Most foot problems result from anatomic disorders or abnormal function of articular or extra-articular structures (see figure ). Less commonly, foot problems reflect a systemic disorder (see table ).
In people with diabetes and/or peripheral arterial disease, careful examination of the feet, with evaluation of vascular sufficiency and neurologic integrity, should be done at least twice a year. People with these diseases should examine their own feet at least once a day.
The feet are also common sites for musculoskeletal pain, pressure and friction injuries Pressure Injuries Pressure injuries are areas of necrosis and often ulceration (also called pressure ulcers) where soft tissues are compressed between bony prominences and external hard surfaces. They are caused... read more , and infections by fungus Tinea Pedis (Athlete's Foot) Tinea pedis is a dermatophyte infection of the feet. Diagnosis is by clinical appearance and sometimes by potassium hydroxide wet mount, particularly if the infection manifests as hyperkeratotic... read more , bacteria Overview of Bacteria Bacteria are microorganisms that have circular double-stranded DNA and (except for mycoplasmas) cell walls. Most bacteria live extracellularly, but some preferentially reside and replicate intracellularly... read more , and viruses Warts Warts are common, benign, epidermal lesions caused by human papillomavirus infection. They can appear anywhere on the body in a variety of morphologies. Diagnosis is by examination. Warts are... read more .
See also table and table .
Bones of the Foot
Considerations for Using Corticosteroid Injections
Corticosteroid injections should be used judiciously to avoid adverse effects. Injectable corticosteroids should be reserved for inflammatory conditions such as gout Gout Gout is a disorder caused by hyperuricemia (serum urate > 6.8 mg/dL [> 0.4 mmol/L]) that results in the precipitation of monosodium urate crystals in and around joints, most often causing recurrent... read more and rheumatoid arthritis Rheumatoid Arthritis (RA) Rheumatoid arthritis is a chronic systemic autoimmune disease that primarily involves the joints. Rheumatoid arthritis causes damage mediated by cytokines, chemokines, and metalloproteases.... read more ). Because the tarsus, ankle, retrocalcaneal space, and dorsum of the toes have little connective tissue between the skin and underlying bone, injection of insoluble corticosteroids into these structures may cause depigmentation, atrophy, or ulceration, especially in older patients with peripheral arterial disease Peripheral Arterial Disease Peripheral arterial disease (PAD) is atherosclerosis of the extremities (virtually always lower) causing ischemia. Mild PAD may be asymptomatic or cause intermittent claudication; severe PAD... read more .
Insoluble corticosteroids can be given deeply rather than superficially with greater safety (eg, in the heel pad, tarsal canal, or metatarsal interspaces). The foot should be immobilized for a few days after tendon sheaths are injected. Unusual resistance to injection suggests injection into a tendon. The use of ultrasound guidance can improve the accuracy of the injection and, depending on the location, may also improve efficacy (1 Reference Most foot problems result from anatomic disorders or abnormal function of articular or extra-articular structures (see figure ). Less commonly, foot problems reflect a systemic disorder (see... read more ). Repeated injection into a tendon should be avoided because the tendon may weaken (partially tear), predisposing to subsequent rupture.
1. Daniels EW, Cole D, Jacobs B, Phillips SF: Existing evidence on ultrasound-guided injections in sports medicine. Orthop J Sports Med 6(2):2325967118756576, 2018. Published 2018 Feb 22. doi:10.1177/2325967118756576