Can Lyme Disease Cause Foot Pain?
Lyme disease foot pain may mimic plantar fasciitis or tendonitis.
Inflammation, neuropathy, and migratory pain can affect the feet and toes.
Persistent or unexplained foot pain may warrant evaluation for Lyme disease.
Can Lyme disease cause foot pain?
Some patients with Lyme disease develop foot pain severe enough to interfere with walking, standing, exercise, or daily activities.
Foot pain may arise from inflammation, tendon involvement, neuropathy, arthritis, autonomic dysfunction, or migratory musculoskeletal symptoms associated with Lyme disease and related tick-borne illnesses.
Case study: unexplained foot pain
One of my patients experienced severe foot pain, even while walking to the bathroom.
A podiatrist diagnosed him with plantar fasciitis, and he tried multiple treatments including icing, NSAIDs, stretching, iontophoresis, shoe inserts, and cortisone injections.
Despite these efforts, his foot pain persisted.
In addition to foot pain, he experienced exhaustion, poor sleep, impaired concentration, neck and back pain, mood disturbances, palpitations, lightheadedness, migratory pains, and sensitivity to light and sound.
Remarkably, his foot pain and associated symptoms resolved following treatment for Lyme disease.
How Lyme disease may affect the feet
Lyme disease foot pain may involve several overlapping mechanisms.
- Inflammatory tendon pain
- Plantar fasciitis-like symptoms
- Peripheral neuropathy
- Migratory joint pain
- Burning or tingling sensations
- Pain involving the toes or heels
- Autonomic dysfunction affecting circulation
Some patients report symptoms that shift location over time, while others develop persistent heel pain, arch pain, or nerve-related discomfort.
For broader neurologic and musculoskeletal symptoms, see the Lyme disease symptoms guide.
Can Lyme disease mimic plantar fasciitis?
Yes. Lyme disease may mimic plantar fasciitis, tendonitis, or overuse injuries.
Patients may initially receive orthopedic, podiatric, or sports medicine diagnoses before the possibility of Lyme disease is considered.
When symptoms persist despite conventional treatment — particularly when accompanied by fatigue, cognitive symptoms, migratory pain, dizziness, palpitations, or neurologic complaints — clinicians may consider broader systemic causes.
Published reports of Lyme disease foot and ankle pain
Several published reports have described Lyme disease manifestations involving the foot and ankle.
Miller and colleagues reported a retrospective case series describing Lyme disease manifestations affecting the foot and ankle, including inflammatory, neurologic, and musculoskeletal presentations.
Earlier reports by Faller and colleagues also described foot and ankle disorders resulting from Lyme disease.
These reports support the possibility that Lyme disease foot pain may present with symptoms resembling orthopedic, neurologic, or inflammatory conditions.
Other unusual Lyme disease presentations
In my practice, Lyme disease has also been associated with a wide range of unusual presentations.
- Thumb pain
- Intermittent blue discoloration of the hands and feet
- Distorted vision and floaters
- Uveitis
- Atypical seizures
- Temporomandibular joint disorder (TMJ)
- Tinnitus
- Movement disorders
- ALS-like and MS-like presentations
- Parkinsonian symptoms
- Dementia
- Gastroparesis
- Mold sensitivity
- Small intestinal bacterial overgrowth (SIBO)
- Mast cell activation syndrome (MCAS)
- Ehlers-Danlos syndrome (EDS)
- Median arcuate ligament syndrome (MALS)
- Fibromyalgia
- Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS)
- Functional and somatic disorders
- Anxiety, depression, OCD, and ADHD
Why Lyme disease foot pain may be overlooked
Foot pain is common in the general population, making Lyme disease easy to overlook when symptoms initially resemble routine orthopedic or inflammatory conditions.
However, unexplained foot pain accompanied by systemic, neurologic, cognitive, or migratory symptoms may raise suspicion for tick-borne illness.
For related diagnostic challenges, see Lyme disease misdiagnosis.
Frequently Asked Questions
Can Lyme disease cause foot pain?
Yes. Lyme disease may contribute to foot pain through inflammation, tendon involvement, neuropathy, arthritis, or migratory musculoskeletal symptoms.
Can Lyme disease mimic plantar fasciitis?
Yes. Some patients with Lyme disease are initially diagnosed with plantar fasciitis or tendonitis before broader systemic symptoms emerge.
Can Lyme disease cause burning feet or tingling?
Yes. Peripheral neuropathy associated with Lyme disease may cause burning, tingling, numbness, or abnormal sensations in the feet.
Can Bartonella cause foot pain?
Some clinicians and patients report foot pain, neuropathy, or burning sensations associated with Bartonella and other tick-borne coinfections.
When should unexplained foot pain raise concern for Lyme disease?
Persistent foot pain accompanied by fatigue, cognitive symptoms, migratory pain, dizziness, neurologic symptoms, or tick exposure history may warrant further evaluation.
Clinical Takeaway
Lyme disease foot pain may resemble plantar fasciitis, tendonitis, neuropathy, arthritis, or other orthopedic conditions.
When foot pain occurs alongside fatigue, cognitive symptoms, migratory pain, neurologic complaints, or other systemic symptoms, clinicians may consider Lyme disease and related tick-borne illnesses in the differential diagnosis.
Persistent or unexplained foot pain should not automatically be dismissed as a routine orthopedic problem when broader Lyme disease symptoms are present.
Related Articles
These related articles explore musculoskeletal symptoms, neurologic complications, coinfections, and diagnostic challenges associated with Lyme disease.
Bartonella and Lyme disease
Autonomic dysfunction in Lyme disease
Persistent Lyme disease
Lyme coinfections
Neurologic Lyme disease
References
- Miller JR, Dunn KW, Braccia D, et al. Lyme disease manifestations in the foot and ankle: A retrospective case series. J Foot Ankle Surg. 2016;55(6):1241-1244.
- Faller J, Thompson F, Hamilton W. Foot and ankle disorders resulting from Lyme disease. Foot Ankle. 1991;11(4):236-238.
- Novak P, Felsenstein D, Mao C, et al. Association of small fiber neuropathy and post treatment Lyme disease syndrome. PLoS One. 2019;14(2):e0212222.
Dr. Daniel Cameron, MD, MPH
Lyme disease clinician with over 30 years of experience and past president of ILADS.
Symptoms • Testing • Coinfections • Recovery • Pediatric • Prevention
yes I have experience some of these symptoms, what can I do?
Thanks as always for educating us Dr. Cameron.
Hi. I woke up one morning with a bullseye on my left forerm. I saw the doctor who prescribed 21 day treatment of doxycycline. I had sensitive scalp, headache, neck pain on right side and sore left hip. I was told by the doctor that if any time down the road I have new joint pain I should see a doctor and get another 21 day course of antibiotics.
I was fine until a few days ago. My feet hurt so bad I can’t even walk around the block. I went to the ER and the doctor wasn’t too informed on Lyme but gave me a prescription. This day 4 of this weird pain. I struggled to walk home. Is this something that is common. I’m 69 and in fairly good health. I live alone and am scared. Thank you.
I have Lyme disease patient whose feet hurt walking to the bathroom at night. They usually have other symptoms. I also have to assess for other illnesses ie Plantar fasciitis.
Feet feet are common in Lyme. I have patients who struggle to walk to the bathroom yet are better during the day. I have patients who have co-infections ie Babesia. You can read more at https://danielcameronmd.com/painful-feet-lyme-disease/
Many people dismiss discomfort on the outer edge of the foot as just muscle strain, but recurring pain in outside of foot can actually point to issues like tendon irritation, ligament stress, or gait imbalances. It’s interesting how small changes in footwear, walking patterns, or activity levels can gradually create tension in this area, making early awareness and proper assessment really important for long-term mobility.