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Most foot problems result from anatomic disorders or abnormal function of articular or extra-articular structures (see Fig. 1: Foot and Ankle Disorders: Bones of the foot.). Less commonly, foot problems reflect a systemic disorder (see Table 1: Foot and Ankle Disorders: Foot Manifestations of Systemic Disorders).

Fig. 1
Bones of the foot.

Table 1
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 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) WarfarinSome Trade Names COUMADIN Click for Drug Monograph therapy Bilateral episodic digital discomfort, pallor, and cyanosis Raynaud's syndrome Bilateral painless cyanosis (in a young female) Acrocyanosis 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 Lymphedema Systemic sclerosis Firm nonpitting edema with nodular appearance above the malleoli Pretibial myxedema Edema with hemosiderin deposition and brownish discoloration Venous insufficiency Recurrent small-vessel vasculitis Edema of feet and toes, numbness and pain at the ankle and heel (tarsal tunnel syndrome) Hypothyroidism Relapsing symmetric seronegative synovitis (rare) Red, dusky patches on the dorsum with flaccid bullae (necrolytic acral erythema) Hepatitis C Vasculitis Emboli 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 Sciatica Toe, foot, or ankle pain with warmth and redness Gout Stress fracture Thickened (> 22 mm) heel pad as determined with x-rays or ultrasonography Hyperpituitarism with acromegaly

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 Cornification Disorders: Calluses and Corns) and infections by fungus (see Fungal Skin Infections: Tinea Pedis), bacteria (see Bacterial Skin Infections), and viruses (see Viral Skin Diseases: Warts).

Table 2: Foot and Ankle Disorders: Common Foot and Ankle Disorders by Anatomic Site lists foot and ankle disorders according to anatomic site. Table 3: Foot and Ankle Disorders: Disorders Associated With Heel Pain According to Location lists common causes of heel pain according to location.

Table 2
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 Ball of the foot Corns and calluses Freiberg's disease Interdigital nerve pain (Morton's neuroma) Metatarsophalangeal joint pain Sesamoiditis Heel (plantar) Inferior calcaneal bursitis Plantar fasciosis Heel (posterior) Achilles tendon enthesopathy Anterior Achilles tendon bursitis Posterior Achilles tendon bursitis Heel (sides) Epiphysitis of the calcaneus (Sever's disease) Medial plantar nerve entrapment Plantar arch (sole) Plantar fascial sprain Plantar fibromatosis Toe Bunion Hammer toe Ingrown toenail Onychomycosis Paronychia

Table 3
Disorders Associated With Heel Pain According to Location Location of Pain Associated Disorder Plantar surface of the heel Plantar fasciosis (plantar fasciitis, calcaneal spur syndrome) Inferior calcaneal bursitis Medial and lateral margins of the heel In children, epiphysitis of the calcaneus (Sever's disease) Medial plantar nerve entrapment Sometimes tarsal tunnel syndrome Anterior to the Achilles tendon at the retromalleolar space Fracture of the posterolateral talar tubercle Tibialis posterior tendinosis Anterior Achilles tendon bursitis Tarsal tunnel syndrome Posterior to the Achilles tendon Posterior Achilles tendon bursitis Tendon nodules Calcaneal insertion of the Achilles tendon Achilles tendon enthesopathy

Last full review/revision March 2008 by Kendrick Alan Whitney, DPM

Content last modified March 2008