Foot Pain and Numbness: Plantar Fasciitis, Neuropathy, Tarsal Tunnel, and More

Foot symptoms localize to specific structures. Accurate diagnosis guides targeted treatment.

1. Plantar Fasciitis

• Medial heel pain, worst first step AM or after rest.
• Plantar fascia degeneration at calcaneal insertion.
• Treatment: stretching (calf, plantar fascia), orthoses, night splints, load management, ESWT, rarely surgery.

2. Peripheral Neuropathy

• Bilateral, stocking-distribution numbness, burning, tingling.
• Causes: diabetes, alcohol, B12 deficiency, chemo, idiopathic.
• Treatment: etiology-specific + neuropathic pain agents.

3. Tarsal Tunnel Syndrome

• Posterior tibial nerve compression at medial ankle (flexor retinaculum).
• Medial ankle pain, plantar numbness, Tinel's at tunnel.
• NCS/EMG, MRI. Treatment: orthoses, injection, decompression.

4. Morton's Neuroma

• Interdigital nerve fibrosis (3rd webspace > 2nd).
• Burning, numbness, "pebble in shoe" sensation. Mulder's click.
• Wide shoes, metatarsal pad, alcohol sclerosing injections, neurectomy.

5. Metatarsalgia

• Pain under metatarsal heads (2nd–3rd).
• Capsulitis, Freiberg's, stress fracture, fat pad atrophy.
• Offloading pads, stiff-soled shoes, treat underlying cause.

6. Other Considerations

• Lumbar radiculopathy (L5/S1) → foot symptoms ± back pain.
• Vascular: PAD (claudication), Raynaud's, chilblains.
• Inflammatory: gout (1st MTP), RA, PsA.

Diagnostic Approach

History (distribution, timing, triggers) → exam (palpation, Tinel's, ROM, neurovascular, gait) → imaging (XR, US, MRI) ± NCS/EMG → targeted treatment.