What's Really Making Your Feet Hurt (Aside From Your Shoes)

Illustrated by: Anna Sudit
We’ve all been there: after a night on the dance floor in those cute (but killer) heels, your feet are aching all over.

Shoes are probably the most common source of foot pain for young women, agrees Jacqueline Sutera, DPM and expert with the Vionic Innovation Lab. “When a person comes to my office, I do an interview and it always goes like this: ‘Have you had an injury? Is there a new exercise activity? Is there a change in your body weight? Did something fall on your foot?’ I try to probe them to see if there’s any kind of trauma. If the answers are ‘no,’ then it’s almost always because of the shoe.”
But footwear is far from the only reason, she adds.

Sometimes, your feet are killing you long after that dance party — and that’s where the real trouble is. Thankfully, your body is always ready to fire out warning signs and where your feet hurt can be very telling of what might be going on. Ahead, we’ll outline some of the most common reasons.
1 of 14
Forefoot

If you’re feeling pain and stiffness in this area of your foot, it's most likely that someone in high heels landed on your foot on the dance floor last night. Or some other type of trauma.

However, if you can't remember anyone landing on your foot, more rarely, it could be actually be a sign of rheumatoid arthritis.

This form of arthritis can manifest in several ways, including in foot pain — with the forefoot being the most common area where people feel pain. Rheumatoid arthritis affects roughly 1% of the population, and 90% of sufferers will feel pain in the joints of their feet as a result of the disease. In fact, forefoot pain is one of the first indicators of rheumatoid arthritis.

Rheumatoid arthritis is a chronic disease, but it can be treated with medication and exercise. Medications, including methotrexate and prednisone, can help prevent the disease from spreading to other joints, while painkillers like ibuprofen can be used to manage any pain. Physical therapy and stretching are also crucial.
Advertisement
2 of 14
Illustrated by: Anna Sudit.
Around The Big Toe Bone

If the pain around your big toe bone persists long after you’ve broken in those cute but painfully tight pointy-toed shoes, it might be a sign of something more serious.

One possible diagnosis: turf toe, which is basically a fancier name for a sprain. Yes, you can actually sprain the main joint of your big toe. It’s an injury that happens commonly in sports like football (hence the term “turf”), when a player extends their foot to push off into a sprint. This kind of sprain is usually treated with resting, icing, compressing, and elevating the foot, but if it’s a serious injury, your doctor may recommend that you go on bed rest for a few weeks.

Another far less common cause is gout, a type of inflammatory arthritis. It happens when uric acid, a chemical created when your body breaks down foods like anchovies, mackerel, dried beans and peas, builds up in your blood due to a kidney issue. Uric acid can form needle-like crystals in your joints and cause pain.

What does this have to do with your feet? Well for starters, those crystals can form in the joints in your foot. For a lot of people, symptoms of gout first manifest as extreme pain or swelling around the joints of the big toe. If you have gout, you’ll most likely also feel pain in other joints, most often lower body joints like your knees or ankles. To diagnose gout, your doctor will examine the joint, and do a blood test. He or she will then be able to prescribe medication to treat the illness, but in the meantime, you can reduce pain by icing the area and elevating the foot whenever you can.
3 of 14
Illustrated by: Anna Sudit
Outer Side Of The Foot

If you’re having issues with the side of your foot, the most common cause is cuboid syndrome. Most often it affects ballerinas and runners, and occurs when the cuboid (one of the small bones on the outer foot) is dislocated, either by an injury like an ankle sprain, or just by gradual repetitive activity that places stress on the outer foot.

In addition to pain along the side of your outer foot, another sign of cuboid syndrome is if it gets worse when you stand up in the morning. The syndrome can be hard for doctors to diagnose because x-rays and MRIs can fail to show cuboid misalignments, though they can help your doctor rule out other causes of foot pain. Your doctor may also try to diagnose cuboid syndrome by moving your foot inwards and outwards to see which movements fire it up.

Once diagnosed, cuboid syndrome is relatively easy to treat. Most of the time, your doctor, podiatrist, or physical therapist can relocate the bone for you. Ice can help to ease the ache.
4 of 14
Illustrated by: Anna Sudit
Underneath The Outer Ankle

Have you recently taken up basketball, or started to intensify your morning runs? If you have, and you’re feeling some pain under the ankle bone that protrudes from the outside of your foot, you might have peroneal tendinosis.

Peroneal tendinosis occurs when the tendons that run along the outside of your ankle are inflamed or torn. It typically happens from overuse — when you’re doing a repetitive activity that increasingly puts pressure on your tendons over time. However, it can be exacerbated by increased activity, like if you’ve recently stepped up your fitness or tried out a new sport that puts added stress on the tendons in that area of your feet.

A telltale symptom of peroneal tendinosis is if, in addition to pain, you have swelling on the outside of your ankle. For an official diagnosis, your doctor will typically perform an ultrasound to check for any abnormalities. Peroneal tendinosis is usually treated without surgery; your doctor will likely recommend resting and icing your ankle and limiting the time spent on your feet, though he or she may also recommend physical therapy in more serious cases (if the condition has led to a sprain, for example).
5 of 14
Illustrated by: Anna Sudit
Side Of The Ankle

Usually, an aching pain on the side of your ankle means that you could have a form of tendonitis: posterior tibial tendonitis.
It’s a mouthful, but it essentially means that the tendon that connects your calf muscle to the bones in your feet has been torn or inflamed.

It’s a common injury, and occurs regularly in people who play high-impact sports like basketball, tennis, or soccer. These sports require repetitive use of the tibial tendon, which can cause tearing or inflammation over time.

If you have PTT, you’ll likely have swelling on the inside of the ankle, and feel pain along the inside of the foot and ankle. The pain may also be worse with activity. Doctors will typically give you a brace or orthotic to help take the pressure off so it can heal on its own. However, if pain continues for more than six months, your doctor may recommend surgery. In that case, surgery likely involves either repairing the tear or removing the inflamed tissue. The good news: Most of the time, surgery isn't necessary.
6 of 14
Illustrated by: Anna Sudit
Heel

If you're aching in the middle of your heel, especially if it's worse in the morning and gets better throughout the day, it could be plantar fasciitis, which is when the band of tissue (a.k.a. fascia) connecting your heel bone to the base of your toes becomes inflamed.

According to Dr. Sutera, the pain can start with the heel and extend into the arch. It becomes especially painful after periods of rest, because the muscle in your foot tightens while you’re asleep or sitting down and not putting on pressure on it. When you get up again, that tightening can cause shooting pain.

If you're having this type of pain, you should see your doctor to rule out other problems. But if it is plantar fasciitis, your doctor will likely recommend a stretching program to loosen the fascia along with anti-inflammatory meds to reduce the pain.
Advertisement
7 of 14
Illustrated by: Anna Sudit
Arch

As previously mentioned, arch pain could be a result of plantar fasciitis extending from your heel into your arch.

But if it's really only in your arch, it could be fallen arches, or "adult acquired flatfoot." This can happen when the posterior tibial tendon (which starts in your arch and connects your calf muscle to the bones in your feet) gets worn out and inflamed due to say, lots of running or otherwise being on your feet too much. You'll notice your foot is caved in, because the inflammation is making it hard for your tendon to support the arch.

Most of the time, wearing supportive braces or orthotics (shoe inserts) can give your tendon a chance to heal.

Otherwise, arch pain may also come from plantar fibroma, a benign nodule that can grow on the bottom of your foot and cause pain. Sometimes, doctors will recommend removing it via surgery, but steroid injections can also help reduce the lump’s size. Your doctor can also prescribe shoe inserts or send you to physical therapy to help reduce pain.
8 of 14
Illustrated by: Anna Sudit
Front Of The Ankle

Are you an athlete?

An ache in the front of your ankle could be a case of anterior ankle impingement, where inflammation is the problem again. But in this case, it can lead to bone spurs (bone overgrowth) in addition to causing pain and limited range of motion. This condition is also called “footballer’s ankle” because it commonly happens in football players. However, it's also pretty prevalent amongst players of other sports, like basketball, soccer, football, and dance.

Alternatively, you might have a high ankle sprain. Most of the time when you sprain your ankle, it's because your foot has turned inward, causing pain in the outside of your ankle. But if your foot twists externally, you can hurt or even tear the ligaments in the front of your ankle. To feel better, remember R.I.C.E.: Rest, Ice, Compression, and Elevation.
9 of 14
Illustrated by: Anna Sudit
Tops Of The Toes

Sure, it could be some leftover ache from a particularly pointy heel, but prolonged pain on the top of your foot in the area just before your toes could also be an indicator of a metatarsal fracture.

The metatarsals are five long bones in the middle of your foot that connect to each of your toes. (If you lift your toes up, you can seem them.)

A fracture can occur thanks to an acute injury from a sudden event — like dropping something on your foot or someone stepping on your foot — but it could also be a stress fracture that occurs over time. This kind of injury is common in runners and people who play sports, like soccer.

While it's possible to injure any one of the bones, the middle bones take on most of the pressure when you're running or walking, so stress fractures are most likely to occur there.
10 of 14
Illustrated by: Anna Sudit
Ball

If it hurts here, you might have metatarsalgia, which sounds scary but is just a fancy way to describe pain that stems from inflammation in the ball of your foot.

This develops most often from overuse — mainly with track-and-field runners, but it can also happen if you play other sports like tennis, football, baseball, and soccer. Most often, it’s a pain that starts mild and gets worse over the course of several months, rather than one that pops up suddenly and severely.

Another thing that causes this pain is a condition called Morton’s Neuroma, which is when the tissue surrounding the nerve that leads to your toes thickens up because of constant pressure. This is often seen among women who wear a lot of pointy-toed high heels or other types of shoes that squeeze their toes.

Dr. Sutera adds that this pain can crop up more often as you get older. As we age, she says, “we have less of a natural cushioning because the fat pad starts to get thin, and you don’t have as much shock absorption."
11 of 14
Illustrated by: Anna Sudit
Under Your Big Toe

Pain in this area, beneath your big toe, can usually be attributed to either a bunion or what’s called a sesamoid injury.

A bunion is a painful, bony bump that develops over time on the side of your big toe. Pressure on the big-toe joint caused by wearing shoes that are too tight or narrow can be a cause, Dr. Sutera says. People with a family history are more prone to this.

Bunions are one of the most common foot injuries, and are up to 10 times more common in women than in men — perhaps due to our preference for narrow, pointed shoes.

The usual treatment for a bunion is first wearing shoes that give your toes room to breathe — and icing your foot to alleviate any pain. However, if none of that works, and you still have pain or difficulty walking, your doctor may recommend surgery to have the bunion corrected.

Another possibility is a sesamoid injury. Sesamoids are bones in your body that aren't connected to other bones. Your kneecap is one example; it just floats atop your knee joint. You also have sesamoids in your big-toe joint. Like other bones, these can fracture due to high-impact injuries, like if you land too hard on your feet after a jump or a fall. But these bones (and the tendons around the bones) can also become bruised or inflamed due to overuse. This is most common among runners or ballet dancers who tend to put a lot of repetitive stress in that region of the foot.

You can usually treat sesamoid inflammation by resting and icing your foot, or by wearing soft-soled and low-heeled shoes. If symptoms persist, your doctor might prescribe medication to reduce swelling — or have you wear a removable brace for four to six weeks.

In the case of a fracture, you will definitely need to wear a brace or a cushioning pad to reduce the pressure, and it may take up to several months to heal.
Advertisement
12 of 14
Illustrated by: Anna Sudit
The Back Of Your Heel

Besides new shoes that pinch into the backs of your feet, the main culprit for pain behind your heel is achilles tendinitis. The Achilles tendon is the biggest tendon in your body, and it connects your calf muscles to your heel bone to help you walk, run, and jump.

Rather than being related to a particular injury, achilles tendinitis is a condition that occurs if you’ve been pushing your Achilles tendon to do more than it can handle. If you’ve recently stepped up your workout routine (sprinting instead of jogging, for example), your Achilles tendon might have become inflamed. Some symptoms of Achilles tendinitis include pain and stiffness behind your heel (particularly when waking up in the morning), trouble standing up on your toes, and swelling in the back or your heel.

If you’ve felt a severely painful “pop” in the back of your heel, you might have torn your Achilles tendon, in which case you should see a doctor immediately. In pretty much all cases of a ruptured tendon, doctors will need to perform surgery to reconnect your calf muscle to the heel.

Otherwise, the first step in reducing pain due to Achilles tendinitis is giving your feet some room to breathe. Take a pause in any high-impact activities like running, and switch to low-impact ones that put less stress on your tendon, like swimming, biking, or getting on the elliptical machines at the gym. You can also ice your heel to reduce any swelling, and take anti-inflammatory medication such as ibuprofen to ease pain.

If symptoms persist for over six months, your doctor may recommend surgery to remove the damaged part of the tendon or to lengthen your calf muscle to decrease the amount of stress placed on your Achilles.
13 of 14
Illustrated by: Anna Sudit
Mid-Foot

You might think you have a simple sprain that will heal with rest, and that may well be the case. However, if it's not getting better, another common cause of pain in the middle of your foot (especially for soccer and football players) is a Lisfranc (mid-foot) injury.

Like a sprain, Lisfranc injuries happen when your ligaments have been torn — and a tear in this particular area of your foot could take months to heal. Because two of the metatarsal bones that support your mid-foot are not held together by connective tissue, a twist could shift them out of place and destabilize the entire foot.

If you have a Lisfranc injury, the top of your foot might be swollen and painful, with bruising on both the top and bottom of the foot and pain that worsens if you stand or walk. If rest, ice, and elevation don’t ease the pain and swelling, that’s when you should check with a doctor.

Treatment for Lisfranc injuries vary according to each injury's severity. If the ligaments haven’t completely torn, your doctor may recommend wearing a cast for six weeks and may ask you to come in for frequent checkups to ensure the cast is working as it should.

If, however, your ligaments have fully torn or your joints have fractured, you may require surgery to realign your joints and bring the bone fragments back to their original positions.
14 of 14
Illustrated by: Anna Sudit
Under Your Pinky Toe

Unsurprisingly, tight heels that pinch at your pinky toe will cause a short-term ache in this area. Painful high heels can also contribute to a condition known as a bunionette, a misalignment of bones that affects the base of your pinky toe.

If you think you might have a bunionette, look out for the telltale bumpy, bony protuberance at the base of your pinky. It might also be increasingly difficult for you to put on those pointy-toed Manolos.
Bunionettes can be caused by genetics and arthritis, but are most frequently caused by wearing shoes that squeeze your toes so they fold over themselves, which makes your bones realign over time.

As such, bunionettes are very common among women, with half of American women affected compared to a quarter of American men. They can usually be treated by wearing shoes that are roomier and that pad your pinky toe, or using custom-made inserts to reduce discomfort. If this doesn’t alleviate symptoms and you cannot wear comfortable shoes because of the size of your bunionette, your doctor may recommend surgery to remove the protruding soft tissue. But don’t worry — surgery is usually pretty quick, and in most cases, you get to leave the hospital on the same day.
Advertisement