Sharp pain in foot: causes, symptoms and treatments

Where does it hurt? A quick guide to sharp foot pain

Sharp foot pain can feel like stabbing, shooting, burning or an electric jolt. The spot where it hurts is the best first clue to the cause:

This is a guide, not a diagnosis. More than one problem can cause pain in the same spot, and a podiatrist can tell them apart with an exam and, if needed, an X-ray.

Sharp, shooting pain in the foot that comes and goes

Pain that strikes suddenly and then fades is common, and the pattern helps narrow down the cause:

• Jolts of shooting or electric pain often come from a nerve. Morton’s neuroma flares in tight shoes, and tarsal tunnel syndrome flares after standing or walking.
• Stabbing pain with your first steps that eases as you get moving is typical of plantar fasciitis.
• Attacks that last several days and then settle are typical of gout.
• Pain that builds with activity and eases with rest, in one spot, suggests a stress fracture.

If the same pain keeps coming back, it’s worth finding out why. Many of these problems are easier to treat early.

Sharp, needle-like pain in the foot at night

Nerve pain is often worse at night, when there’s less to distract you. Burning, tingling or needle-like pain in both feet at bedtime is a common sign of peripheral neuropathy, and pain in the sole and inner ankle can come from tarsal tunnel syndrome. Our guide to damaged nerves in the foot explains more.

Gout attacks also often start during the night. If night-time foot pain eases when you hang your leg over the side of the bed, or you get calf cramps when you walk, have your circulation checked. Poor blood flow to the feet can cause these symptoms and needs medical care.

Common causes of sharp foot pain

Plantar fasciitis

Plantar fasciitis is the most common cause of sharp heel pain. The plantar fascia, a thick band of tissue along the bottom of your foot, becomes irritated where it attaches to the heel. The pain is usually worst with your first steps in the morning or after sitting.

Risk factors: running and other high-impact activity, tight calf muscles, excess body weight, and shoes with little support.

Treatment:

• calf and foot stretches, done daily
• supportive shoes and orthotic inserts
• ice and over-the-counter pain relievers
• night splints and physical therapy
• steroid injections or shockwave therapy if pain lingers; surgery is rarely needed

Most people get better within a few months with home care. Learn how we treat plantar fasciitis and heel pain.

Morton’s neuroma

Morton’s neuroma is a thickening of the tissue around a nerve between the toes, most often between the third and fourth toes. It causes sharp, burning pain in the ball of the foot, a feeling of standing on a pebble, and sometimes numb toes.

Risk factors: tight or narrow shoes, high heels, flat feet or high arches, and high-impact sports.

Treatment:

• wider shoes with a low heel
• metatarsal pads or orthotic inserts
• ice and anti-inflammatory medicine
• a steroid injection
• surgery for pain that doesn’t improve with other treatment

Tarsal tunnel syndrome

Tarsal tunnel syndrome happens when the tibial nerve is squeezed where it passes along the inside of the ankle. It causes burning, tingling, numbness and shooting pain along the sole of the foot.

Possible causes: flat feet, swelling from a sprain or injury, cysts or bone spurs near the nerve, and conditions such as diabetes or arthritis.

Treatment:

• rest and ice
• anti-inflammatory medicine
• supportive shoes or orthotics
• physical therapy
• a steroid injection, or surgery to release the nerve in severe cases

Stress fractures

A stress fracture is a small crack in a bone caused by repeated impact rather than one injury. It often follows a sudden increase in walking, running or standing. The pain builds with activity, eases with rest, and there’s usually one spot, often on the top of the foot, that hurts to press. Swelling is common.

Risk factors: a sudden jump in activity, low bone density, and not enough calcium, vitamin D or calories for your activity level.

Diagnosis and treatment: an X-ray may look normal for the first few weeks, so an MRI is sometimes needed. Treatment is rest from impact, a fracture boot or post-op shoe, and a gradual return to activity over about 6 to 8 weeks. Our guide to telling a fracture from a sprain can help.

Gout

Gout is a type of arthritis caused by uric acid crystals forming in a joint. An attack comes on suddenly, often at night, with severe pain, redness, heat and swelling, most often in the big toe joint. Even the weight of a bedsheet can hurt.

Common triggers: alcohol, especially beer; red meat and shellfish; sugary drinks; dehydration; and some water pills.

Treatment: prescription medicines calm an attack, and long-term medicine can lower uric acid to prevent more. See a doctor promptly for a red, hot, swollen joint, because an infection can look the same.

Nerve damage (peripheral neuropathy)

Peripheral neuropathy is damage to the nerves in the feet and legs. It causes burning, tingling, shooting or electric pain and numbness, usually in both feet, and it’s often worse at night. Diabetes is the most common cause. Others include low vitamin B12, heavy alcohol use, some medicines, thyroid problems and kidney disease.

Diagnosis: a foot and nerve exam, blood tests and sometimes nerve tests.

Treatment:

• treating the cause, such as keeping blood sugar in range
• prescription medicine for nerve pain
• physical therapy for balance and strength
• protective shoes and daily foot checks

Numb feet can hide injuries, so neuropathy needs regular foot care. See nerve pain and neuropathy in the feet and diabetic foot care at Evolve Health.

What helps sharp foot pain at home

For a new injury: RICE

For a fresh injury, such as a twist or a knock, use RICE for the first 2 or 3 days:

1. Rest: stay off the foot as much as you can.
2. Ice: 15 to 20 minutes every 2 to 3 hours, with a cloth between the ice and your skin.
3. Compression: wrap the foot with an elastic bandage, snug but not tight.
4. Elevation: raise your foot above the level of your heart.

An over-the-counter pain reliever can help, if it’s safe for you.

Shoes and stretching

• Choose supportive shoes with good arch support, cushioning and a roomy toe box. Replace them once the cushioning wears out.
• Avoid flat, flimsy shoes and high heels, and don’t walk barefoot on hard floors if your heel hurts.
• Stretch every day. Calf stretches, pulling your toes back to stretch the bottom of the foot, toe curls and ankle circles all help. Aim for twice a day.
• Build up new exercise gradually, adding no more than a little distance or time each week.

For nerve pain

• Wear roomy, cushioned shoes that don’t squeeze the toes.
• Don’t use heating pads, hot soaks or ice on numb feet. You may not feel a burn.
• Check your feet every day for cuts, blisters and color changes.
• Over-the-counter lidocaine cream or patches may ease the pain.
• Limit alcohol, and if you have diabetes, keep your blood sugar in range.

When to see a podiatrist

Get care the same day if:

• you can’t put weight on your foot, or it looks deformed after an injury
• the foot is red, hot and swollen, or you have a fever
• you have diabetes and notice a new wound, blister or color change

Go to the emergency room if your foot or toes suddenly turn cold, pale or blue, or you have sudden weakness or numbness in your leg.

Book a visit if:

• the pain isn’t easing after 2 to 3 days
• it keeps coming back, or wakes you at night
• you have burning, tingling or numbness
• the pain is changing the way you walk

A podiatrist will examine your foot, watch how you walk and ask about your symptoms. Evolve Health podiatrists have digital X-ray on site, and may order an ultrasound, MRI or nerve tests if needed. Getting the right diagnosis matters, because each cause is treated differently. You can find a podiatrist near you and book online.