Causes
A number of different diseases can cause pain in the sole of the foot. Only a few diseases, however, express themselves exclusively in pain on the sole of the foot. These include the so-called Fasciitis plantaris and the posterior tarsal tunnel syndrome.
Both diseases cause severe pain in the affected persons, which is noticeable on the sole of the foot. Plantar fasciitis is a relatively common disease that affects the tendon plate at the heel. In plantar fasciitis, this tendon plate is inflamed due to an overload of the structure and causes pain.
Various factors, such as overweight or shortened leg muscles, can promote the development of such an inflammation of the tendon plate. The so-called posterior tarsal tunnel syndrome is a compression of a specific nerve in the area of the foot: the tibial nerve. Especially after injuries in the ankle joint area, such a compression of the nerve can occur.
In many cases, however, no concrete cause for the syndrome can be found. Due to the compression of the nerve, which is among other things responsible for the sensitive supply of the sole of the foot, this syndrome causes severe pain in the area of the sole of the foot and possibly also sensitive deficits. There are a number of other diseases that can cause pain in the sole of the foot.
Mostly, however, there are other symptoms in addition to the pain, which can usually limit the different causes. For example, a heel spur can cause severe pain when it occurs. This is the phenomenon of a new bone formation on the heel bone, which can cause severe pain there.
Vitamin deficiency can also cause pain in the sole of the foot. The clinical picture of a so-called Burning-Feet Syndrome is caused by a lack of vitamins, but is almost non-existent in the developed world. More common is a symptomatology that is caused by malpositioning of the feet.
Especially flat and bent feet can cause pain. If such malpositions of the feet are detected early on, remedy can usually be found quickly so that the symptoms of the painful sole of the foot disappear relatively quickly. Skin diseases can also cause pain on the sole of the foot.
For example, the skin on the sole of the foot should be examined for warts, as these can also cause pain. Rare skin diseases like erythromelalgia can also cause a burning sensation on the sole of the foot. Finally, of course, inflammation, either due to a bacterial infection on the foot, as is often the case in diabetic foot syndrome, for example, or rheumatic processes in the joints of the foot, can also lead to pain on the sole of the foot.
In addition to the causes described above, there are a number of other diseases that can also cause symptoms on the sole of the foot. However, these are mostly rare or can be traced back to a specific injury. In children and adolescents, pain, which is mainly localized at the heel, can also be caused by apophysitis calcanei.
If the cause is not banal and obvious and the pain does not show any improvement after a few days, a doctor should be consulted in any case, who can determine the cause. Only with a correct diagnosis can a therapy be initiated which can effectively combat the pain and at the same time treat the cause of the disease. Only a few diseases manifest themselves exclusively in pain on the sole of the foot.
In most cases other symptoms occur in the affected region, which can give an indication of the cause of the underlying disease. The pain experienced can also vary greatly from person to person. Pain is not always the same.
It is important to distinguish between the so-called pain qualities. Here, a distinction must be made between stabbing, dull, pressing, light, or burning pain. The quality of pain can usually give the treating physician an indication of the type of illness.
It is also important to discuss when the pain occurs. For example, pain that can only be perceived when it occurs can be an indication of a wart or heel spur.Pain, which also occurs at rest, in turn speaks for other diseases. Finally, it is important to discuss whether other symptoms occur in the context of the disease.
Especially symptoms such as swelling, redness, or particularly warm skin at the affected area can be an indication of an inflammatory process. Pain, together with sensitive or motor deficits of the foot, usually indicate a neurological problem. For example, pain together with reduced sensitivity of the foot can be a sign of a posterior tarsal tunnel syndrome.
The therapy against pain on the sole of the foot depends in principle on the underlying disease. Painkillers such as NSAIDS can relieve the symptom of pain, but they usually do not eliminate the disease that caused the pain. Thus, before any therapy is started, the correct diagnosis by a physician must be made.
After the diagnosis has been made, the diseases in question are treated with a wide variety of methods. For almost all illnesses that cause pain in the sole of the foot, it is recommended that the affected area be spared at first. For example, the first step in case of an existing Fasciitis plantaris is to spare the affected foot.
Since the disease is a reaction to overloading the tendon, it should not be subjected to any further strain at first. Risk factors such as the practice of certain sports should be avoided and, if necessary, long-term weight reduction should be aimed for. If the attending physician determines a posterior tarsal tunnel syndrome, a conservative therapy is initially started.
In most cases, this means the application of orthopedic insoles that promise to improve the symptoms. If conservative therapy is not successful, tarsal tunnel syndrome can also be treated surgically. In case of a painful heel spur, apart from an adequate pain therapy with medication, a relief of the foot, cold therapy and physiotherapy can help.
In some cases it is also necessary to operate and remove a heel spur. Inflammatory processes, which cause redness, swelling and heat at the affected area in addition to pain, should be treated adequately as soon as possible. Bacterial infections should be treated with antibiotics, whereas in the case of degenerative diseases, drugs such as cortisone can alleviate the symptoms.
In the case of warts, which frequently occur on the sole of the foot, a so-called icing of the warts can quickly bring about improvement. Malpositions of the feet can be treated with orthopedic insoles, which can also lead to a long-term improvement of the position. In particularly severe cases, it may also be advisable to perform surgery and correct the position intraoperatively.
Individual therapy options for foot malpositions should be discussed with the treating orthopedic specialist. If there is chronic pain in the sole of the foot, different therapy concepts may be considered. It is recommended to consult a specialist who is familiar with the treatment of chronic pain.
For the treatment of plantar fasciitis, the use of a kinesio tape can help. The elastic tapes are stuck to the skin and create tension in the skin, tendons and muscles. This tension promotes blood circulation and thus increases the ability to regenerate.
The tape also reduces pain and tension. The tapes can be worn day and night and during sports. Furthermore, they provide additional stability in the ankle joint.
The diagnosis of pain in the sole of the foot can vary greatly. However, every proper diagnosis begins with a discussion of the patient’s history, also called anamnesis. Here, special attention is paid to the acute symptoms and their qualities, as well as to any previous illnesses and the medication taken.
Already during the anamnesis, a number of diseases can usually be excluded, or an idea can be developed as to which diseases are likely to cause the symptoms. After the thorough anamnesis follows a physical examination. During this examination, the attending physician will examine the skin surface of the affected area for irregularities, redness and swelling.
The mobility of the foot can also give an indication of the underlying disease.To exclude neurological causes, sensitivity can also be tested on the sole of the foot. If such a simple physical examination together with the patient’s history could not yet provide a clear diagnosis, modern diagnostic tools usually follow. For example, imaging procedures such as an MRI, CT, X-ray or ultrasound can be performed depending on the individual’s individual situation. For example, in order to be able to make an unambiguous diagnosis of a calcaneal spur, an X-ray must be performed. On the image produced by this procedure, the bony prominence can usually be identified beyond doubt.
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