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Most foot problems result from anatomic disorders or abnormal function of articular or extra-articular structures (see Fig. 1: Foot and Ankle Disorders: Bones of the foot. ). Less commonly, foot problems reflect a systemic disorder (see Table 1: Foot and Ankle Disorders: Foot Manifestations of Systemic Disorders ).
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Table 1
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Foot Manifestations of
Systemic Disorders
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Foot Symptoms or Signs
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Possible Cause
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Pain at rest (feet elevated), relieved by dependency
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End-stage peripheral arterial disease
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Cold, red, or cyanotic feet
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Advanced arterial ischemia
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Episodically red, hot, very painful feet
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Erythromelalgia—idiopathic (most commonly) or secondary to various disorders (eg, myeloproliferative disorders, which are rare)
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Foot pain that becomes severe within seconds or possibly minutes, particularly in patients with atrial fibrillation; foot often cool
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Embolic arterial occlusion
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Cyanosis of a single toe (blue toe syndrome)
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Thromboembolic disease due to aortic-iliac stenosis, arrhythmia, or cholesterol embolization (after coronary artery bypass or catheterization); warfarin therapy
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Bilateral episodic digital discomfort, pallor, and cyanosis
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Raynaud's disease or phenomenon
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Bilateral painless cyanosis (in a young female)
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Acrocyanosis
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Bilateral edema
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Renal, hepatic, or cardiac dysfunction; drugs (eg, Ca channel blockers)
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Unilateral edema
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Deep vein thrombosis, lymphatic obstruction
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Firm non-pitting foot and leg edema
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Lymphedema, scleroderma
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Firm non-pitting edema with nodular appearance above the malleoli
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Pretibial myxedema
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Edema with hemosiderin deposition and brownish discoloration
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Venous insufficiency, recurrent small-vessel vasculitis
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Edema of feet and toes, numbness and pain at the ankle and heel (tarsal tunnel syndrome)
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Hypothyroidism, relapsing symmetric seronegative synovitis (rare)
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Red, dusky patches on the dorsum with flaccid bullae (necrolytic acral erythema)
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Hepatitis C, vasculitis, emboli
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Isolated toe swelling and deformity with pain (sausage digits)
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Psoriatic arthritis, reactive arthritis, other spondyloarthropathies; crystal-induced arthritis,
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Painful feet with paresthesias
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Peripheral neuropathy (local or systemic—eg, diabetic neuropathy)
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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
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Sciatica
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Toe, foot, or ankle pain with warmth and redness
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Gout, stress fracture
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Thickened (> 22 mm) heel pad as determined with radiographic or ultrasonic imaging techniques
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Hyperpituitarism with acromegaly
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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/year. People with these diseases should examine their own feet at least once/day.
The feet are also common sites for corns and calluses (see Cornification Disorders) and infections by fungus (see Fungal Skin Infections: Tinea Pedis), bacteria (see Bacterial Skin Infections), and viruses (see Viral Skin Diseases).
Table 2: Foot and Ankle Disorders: Common Foot and Ankle Disorders by Anatomic Site lists foot and ankle disorders according to anatomic site. Table 3: Foot and Ankle Disorders: Disorders Associated With Heel Pain According to Location lists common causes of heel pain according to location.
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Table 2
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Common Foot and Ankle Disorders
by Anatomic Site
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Ankle (anterolateral)
Neuralgia of the intermediate dorsal cutaneous nerve
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Ankle (medial)
Tibialis posterior tendinosis
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Ball of the foot
Interdigital nerve pain (Morton's neuroma)
Metatarsophalangeal joint pain
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Heel (plantar)
Inferior calcaneal bursitis
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Heel (posterior)
Achilles tendon enthesopathy
Anterior Achilles tendon bursitis
Posterior Achilles tendon bursitis
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Heel (sides)
Epiphysitis of the calcaneus (Sever's disease)
Medial plantar nerve entrapment
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Plantar arch (sole)
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Toe
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Table 3
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Disorders Associated With
Heel Pain According to Location
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Location of Pain
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Associated Disorder
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Plantar surface of the heel
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Plantar fasciosis (plantar fasciitis, calcaneal spur syndrome), inferior calcaneal bursitis
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Medial and lateral margins of the heel
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Epiphysitis of the calcaneus (Sever's disease, in children), medial plantar nerve entrapment, sometimes tarsal tunnel syndrome
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Anterior to the Achilles tendon at the retromalleolar space
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Fracture of the posterolateral talar tubercle, tibialis posterior tendinosis, anterior Achilles tendon bursitis, tarsal tunnel syndrome
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Posterior to the Achilles tendon
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Posterior Achilles tendon bursitis, tendon nodules
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Calcaneal insertion of the Achilles tendon
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Achilles tendon enthesopathy
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Last full review/revision March 2008 by Kendrick Alan Whitney, DPM
Content last modified March 2008
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