Pain in the front part of the foot can be the result of a number of conditions. Pain underneath, on the balls of the foot (metatarsalgia) can be caused by inflammatory conditions such as rheumatoid arthritis or psoriasis, overuse or transfer overload of the front of the foot due to bunions (hallux valgus) and arthritis. Pain in the forefoot along with altered sensation between the toes (especially 3rd and 4th) can be the result of a Morton’s neuroma. Occasionally, pain in the forefoot can be due to a stress fracture of the metatarsal bone.

Pain over the metatarsals is most commonly due to stress fractures or trauma. Stress fractures occur for many reasons, such as stiff and arthritic nearby joints, foot deformities or overuse. The most common location for a stress fracture is the second metatarsal. Stress fractures are often not seen on X-rays initially and management does NOT usually require surgery.

More significant fractures can be due to crushing injuries of the foot and can also be associated with significant midfoot ligament damage.

Pain in this region is often caused by arthritis of the midfoot joints. Deep pain can be caused by the irritation from the arthritic joints, however many patients find the prominent spurs on the top of the foot uncomfortable in closed shoes (or from the strap in sandals). Treatment can be operative and non operative depending on the degree of symptoms and the severity of the arthritis.

Like hammer toes, mallet toe deformities can result in pressure on the tip of the toe causing pain and occasionally affect the toenail. LIke for hammer toes, surgery can correct such deformities if non-operative measures are unsuccessful. Pain between the toes can result from corns caused by crowding of the toes in conditions such as bunions or arthritis.

 A bunionette (or Tailor’s Bunion) describes a bony bump or prominence at the base of the little toe. Like bunions of the big toe, the bunionette can cause pain through rubbing in shoes. Treatment is not dissimilar to bunions, where appropriate shoewear can alleviate symptoms. Should non-operative symptoms fail, then surgery can be help with the deformity.

The most common cause of heel pain (on the sole of the foot) is plantar fasciitis. It is a very common condition where the pain is caused by an inflammed ligament (plantar fascia) which inserts on the heel bone. Commonly the pain is worse in the morning and after rest and it is not usually associated with previous trauma to the area. The condition responds very well to non-operative management however persistent cases do require surgery. 

Other causes of pain in this area are stress fractures, however this is quite rare. Severe falls onto the heel can result in fracture which may require surgery if they are significantly crushed.

Pain over the back of the heel is most commonly caused by wear and tear of the achilles tendon. Inflammation can occur within the achilles tendon itself or at the place where the tendon inserts into the heel bone (often resulting in a large tender bump). Non-operative management with stretches and a heel lift are often helpful in mild cases. Surgery is mostly reserved for patient s who have had unsuccessful non-surgical treatment or in cases of severe tendon degeneration. Cortisone injections have little role in treating this condition and can actually increase the risk of a unexpected tendon rupture.

Pain around the base of the big toe is commonly caused by arthritis in the joint (hallux rigidus) or because the toe turns towards the second toe (hallux valgus or bunion) and a prominent bump rubs on shoes. Other causes of pain, especially underneath the ball of the big toe, include pain from the sesmoid bones.

Pain around the tip of the big toe is often caused by an ingrown toenail. This can become infected and requires treatment with antibiotics or occasionally surgery to stop it recurring. Other causes of pain include arthritis in the inter-phalangeal joint which is just adjacent to the nail.

Pain in the toes, especially the second, can be the result of pregressive deformities such as a hammer toe. These can cause the knuckle of the toe to rub on shoes and cause large painful calluses.

Like hammer toes, mallet toe deformities can result in pressure on the tip of the toe causing pain and occasionally affect the toenail. LIke for hammer toes, surgery can correct such deformities if non-operative measures are unsuccessful. Pain between the toes can result from corns caused by crowding of the toes in conditions such as bunions or arthritis.

Pain in the front part of the foot can be the result of a number of conditions. Pain underneath, on the balls of the foot (metatarsalgia) can be caused by inflammatory conditions such as rheumatoid arthritis or psoriasis, overuse or transfer overload of the front of the foot due to bunions (hallux valgus) and arthritis. Pain in the forefoot along with altered sensation between the toes (especially 3rd and 4th) can be the result of a Morton’s neuroma. Occasionally, pain in the forefoot can be due to a stress fracture of the metatarsal bone.

Pain on the outside of the ankle is often caused by arthritis of the surrounding joints, tears of the ankle ligaments and more commonly a tear or inflammation of the peroneal tendons. The peroneal tendons are a pair of tendons who’s role becomes very important after ankle sprains to provide stabilty to the ankle. Over time these tendons can wear out, especially if overworked and can cause pain and swelling.

Pain over the side of the foot, specifically near the base of the fifth metatarsal/toe is commonly caused by a fracture of the metatarsal or wear-and-tear of the peroneus brevis tendon. Sprains (rolling the ankle) can cause a fracture of the fifth metatarsal bone. Treatment is based on the type of fracture and the separation of the bone fragments. Ongoing instability of the ankle can lead to extra work performed by the tendons on the side of the ankle and these can wear out over time.

 Pain at the front of the ankle is commonly caused by previous injury and ankle arthritis. Damage to the cartilage (joint lining) inside the ankle can cause inflammation, swelling and pain. Over time, spurs of bone can develop at the front of the ankle and cause further discomfort and reduced ankle movement. Accurate diagnosis of the underlying problem is important in the treatment of ankle pain. Occasionally non-operative treatment can help, however ongoing pain can be improved with surgical intervention.

Pain in this region is often caused by arthritis of the midfoot joints. Deep pain can be caused by the irritation from the arthritic joints, however many patients find the prominent spurs on the top of the foot uncomfortable in closed shoes (or from the strap in sandals). Treatment can be operative and non operative depending on the degree of symptoms and the severity of the arthritis.

Pain on the inside of the ankle is most commonly caused by inflammation or wear-and-tear of the tibialis posterior tendon. Over time this can cause the foot to flatten out and sometimes lead to arthritis. Commonly, treatment with custom SOFT full length orthotics can help with the pain, however some patient occasionally require surgery. Other causes of pain on the inside of the foot arthritis and inflammation of the tibialis anterior tendon.

Pain on the outside of the ankle is often caused by arthritis of the surrounding joints, tears of the ankle ligaments and more commonly a tear or inflammation of the peroneal tendons. The peroneal tendons are a pair of tendons who’s role becomes very important after ankle sprains to provide stabilty to the ankle. Over time these tendons can wear out, especially if overworked and can cause pain and swelling.

Pain on the inside of the ankle is most commonly caused by inflammation or wear-and-tear of the tibialis posterior tendon. Over time this can cause the foot to flatten out and sometimes lead to arthritis. Commonly, treatment with custom SOFT full length orthotics can help with the pain, however some patient occasionally require surgery. Other causes of pain on the inside of the foot arthritis and inflammation of the tibialis anterior tendon.

Pain over the back of the heel is most commonly caused by wear and tear of the achilles tendon. Inflammation can occur within the achilles tendon itself or at the place where the tendon inserts into the heel bone (often resulting in a large tender bump). Non-operative management with stretches and a heel lift are often helpful in mild cases. Surgery is mostly reserved for patient s who have had unsuccessful non-surgical treatment or in cases of severe tendon degeneration. Cortisone injections have little role in treating this condition and can actually increase the risk of a unexpected tendon rupture.

Pain in the toes, especially the second, can be the result of pregressive deformities such as a hammer toe. These can cause the knuckle of the toe to rub on shoes and cause large painful calluses.

Pain around the tip of the big toe is often caused by an ingrown toenail. This can become infected and requires treatment with antibiotics or occasionally surgery to stop it recurring. Other causes of pain include arthritis in the inter-phalangeal joint which is just adjacent to the nail.

Pain around the base of the big toe is commonly caused by arthritis in the joint (hallux rigidus) or because the toe turns towards the second toe (hallux valgus or bunion) and a prominent bump rubs on shoes. Other causes of pain, especially underneath the ball of the big toe, include pain from the sesmoid bones.