience back of foot pain with inability to move around.

In the bottom of the foot is what we call the plantar fascia. This fascia extends from just under the heel bone to the ball of the foot. When it is injured, you are likely to experience the bottom of foot pain.

Symptoms of foot pain

Now we understand the basic anatomy of the foot, its time to delve into what causes foot pain. But first, what are the most common symptoms of a foot injury or inflammation?

When you get an injury to your foot bones, tendons or ligaments, you will definitely feel pain. Now pain may be mild, moderate, or severe.

There is not a clear cut severity pattern of the pain as no two individual is the same. In other words, depending on the type of injury and the person’s threshold for pain, pain may be mild or enough to disrupt activity.

The most characteristic sign you may experience is pain around the area when there is an injury. In other words, if you’ve injured you navicular bone that is located medially in the foot, you will feel inside foot pain. Likewise, if your plantar fascia is inflamed, you will experience pain in the bottom of the foot.

So, pain is the most common sign most people with foot injury will experience.

Another more characteristic symptom of foot injury is swelling. Swelling can affect the whole foot or part of it. That is you may notice swelling just around the top or on the side of the foot. In severe cases, it may extend from the top of the foot to the ankle and the legs.

When you are dealing with foot swelling, it is essential you also know that the primary cause may be systematic. That is, it may be a result of issues with one of your body’s main organ. For example, leg swelling with mild pain is common with people with an ailment called heart failure.

Heart failure means your health is not functioning as usual, so it is not pumping blood at the required capacity. In this condition, you are likely to have a blood pool at your lower limbs and foot. If this happens, you can have foot swelling, even without a visible injury to the foot.

In the case of foot swelling from direct injury, you will notice that there is welling around the specific part of the foot (though it could affect other areas too) and there is redness.

Another quite common symptom of a foot injury is difficulty walking. You may find it challenging to move around. The Pain will often get severe on movement and worse as you run or walk. Immediately there is a cessation of movement or activity, the pain stops. This kind of pain signifies possible injury of the foot.

Investigations for Foot pain

As earlier explained, not all foot swelling and pain originate from the foot. This means you must see your doctor if your symptoms continue for days or weeks.

At first, your doctor will ask you multiple questions to try to find out why you have foot pain. In most cases, an apparent cause is seen.

For example, if you have swelling from heart failure, your doctor will examine your chest wall, and abdomen, and do a general examination of your body system. Not just your legs will be swollen, but your thighs in severe illness with an enlarged tender liver. Your doctor may also find your lungs a little bit congested will lots of crepitations in the lower zones of the lungs.

These are classic finding that can be picked up by your doctor, which may not require a test. Nevertheless, some investigations will be necessary to identify the main reason you have foot pain. They include,


This is the most ordinary investigation we may require to determine the cause of your foot pain. Depending on when it is carried out and the type of fracture, it may not be beneficial.

Nevertheless, your doctor will see an obvious fracture if there is one. For ladies who wear high heels and later on develop stress fractures of the small bones of the foot, An x-ray scan may not be useful right away.

If your doctor finds a fracture, he will definitely communicate to you.

Xray may not be limited to just your foot in cases of systemic illness. Your doctor may request you to do other investigations like a chest x-ray. This is necessary to examine the organ in your chest area to determine if there are signs of systemic disease.

Bone scan.

This is another test that will be requested by your doctor, but this depends on the facility. Most rural facilities, like the one I work, do not have a bone scan. But should be available in teaching hospital around the country.

A bone scan is more sensitive than an x-ray and can determine even small cracks in your bone. A small type of fracture called stress fracture may not be easily picked up with an x-ray. In such cases, a bone scan is of most importance

Other tests that will be required. But this depends on your social or financial status and if it is available in your hospital. They include a CT scan or an MRI.

Causes of Foot Pain

There are different causes of pain in the foot. Here are a few

  1. What causes the top of foot pain

Now, pain can happen at the top of the foot. So, if you are experiencing this type of pain, it is most likely you have extensor tendonitis.

Extensor tendonitis means that the top tendons that run above your foot from your legs are inflamed. This is most common in ladies who wear tight shoes or runners who use inappropriately tight footwear.

If you also play football regularly, you may get this type of pain if you do not use shoes that fit entirely the size of your feet.

  1. What causes pain on the lateral side of the foot

The lateral side of the foot is the outmost area ut side your foot. This type of foot pain may result from a sprain involving the lateral ligament.

The lateral side of the foot pan depends on if the lateral ligament is torn. If it is, that’s a severe injury that requires an Orthopedic surgeon review and management.

  1. What causes ankle and foot tendonitis

Another reason for foot pain is tendonitis involving the foot. Foot tendonitis means tendon pain. That is, if tendons are inflamed, the area swells up, causing pain.

But foot tendonitis can be treated, so see your doctor.

  1. Bottom of foot pain

Pain in the bottom of the foot can also happen if the plantar fascia is involved. That is a broad like fascia that spans the bottom of the foot. If injured, pain is more when waking up in the morning and tend to subside after taking a few steps.

Bottom of foot pain can be treated. So, see your doctor.

How to prevent Foot pain

There are numerous ways you can prevent injuries, even in a physically demanding Job. As the WashingtonPost explains, taking care of your feet is one of them. If you are a runner or sportsman, wear appropriately sized footwear.

Do not continue running with foot pain. It could be a fracture that could break further with severe complications. For ladies, its time to stop wearing high heels but shoes that fit.

Do not do sports also on an uneven surface. This can twist your ankle and cause inflammation of your lateral or medial ligament.

Finally, before seeing your doctor, rest your foot, use ice and bandages, elevate your foot and take painkillers for the pain. Usually, this will help for mild pain, but you must see your doctor.

Dr Akatakpo Dunn works at the Presbyterian missionary hospital located in Ebonyi state, Nigeria. He is a passionate medical writer and a lover of Christ.