Foot pain when walking is commonStrong evidence
About 1 in 4 adults aged 45 and over (24%) have frequent foot pain, a review of 31 studies found, more often women, and most often in the toes and the front of the foot; two-thirds of them had at least moderate trouble with daily life.
The NHS lists the usual reasons as exercising too much, standing on hard surfaces for too long, being overweight and shoes that are too tight. Shoes that don't fit are common: in the studies reviewed, 63 to 72% of people wore shoes that didn't match the width or length of their feet, and poor fit went with foot pain, corns, calluses and toe problems.
Sources 1, 2, 3, 4, 5
Where it hurts points to the causeStrong evidence
Pain under the heel that's much worse on the first steps after sleeping or resting, eases as you get going, then comes back after long spells standing or walking is the NHS's pattern for plantar fasciitis. A shooting, stabbing or burning pain between the 3rd and 4th toes, like a pebble under the foot, worse in tight or high-heeled shoes, is Morton's neuroma. Pain under the ball of the foot can also come from hard skin, a bunion or bursitis.
Pain on the top of the foot can come from tight shoes or laces, a strained tendon, arthritis or gout. Pain along the arch and the inside of the ankle, with swelling along the tendon, trouble walking or standing for long and weakness rising onto tiptoe, points to the tibialis posterior tendon, the American Academy of Orthopaedic Surgeons says. Bunions hurt more in shoes and when walking.
Sources 6, 7, 8, 9, 10, 11
One sore spot on a boneStrong evidence
A stress fracture is a small crack in a bone from repeated load. Health New Zealand says "you can point your fingertip to the sore spot on your bone": it's worse with activity and better with rest at first, but it can become "a constant dull throbbing ache, even at night". A sudden increase in activity, "worn-out shoes or hard surfaces", flat feet or high arches, and low bone density or low body weight raise the risk. It usually takes 6 to 8 weeks to heal, and can come back if you return too early or build up too fast.
Source 12
Burning feet, and a calf that aches as you walkStrong evidence
Burning, stabbing or shooting pain, tingling or numbness in both feet can be nerve damage (peripheral neuropathy). It affects almost 1 in 10 people aged 55 and over in the UK, and diabetes is the commonest cause, so see a GP. An ache in the leg as you walk that goes after a few minutes' rest is the typical pattern of peripheral arterial disease (narrowed leg arteries), the NHS says, and it also needs a GP.
Sources 13, 14
Flat feetStrong evidence
Flat feet are common and "do not usually cause any problems", the NHS says; they shouldn't stop you doing any activity, and they're rarely a sign of anything serious. Most children develop arches between 3 and 10. See a GP if flat feet are painful, stiff, weak or numb, new, or on one side only.
In 3,378 adults in the Framingham foot study, a flat foot went with arch pain only in men, and the link was small; feet that roll in as you walk went with general foot pain and heel pain in men. It was a snapshot in time, so it can't show cause. Insoles and shoes can help with pain or stiffness, the NHS says, but they "will not change the shape of your feet".
Sources 15, 16
Diabetes and gout: when a foot problem is urgentStrong evidence
With diabetes, Diabetes UK says see your local foot team urgently, within 24 hours, for a change in the colour or shape of the foot, a part that feels much colder or hotter than usual, new blisters, cuts or wounds (especially ones you can see but don't feel), a wound that smells or leaks, or "new or unexplained pain in your foot". The National Institute for Health and Care Excellence (NICE) counts "an unexplained hot, swollen foot with a change in colour, with or without pain" as an active diabetic foot problem that should reach a specialist foot service within 1 working day, or go straight to hospital if a limb or life is at risk.
Gout typically comes on rapidly, often overnight, with severe pain, redness and swelling, most often in the big toe joint, NICE says. A hot, red, swollen joint with a fever could be an infection instead, which is urgent.
Sources 17, 18, 19
When a scan or test helpsStrong evidence
Most foot pain on walking doesn't need a scan to start treatment. The exceptions: a suspected stress fracture needs checking, and our stress fracture guide covers imaging; with diabetes, a hot, swollen foot that could be a Charcot foot needs an X-ray, and a magnetic resonance imaging (MRI) scan if the X-ray is normal, with the foot kept off weight until it has been checked (NICE); and a leg that aches as you walk can be checked with a simple test that compares the blood pressure at your ankle and arm (the NHS). New, painful or one-sided flat feet need a GP check.
Sources 18, 14, 15, 12
