Fibromyalgia is a chronic pain condition characterised by widespread musculoskeletal pain, fatigue, sleep disturbance, and heightened sensitivity to sensory input. Although it is often discussed in terms of “whole-body” pain, many people experience symptoms that feel very local—especially in the feet. Foot pain in fibromyalgia can be confusing because it may mimic plantar fasciitis, neuropathy, arthritis, or tendon problems, yet imaging and standard tests are frequently normal. Understanding the mechanisms behind fibromyalgia helps explain why the feet can hurt intensely even without obvious tissue damage.
1) Central sensitisation: when the volume knob is turned up
The best-supported explanation for fibromyalgia is central sensitisation—a state in which the central nervous system (brain and spinal cord) amplifies pain signals. In central sensitisation, normal sensory input (pressure, temperature, movement) can be interpreted as painful (allodynia), and mildly painful input can feel disproportionately severe (hyperalgesia).
Feet are especially vulnerable to this effect because they are rich in sensory nerve endings and are constantly exposed to mechanical load. Every step creates repeated pressure and stretch through the plantar fascia, heel fat pad, small joints, tendons, and skin. In someone with central sensitisation, this everyday input can be “upscaled” into persistent pain. This is one reason people with fibromyalgia may report burning soles, aching heels, or sharp pain with standing—even when there is no clear structural injury.
2) Altered pain processing and “referred” pain patterns
Fibromyalgia is associated with changes in how the nervous system processes and filters pain. The spinal cord and brain can become more responsive to incoming signals, and the usual inhibitory pathways that dampen pain may be less effective. This can create pain that feels diffuse, migratory, or inconsistent.
In practical terms, foot pain may not map neatly onto one tendon or one joint. A person may describe pain in the heel one week, the arch the next, then the top of the foot—sometimes on both sides. This variability does not mean the pain is “imagined”; it reflects a nervous system that is generating pain more readily and in less predictable patterns.
3) Small-fibre neuropathy-like symptoms
A subset of people diagnosed with fibromyalgia show evidence of small-fibre nerve dysfunction on specialised testing. Small fibres help transmit pain and temperature sensations and also influence autonomic functions such as sweating and blood flow.
When small fibres are irritated or dysfunctional, symptoms can include burning, tingling, electric-shock sensations, numbness, or “walking on hot coals” feelings—often most noticeable in the feet. Even when formal nerve conduction studies are normal (they mainly test large fibres), small-fibre involvement can still contribute to foot symptoms.
4) Autonomic nervous system dysregulation and circulation changes
Fibromyalgia is frequently associated with autonomic nervous system dysregulation (sometimes overlapping with conditions like orthostatic intolerance). If autonomic control of blood flow is altered, the feet may experience temperature changes, swelling sensations, colour changes, or discomfort that worsens with prolonged standing.
Poor sleep, stress, and fatigue—common in fibromyalgia—can further destabilise autonomic balance. The result can be feet that feel heavy, sore, or hypersensitive, particularly later in the day.
5) Muscle tension, trigger points, and overload of the foot’s support system
People with fibromyalgia often have increased muscle tension and tenderness in multiple regions. Persistent guarding and tension can change gait and loading patterns. For example, if calf muscles are tight or painful, a person may alter ankle motion and shift load toward the forefoot or heel. If hip or back pain changes stride length, the foot may absorb more impact.
In addition, myofascial trigger points in the calf (gastrocnemius/soleus), tibialis posterior, or intrinsic foot muscles can refer pain into the heel, arch, or toes. This can mimic plantar fasciitis or tendonitis.
Over time, altered movement patterns can create a “double hit”: sensitised nerves plus genuine mechanical overload. Even if fibromyalgia is the primary driver, secondary issues like plantar fascia irritation, Achilles tendinopathy, or metatarsalgia can develop.
6) Sleep disturbance and impaired recovery
Sleep problems are not just a symptom of fibromyalgia—they are a key amplifier of pain. Poor-quality sleep reduces pain inhibition, increases inflammation-related signalling, and impairs tissue recovery. Feet, which endure repetitive daily load, rely on overnight recovery. If sleep is fragmented, the threshold for pain drops and normal post-activity soreness can become persistent.
This is why some people notice that foot pain flares after a bad night’s sleep, a stressful week, or a period of increased fatigue—even if their activity level has not changed dramatically.
7) Coexisting conditions that commonly affect the feet
Fibromyalgia can coexist with other conditions that independently cause foot pain. Common examples include:
- Plantar fasciitis/plantar heel pain: may be triggered or prolonged by sensitisation.
- Osteoarthritis in the midfoot or big toe joint.
- Hypermobility: increased joint motion can strain ligaments and tendons.
- Inflammatory arthritis (less common but important to rule out if there is swelling, warmth, or morning stiffness).
- Peripheral neuropathy from diabetes, B12 deficiency, thyroid disease, or medications.
Because fibromyalgia can heighten pain perception, these conditions may feel more severe than expected based on imaging or exam findings.
Practical implications: what helps when fibromyalgia and foot pain overlap
A useful approach is to treat foot pain in fibromyalgia as both a nervous system issue and a load-management issue.
- Validate the pain and broaden the lens: pain can be real and intense even without visible damage.
- Gentle, graded loading: short, tolerable walks or strengthening that slowly increases can improve tissue capacity without triggering flares.
- Footwear and cushioning: reducing impact and pressure can lower sensory input to a sensitised system.
- Calf and foot mobility: gradual stretching and strengthening may reduce overload and trigger point activity.
- Sleep and stress strategies: improving sleep quality and reducing stress often reduces pain sensitivity.
- Medical review when needed: burning, numbness, marked swelling, skin colour changes, or progressive symptoms warrant assessment to rule out neuropathy, vascular issues, or inflammatory disease.
Fibromyalgia can cause foot pain through central sensitisation, altered pain modulation, possible small-fibre nerve dysfunction, autonomic dysregulation, and secondary mechanical overload from changes in movement and muscle tension. The feet are a common site for symptoms because they are highly innervated and constantly loaded. A combined strategy—addressing nervous system sensitivity while also managing mechanical stress—tends to be the most effective way to reduce pain and improve function.
