Common Foot Problems and What They're Telling You

Feet get very little attention until they stop working, at which point they get all of it. Most of what we see in clinic falls into a handful of patterns, and each one is telling you something fairly specific about load, footwear or how you are moving.

Heel pain

The most common single complaint in podiatry.

Pain under the heel, worst with the first steps in the morning. This is the classic plantar fasciitis presentation. The pain eases after a few minutes of walking, then returns after periods of sitting. It typically builds over weeks rather than starting suddenly, and it is a loading problem — usually a recent increase in standing, walking or running, or a change of footwear.

Pain at the back of the heel. Points toward the Achilles tendon or the bursa beneath it. Stiff for the first steps of the day, sore at the start of exercise, and often better once warmed up.

Heel pain in an active child or adolescent. Usually Sever’s disease, an irritation of the growth plate at the back of the heel. It is self-limiting and resolves once the growth plate closes, but it responds well to load management in the meantime.

Forefoot pain

Pain under the ball of the foot. Metatarsalgia — usually a load distribution problem, where more force is going through one or two metatarsal heads than they can tolerate. Footwear with a thin sole or a high heel is a frequent contributor.

Burning, or a feeling of walking on a pebble, often with numb toes. Suggests a Morton’s neuroma, a thickening of the tissue around a nerve between the toes. Squeezing the forefoot typically reproduces it.

Pain at the base of the big toe, with a visible bump. A bunion. The joint deviates over years, and the pain usually comes from footwear pressure and altered load rather than the deformity itself.

Sudden, severe pain in the big toe joint, often overnight, with redness and heat. This pattern needs a GP — it is the classic presentation of gout, which is a medical condition requiring medical management.

Arch and midfoot

Flat feet. Extremely common and, in the absence of symptoms, generally not a problem requiring treatment. Feet come in a range of shapes. A flat foot that is painful, or that is getting flatter in adulthood, is worth assessing; a flat foot that has always been flat and does not hurt usually is not.

High arches. Less common, and tend to distribute load onto the heel and forefoot with less area in between. Often associated with reduced shock absorption.

Pain along the inside of the ankle and arch, particularly in adults whose arch is collapsing. Warrants proper assessment, as progressive tendon dysfunction responds much better when caught early.

Ankle

Repeated ankle sprains. The most under-treated foot and ankle problem there is. A first sprain that is not properly rehabilitated leaves reduced balance and proprioception, which makes the next one more likely. People arrive after their fourth or fifth, having never rehabilitated the first.

Stiffness and aching after activity in an ankle sprained years ago. Often a consequence of exactly the above.

Nails and skin

Thickened, discoloured nails. Often fungal, sometimes the long-term result of trauma. Worth confirming which, because they are treated differently and fungal treatment is a long commitment.

Nail edges digging into the surrounding skin. Ingrown toenails. Usually related to nail shape, cutting technique, or footwear pressure. Very treatable, and worth treating early rather than after infection sets in.

Calluses in a consistent spot. Calluses are informative — they form where load concentrates. A callus in the same place every time is a map of where pressure is going, and it usually points to a mechanical cause worth addressing rather than just filing off.

When to get a foot assessed

Reasonable triggers: pain that has lasted more than two weeks, pain that is present with the first steps of the day, any change in how you walk, recurring ankle sprains, or a callus or nail problem that keeps returning after you deal with it.

The most useful part of an assessment is usually not naming the condition — it is working out why the load is going where it is going. That is what determines whether the problem stays away after it settles, and it is specific to your foot shape, your footwear and what you do all day.

We see foot and ankle problems at Marrickville, and for most people it is a short course of treatment plus a change to footwear or loading rather than anything ongoing.