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Foot Pain? 6 Reasons You Shouldn’t Ignore It

Pain in the foot can point to a number of health issues, experts say

close up shot of a woman holding her foot in pain
Anupong Thongchan / EyeEm

If you are over the age of 50, you’re likely no stranger to foot pain. About a quarter of all older adults experience it, according to a 2011 study published in the journal PAIN — and there are several reasons why.

Being overweight can cause your feet to hurt; so can years in poor footwear. Even just the wear and tear that comes with activity and advancing age can contribute, says Sean Peden, M.D., a foot and ankle specialist at Yale University School of Medicine.

But foot pain should never be ignored, as research suggests it can impair balance and foot function, and may even increase a person’s risk of falling. It’s also important to know that not all foot pain is the same, Peden says. In particular, there’s a difference between muscle soreness from a hard workout and sharp pain that comes from a bone or a joint — that’s the kind that warrants a call to the doctor for a diagnosis and proper treatment, he stresses.

Your pain may even point to other, potentially serious health issues. Here are six to put on your radar.

1. Stress fracture

Older adults are particularly vulnerable to stress fractures, or tiny cracks in the bone, because the trabeculae (the spongy tissue that connects your body’s bones) thin with age. The most common symptom is pain with activity that subsides with rest.

“We saw a lot of stress fractures throughout the pandemic. People were barefoot more because they worked from home, and they gained weight, which together is not a good combination,” says Jacqueline Sutera, a podiatrist in New York City.

It’s important to realize that the symptoms of a stress fracture are more subtle than those you’d experience with an actual broken bone. In fact, a lot of people don’t even realize they have one, Sutera says. “There’s usually not much swelling or bruising, they don’t remember hurting themselves, and they usually can still walk, albeit with pain,” she explains.

If pain lasts for more than a few days and doesn’t seem to get better with ice and rest, see your doctor. And keep in mind that not all stress fractures show up right away on an X-ray, so you may need an MRI (a magnetic resonance imaging scan), Sutera adds. Treatment is rest for six to eight weeks; you may also need a special shoe insert or braces to help the injury heal.

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If you are diagnosed with a stress fracture in your foot, talk to your doctor about whether you should undergo screening for osteoporosis. It may be a sign that your bones are thinning, according to the American College of Foot and Ankle Surgeons.

2. Persistent heel pain

Plantar fasciitis is a common condition where the plantar fascia — the thin ligament on the bottom of your foot that connects your heel to the front of your foot — becomes irritated and inflamed. It often resolves on its own with icing and rest, but if it continues, you should get it checked out, Sutera says. “If it’s torn, it won’t get better by itself,” she cautions.

While an X-ray can reveal problems like osteoarthritis or a stress fracture, an MRI is needed to diagnose an actual ligament tear. First-line treatment is usually a short leg boot cast combined with crutches. If that doesn’t work, you may need surgery.

3. Psoriatic arthritis

Foot pain can be a common symptom of psoriatic arthritis, an inflammatory disease that causes pain and swelling in the joints. Most people with psoriatic arthritis also already have psoriasis, a skin condition that causes red, scaly, inflamed skin. You may notice that one or more toes are so swollen that they look like little sausages, a condition known as dactylitis. Other signs include heel pain, bottom of the foot pain, and thick, pitted toenails.

“If you have a lot of pain in the morning and it’s focused on one side of your body — your right ankle, your right toes, your right foot — it may be a sign of psoriatic arthritis,” Peden says.

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It’s diagnosed with a physical exam, imaging such as X-rays and MRIs, and blood tests to rule out other conditions. It’s important to catch psoriatic arthritis early, before joints deteriorate. Treatment includes disease-modifying anti-rheumatic drugs such as sulfasalazine (Azulfidine) or biologics like adalimumab (Humira).

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4. Diabetes

About half of people with diabetes develop neuropathy, or nerve damage, a condition that leads to tingling, burning or stinging pain, and even foot numbness and weakness. But neuropathy can have other causes, ranging from alcohol overuse to undiagnosed infections such as Lyme disease — even cancer. So it always needs to be checked out, Peden says.

Regardless of the cause, you’ll need to monitor your feet carefully. Check them every day for cuts, redness or swelling, and never go barefoot — not even inside (wear socks or slippers instead). If you see corns or calluses, have a podiatrist remove them rather than trying to remove them yourself. And keep your toenails trimmed. If you have trouble doing that, your podiatrist can do it for you.

5. Gout

Gout — a form of inflammatory arthritis where high levels of a substance known as urate build up in your body, leading to joint pain and swelling — often begins in your big toe, but it can be misdiagnosed and overlooked, Peden says. “People will go to the emergency room because their toe is killing them, and they’re told they have an infection or a fracture even though there’s no real history or symptoms to look for those things,” he says. The condition usually develops in middle age and is more common in men than in women.

If the pain is so severe that it keeps you up at night, there’s a good chance it’s gout, Peden says. Ask your doctor to do bloodwork to check your urate levels or take a fluid sample from the painful joint to look for urate crystals under a microscope. An ultrasound of the affected area can also offer a clue.

Most of the time, gout can be treated either by your primary care provider or by a rheumatologist. There are certain medicines, such as colchicine, that help treat gout pain.

Lifestyle measures like losing weight and following a specific eating plan known as the DASH diet, which is rich in fruits, veggies, whole grains and low-fat dairy, can also help lower blood urate levels.

6. Blood clot

When you think of deep vein thrombosis, you may automatically think of leg swelling and leg pain. But this condition, where a blood clot forms in one of the body’s deep veins, can also cause sudden and severe pain in the ankle or foot, Sutera says. You’re more at risk if you’re a smoker, overweight or over the age of 60, particularly if you are sedentary. If you notice leg or foot swelling and pain that doesn’t seem to have a cause, see your doctor right away, especially if the area feels warm to the touch and is discolored (usually a pale red or blue). “These blood clots can break off and travel to the lung or brain, where they cause a fatal pulmonary embolism,” Sutera warns.

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