Phrases like “My feet hurt under the toes, as if I’m walking on stones” or “When I wake up in the morning, I can’t step on the floor or walk because of the pain” are commonly heard. There are other complaints too, such as: “My big toe hurts and is turning inward. They told me it’s a bunion and that I’ll need surgery!”
Let’s take a look at the three most common problems affecting the lower limbs—and how they can be treated:
Metatarsalgia:
“My feet hurt under the toes, like I’m stepping on stones.”
This case refers to the symptom of metatarsalgia, characterized by pain under the ball of the foot—mainly beneath the second and third toes. It occurs when one or more of the metatarsal bones (long bones ending at the toes) drop and press more intensely on the ground. Depending on factors such as how much time someone stands, their body weight, the type of shoes worn, and the surfaces they walk on, symptoms may develop gradually or more rapidly.
- It affects women more often due to frequent use of high heels (which shift body weight forward onto the forefoot) or tight footwear (increasing compression in the metatarsal area). The combination of these shoe types significantly raises the risk of developing metatarsalgia in the future.
- When it appears in men, it often indicates more serious biomechanical predispositions (but treatable ones), such as severe flatfoot, overpronation, or rigid forefoot valgus.
- Prolonged pressure can lead to ischemia (reduced blood flow) in the area, resulting in a burning pain.
Heel Spur (Plantar Fasciitis):
“When I wake up in the morning, I can’t put my foot on the floor because of pain. But after walking a bit, it eases.”
This relates to stretching of the thick plantar fascia—a ligament connecting the heel bone to the toes—or sometimes injury to the membrane covering the heel bone. The presence of a heel spur causes irritation in the surrounding area, leading to sharp pain when standing, walking, or running. Factors contributing to this condition include mechanical imbalance (e.g. limping), obesity, and inappropriate footwear. Inflammation may worsen with shoes that lack proper arch support, as well as from chronic strain during athletic or daily activities.
Bunion (Hallux Valgus):
“My big toe hurts and is turning inward.”
A bunion is essentially the protruding head of the first metatarsal, next to the big toe, which becomes misaligned. The big toe shifts outward, leaning toward the second toe. This anatomical deformity primarily affects women, with up to 70% experiencing it. In advanced stages, surgery may be necessary. However, with the right advice, you can prevent the condition from progressing and avoid long-term issues. Bunions form due to poor foot posture and enlargement of the big toe joint, eventually leading to what is called hallux valgus, a deformity that significantly limits daily activities and shoe choices.
Underlying Causes
Several factors may be behind the pain and walking difficulties:
- Improper footwear (narrow or rigid shoes that lack shock absorption)
- Increased body weight
- Hereditary predisposition
- Mechanical deviations in foot alignment during walking
Electronic Foot Pressure Analysis (Pedography)
Recording and analyzing gait using an electronic pedograph is essential for diagnosing musculoskeletal conditions such as flatfoot, high arches, metatarsal drop, and overuse syndromes. The pedograph consists of multiple sensors that measure pressure distribution on the sole during walking.
It provides both static and dynamic analysis, identifying variations in gait and weight-bearing axis.
- Static analysis helps assess body weight distribution and mechanical pressures on the foot.
- Dynamic analysis records all phases of foot support (heel strike, mid-stance, and toe-off), maximum pressures, and pressure timing during each step.
The analysis is 3D and kinematic.
Treatment
All of the above conditions are treatable—as long as the individual is guided properly. Conservative treatment (physical therapy and custom orthotic insoles) is always the first step.
With the use of orthotic insoles, the lower limbs and spine are corrected, supported, or offloaded, leading to improved function in daily life and athletic performance. Orthotic insole fabrication is recommended for correcting, supporting, and relieving stress on the musculoskeletal system in children, adults, pregnant women, and athletes of all levels.
Read the full article (PDF)
Mimi Marcellou, PT, M.Sc.
New York University
Physiotherapist & Executive Director, Praxis Physiotherapy
Magazine: Physical Therapy
Publication Date: December 2013
