Many patients presenting with pain in the foot or toes have joint disease (see pages 284 and 286 for a discussion of these differentials). Other anatomic components of the foot and toes may cause pain as well, so a consideration of the differential diagnosis of foot and toe pain must include diseases of these structures. Let us develop our list by moving from the skin inward. Many of these conditions are illustrated on page 185 (Table 30). Painful conditions of the skin include warts, calluses, bunions, and corns, conditions often caused by bad posture and poor-fitting shoes. Ingrown toenails may be found. Herpes zoster in this location is unusual. Moving to the subcutaneous tissue and fascia, cellulitis and plantar fasciitis are suggested. In plantar fasciitis, a spur of the calcaneus will be found on the x-ray. Achilles bursitis and tendonitis are suggested in this layer. The veins may be involved by phlebitis and hemorrhage.
FOOT, HEEL, AND TOE PAIN
M I N T S Malformation Inflammation Neoplasm Trauma Systemic Disease
The arteries may be inflamed in Buerger disease and periarteritis nodosa; they are painfully obstructed in the arteriolar sclerosis of diabetes mellitus and arteriosclerosis. Emboli may be a cause of foot pain. Raynaud disease may also affect the foot. The nerves of the foot may be involved by the many causes of peripheral neuropathy, as well as herniated lumbosacral discs and cauda equina tumors; the radiation of the pain should suggest the latter two conditions. Trapping of the plantar tibial nerve may cause pain just like the carpal tunnel syndrome in the hand. Metatarsalgia may be caused by a plantar digital neuroma. Tracing the arteries centrally will suggest Leriche syndrome, whereas tracing the nerves centrally will suggest a thalamic syndrome. Finally, the bones may be involved by fractures, by deformities such as pes planus, pes cavus, talipes equinovarus, and hallux valgus and by many postural defects. Kohler disease is aseptic bone necrosis in the calcaneus (considered in the section on joint pain, page 284).
Special considerations in the approach to the diagnosis of foot pain include examining the shoes for abnormal areas of wear and tear, measuring the arches, palpating the joints for maximal tenderness, and ordering laboratory tests for joint disease (page 286). Nerve blocks and lidocaine injections in the plantar fascia and other areas of maximum tenderness will assist in diagnosis. Abnormal weight distribution is diagnosed by quantitative scintigraphs. A therapeutic trial of proper-fitting shoes and arches may be indicated. Weight control is essential in the obese. Referral to a podiatrist or orthopedic surgeon is often necessary.
Read excerpts from these other book chapters related to Foot pain:
Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2008 Williams & Wilkins.
|
More About This Book:
Title: Differential Diagnosis in Primary Care Authors: R. Douglas Collins MD, FACP Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 0-7817-6812-8 
|
|
What do you think about the features of this website? Take our user survey and have your say:
Next articles:
Tools & Services:
Medical Articles:
Search Specialists by State and City
By using this site you agree to our Terms of Use. Information provided on this site is for informational purposes only; it is not intended as a substitute for advice from your own medical team. The information on this site is not to be used for diagnosing or treating any health concerns you may have - please contact your physician or health care professional for all your medical needs. Please see our Terms of Use.
Copyright © 2009 Health Grades Inc. All rights reserved.
