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INTRODUCTION

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In this chapter, we examine the common causes of foot pain, evaluate the appropriate laboratory and imaging modalities used in diagnosis, review the relevant clinical examination, and detail the effectiveness of current treatments.

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Foot pain, not unlike pain experienced in other areas of the body, can be debilitating. One aspect separating it from other areas is that the entire weight of the body rests on the feet. It is difficult to ambulate while maintaining a non-weight-bearing position and almost impossible without assistive devices. Although the geographic region of foot pain may be visible, palpable, or reproducible, its etiology is more difficult to determine, and a definitive treatment may not exist.

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This chapter examines the common causes of foot pain, evaluating the appropriate laboratory and imaging modalities used to diagnose foot pain. Coupled with a review of the relevant clinical examination, the effectiveness of current treatments is detailed for regularly encountered foot pathologies.

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The following six sections guide the clinician in diagnosis and treatment of foot pain, beginning with the most commonly seen painful pathologies. The remaining sections review pain caused by overuse injuries, trauma, and neurologic, metabolic, and iatrogenic causes.

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COMMON FOOT DEFORMITIES

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The diagnosis of distal extremity pain is usually not difficult in that there is often either a visible malformation or the pain has a trigger point and is reproducible. In this section, the most common pathologies seen in the foot are discussed in detail. The cause of deformity is addressed along with clinical, laboratory, and imaging tools that aid in the diagnosis. Treatment modalities are discussed for the following pathologies: onychocryptosis, hyperkeratosis, soft-tissue tumors, tinea pedis, hammertoes, hallux valgus, pes plano valgus, neuroma, gout, and plantar fasciitis.

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ONYCHOCRYPTOSIS/INGROWN NAIL

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The normal appearance of the nail is a translucent nail plate with an underlying nail bed; the matrix is deep and proximal with surrounding periungual tissue medially and laterally. Discomfort presents when external pressures such as tight shoe gear, a misshapen nail, or a thickened nail from a fungal infection of the nail (onychomycosis) impinge on the nail plate that has been driven into the periungual tissue. Internal pressure from abnormal bone growth (subungual exostosis) may also cause an ingrown toenail. Pain is a result of inflammation or resulting soft-tissue infection caused by a break in the skin, allowing the entry of bacteria (see Table 43-1).

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TABLE 43-1

Common Causes of Onychocryptosis

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The diagnosis is based on clinical examination, noting the ingrown nail with erythema, or edema to the surrounding soft tissue. If the nail plate is misshapen, an x-ray is beneficial to help rule out ...

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