From the Guidelines
Foot pain can be effectively managed with a combination of rest, ice, compression, and elevation (RICE), along with stretching exercises and proper footwear, as evidenced by recent studies 1. The management of foot pain involves a multifaceted approach, including:
- Taking over-the-counter pain relievers like ibuprofen (Advil, Motrin) 200-400mg every 6-8 hours or acetaminophen (Tylenol) 500-1000mg every 6 hours as needed for pain 1
- Applying ice to the painful area for 15-20 minutes several times daily, especially after activity
- Wearing supportive, properly fitting shoes with good arch support and considering the use of cushioned insoles or orthotic inserts
- Stretching exercises for the feet and calves, particularly for plantar fasciitis, such as rolling the foot over a tennis ball or stretching the calf by leaning against a wall with the affected leg extended behind
- For persistent pain, especially in the heel or arch, night splints may help maintain a stretched position while sleeping It is essential to seek medical attention promptly if the pain is severe, worsens despite these measures, or is accompanied by swelling, redness, or inability to bear weight. The American College of Radiology recommends radiography as the initial imaging study for chronic foot pain of unknown etiology, with MRI or CT scans considered for further evaluation if necessary 1. In cases of suspected plantar fasciitis or Achilles tendinopathy, eccentric strength training and stretching exercises have been shown to be effective treatments 1. Overall, a comprehensive approach to managing foot pain, incorporating both conservative measures and, when necessary, medical imaging and intervention, can significantly improve outcomes and quality of life for individuals suffering from this condition.
From the Research
Causes of Foot Pain
- Foot pain can be caused by various factors, including advancing age, obesity, and biomechanical abnormalities in the foot, such as tight Achilles tendon, pes cavus, and pes planus 2, 3.
- Plantar fasciitis is a common cause of heel pain, which can be associated with a degenerative process at the origin of the plantar fascia at the calcaneus 3.
- Morton neuroma, consisting of interdigital neuronal thickening and fibrosis, can also cause burning pain in the ball of the foot and numbness or burning pain that may radiate to the affected toes 4.
Prevalence and Impact of Foot Pain
- Foot pain is a common accompaniment of advancing age, affecting at least one in four older people 2.
- Foot pain can have a significant impact on mobility and quality of life, resulting in many older people needlessly enduring chronic foot pain and related disability 2.
- Foot and ankle pain affects 20% of the population over 50 and significantly impairs mobility and ability to participate in activities of daily living (ADLs), as well as increases fall risk 5.
Management of Foot Pain
- Conservative interventions such as routine foot care, footwear advice, and foot orthoses are effective at reducing foot pain and may also assist in maintaining mobility and independence in older people 2.
- Nonoperative treatment, including activity restriction, orthotics, and corticosteroid injection, can be effective for Morton neuroma, plantar fasciitis, and Achilles tendinopathy 4.
- Injection therapy, including steroid, alcohol, and capsaicin injections, can provide some benefit for chronic foot pain conditions, but the evidence is limited and the benefit is often short-lived 5.
- Foot orthoses and corticosteroid injection can be effective interventions for plantar heel pain, and predictors of response to these interventions include ankle dorsiflexion, fear-avoidance beliefs, and BMI 6.