Pain in the bottom of the foot is very common and can be frustrating for a patient. Logically, if you’re walking on your injury, it’s going to be difficult to get it to settle down.
There are various diagnoses for pain in the bottom of the foot. Some of the possibilities include plantar fasciosis (or plantar fasciitis), fat pad syndrome, fracture or stress fracture, tibialis posterior strain, achilles tendon injury or bursitis.
Treatments for these conditions can vary. Obviously, the optimal treatment approach depends on the specific diagnosis. In general, reasonable options often include manual therapy (massage, myofascial release), modalities like laser therapy, instrument-assisted soft tissue release, stretching, orthotics or footwear modification and strengthening exercises to name a few. Like any condition, prevention is preferred. So, are there any ways to prevent pain in the bottom of the foot?
Thankfully some research done in recent years has shown some patterns in those people with pain in the bottom of the foot. The following points are the risk factors that have some evidence to support them:
- Reduced range of motion in the ankle – It has been found that those patients with a reduced ability to bring the toes up to the shin (dorsiflexion) are prone to the development of pain in the bottom of the foot. Those people with pes planus or “flat feet” may also have a reduced range of ankle dorsiflexion. It has been suggested that overpronation in a foot (flat feet) might be a natural compensation to having a reduced range of ankle dorsiflexion. Regardless, a reasonable preventative strategy might be to strengthen the tibialis posterior, wear shoes that are more supportive through the arch and make efforts to increase the ankle dorsiflexion range of motion. This might involve stretching of the calf muscles and manual therapy to increase the available range of dorsiflexion in the ankle.
- A lack of extension at the first metatarsophalangeal joint (MTP) – Similar to the above finding, a reduced ability to extend the “main” joint of the big toe is linked to altered gait and changes in surrounding soft tissues. This could lead to pain in the bottom of the foot. Given this, it might be wise to speak to a manual therapist to see if they can help you improve the range of motion in the first metatarsophalangeal joint.
- Age – Unfortunately, it has been established that older age is a risk factor for the development of pain in the bottom of the foot. Not that we can do anything about this, but it would be prudent to recognize that as we go through life, the likelihood of plantar foot pain may be increased so we would be wise to think ahead and address any of the other risk factors that may be present. Perhaps start stretching your calf muscles or purchase more supportive shoes for example.
- If you are non-athletic, start dropping your weight – It has been established that those people who are “not athletic” and have a high body weight are at more risk of plantar foot pain. It may then we wise for these people to speak with their healthcare practitioner about strategies to reduce body weight and exercise while not jeopardizing foot health.
- Standing too long – For most people, this is likely related to your job. Stand up desks have become popular in recent years which are great for many cases of spinal pain. However, standing all day at work might not be helpful for the individual with foot pain. Cashiers at the grocery store, retail salespeople, assembly line workers and crossing guards are examples of professions that might put their employees at greater risk for plantar foot pain. Perhaps using a stool or choosing very supportive footwear could be helpful for these populations.
A 2017 systematic review found that manual therapy may be effective in helping people with plantar heel pain. In fact, the evidence suggested that it may be more effective in the long-term recovery for these patients when compared to the short-term benefit.
We can be optimistic about pain in the bottom of our feet. We have preventative strategies, treatment options that have shown efficacy and we know that most of these conditions, although painful, usually follow an uncomplicated recovery pattern. If you have pain in the bottom of your foot, please give us a call, we can help!
Dr. Kevin McIntyre B.Kin, DC
Clinic Director at Burlington Sports Therapy
Mischke JJ, Jayaseelan DJ, Sault JD & Emerson Kavchak AJ. The symptomatic and functional effects of manual physical therapy on plantar heel pain: a systematic review. Journal of Manual & Manipulative Therapy 2017; 25(1): 3-10.
Irving DB, Cook JL, Menz HB. Factors associated with chronic plantar heel pain: a systematic review. J Sci Med Sport 2006; 9(1-2): 11-22; discussion23-24.
Riddle DL, Pulisic M, Pidcoe, et al. Risk factors for plantar fasciitis: a matched case-control study. J Bone Joint Surg Am 2003; 85-A(5): 872-877.
Martin RL, Davenport TE, Reischl SF, et al. Heel pain – plantar fasciitis: revision 2014. J Orthop Sports Phys Ther 2014; 44(11): A1-A33.