Bombay Hospital Journal Issue SpecialContentsHomeArchiveSearchBooksFeedback

THE PAINFUL FOOT

Nilesh Baxi

Family Physician, Tardeo, Mumbai 400 007.

There are so many conditions which afflict such a small area that it looks very difficult to diagnose a given condition. Following simplified tabular version will surely help you reach the right diagnosis. For convenience, painful foot has been divided into forefoot pain, midfoot pain and hind foot pain.

Forefoot pain
Site of pain/tenderness
Disease
Management
2nd or 3rd metatarsal shaft March # (stress) Walking POP
Intermetatarsal spaces-3rd/4th Neuroma Surgery
1st MTP joint 1. Gout NSAID or colchicine
       2. Hallux rigidus (OA) Pad, NSAID, inj., surgery
        3. Hallux valgus (bunion) Pad. Inject, surgery
Head of 5th metatarsal Bunion Pad, Inject, surgery
MTP and PIP RA NSAID and rocker bar
DIP SSA NSAID
Sole of the foot 1. Plantar warts Cryosurgery
       2. Corns and callosities Corn tapes/chiropody

Midfoot pain
Site of pain/tenderness
Disease
Management
Arch Pes planus Insole + intrinsic muscle exercises
Navicular Kohlerís disease Rest or ignore
Dorsum 1. Extensor tenosynovitis Local steroid inj., ultrasound
       2. Midtarsal strain NSAID + rest

Hindfoot pain
Site of pain/tenderness
Disease
Management
Achilles Tendon Achilles tendinitis Rest, ultrasound, stretching exercises
Lower end of Achilles Tendon Heel Subachilles bursitisPlantar fasciitis Local steroid injectionRubber heel pad, NSAID,exercises, local steroid injection
Behind and below medialmalleolus 1.Flexor tenosynovitis

2. Medical ligament strain
Ultrasound or local steroid injection
RICE, NSAID +/- Local steroid injection
Behind and below lateral Malleolus 1.Peronial tenosynovitis

2.Lateral ligament strain
Ultrasound or local steroid injection
RICE, NSAID +/- Local steroid injection
Diffuse foot pain could be due to PVD, peripheral neuropathy, tarsal tunnel syndrome, extensive RA, diabetic charcotís joint etc.


    To Section TOC
    Sponsor-Dr.Reddy's Lab