Merck Manual

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Foot Manifestations of Systemic Disorders

Foot Manifestations of Systemic Disorders

Foot Symptoms or Signs

Possible Cause

Pain at rest (feet elevated), relieved by dependency

Cold, erythematous, or cyanotic feet

Advanced arterial ischemia

Episodically erythematous, hot, very painful, burning feet

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

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 or unilateral episodic digital discomfort, pallor, and cyanosis, sometimes with longer lasting tender reddish purple papules ("pernio")

Bilateral painless cyanosis

Bilateral edema

Renal, hepatic, or cardiac dysfunction, intra-abdominal venous obstruction

Medications (eg, calcium channel blockers)

Unilateral edema

Lymphatic obstruction

Firm nonpitting foot and leg edema

Firm, nonpitting edema with nodular appearance above the malleoli

Pretibial myxedema

Edema with hemosiderin deposition and brownish discoloration

Numbness and pain at the ankle and heel (tarsal tunnel syndrome) more common in people with chronic edema

Relapsing symmetric seronegative synovitis (rare)

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


Isolated toe swelling and deformity (dactylitis, or sausage digits) with pain

Infection (including nontuberculous mycobacteria)

Painful feet with paresthesias


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 erythema

Foot swelling, erythema, and warmth with little or no 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 Achilles Tendon Enthesopathy Achilles tendon enthesopathy is pain at the insertion of the Achilles tendon at the posterosuperior aspect of the calcaneus. Diagnosis is clinical. Radiographs in the lateral view may show enthesophytes... read more associated with spondyloarthropathies Overview of Seronegative Spondyloarthropathies Seronegative spondyloarthropathies (seronegative spondyloarthritides) share certain clinical characteristics (eg, inflammatory back pain, uveitis, gastrointestinal symptoms, rashes). Some are... read more (eg, ankylosing spondylitis Ankylosing Spondylitis Ankylosing spondylitis is the prototypical spondyloarthropathy and a systemic disorder characterized by inflammation of the axial skeleton, large peripheral joints, and digits; nocturnal back... read more Ankylosing Spondylitis , psoriatic arthritis Psoriatic Arthritis Psoriatic arthritis is a seronegative spondyloarthropathy and chronic inflammatory arthritis that occurs in people with psoriasis of the skin or nails. The arthritis is often asymmetric, and... read more Psoriatic Arthritis ), retrocalcaneal bursitis Anterior Achilles Tendon Bursitis Anterior Achilles tendon bursitis is inflammation of the retrocalcaneal bursa, located anterior (deep) to the attachment of the Achilles tendon to the calcaneus. Diagnosis is mainly clinical... read more , calcaneal apophysitis Apophysitis of the Calcaneus Apophysitis of the calcaneus is painful disruption between the calcaneal apophysis and the body of the heel that occurs before calcaneal ossification is complete. Diagnosis is clinical. The... read more Apophysitis of the Calcaneus (in children and young adolescents)