Foot Notes

The areas of feet that are painful

Plantar Fasciitis

Plantar FasciitisWhen the plantar fascia that is attached to the heel bone is over stretched, it indicates your foot is pronating beyond neutral and causing the plantar fascia to be stretched. If stretched too far, the plantar fascia becomes inflamed either in the forefoot, arch or heel where it is attaching to the heel bone. Sometimes it is a combination of all 3 areas. This stretching can sometimes tear the plantar fascia and even cause a heel spur at its attachment into the heel.


We describe a foot as pronating when it goes beyond its neutral position. When we step down, the foot naturally has some shock absorption in the middle of the arch. However, too much flexion in the arch is called pronation. Pronation does not mean you have flat feet - pronation is the action of the foot.

Heel Spur

When the plantar fascia that attaches into the heel bone is stretched too much, the tendon pulls away. The heel bone reacts by putting more bone down - a spur, just like when the skin is irritated, and it puts down a callous.

Neutral Position

The neutral position is where the bones are properly aligned, specifically in the subtalar joint (heel and talus bone) and the arch of the foot. The mid-arch bone joints are flexible, allowing the foot to have some shock absorption. Only your ligaments keep these bones in place. With time, weight and activity, these ligaments can weaken and the arch will start to pronate.

Flat Feet

flat feetIf the arch collapses (pronates) under pressure, and the first ray (medial cuneiform, first metatarsal and hallux) has hypermobility, a person is diagnosed with flat feet. More than 30% of the population is born with flat feet; however, over time people born with average arches can develop flat feet.


At the base of the big toe is the first metatarsal phalangeal joint. If the metatarsal bone at this joint starts to protrude, you have a bunion. Some people don't develop a visible "bump," but still have pain in this joint.

The pain can be caused when the first metatarsal bone is too long (as diagnosed on x-ray), by gout, by arthritis, or by wear and tear on the joint. Bunions are hereditary, but they are also due to the foot pronating. They're more common in someone with flat feet.


Also called Tailor's bunions, bunionettes are located at the base of the little toe. Bunionettes are hereditary just as bunions are, but can also be caused from compensating from arch/heel pain and/or poor fitting shoes.


There are three joints in each toe: The metatarsophalangeal joint (MPJ) at the base; the proximal interphalangeal joint (PIPJ) in the middle; and the distal interphalangeal joint (DIPJ) closest to the toenail. When the PIPJ contracts, it's called hammertoe; when the DIPJ contracts, it's called a mallet toe; when all three contract, it's called a claw toe.

Some hammertoes, especially in the third, fourth and fifth digits, are the foot's reaction to pain in the arch. When our feet start to hurt on the inside, we compensate by turning our foot out. The toes then have to grasp and curl more. Hammertoes are also hereditary and are more common in people with high or average arches.

Hammertoes are mostly hereditary and more common in people with high or average arches, but they can also be caused by tight shoes.


A neuroma is a benign tumor of the nerve. The tumor is generally scar tissue that has been caused from the two adjoining metatarsals (the long bones in the foot) pinching the nerve. The result is a burning pain in the area of the nerve, often shooting pains into the toes.

Many people walk on the outside of the foot -- due to worn-down shoes or pain on the inside of the arch -- causing the metatarsals to pinch. The arch can collapse due to pronation, compensation, hammertoes and/or pointed shoes such as cowboy boots.



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