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Overview of Foot and Ankle Disorders

by Kendrick Alan Whitney, DPM

Most foot problems result from anatomic disorders or abnormal function of articular or extra-articular structures (see Figure: Bones of the foot.). Less commonly, foot problems reflect a systemic disorder (see Table: Foot Manifestations of Systemic Disorders).

Bones of the foot.

Foot Manifestations of Systemic Disorders

Foot Symptoms or Signs

Possible Cause

Pain at rest (feet elevated), relieved by dependency

End-stage peripheral arterial disease

Cold, red, or cyanotic feet

Advanced arterial ischemia

Episodically red, hot, very painful, burning feet

Erythromelalgia—idiopathic (most commonly) or secondary to various disorders (eg, myeloproliferative disorders, which are rare)

Foot pain that becomes severe within seconds or possibly minutes, particularly in patients with atrial fibrillation; foot often cool

Embolic arterial occlusion

Cyanosis of a single toe (blue toe syndrome)

Thromboembolic disease due to aortic-iliac stenosis, arrhythmia, or cholesterol embolization (after coronary artery bypass or catheterization)

Warfarin therapy

Bilateral episodic digital discomfort, pallor, and cyanosis

Raynaud syndrome

Bilateral painless cyanosis

Acrocyanosis, drug-induced discoloration (eg, minocycline)

Bilateral edema

Renal, hepatic, or cardiac dysfunction

Drugs (eg, Ca channel blockers)

Unilateral edema

Deep venous thrombosis

Lymphatic obstruction

Firm nonpitting foot and leg edema


Systemic sclerosis

Firm, nonpitting edema with nodular appearance above the malleoli

Pretibial myxedema

Edema with hemosiderin deposition and brownish discoloration

Venous insufficiency

Recurrent or prior small-vessel vasculitis

Edema of feet and toes, numbness and pain at the ankle and heel (tarsal tunnel syndrome)


Relapsing symmetric seronegative synovitis (rare)

Red, dusky patches on the dorsum with flaccid bullae (necrolytic acral erythema)

Hepatitis C



Isolated toe swelling and deformity (sausage digits) with pain

Psoriatic arthritis

Reactive arthritis

Other spondyloarthropathies

Crystal-induced arthritis


Painful feet with paresthesias

Peripheral neuropathy (local or systemic—eg, diabetic neuropathy)


Pain or paresthesias in the leg and foot; pain in the foot and back when the leg is extended, relieved when the knee is flexed


Toe, foot, or ankle pain with warmth and redness


Stress fracture associated with osteoporosis

Foot swelling, redness, and warmth with little or no pain

Charcot (foot) arthropathy (usually in the absence of pain)

Posterior heel pain below the top of the shoe counter during ambulation

Tendon tenderness at its insertion (diagnostic)

Exacerbation of tendon pain by passive ankle dorsiflexion

Achilles enthesopathy associated with spondyloarthropathies (eg, ankylosing spondylitis, psoriatic arthritis)

In people with diabetes and people with peripheral vascular disease, careful examination of the feet, with evaluation of vascular sufficiency and neurologic integrity, should be done at least twice/yr. People with these diseases should examine their own feet at least once/day.

The feet are also common sites for corns and calluses (see Calluses and Corns) and infections by fungus (see Tinea Pedis), bacteria (see Bacterial Skin Infections), and viruses (see Warts).

Common Foot and Ankle Disorders by Anatomic Site lists foot and ankle disorders according to anatomic site. Disorders Associated With Heel Pain According to Location lists common causes of heel pain according to location.

Common Foot and Ankle Disorders by Anatomic Site

Ankle (anterolateral)

Meniscoid body

Neuralgia of the intermediate dorsal cutaneous nerve

Peroneal tenosynovitis

Ankle (medial)

Tarsal tunnel syndrome

Tibialis posterior tendinosis

Tibialis posterior tenosynovitis

Ball of the foot

Corns and calluses

Freiberg disease

Interdigital nerve pain (Morton neuroma)

Metatarsophalangeal joint pain


Heel (plantar)

Inferior calcaneal bursitis

Medial or lateral plantar nerve entrapment

Plantar fasciosis

Heel (posterior)

Achilles tendon enthesopathy

Anterior Achilles tendon bursitis

Posterior Achilles tendon bursitis

Heel (sides)

Epiphysitis of the calcaneus (Sever disease)

Tarsal tunnel syndrome

Plantar arch (sole)

Cuboid subluxation syndrome

Plantar fascial sprain

Plantar fibromatosis

Posterior tibial tendon rupture with arch collapse



Hallux rigidus

Hammer toe

Ingrown toenail



Disorders Associated With Heel Pain According to Location

Location of Pain

Associated Disorder

Plantar surface of the heel

Inferior calcaneal bursitis

Plantar fasciosis (plantar fasciitis, calcaneal spur syndrome)

Medial and lateral margins of the heel

In children, epiphysitis of the calcaneus (Sever disease)

Medial or lateral plantar nerve entrapment

Sometimes tarsal tunnel syndrome

Anterior to the Achilles tendon at the retromalleolar space

Anterior Achilles tendon bursitis

Fracture of the posterolateral talar tubercle

Tarsal tunnel syndrome

Tibialis posterior tendinosis

Posterior to the Achilles tendon

Posterior Achilles tendon bursitis

Tendon nodules

Calcaneal insertion or body of the Achilles tendon

Achilles tendon enthesopathy

Tendon tear (due to trauma or associated with fluoroquinolone use—see Achilles Tendon Tears)

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