Your feet absorb thousands of small impacts during every run, so it is no surprise that foot pain from running is one of the most common complaints we see. Whether the pain is on the top of your foot, in the arch, or under your heel, the cause is rarely random. With the right assessment and a clear plan, most cases settle well.
In this guide, we cover the most common types of running-related foot pain, where they sit, what causes them, and how a physiotherapist can help.
Where is your foot pain?
Top of the foot
Pain across the top of the foot is one of the most common runner’s complaints. The most likely causes are:
- Extensor tendinopathy: irritation of the tendons that lift your toes, often related to tight or laced-too-tightly shoes.
- Stress reaction or stress fracture of the metatarsal bones, particularly the second or third metatarsal
- Synovitis of the small joints in the midfoot, often from a sudden change in training or footwear
Arch pain
Pain under the arch is most commonly plantar fasciitis, an irritation of the thick band of tissue along the sole of your foot. Classic features are sharp heel pain with the first few steps in the morning that eases as you warm up, then returns later in the day. Other arch-related causes include posterior tibial tendon dysfunction and intrinsic foot muscle fatigue.
Heel pain
Plantar fasciitis is the most common cause of heel pain in runners. Less common causes include heel fat pad irritation, calcaneal stress fractures, and Achilles insertional tendinopathy at the back of the heel.
Forefoot pain (ball of the foot)
Metatarsalgia is a general term for pain under the ball of the foot. Other forefoot causes include Morton’s neuroma, sesamoiditis under the big toe joint, and stress reactions of the metatarsals.
What causes foot pain in runners?
- Sudden increases in training load or a switch to faster, longer, or more frequent sessions
- Footwear changes: switching to a different shoe type or model without transition
- Worn-out shoes that no longer provide adequate support
- Surface changes: moving from soft to hard surfaces, or vice versa
- Foot strength deficits: weak intrinsic foot muscles can struggle to support repeated loading
- Calf and ankle stiffness: limited ankle mobility increases foot loading
- Bone density factors: low energy availability or hormonal changes can increase stress reaction risk
“In my experience as a physiotherapist, many running-related foot injuries develop gradually due to training load, footwear or biomechanical factors rather than a single incident. Early assessment and targeted rehabilitation can help address the underlying cause, reduce recovery time and minimise the risk of recurrence.”
— Kim Dinh here, Physiotherapist at Clinical Physio Solutions
When to see a physio for foot pain.
- Pain has lasted more than seven to ten days despite rest
- Pain is sharp, localised, and over a specific bone
- Pain wakes you at night or persists with daily walking
- You have noticeable swelling or bruising
- The pain is changing your gait or causing you to limp
Localised bone tenderness that does not settle is a particular red flag for stress reaction or fracture. Speak to a physiotherapist or doctor promptly if this applies to you.
How a physio treats running-related foot pain.
Treatment is always tailored to the diagnosis, but typically follows this framework:
Assessment
A detailed history of your training, footwear, and symptoms, followed by hands-on assessment of your foot, ankle, and lower limb. Your physio may also screen your running gait.
Pain relief
Soft tissue work, taping, footwear advice, and temporary load modification help settle the early stages.
Strengthening
Targeted exercises for the intrinsic foot muscles, calves, and lower limb are the cornerstone of long-term recovery. Heavy slow calf raises, foot doming, and toe flexor strengthening are commonly prescribed.
Return to running
A graded return-to-running plan, typically starting with walk-runs at low intensity, with monitoring of symptoms during, after, and the morning following each session.
Preventing foot pain when running.
- Build training load gradually with the 10 percent rule
- Replace running shoes every 600 to 800 kilometres
- Transition gradually if changing shoe type, especially when moving to lower-drop or minimalist/barefoot shoes
- Include calf and foot strengthening twice a week
- Address ankle stiffness with mobility work
- Avoid lacing shoes too tightly across the top of the foot
- Pay attention to early niggles rather than running through them
Frequently Asked Questions
Why does the top of my foot hurt when I run?
Pain on the top of the foot in runners is most commonly caused by extensor tendinopathy (often related to tight shoelaces or footwear), stress reactions in the metatarsal bones, or midfoot joint irritation. A physiotherapist can help differentiate between these and recommend the right treatment.
Is it OK to run with foot pain?
Mild discomfort that settles within the first ten minutes and does not worsen may be acceptable, but sharp or localised pain over a bone, pain that changes your gait, or pain that worsens after running should not be run through. Early assessment generally leads to faster recovery.
How long does plantar fasciitis take to heal?
Mild plantar fasciitis often improves within four to eight weeks with appropriate load management and strengthening. More chronic or severe cases can take three to six months. Calf and foot strengthening combined with footwear and load management is the most evidence-based approach.
Do I need orthotics for running foot pain?
Orthotics can help in some cases, particularly as a short-term aid alongside other treatment. They are not a fix on their own, and most foot pain responds best to a combination of strengthening, load management, and appropriate footwear. Your physiotherapist can advise whether orthotics are likely to help in your situation.
How do I know if I have a stress fracture?
Stress fractures typically cause sharp, localised bone pain that does not settle with rest, may wake you at night, and worsens with activity. If you have point-tender pain over a bone that has lasted more than a week, see a physiotherapist or doctor for assessment. Imaging may be required.
Foot pain when running can be frustrating, but it is usually very treatable with the right plan. If you have been dealing with foot pain that is not settling, our physiotherapy team can assess what is driving it and help you get back to training.
We see runners across our Burwood, Newington, Top Ryde, and Eastgardens clinics. For a broader overview, see our common running injuries guide.
Book your appointment today and get expert support for your foot pain recovery.