How to diagnose
and treat foot pain

How do clinicians diagnose foot pain?

When you see a clinician for foot pain, the visit usually starts with your story. They will ask where the pain is, what it feels like, when it started, and what makes it better or worse. Changes in activity, long hours on your feet, new shoes, other joint pain, and medical conditions such as diabetes or gout all matter for understanding the cause^{2 3 11}.

They will then look at how your foot moves and how it carries load. This can include:

• Watching you stand and walk to see how your foot and ankle line up
• Checking your arch height and any calluses, or deformities
• Pressing on specific spots, such as the heel, arch, or ball of the foot, to find tender structures
• Testing calf and foot strength, and asking you to do a single-leg heel raise or short balance tasks
• Checking sensation, reflexes (automatic muscle reaction to nerve stimulation), and pulses, especially if you have numbness, tingling, or diabetes ^{2 3 5 9 12}

For many common problems, such as plantar (sole) heel pain (often called plantar fasciitis), diagnosis is based on this history and physical exam. Routine imaging is often not needed at first if symptoms and exam are typical^{9 10}.

Imaging is more likely if:

• You had a recent injury and there is concern for a fracture
• Pain is very localized and linked to impact, which could suggest a stress fracture
• Symptoms do not improve after a period of good conservative care
• There are signs of joint inflammation, nerve entrapment, or more complex deformity^{4 5 10 11}

In these cases, clinicians may order:

• X-rays to look at bones, joint space, and alignment
• Ultrasound to assess the plantar fascia (tissue which connects the heel to the base of your toes), tendons, or nerves
• MRI (Magnetic Resonance Imaging) when soft tissue injury or bone stress (overuse injury from repetitive loading, causing tiny cracks) is strongly suspected but not clear on other tests^{4 5 9 10}

If you have diabetes and a warm, swollen, or oddly shaped foot, or an open wound that is not healing, you may be checked urgently for infection or Charcot changes (damaged bones, joints, and soft tissue in the foot and ankle due to nerve disease, most commonly from diabetes). These cases often need rapid offloading and a specialist team^{12 13}.

For new injuries, some clinicians use the Ottawa Foot and Ankle Rules, which are well studied tools that help decide when an X-ray is needed to safely rule out a fracture. These rules cut down on unnecessary imaging after minor sprains^{10 17}.

Clinical insight

Clinical guidelines for plantar heel pain suggest that most people can be diagnosed without scans. Imaging is usually reserved for unusual or stubborn cases. This helps you avoid worrying about common “wear and tear” changes that show up on scans but do not match your pain, and keeps the focus on active recovery with movement, footwear, and gradual loading^{9 10}.

What are the treatment options for foot pain?

Treatment for foot pain is usually stepwise. Most people start with noninvasive options such as education, activity changes, footwear, and exercise. More invasive treatments, such as injections or surgery, are reserved for specific situations or when earlier steps have not helped enough^{2 6 9 10}.

Common parts of a treatment plan can include:

1. Education and activity changes

You and your clinician work together to find the right amount of load for your foot. This often means:

• Cutting back on the activities that flare symptoms, like long periods on hard floors
• Keeping some movement in your day, such as shorter walks spread out over time
• Adjusting training plans so increases in walking or running are gradual rather than sudden
• Looking at body weight and overall health, since extra load and diseases like diabetes, can raise risk of foot pain and joint inflammation^{2 3 11}

Guidelines for heel pain and other foot conditions consistently include education and load management as early, core steps^{2 9 11}.

2. Exercise-based rehabilitation

A structured exercise program helps tissues adapt to load and often reduces pain over time. Depending on your diagnosis, this might include:

• Plantar heel pain: stretches for the calf and plantar fascia, strengthening for the calf and small foot muscles, and sometimes taping for short term relief⁹
• Achilles tendinopathy (heel cord disease): progressive loading exercises, such as heel raises, that slowly increase challenge while staying within a tolerable pain range¹⁴
• Posterior tibial tendinopathy (inside ankle and arch pain due to disease of a ankle tendon): strengthening of the inner calf and foot, balance work, and sometimes hip strengthening, often combined with arch support¹⁵

Best practice guidelines recommend these active, loading programs as first-line care for many tendon and plantar heel problems^{9 14 15}.

3. Footwear and orthoses

Shoes and insoles can change how forces pass through your foot. Helpful options might include:

• Supportive shoes with cushioning and a stable heel
• Rocker-bottom soles (thicker-than-normal sole with a rounded heel) that reduce load on the front of the foot
• Prefabricated or custom orthoses to support the arch or offload painful areas^{2 4 6}

For plantar heel pain, systematic reviews show that foot orthoses can give small to moderate pain relief over about 6 to 12 weeks. Custom devices are not always better than well chosen prefabricated inserts^{6 9 16}.

4. Medications

Short courses of non-steroidal anti-inflammatory drugs or other pain relievers may be used to help manage pain so that you can stay active and work through your rehab plan, as long as they are safe for your other health conditions. For foot pain caused by gout, guideline-based medicines are used to calm flares and manage uric acid over time^{9 11}.

5. Injections and other procedures

In some cases, injections are considered if symptoms remain very limiting despite good conservative care:

• Corticosteroid injections can provide short term relief for some people with plantar heel pain, but do not offer better long term results than active care and carry small risks such as to loss or deterioration of the protective fatty cushioning under the heel and ball of your foot or fascia weakening^{6 7 9}.
• Injections for Morton’s neuroma (damaged and enlarged nerve leading to your toes) may reduce burning pain between the toes in the short term and are often one step before considering surgery^{2 8}.
• Extracorporeal shockwave therapy (ESWT) is another option for long-lasting plantar heel pain when exercise and orthoses alone have not helped. Meta-analyses suggest ESWT can improve pain and function compared with sham treatment^{7 9}.

6. Surgery

Surgery is uncommon for most types of foot pain. It is mainly considered when:

• Symptoms have lasted many months despite high quality nonsurgical care
• There is a high-risk stress fracture that is not healing
• There is major deformity or nerve entrapment that does not improve^{4 5 8 9 10}

Examples include plantar fascia release for very stubborn plantar heel pain, neurectomy (nerve removal) for Morton’s neuroma, decompression for tarsal tunnel syndrome (compression of an ankle important nerve , leading to symptoms like pain, tingling, numbness, and a burning or electrical sensation in the sole of the foot), reconstruction for progressive flatfoot, or fixation of high-risk stress fractures. These choices are made carefully after discussion of risks, benefits, and recovery^{4 5 8 9 15}.

Digital physical therapy programs that combine exercise, education, and behavioral support have been shown to give similar pain and disability improvements to in-person therapy for chronic musculoskeletal problems such as low back pain in high-quality trials¹⁸.

Recovery timelines vary. Many people with plantar heel pain feel better within 6 to 12 weeks of regular exercise and footwear changes, though some cases take 6 to 12 months. Tendon problems often need several months of progressive loading. Bone stress injuries and diabetic complications can require longer and closer follow-up^{4 9 11 13}.

Sword's approach

Sword Health helps people manage pain and movement issues with expert-guided AI care you can use from home. Our model combines clinical support with modern technology, designed to work around your life.

Sword makes recovery easier and more accessible. You get high-quality care at home, guided by clinicians and supported by smart technology.

• Care that adapts to your progress in real time
• Licensed experts guiding every step
• Simple, non-invasive, evidence-based programs
• Proven results for pain relief, movement, and satisfaction

How can I find pain relief for foot pain?

There are several low-risk steps many people can try, often alongside guidance from a clinician or physical therapist:

• Pace your activities. Instead of standing or walking for long blocks of time, break tasks into shorter bouts with rest. This reduces repeated stress on sore tissues while keeping you moving^{2 3 9}.
• Choose supportive footwear. Use shoes with good cushioning, a stable heel, and enough room in the toe box. Avoid very worn out soles or shoes that pinch the toes, which can increase pressure on the forefoot and nerves^{2 3 6}.
• Use simple supports. Over-the-counter heel cups or arch supports can give short term comfort, especially for plantar heel pain or metatarsalgia (pain at the ball of the foot), while you work on long term strength^{6 9 16}.
• Try gentle daily stretches. Many people find relief from daily calf stretches and a simple plantar fascia stretch done before getting out of bed or after sitting. Small, steady changes in flexibility can reduce “first step” pain^{9 14}.
• Build strength gradually. Calf raises, foot exercises, and balance drills, when prescribed safely, help your foot tolerate day-to-day loads and can reduce the chance of recurring pain^{9 14 15}.
• Support whole-body health. Working on sleep, stress, and long term weight management can help with pain and reduce load across your feet, especially in conditions like joint wear and gout^{3 11}.

Pain flares are common as you recover. A short increase in pain after a busy day or harder session usually does not mean damage. It is often a sign that the tissue is reacting to load and may need a small step back, not a full stop. If pain is severe, does not settle with rest, or comes with swelling, warmth, or a change in foot shape, it is important to check in with a clinician^{3 4 9 11 13}.