What does achy feet mean?

Understanding Achy Feet: Causes and Management

Achy feet typically indicate underlying mechanical, vascular, or neurological issues that require proper evaluation and targeted treatment based on the specific cause. Foot pain is a common complaint affecting approximately 14% to 42% of adults in the United States, often significantly impacting mobility, daily activities, and increasing fall risk, particularly in older individuals 1.

Common Causes of Achy Feet

Vascular Causes

• Peripheral artery disease (PAD) can cause claudication, defined as "fatigue, discomfort, cramping, or pain of vascular origin in the muscles of the lower extremities that is consistently induced by exercise and consistently relieved by rest (within 10 min)" 1
• Critical limb ischemia may present as chronic (≥2 weeks) ischemic rest pain in the feet 1
• Erythromelalgia - characterized by episodic burning pain associated with redness and warmth of the extremities, most commonly affecting feet 1

Neurological Causes

• Painful diabetic peripheral neuropathy - presents with burning pain, electrical shock-type shooting pain, uncomfortable tingling, and contact pain (allodynia) 1
• Nerve entrapment syndromes - may cause burning, tingling, or numbness in the feet 2
• Tarsal tunnel syndrome - compression of the posterior tibial nerve causing medial midfoot heel pain, particularly with continued weight bearing 2, 3

Musculoskeletal/Mechanical Causes

• Plantar fasciitis - medial plantar heel pain, especially with first steps in the morning 4, 2, 3
• Achilles tendinopathy - posterior heel pain, 2-6 cm proximal to the Achilles insertion 5, 4, 6
• Calcaneal stress fracture - progressively worsening pain following increased activity 2, 3
• Heel pad syndrome - deep, bruise-like pain in the middle of the heel 2, 3
• Morton's neuroma - burning pain in the ball of the foot with possible radiation to the toes 4
• Tendinopathies - pain localized to the insertion site of affected tendons 6
• Sinus tarsi syndrome - lateral midfoot heel pain and feeling of instability 3

Evaluation Approach

Initial Assessment

• Determine location of pain - plantar, posterior, medial, or lateral aspect of the foot 2, 3
• Characterize the pain - burning, cramping, shooting, aching, or throbbing 1
• Identify timing patterns - worse in morning, after activity, or at night 1, 2
• Note aggravating and relieving factors - worsened by exercise, relieved by rest (vascular) 1
• Assess for associated symptoms - swelling, redness, numbness, tingling 1

Physical Examination

• Inspect for deformities, skin changes, or swelling 1
• Palpate for tenderness at specific anatomic locations 2, 3
• Assess pulses if vascular etiology is suspected 1
• Evaluate neurological status - sensation, reflexes 1

Initial Imaging

• Conventional radiography is usually the first imaging study for evaluating chronic foot pain 1
• More advanced imaging (MRI, CT, bone scan) is not recommended as initial imaging 1

Management Approach

For Vascular Causes

• For PAD-related pain: structured exercise program (supervised or community/home-based) 1
• Modify risk factors - smoking cessation, diabetes control, hypertension management 1
• Consider referral to vascular specialist for severe symptoms or critical limb ischemia 1

For Neurological Causes

• For painful diabetic neuropathy: consider medications such as tricyclic antidepressants, serotonin and noradrenaline reuptake inhibitors 1
• Address sleep disturbances which often accompany neuropathic pain 1
• Avoid triggers for nerve compression 1

For Musculoskeletal/Mechanical Causes

• For Achilles tendinopathy: eccentric strengthening exercises, activity modification, stretching, and NSAIDs 5, 4, 6
• For plantar fasciitis: stretching of the plantar fascia and foot orthotics 4, 3
• For Morton's neuroma: reduce activities that cause pain, use orthotics, consider interdigital corticosteroid injection 4
• Avoid corticosteroid injections into or around the Achilles tendon as they may inhibit healing and predispose to rupture 5

Important Considerations

• Chronic foot pain can significantly impact quality of life and functional status 1
• Even "asymptomatic" PAD is associated with impaired lower extremity functioning 1
• Depression and anxiety often accompany chronic foot pain, particularly with painful diabetic neuropathy 1
• Many conditions causing achy feet respond well to conservative management, with surgery rarely necessary 7

When to Seek Medical Attention

• Pain that is severe or worsening despite initial self-care measures 5, 3
• Signs of infection (increased warmth, redness, fever) 2
• Pain associated with significant swelling or inability to bear weight 2, 3
• Symptoms of vascular compromise (cold, pale foot, absent pulses) 1