Feet are unfairly blamed as a unit. “My feet hurt” can mean a strained plantar fascia, an arthritic big-toe joint, a stress reaction in a metatarsal, a tendon working overtime on the inside of the ankle, or pain referred from somewhere else entirely. The treatment for each is different, and the generic advice, rest, ice, new shoes, only gets some of them better. Specific beats generic, so the first step is naming the problem properly.
The usual suspects
Plantar fasciitis is the headline act: pain under the heel and arch, worst with the first steps in the morning. It has its own article here because the evidence for treating it is unusually good, a specific stretching protocol resolved most cases in the landmark trial.
Pain in the ball of the foot (often called metatarsalgia, sometimes a Morton’s neuroma when a nerve between the toes is irritated) feels like walking on a pebble. Footwear is usually part of the story; so is how load moves through the foot as the calf and big toe do, or do not do, their jobs.
Inside ankle / arch tendon pain (posterior tibial tendon) shows up as pain along the inner ankle with an arch that flattens more on one side. Caught early, strengthening and support work well; ignored, it can progress to a significant deformity.
Big-toe joint arthritis makes push-off painful and changes how people walk, which then loads everything upstream, ankle, knee, hip, differently.
Stress reactions and stress fractures are the ones not to push through: focal, pinpoint bony pain that escalates with activity needs imaging and offloading, not a strengthening program.
What an assessment adds
Beyond locating the tissue, we look at how you load the foot: calf strength and length, single-leg balance, how the arch behaves standing versus sitting, your footwear’s wear pattern, and what a typical week actually demands of your feet. A warehouse worker on concrete and a runner building to a marathon can have the same diagnosis and need quite different plans.
The honest word on orthotics
Shoe inserts help some people, some of the time. For plantar heel pain there is reasonable support for them as part of a plan. But they are not a substitute for getting the foot and calf stronger, and expensive custom devices are rarely the first move. Often the sequence is: calm the tissue down, load it progressively, fix the footwear issues, and use simple supports if they earn their place.
See a doctor promptly for
- A hot, red, swollen foot, especially with diabetes, where foot problems escalate fast
- Pain after a specific injury with inability to bear weight
- Numbness, colour changes, or wounds that are not healing
- Pinpoint bony pain that keeps escalating
References
- DiGiovanni BF, Nawoczenski DA, Lintal ME, et al. Tissue-specific plantar fascia-stretching exercise enhances outcomes in patients with chronic heel pain: a prospective, randomized study. Journal of Bone and Joint Surgery (American). 2003;85-A(7):1270–1277. Summary: American Family Physician
- Martin RL, Chimenti R, Cuddeford T, et al. Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision 2018. Journal of Orthopaedic & Sports Physical Therapy. 2018;48(5):A1–A38. doi:10.2519/jospt.2018.0302
General information only, not medical advice. Foot pain in people with diabetes deserves prompt professional assessment, always.