Foot Pain in Athletes

By Matt Paulus MS, ATC

Foot Pain in Athletes

The foot is generally a very resilient structure and is able to sustain forces up to 20 times body weight with some sport specific movements.  It can sustain over 10,000 contacts with the ground each day in active populations.  However, due to its constant role in weight bearing and movement, it is susceptible to injury.  Athletic foot injuries can be classified based on the location of pain.

Foot pain in athletics are common.

Image of the feet on a treadmill

Common causes of foot pain for athletes broken down by location

Bottom of the heel  

  • Heel Bruise
    • This seemingly minor injury caused by direct impact to the calcaneous (heel bone) can become quite persistent and debilitating.
    • After an injury to the bone or the fatty padding that covers it, protecting the injury from continued trauma is difficult because we are constantly bearing weight on our heels.
    • A silicone heel cup in the shoe for all weight bearing helps to speed recovery.
  • Plantar Fasciitis
    • Caused by inflammation or degeneration of fascia of the longitudinal arch where it attaches to the bottom of the heel.
    • Tendency is to become chronic in nature if it is not addressed initially.
    • Athletes with high arches need to stretch the fascia by pulling the toes up towards the shin.
    • Athletes with low arches need to stay in supportive footwear with arch support.

Back of the Heel

  • Achilles Tendinosis
    • Characterized by aching pain at the back of the heel, not on the bottom, that is worst at the onset of activity and then after activity.
    • The tendon fibers begin to degenerate and lose strength in chronic cases.
    • Acute cases can be managed with a heel lift and ice, but more chronic cases need eccentric loading exercises to remodel the tendon.

Mid Foot

  • Metatarsal Stress Fracture
    • In athletic populations, this usually occurs in the fifth metatarsal bone on the outside of the foot.
    • Athletes will have centralized pain with impact activity that is not relieved with rest.
    • Treatment involves a period of immobilization and limited weight bearing and full recovery will be extensive.
  • Posterior Tibial Tendonitis
    • Pain on the instep of the foot in the arch that is increased with prolonged activity.
    • Typically occurs in patients with low arches or flat feet.
    • Can be managed with over the counter arch supports or custom orthotics.

Forefoot

  • Morton’s Neuroma
    • Pain in the ball of the foot between 2nd and 4th toes caused by irritation of nerve between metatarsal bones.
    • Need to constantly stay in shoes and recommend a teardrop shaped metatarsal pad in placed just behind the area of pain for all footwear.

Toes

  • Bunion
    • Pain caused by degeneration of the large joint in the big toe as it bends inwards towards the second toe.
    • Can slow the rate of progression by stretching the big into extension towards the top of the foot.
  • Toenail Problems
    • While they seem rather minor, Ingrown Toenails and Black Toenails (Subungual Hematoma) if left untreated can sideline runners and impact athletes.
    • Ingrown toenails can be treated by packing cotton under the nail, lifting it out of the affected area.  Black toenails can be decompressed with the use of a needle, heated paperclip, or other cauterizing device.
    • To avoid further complication these techniques are best performed by a medical professional.

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