Common in men, a little less than in womenStrong evidence
About 1 in 5 men report foot pain on most days: 19% of men against 29% of women in Framingham in the US, and 15.1% against 19.6% in Adelaide. Across population studies, foot pain rose with age in women more clearly than in men. In 12 English practices, men consulted about the foot more as they got older: 239 per 10,000 a year at 45 to 64 and 329 from 75.
Sources 1, 2, 3, 4
Heel pain: as common in men, and commoner in manual jobsStrong evidence
In 5,109 UK adults aged 50 and over, 9.2% of men and 10.0% of women had plantar heel pain, and it was more than twice as common in routine and manual jobs as in managerial ones (10.9% against 4.6%). Women see a GP about it more often (4.64 against 2.98 per 1,000 a year in Dutch general practice). Higher weight goes with it, and the NHS lists being 40 to 60, a lot of standing, walking or running, and poorly cushioned shoes.
Standing and walking on hard floors at work went with heel pain in a review of 4 studies, all with a high or unclear risk of bias; the clearest example was a car engine assembly plant.
Sources 5, 6, 7, 8, 9, 10
Heel spurs don't cause the painStrong evidence
"most people who have bone spurs on their heels do not have heel pain", the American Academy of Orthopaedic Surgeons (AAOS) says, and "Heel spurs do not cause plantar fasciitis pain". In a cohort followed for up to 15 years, a spur at the start made no difference to how people did. A spur on an X-ray isn't a reason to remove it.
Sources 11, 12
Gout: about 4 times as common in menStrong evidence
Gout affects 3.97% of UK men against 1.05% of women, and the gap is widest in the 30s, when men are about 11 times as likely to have it. The big toe joint is the first joint in most first attacks (56% to 78%, as a review reports older studies), and the midfoot and ankle are common too. The National Institute for Health and Care Excellence (NICE) asks clinicians to suspect it with rapid onset, often overnight, of severe pain, redness and swelling in the big toe joint.
Sources 13, 14, 15, 16
What causes gout: genes and kidneys more than drinkStrong evidence
The NHS lists a family history, being a man, being overweight, alcohol, water tablets and some blood pressure tablets, high cholesterol, high blood pressure, kidney problems and diabetes. In 47,150 men, alcohol raised the risk with the dose (about 2.5 times at 50 g a day or more), beer most, spirits less, and wine not clearly; two or more sugary soft drinks a day raised it too.
But in 16,760 adults, diet explained 0.3% or less of the variation in blood urate, against 23.9% for common genes, and "about three-quarters of the urate in our bodies comes from the breakdown of purines produced within our body", Arthritis UK says. NICE: "there is not enough evidence to show that any specific diet prevents flares".
Sources 17, 18, 19, 20, 14, 16
The Achilles: tendon pain and rupturesStrong evidence
Achilles tendinopathy affects about 2 per 1,000 adults a year in general practice, with only about a third linked with sport; there was no clear difference between men and women there, though male runners had nearly twice the risk in 2 studies.
Achilles ruptures are 3 to 4 times as common in men (79% of 27,702 in Sweden; 3 to 1 in Denmark), at an average age of about 45, and rising in people over 50. About two-thirds happen in sport, often ball and racquet games. Steroid injections near the tendon and some antibiotics (fluoroquinolones such as ciprofloxacin) are linked with tears.
Sources 21, 22, 23, 24, 25, 26, 27, 28
Stress fractures: commoner in women, but men get themStrong evidence
About 3% of male military recruits get a stress fracture, against 9.2% of female recruits, and runners who are women have about twice the risk. Men get them in the second and third metatarsals from running and marching, and footballers in the fifth metatarsal, where 45% had warning symptoms first. Eating too little for your training (low energy availability) affects men's bones too, though it takes a bigger shortfall than in women.
Sources 29, 23, 30, 31, 32, 33
Work boots: discomfort and fitEmerging evidence
Foot pain and discomfort are commonly reported in safety footwear: 42% to 61% in a review of 7 studies of 2,063 workers, and 42.3% of 358 underground coal miners, mostly men, over half of whom felt their boots played a part. But every study was a survey with a high risk of bias, so they can't show that boots cause foot pain rather than long hours, heavy work or weight. What the evidence supports is fit, cushioning and comfort: "Cushioned soles make standing more comfortable", the Health and Safety Executive (HSE) says.
Sources 34, 35, 36, 37
Morton's neuroma and big toe arthritisEmerging evidence
Morton's neuroma was diagnosed in 50.2 men and 87.5 women per 100,000 a year in UK general practice, so about a third of new cases are men. Painful big toe arthritis on X-ray affects 6.7% of men over 50. Tight shoes make Morton's neuroma worse, the NHS says.
Sources 38, 39, 40
Diabetes, nerves and circulationStrong evidence
In England and Wales, people with a new diabetic foot ulcer were "more likely to have Type 2 diabetes, be male and of white ethnicity", and across 22 studies men had a higher risk of amputation. With diabetes, "pain, tingling or numbness" can be nerve damage, and NICE asks for a foot check at least once a year.
Smoking is "the most significant risk factor" for narrowed leg arteries; by the ankle-brachial index they weren't more common in men in high-income countries. The NHS lists erectile dysfunction in men among the symptoms.
Sources 41, 42, 43, 44, 45, 46
When a scan or test helpsStrong evidence
Heel pain needs no scan unless something else is suspected; an X-ray can rule out a break or arthritis, and a spur on it doesn't explain the pain. A suspected stress fracture needs an X-ray and often magnetic resonance imaging (MRI): X-rays "rarely reveal an obvious fracture" early, and in recruits only 15% of heel bone stress injuries on MRI showed on X-ray.
Gout needs a blood urate test (repeated at least 2 weeks after the flare if it was low during it) and, if unclear, fluid from the joint. An Achilles rupture is diagnosed by examination: squeezing the calf (the calf squeeze test) picked up 96% of ruptures in one study. With diabetes, a foot check at least once a year; with leg ache on walking, the ankle-brachial pressure index.
Sources 11, 47, 48, 16, 49, 43, 50
How it usually goesMixed evidence
"More than 90% of patients with plantar fasciitis will improve within 10 months of starting simple treatment methods", AAOS says, but in a hospital cohort half still had symptoms at 5 years, and there men recovered about twice as fast as women. Achilles tendinopathy takes "in most cases several months or more". A gout attack "usually lasts 1 to 2 weeks if left untreated". After an Achilles rupture, sport returns "between 4-12 months depending on the sport". No one can promise a timescale.
Sources 11, 12, 51, 17, 52