Overview of Foot and Ankle Disorders
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).
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 or unilateral episodic digital discomfort, pallor, and cyanosis |
|
|
Bilateral painless cyanosis |
Acrocyanosis, drug-induced discoloration (eg, minocycline) |
|
Bilateral edema |
Renal, hepatic, or cardiac dysfunction, intra-abdominal venous obstruction Drugs (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 |
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) |
Emboli |
|
Isolated toe swelling and deformity (dactylitis, or sausage digits) with pain |
Infection |
|
Painful feet with paresthesias |
Peripheral neuropathy (local or systemic—eg, diabetic neuropathy) Ischemia |
|
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, including fragility fractures associated with osteoporosis or repetitive trauma |
|
Foot swelling, redness, and warmth with little or no pain |
Neurogenic arthropathy (Charcot joints; 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), retromalleolar bursitis |
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 a year. People with these diseases should examine their own feet at least once a day.
The feet are also common sites for corns and calluses and infections by fungus, bacteria, and viruses.
See also table Common Foot and Ankle Disorders by Anatomic Site and table Disorders Associated With 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) |
|
Ball of the foot Interdigital nerve pain (eg, Morton neuroma) |
|
Heel (plantar) |
|
Heel (posterior) Achilles tendon enthesopathy, fluoroquinolone tendinopathy |
|
Heel (sides) Epiphysitis of the calcaneus (Sever disease) |
|
Plantar arch (sole) Cuboid subluxation syndrome Plantar fascial sprain Posterior tibial tendon rupture with arch collapse |
|
Toe Dactylitis (painful, isolated toe swelling due to inflammatory arthritis) Hallux rigidus |
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) |
|
Medial and lateral margins of the heel |
In children, epiphysitis of the calcaneus (Sever disease) Sometimes tarsal tunnel syndrome |
|
Anterior to the Achilles tendon at the retromalleolar space |
Fracture of the posterolateral talar tubercle |
|
Posterior to the Achilles tendon |
Tendon nodules |
|
Calcaneal insertion or body of the Achilles tendon |
Tendon tear (due to trauma or associated with fluoroquinolone use—see Achilles Tendon Tears) |
Drugs Mentioned In This Article
| Drug Name | Select Trade |
|---|---|
minocycline |
MINOCIN |
Warfarin |
COUMADIN |
