Foot Pain

Definition[edit | edit source]

Shoe pain.jpg

Pain or discomfort can be felt anywhere in the foot. You may have pain in the heel, toes, arch, instep, or insole of the foot[1]. Most women know the pain associated with a long day in shoes in image.

Background Knowledge[edit | edit source]

Foot care, in terms of health, remains listed far behind heart, eye, teeth, skin care and nutrition among the health care of different parts of the body[2]. Hence, the epidemiological literature received less attention, in spite of the fact the incidence of foot pain and related problems is very high and common, especially in older population[3][4][5]. However, in a recent American Podiatric Medical Association (APMA) survey 51% of adults reported that although they had restricted activities of daily living due to foot pain, they still had little knowledge about podiatrists and would rather seek care from a primary care physician (PCP). The same survey also revealed that 80% of Americans believed that foot health is fundamental for over well-being and half of them want to know more about podiatrists[2].

Epidemiology[edit | edit source]

Foot pain is a common problem[4][5][6] and one of the common musculoskeletal conditions that is treated by physical therapists[7]. It is highly prevalent in the older population, as one in three people aged above 65 years experience foot pain[4][5][6][8]. Multiple factors may responsible for producing foot pain such as: increased age, gender, ill-fitted footwear, obesity and chronic degenerative diseases. The incidence of foot pain in a US national health survey (1990)[9] and the Framingham foot study (2009) have shown 24% and 28% of participants reported generalised foot pain without any obvious underlying pathology, respectively[6]. The more recent survey conducted by APMA (2014) have shown that eight in ten US adults experienced foot problems; including pain as third most common complaint[2]. The Cheshire random community based survey (2004) revealed that 10 percent of the participants between age 18-80 reported “disabling” foot pain[10]. A study held in Northwest Adelaide, Australia indicated that one in five people over age 18 years have reported foot pain with higher prevalence in females[3]. The prevalence of foot pain has also been documented amongst randomly selected Danish (2010) population aged 18-80 years with prevalent rate of 30.4%[11]. In an Asian population, 50% of young urban working women reported recurrent non traumatic foot pain and 68.4% believed that the pain is associated to the footwear they worn at work[4].

Foot Pain and Gender[edit | edit source]

There are strong supportive evidences that women are susceptible to have foot pain that may be associated to variety of footwear they use throughout the life span and this may be due to increased weight and a lower pain threshold[3][4][12][13]. Evidence of foot pain experienced by males has been reported in the Framingham study (19%) and an Australian study[3] showed 15% of men reported foot pain.

Biomechanical Effects of Different Types of Footwear[edit | edit source]

The foot’s biomechanics alters greatly due to high variation in footwear types, especially among female footwear. The popular summertime flipflops tends to cause heel pain and conditions like overuse injuries of muscle (Tibialis anterior) and toes that have been identified by podiatrists[14]. Furthermore, walking with flipflops resulted in shorter stride, decreased stance time, and smaller ground reaction force (GRF) impulse, and larger ankle contact angle in comparison with running shoes among both genders[15]. Research conducted on children wearing flipflops showed that children have a tendency towards more dorsiflexion, eversion and abduction that predisposes to flat feet in later life[16].

The use of high heels among female population is very common. Biomechanically, the increased heel height significantly causes to decrease trunk flexion angle, increases body center of mass and profound changes in center of pressure. It also reduces walking speed and increases time of contact during stance with shifted GRF[17].


Possible Pathologies Due to Different Types of Footwear[edit | edit source]

High Heels[edit | edit source]

49% of US women wear high heels that is 3” or more and 71 % of total women experience foot pain attributed to high heels[2]. The consequential negative effects of wearing shoes with elevated heels also includes sprained ankles, low back pain, leg pain due to more weight placed on the toes, a shortened Tendo-Achilles, an unstable gait pattern and poor balance, as well as increased energy consumption[18]. It has also been evident that wearing high heels and shoes with pointed toe box to be associated with the development of corns, lesser toe deformity and hallux valgus (bunion)[19]. there is very high prevalence of foot pain (96%) among females wearing high heels. Long term use of high heels significantly affects the foot health and activities of respondents.[20]

Pointed/ Narrow Toe Box[edit | edit source]

The shoe toe box (shape and volume) is also significant in terms of producing ill-effects on foot’s health similar to high heels. Decreased volume of toe box causes cramping of the toes that has been linked to produce foot deformities, joint pathologies and forefoot lesions[21]. Development of metatarsalgia, callus formation and higher risk of ulceration under metatarsal heads have also been shown to be related with increased forefoot plantar pressure[13]. A hammer toe deformity can also be observed, where interphalangeal joint become prominent and toes curls downward produces pain and callus because of the irritation caused by footwear[22].

Shoes with pointed toe box significantly produces higher peak pressure at the medial heel area than any other shoe. Hyperkeratotic skin around fifth digit is thought be due to the shoe toe box style. A significant association of 43% have been found between the shoes with narrow toe box and hallux valgus (bunion formation)[13].


Treatment for Hallux Valgus

Twenty-five articles (1003 participants) were identified in this review. Three studies chose conservative therapies for HV deformity, incorporating foot orthotics and minimalist running intervention, and surgeries were performed in twenty-two studies. For the pressure parameter alteration under the hallux, the effect size (ES) in the conservative treatment subgroup was − 0.95 with 95%CI [− 1.69, − 0.21]. It demonstrated a moderate ES of − 0.44% and 95%CI [− 0.81, − 0.07] in the surgery subgroup. The five operations’ peak pressure alteration under the hallux demonstrated a moderate ES of − 0.45% and 95%CI [− 0.54, − 0.36].Both non-operative and operative treatments could achieve the forefoot pressure redistribution, decreasing loading beneath the hallux and first metatarsal regions,However, the treatment effects of surgeries were not very robust. The percutaneous DSTR-Akin technique is recommended as an adequate operative treatment, with a large ES and moderate heterogeneity. The negative gait return effect should be noticed while using Scarf osteotomy, despite positive clinical and radiographic outcomes.[24]

Footwear Choices in Relation to Fashion and Body Image[edit | edit source]

Many previous studies have given enough evidences that foot wear choices are highly influenced by fashion trends including colour-matching, comfort and brand therefore the problems associated with footwear may vary from different types of footwear and their frequency may be influenced by the period of specific fashion trends[3][8][12][25]. Body image and emotional influences also seem to play a critical role in choosing footwear, especially among females.

It has been found that orthopedic footwear has direct impact on the self-esteem and body image of people who are being prescribed and only 5% of the participants choose to wear prescribed footwear as it feels unattractive to them and they would rather prefer to go with fashion trends. On the contrary, the strong emotional connection has been found between the footwear and body image among the participants who owns high heels and flat ballet shoes, describing their feelings as “content and cheerful”[12].

Common Footwear Choices Among Women[edit | edit source]

Amongst footwear choices, high heels and pointed toe box shoes are characteristically two most common footwear that mostly women owned[25]. High heels remains the top notch footwear choices that is evident in literature[2][3][12][18]. In an APMA[2] survey (2014) the average US woman owns nine pairs of high heels. Another study shows that 60% of women owned high heels, sandals and slippers which were categorized as “poor” footwear choices with potential impact on foot ,Even after taking age and weight into account, past shoewear use in women remained associated with hindfoot pain.Even after taking age and weight into account, past shoewear use in women remained associated with hindfoot pain. Future studies should address specific support and structural features of shoewear.[26]

  1. How to prevent foot pain
    1.Decrease use high heel to prevent incidence of ankle sprain and low back pain.
  2. Decrease use shoe with pointed toe box to prevent metatarsalgia and hallux valgus conditions.
  3. Use appropriate shoes which preserve normal foot mechanics.

Conclusion[edit | edit source]

It is evidently proven that different types of footwear impacts differently on foot’s health and the prevalence of foot pain has increased comparatively from past years. It may be associated due to higher variation among footwear designs and style. It is also observed that fashion trends and overall body appearance have great significance in making choices of purchasing footwear. There is a need to create awareness among general population to make appropriate footwear choices that fit properly and do not impede normal foot biomechanics.

References[edit | edit source]

  1. Ma CB, Zieve D,Ogilvie I. Foot Pain. Available at Accessed 27 May 2016.
  2. 2.0 2.1 2.2 2.3 2.4 2.5 APMA. Public Opinion Research on Foot Health and Care Findings from a Survey of 1000 US Adults. Edge Research 2014.
  3. 3.0 3.1 3.2 3.3 3.4 3.5 Hill CL, Gill TK, Menz HB, Taylor AW. Prevalence and correlates of foot pain in a population-based study: the North West Adelaide health study. Journal of Foot and Ankle Research 2008; 1(2).
  4. 4.0 4.1 4.2 4.3 4.4 Chua YP, Tan WJ, Yahya TS, Saw A. Prevalence of nontraumatic foot pain among urban young working women and its contributing factors. Singapore Med J 2013; 54(11): 630-633.
  5. 5.0 5.1 5.2 Chatterton BD, Muller S, Roddy E. Epidemiology of posterior heel pain in the general population: cross-sectional findings from the clinical assessment study of the foot. Arthritis Care Res 2015; 67(7). Accessed 26 July 2019.
  6. 6.0 6.1 6.2 Dufour AB, Broe KE, Nguyen US, et al. Foot pain: is current or past shoewear a factor?. Arthritis Rheum. 2009;61(10):1352–1358. doi:10.1002/art.24733. Accessed 25 July 2019.
  7. Reischl S. Physical therapist foot care survey. Orthop Pract. 2001;13:548.
  8. 8.0 8.1 Burns SL, Leese GP and McMurdo ME. Older people and ill-fitting shoes. Journal of Postgraduate Medicine 2002;78: 344–346. Accessed 26 July 2019.
  9. Greenberg L, Davis H: Foot problems in the US. The 1990 National Health Interview survey. Journal of the American Podiatric Medical Association 1993, 83:475-483.
  10. Garrow AP, Silman AJ, Macfarlane GJ: The Cheshire foot pain and disability survey: a population survey assessing prevalence and associations. Pain 2004, 110:378-384.
  11. Mølgaard C, Christensen SL, Simonsen O. High prevalence of foot problems in the Danish population: A survey of causes and associations. thefootjourna 2010; 20(1).
  12. 12.0 12.1 12.2 12.3 Branthwaite H, Chockalingam N, Grogan S, Jones M. Footwear choices made by young women and their potential impact on foot health. J Health Psychol. ; 2013 Nov;18(11):1422-31. Accessed 26 July 2019.
  13. 13.0 13.1 13.2 Branthwaite H, Chockalingam N, Greenhalgh A. The effect of shoe toe box shape and volume on forefoot interdigital and plantar pressures in healthy females. J Foot Ankle Res.2013;28 (6). Accessed 26 July 2019.
  14. Price C, Andrejevas V, Findlow AH,Graham-Smith P,Jones R. Does flip-flop style footwear modify ankle biomechanics and foot loading patterns? Journal of Foot and Ankle Research 2014; 7:40. Accessed 26 July 2019.
  15. Shroyer JF, Weimar WH: Comparative analysis of human gait while wearing thong-style flip-flops versus sneakers. J Am Podiatr Med Assoc 2010, 100:251 –257. Accessed 26 July 2019.
  16. Chard A, Greene A, Hunt A, Vanwanseele B, Smith R: Effect of thong style flip-flops on children’s barefoot walking and jogging kinematics. J Foot Ankle Res 2013, 6:8. Accessed 26 July 2019.
  17. Wohleeben M. High Heels and their Biomechanical Consequences. Available at Accessed 26 July 2019.
  18. 18.0 18.1 Lee CM, Jeong E, Freivalds A. Biomechanical effects of wearing high-heeled shoes. Int J Ind Ergonom. 2001; 28(6). Accessed 26 July 2019.
  19. Menz HB, Morris ME. Footwear characteristics and foot problems in older people. Gerontology. 2005, 51:346-351.
  20. Fatima S, Riaz U, Sadia A, Khalid M, Jamal A, Ilyas T. Association Between Foot Pain and High Heeled Shoes in Working Women: Association between Foot Pain and High Heeled Shoes . PBMJ [Internet]. 2022 May 31 [cited 2022 Nov. 24];5(5):49-53. Available from:
  21. Paiva De Castro A, Rebelatto JR, Aurichio TR: The relationship between foot pain, anthropometric variables and footwear among older people. Appl Ergon 2010, 41:93–97.
  22. Myerson M, Shereff M: The pathological anatomy of claw and hammer toes. J Bone Joint Surg 1989, 71-A(1):45–49. Accessed 26 July 2019.
  24. Xiang L, Mei Q, Wang A, Fernandez J, Gu Y. Gait biomechanics evaluation of the treatment effects for hallux valgus patients: A systematic review and meta-analysis. Gait & Posture. 2022 Feb 26.
  25. 25.0 25.1 Menz HB, Roddy E, Marshall M, Thomas MJ, Rathod T, Peat GM, Croft PR. Epidemiology of Shoe Wearing Patterns Over Time in Older Women: Associations With Foot Pain and Hallux Valgus. J Gerontol A Biol Sci Med Sci. 2016. 71(12): 1682–1687. Accessed 26 July 2019.
  26. Dufour AB, Broe KE, Nguyen US, Gagnon DR, Hillstrom HJ, Walker AH, Kivell E, Hannan MT. Foot pain: is current or past shoewear a factor?. Arthritis care & research. 2009 Oct 15;61(10):1352-8.