FOOT AND TOE PAIN

FOOT AND TOE PAIN: Excerpt from Algorithmic Diagnosis of Symptoms and Signs

Ask the Following Questions:

1. Is there fever or localized erythema? Localized erythema would suggest phlebitis, gout, osteomyelitis, cellulitis, ingrown toenail, and paronychia. The presence of fever would make one suspect osteomyelitis and cellulitis.
2. Is there associated deformity of the foot? Hallux valgus, hammertoe, hallux rigidus, arthritis, and displaced fracture are the main causes of a deformity of the foot.
3. Are the peripheral pulses palpable? Diminished arterial pulses would make one think of arterial embolism, peripheral arteriosclerosis, and diabetes.
4. Are there associated neurologic findings? The presence of loss of sensation to touch and pain should make one think of peripheral neuropathy and tarsal tunnel syndrome. Numbness or loss of sensation in the 3rd and 4th toes is often associated with a Morton's neuroma.

DIAGNOSTIC WORKUP

Routine diagnostic tests include a CBC, sedimentation rate, chemistry panel, VDRL test, and an x-ray of the foot. If the peripheral pulses are diminished, Doppler studies and angiography should be considered. If there is diffuse swelling and erythema, venography may need to be done. If there are neurologic findings, nerve conduction velocity studies and electromyograms (EMGs) may be helpful. Consider bone scans, CT scans, and arthroscopy if the above tests are negative. An MRI may be needed to diagnose stress fractures. Abnormal weight distribution is diagnosed by quantitative scintigraphs. It is wise to refer the patient to an orthopedic surgeon or podiatrist before ordering expensive diagnostic tests.

Book Source Details

• Book Title: Algorithmic Diagnosis of Symptoms and Signs
• Author(s): R. Douglas Collins
• Year of Publication: 2003
• Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2003 Lippincott Williams & Wilkins.

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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.

More About This Book: Title: Algorithmic Diagnosis of Symptoms and Signs Authors: R. Douglas Collins Publisher: Lippincott Williams & Wilkins Copyright: 2003 ISBN: 0-7817-3805-9

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