The Causes of Foot Pain Sound Like a Different Language

Sometimes doctors speak a different language.  I am flying home after taking part in a lecture series at the podiatry school in Oakland, CA.  There were 4 speakers from prestigious teaching hospitals lecturing to an audience of 2nd year medical students.  I enjoy listening to my friends lecture, but as I looked at the audience it was a sea of blank expressions.  It was like the lecture was in a foreign language and the interpreter had taken a break.  I suddenly realized that the lectures and slides were complicated surgeries and doctor talk. These students have been in a classroom for 2 years working in the science of medicine.  No one in that audience had seen a patient yet, so the lecture was in a foreign language.

When I talk to you about the causes of your foot pain I have to remember that we speak different languages.  For example, your big toe in podiatry talk is your hallux (hal-ux).  I’ve been calling the big toe a hallux since the beginning of medical school.  I have to speak your language, but sometimes I can slip so let’s go over some common causes of foot pain in both for comparison.

First of all the foot is divided into three areas.  The front part containing your toes and the ball of your foot is called the forefoot.  Your arch is in the middle of your foot and is called the midfoot.  The back part of your foot has the heel, but of course that’s too easy for doctor talk so we refer to the back of the foot as the rearfoot.  Each area has a unique set of problems that can cause foot pain.  Since this is like learning a foreign language I will cover the front of the foot in this article and then the middle and heel next time.

It doesn’t matter if your 2nd toe is longer or shorter than your big toe.  Any toe that is buckled or bent is called a hammertoe.  When a toe is crooked like it can press harder on your shoe causing hard skin to form.  An area of hard skin that develops on a toe from pressure is called a corn or heloma durum.  Your toe can curl so much that it almost sits on the top of your foot.  This causes increased pressure on the bone in the ball of your foot and hard skin can form at this point.  Hard skin forming on the ball of the foot is called a callus or IPK, which stands for intractable plantar keratoma.  Not all hard skin is a corn or callus.  Warts are areas of hard skin with tiny black spots in the center.  This is a virus infection of the skin called verruca.

What about lumps and bumps on the toes and ball of the foot?  A bump at the base of your big toe, remember that’s called the hallux, is a bunion.  In podiatry talk we say the big toe has drifted toward the 2nd toe or hallux valgus.  On the opposite side of your foot at the base of the little toe you can get a bump.  At some point in time this was common in jobs where people sat with their legs criss-crossed or Indian style.  Tailors used to sew sitting in this position so they call this a tailor’s bunion or little bunion, bunionette.  In the center could be due to a broken bone.  Stress fractures are a common cause of swelling, bruising, and pain in the forefoot.

Another cause of pain in the forefoot is a pinched nerve called a neuroma.  You might have a neuroma if the pain is in the ball of your foot and shoots out your toes.  Unfortunately not all foot pain in the ball of your foot is a pinched nerve.  There are tendons and joint capsules in the same area that can become irritated.  When tendon or joint capsule becomes inflamed this is called tendonitis or capsulitis.

That’s a lot of new words so I’ll let you study this for a while then come back with the common terms used in the middle and back of the foot, the midfoot and rearfoot.

Foot Pain

Seeing a new patient is like an athlete getting ready to go onto the field or an actor waiting in the wings preparing to go onstage.  I have to get psyched, this is your first impression of me.  I pick up the paperwork you filled out and see that the reason you came to see me was “foot pain”.  Imagine my reaction.  I start sweating, my heart is beating in my throat, I might pass out.  Foot pain is just about everything and anything.  I need to find out where exactly in your foot the pain is located, what it feels like, and when it hurts.  This is why I write this article.  Help me help you.  Below is a list of common causes of “foot pain”.  There is a brief definition of the problem, where it is located, and in general what the pain feels like.

Bunion:

A lump behind your big toe caused by the big toe going one way, towards the 2nd toe, and the bone that supports the big toe, metatarsal, going the opposite way.  The lump is the metatarsal.  Pain can be divided in two:  on the lump is usually sharp pain with pressure from shoes, redness, and sometimes swelling, while the other pain is deep in the joint described as aching or throbbing that gets worse when you walk.

Bunionette or Tailor’s Bunion:

Similar to a bunion, but at the little toe.  This is where the 5th toe moves toward the 4th and the bone supporting the toe, 5th metatarsal, moves the opposite way making a lump on the outside of your foot.  Pain can be described just like it can for a bunion.

Corns: 

Hard skin on any side of a toe that usually causes sharp pain to pressure or shoes.  You might notice that the toe has changed position or shape.

Calluses:

Hard skin on any surface of the foot other than the toe, usually causing sharp pain while walking.  Why is a corn on the toe and callus on the foot?  I have no idea.

Exostosis:

This is an abnormal growth of bone.  Places where you might be able to see this are on a toe, top of the 1st metatarsal, or on the top of your arch.  These cause sharp pain when pressure is applied, but are caused by arthritis in the nearby joint.  Arthritis pain is deep aching, throbbing and yes it does get worse with the weather.

Hammertoe:

A toe that is buckled, curled, or bent any way other than straight.  Pain from the toe is usually related to a corn, but the joints can cause deep aching pain when walking.

Hallux limitus or hallux rigidus:

The hallux is the big toe and these conditions describe the joint at the base of the big toe.  The motion in this joint can be limited or completely gone, rigid.  These are forms of arthritis commonly described as deep aching, throbbing, or even sharp.  Anything that makes the toe move aggravates the pain such as walking especially in heels or up hill.

Metatarsalgia:

This is a general term for inflammation of a metatarsal.  It has fallen out of favor recently since it is not very descriptive.  Now-a-days this would be inflammation of the joint in the ball of your foot called capsulitis.  This is deep aching or throbbing pain when the joint moves, such as when walking, but usually better in supportive shoes and worse in heels or on stairs.

Metatarsal stress fracture:

A stress fracture is true inflammation of the bone that weakens the structure of the bone and can become a real break.  This is deep aching and throbbing with swelling of the foot in the area of the break.  Usually you have increased your activity or changed shoes before this started.

Neuroma:

A pinched nerve in the ball of the foot.  This causes sharp shooting pains that might travel out the end of your toes, most commonly the 3rd and 4th toes.  Some people can describe a clicking feeling in the ball of their foot when they walk.

Peripheral neuropathy:

The sensations of burning, tingling, or insects crawling on your skin worse when you have no other distractions like when you lay in bed.  These usually follow nerve patterns and can travel up and down the foot or leg.  This can get worse leaving you with loss of feeling.  You would think that loss of feeling has no way to be described, but since you had feeling then lost it patients are able to describe this lack of sensation.

Plantar fasciitis:

Arch pain in the muscles that is often described as cramping, aching, pulling, or even sharp when you walk.  This pain is usually worse with the first steps in the morning or after a period of sitting.  The plantar fascia is a big strong ligament running from the heel to the toes, but it is actually the muscles that sit just beneath the fascia that are inflamed.  The heel is usually involved in the pain as well.

Sesamoiditis:

The sesamoids are like knee caps for your big toe.  They sit in the ball of your foot behind the big toe and help the tendons hold your big toe on the ground.  These can be injured directly or by forceful upward motion of the big toe.  Aching in the ball of the foot at the base of the big toe with or without swelling is usually described by patients.

Tendonitis:

The muscles in your leg travel to your foot by tendons.  Any of these tendons can become irritated, injured, or inflamed.  The pain is usually along the line of the tendon and is commonly described as sharp, stabbing, aching, or throbbing depending on your activity.

Ulcer:

An ulcer is a break in the skin.  Obviously this would hurt, but most patients with ulcerations on their feet are lacking the ability to feel pain.  This can be hidden under callus or develop from a blister next to a callus.

These are the most common causes of “foot pain”.  I hope this will help when you need to explain the pain.  My heart can only handle so many complaints of “foot pain” in a day.