Foot Pain Clinic | Heel, Ball, Arch or Toes?

First steps of the day: Sharp heel pain that eases after a few minutes points to the arch tissue.
Numbness rather than pain: Points to a nerve, at the foot, the ankle or the lower back.
Diabetes changes things: Reduced sensation means damage can go unnoticed. Any wound needs seeing.

Where in the foot?

Heel

Pain under the heel on the first steps of the day, easing as you walk, is the classic pattern of plantar fascia irritation
Pain at the back of the heel belongs to the Achilles tendon where it attaches
A heel spur seen on X-ray is usually not the cause — many people have one and no pain at all

Ball of the foot

Burning or a feeling of a pebble underfoot, with numbness between two toes, suggests a nerve growth between the bones
Diffuse aching under the ball, worse in hard shoes or on hard ground
A stress fracture after a jump in training: sharp, local, worse with every session

Arch and midfoot

An arch that is flattening, with aching on the inner side, points to the tendon that supports it
Midfoot arthritis — aching across the top with activity, sometimes with a bony ridge
Pain on the top of the foot in a runner, worse each session, may be a stress fracture

Toes

A bump at the base of the big toe that rubs in shoes, with the toe drifting across
Stiff, painful big toe on pushing off, which is arthritis of that joint
A red, swollen, exquisitely painful big toe coming on overnight suggests gout
A nail digging into the skin, red and tender at the edge

When it hurts matters as much as where. Pain worst on the first steps out of bed, pain that builds through a day on your feet, and pain at night without any use at all point in three different directions.

If you have diabetes

Reduced sensation means a blister, a cut or a stone in a shoe can go unnoticed until it has become a problem. The foot stops giving warnings.

Check your feet daily, including between the toes and the soles, using a mirror if you cannot see them easily
Any break in the skin that is not healing needs to be seen, not watched
Burning or numbness in both feet, starting at the toes, is usually nerve damage rather than a foot problem — see neuropathic pain
New swelling, warmth or a change in shape in a numb foot should be assessed promptly

When foot pain needs attention quickly

The same day for a wound or ulcer that is not healing, particularly with diabetes, and for a hot, red, swollen foot with fever.

An emergency department if the foot is cold, pale or numb after an injury, if it looks deformed, or if you cannot bear weight at all.

How foot pain is assessed

History. Where it hurts, when in the day, what footwear and what activity
Examination. Standing and walking, arch shape, tenderness by location, joint movement, sensation and pulses
X-ray, weight bearing. The foot only shows its true shape under load
Ultrasound or MRI. For tendons, the plantar fascia, nerve growths and stress fractures
Blood tests where gout or inflammatory arthritis is possible

Foot pain treatment

Most foot problems respond to changing what the foot is asked to do, which is unglamorous and effective. Surgery is reserved for the ones that do not.

Footwear and load

A stiffer sole, more room across the toes, or a heel that is neither flat nor high. Reducing the miles or the hours standing, temporarily, often does more than any treatment.

Stretching and strengthening

Calf stretching in particular. A tight calf loads the arch and the forefoot with every step, and is part of the picture in a great many foot complaints.

Insoles and padding

Off-the-shelf supports help many people; a made-to-measure insole is worth it where the foot shape is the problem rather than the load.

Injections and surgery

A guided injection for a stubborn tendon or nerve problem, and surgery for a deformity that shoes cannot accommodate, a nerve growth that has not settled, or arthritis that limits walking.

Your surgeon

Foot problems here are seen by Dr Jeffrey Tan Gek Meng, an orthopaedic surgeon whose subspecialty is foot and ankle. He also treats sports injuries and lower limb trauma, and consults in English, Mandarin and Hokkien.

Footwear and load first. Most foot pain improves with changes that cost nothing.
Surgery where shoes cannot solve it, which is the honest test for most deformities.

When to see someone about it

Pain lasting more than a few weeks despite changing footwear
Numbness or burning, in one foot or both
A deformity that shoes no longer fit around
Pain that wakes you, or is there before you stand up
Any wound on the foot that is not healing, particularly with diabetes

Why see us about it

Foot and ankle is a subspecialty here. Dr Jeffrey Tan is our foot pain specialist by training.
The nerve is considered too. Burning in both feet is often not a foot problem at all.
Weight-bearing X-rays, because a foot examined lying down tells you less than half the story.

Common questions

Why is my heel worst first thing in the morning?

The tissue along the arch tightens overnight and is stretched suddenly when you stand. Pain that is sharp for the first few minutes and then eases is the classic pattern.

I was told I have a heel spur. Is that the problem?

Usually not. Spurs are common in people with no pain at all, and removing one is rarely the answer. The pain generally comes from the soft tissue rather than the bone.

Do I need special insoles?

Not always. Off-the-shelf supports help many people, and footwear changes help more. Custom insoles are worth it when the shape of the foot is the problem rather than the load on it.

Both my feet burn at night. Is that a foot problem?

Often not. Burning in both feet, starting at the toes, usually points to nerve damage, with diabetes the commonest cause, and it is treated differently from a mechanical foot problem.

Can I keep running?

Frequently yes, at a reduced volume, but not if the pain is sharp, local and worse with every session. That pattern suggests a stress fracture and needs assessing before you continue.

Do I need a referral to see a foot pain doctor?

No. Bring the shoes you wear most, along with any X-ray or scan reports. The shoes are often more informative than the pictures.

Related conditions

Ankle pain · Gout · Neuropathic pain · Nerve and leg pain · Osteoporosis

Foot pain