What’s Causing Your Foot Pain?

Foot pain has always been a hot topic in my household. Between having to take two weeks off from running before the 2017 Western States 100 due to a Morton’s Neuroma (which I thought was a stress fracture) and tearing my plantar fascia in December of 2018, I’m always on the lookout for causes and treatments of niggles in the foot.

The foot is an incredibly complex network of bones, tendons, ligaments and muscles that all have to work together in harmony. If one part gets knocked out of synch, the whole machine can stop working.

Here are the most common foot ailments in athletes and a few suggestions on how to break free from the pain cycle.

Plantar Fasciitis

Nearly every runner knows the plantar fascia tendon that runs lengthwise across the bottom of the foot. Plantar fasciitis is that sharp, stabbing pain at the bottom of your foot, in the arch and where the arch connects to the heel.

An overuse injury, plantar fasciitis can be caused by a biomechanical issue, improper running shoes, increasing training volume or intensity too quickly, or even from tight or weak calf, hip or core muscles.

Treating plantar fasciitis is a matter of identifying what your root cause is, making sure you’re running in shoes that offer enough support and possibly using an insert or an orthotic.

Addressing my chronic plantar fascitis and eventual tear meant addressing weak core muscles and low back issues caused by an accident that occurred in 2015. In other cases, the underlying cause might not be the most available or obvious, so I recommend seeing a physical therapist. Jim Heafner, my PT, also has a lot of online resources which he and I used to help resolve my plantar fascitis.


Metatarsalgia is hard to diagnose and even harder to heal. I’ve battled metatarsalgia for a number of years with no end in sight. Luckily, it’s one of the less severe foot ailments.

Metatarsalgia is an irritation to the head of one or many of the long bones in the foot. There are five metatarsals in the foot and any of them can become irritated when running. If you develop metatarsalgia, you will likely feel aching or burning in the ball of your foot while running. Running uphill tends to be especially irritating.

Strengthening the foot and improving striking patterns is always beneficial. Adding strength around the contact points can also add muscle cushioning.

Stress Fracture

Stress fractures can flare up in any of the foot’s many bones but most often plague the metatarsals. Stress fractures tend build slowly. They’ll be fairly easy to ignore for a while until all of a sudden you feel a sharp pain. Afterward, it can be hard to distinguish if the foot pain is a bone or tendonitis problem. Even X-rays can be unreliable; nothing may show up until there is actual healing going on in the bone. Your doctor may order an MRI or bone scan to look for a stress fracture.

A standard test for a stress fracture is to place a tuning fork against the foot. The vibrations will rattle the bones, and if you’ve got a stress fracture, you’ll feel the pain light up. Another popular at-home way to diagnose a stress fracture is the hop test. Try to hop on one foot. If the impact causes pain, you’ve likely got your answer. Note that these at-home tests shouldn’t be used for self-diagnosis or in place of seeing a doctor. If you suspect you have a stress fracture, see your physician or sports medicine doctor for a proper diagnosis.

Stress fractures are usually caused by rapidly increasing training volume or intensity, but can also occur when runners step awkwardly on a rock, root or pothole.

If you have a stress fracture, you have to take time off from running. There’s no way around it. It takes about six weeks of non-weight bearing activity for the bone to heal correctly. Cross-train like a champ if you have a race on the horizon, otherwise, take some time to let it heal while incorporating light cross-training if desired. Wear a boot and do your best to enjoy your break from running.