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Foot Pain

The foot is a common site of pain, deformity and loss of function foot pain associated with hallux valgus, bunion, pes cavus, metatarsalgia, plantar fasciitis and hallux rigidus. The primary care physician is Often the first to evaluate and treat these conditions. Often the source of the patient's complaints lies in structural malalignments, either at the location of the complaint or elsewhere in the foot. Successful management of these problems depends upon identifying and treating the primary pathology.

Common Disorders of the Foot

Hallux Valgus (Bunion)

Clinical presentation: The patient complains of a painful and prominent medial eminence of the first metatarsal head. The hallux assumes a valgus and pronated position. Hammering of the second toe often accompanies hallux valgus. In severe cases, the second hammertoe overlaps the deviated hallux. The patient often has pain/difficulty.

Hammer toes/Metatarsalgia

Clinical presentation: The patient complains of painful "rocks under the balls of their feet" and curled up toes that rub against the tops of their shoes.

Primary pathology: Several possible etiologies. Mechanical overload of the forefoot inflames then attenuates the plantar structures, allowing the toe extensor tendons to pull the toes up at the MTPJ while the toe flexor tendons pull the end of the toe back down through the PIPJ. Also Pes Cavus feet due to Charcot-Marie-Tooth disease.

Posterior tibial tendinitis/dysfunction and acquired flatfoot

Clinical presentation: The patient may complain of a pain and swelling in several locations. Pain and swelling due to an inflamed tendon will extend from behind the medial malleolus to the navicular tuberosity and under the arch of the foot. Pain at the tip of the lateral malleolus may represent impingement of the peroneal tendons.

Pes Cavus

Clinical presentation: The patient may complain of pain along the lateral border of their foot with a thick callus under the base and/or head of the fifth metatarsal. A painful callus can also be found under all the metatarsal heads with the worse one under the first metatarsal. They may give a history of "weak ankles" and recurrent sprains. They don't like walking on uneven ground or on inclines because of pain or unsteadiness.

Posterior heel pain (Haglund's syndrome)

Clinical Presentation: The patient complains of a painful bump on their heel that rubs against their shoe. Their heel feels stiff, painful and swollen by the end of the day and their "pump bump" is especially sensitive. The Achilles tendon is contracted and there is chronic edema between the tendon and the calcaneus.

Plantar heel pain (plantar fasciitis)

Clinical Presentation: The patient complains of sharp pain under their heel especially getting out of bed or after prolonged sitting. Their heel feels stiff, achy and swollen by the end of the day. The onset of these complaints often coincides with a change in activity level. The Achilles tendon is contracted and there is point tenderness at

Peroneal tendinitis

Clinical Presentation: Patient complains of pain along the lateral hindfoot/ankle. They may give a recent or remote history of an "ankle sprain" as the source of this pain. They may report snapping or popping behind the

Hallux rigidus (osteoarthritis of first MTPJ)

Clinical Presentation: The patient complains of a painful and stiff great toe. A dorsal osteophyte of varying size may also be present. The patient has difficulty / pain with shoewear and may walk on the lateral border of their forefoot to avoid bending the hallux during gait.

Primary Pathology: Degenerative arthritis of the first MTPJ due to cumulative trauma or prolonged increased stress in the joint.

Secondary manifestation: Often none accompany this problem.

Initial treatment

Reduce inflammation. NSAID, steroid injection and/or immobilization will rest the joint.

Accommodate the deformity. High toe box, lace-up shoes will provide more room for the hallux. Steel shank shoes with a rocker-bottom sole will limit MTPJ motion during gait.

Diabetic foot

Clinical Presentation: The patient presents with a neuropathic ulcer on the plantar aspect of the foot. The is usually accompanied by an underlying bone or joint deformity which leads to increased pressure, skin necrosis and skin breakdown. The ulcer will deepen down to bone and become infected over time. The patient may