Foot Pain: Understanding the Causes & Differential Diagnosis

Introduction

Our feet are the foundation of everything we do — walking, standing, running, and balancing. But when pain strikes, it can feel like your whole body is affected. Foot pain is a common issue, yet it can stem from many different conditions, not just one.

Accurate diagnosis is the key to effective treatment. In this blog, we’ll explore:

• Common causes of foot pain

• Areas of foot pain and what they may indicate

• Differential diagnoses your physiotherapist will consider

• When to seek professional help

Where Does It Hurt? Location Matters.

Understanding where the pain is located helps narrow down the possible causes:

Heel Pain

• Plantar fasciitis

• Calcaneal spur

• Fat pad atrophy

• Achilles tendinopathy

• Tarsal tunnel syndrome

Arch Pain

• Plantar fasciitis

• Flat feet (pes planus)

• Posterior tibial tendon dysfunction

• Stress fractures

Ball of Foot Pain (Metatarsalgia)

• Morton’s neuroma

• Metatarsal stress fractures

• Fat pad thinning

• Bursitis

Toe Pain

• Gout

• Bunion (hallux valgus)

• Claw or hammer toes

• Nail conditions or infections

Outer or Inner Foot Pain

• Peroneal tendinitis (lateral)

• Posterior tibial tendinopathy (medial)

• Ankle sprain with referred pain

• Accessory navicular syndrome

Key Differential Diagnoses

When a patient presents with foot pain, a physiotherapist or clinician will consider several differential diagnoses, depending on symptoms, activity, and history.

Here are the most common ones:

1. Plantar Fasciitis - Morning heel pain, improves with movement

2. Heel Spur - Pain with pressure on the heel, may or may not be symptomatic

3. Fat Pad Atrophy - Dull ache or burning sensation in the heel, especially in older adults

4. Morton’s Neuroma - Burning pain or numbness between the 3rd and 4th toes

5. Tarsal Tunnel Syndrome - Burning/tingling along the inner ankle or foot

6. Posterior Tibial Tendinopathy - Pain and swelling along the inner ankle

7. Gout or Rheumatoid Arthritis - Sudden, red, hot, swollen toe joint (often the big toe)

8. Peripheral Neuropathy - Burning, tingling, or numbness in the feet

When to See a Physiotherapist

See a physiotherapist when:

• Pain lasts more than 1–2 weeks

• You feel stiffness, burning, or weakness

• You're modifying your activity due to pain

• You notice swelling, deformity, or change in foot posture

• You suspect plantar fasciitis or nerve compression

What Will a Physiotherapist Do?

• Detailed movement and gait analysis

• Postural screening and load distribution tests

• Manual therapy for fascia, muscles, and nerves

• Strengthening and mobility protocols

• Footwear and orthotic advice

• Preventive training and return-to-walk/run plans

Final Thoughts

Foot pain may seem small, but it can impact your entire kinetic chain — knees, hips, and back. Don’t ignore it. Understanding the cause helps guide the right treatment.

Whether it's fascia inflammation, nerve pain, or joint stress, the right physiotherapy support will help you step into a pain-free life.