ABC of Rheumatology: PAIN IN THE FOOTBMJ 1995; 310 doi: https://doi.org/10.1136/bmj.310.6983.860 (Published 01 April 1995) Cite this as: BMJ 1995;310:860
- S G West,
- J Woodburn
Foot pain is common, whether local to the foot or due to systemic disease, mechanical dysfunction, degeneration, or inflammation. In general a multidisciplinary approach to treatment is best, and this is reflected in increasingly close liaison between podiatry, rheumatology, and orthopaedics. Podiatrists (chiropodists) offer a range of treatments from surgery to orthoses. To understand dysfunction, clinicians should be familiar with the normal development and anatomical variants of the foot.
Characteristics of the adult foot
Three main types:
Supinated (high arch)
Examine the foot when bearing weight and when unloaded
Inspect patient's shoes for abnormal or uneven wear
Consult a podiatrist if a structural or mechanical abnormality is suspected—many can be treated with orthoses
Characteristics of child's foot
Flexible foot structure (may look flat with a valgus heel)
Rigid valgus or pronated heel
Medial longitudinal arch forms when child stands on tiptoe
High arch foot with toe retraction and tight extensor tendons
Heel to toe walking
Delay or difficulty in walking or running
Forefoot in line with rear foot
Abducted or adducted forefoot relative to heel
Mobile joints with pain free motion and no swelling
Pain, swelling, or stiffness of joints
Adopts adult morphology by about 8 years of age
Lesser toe deformities
Pain in the forefoot (metatarsalgia)
This is one of the most common forms of foot pain and has several possible causes.
Morton's metatarsalgia (interdigital neuroma)
This normally affects the proximal part of the plantar digital nerve and accompanying plantar digital artery. Trauma to these structures leads to histological changes including inflammatory oedema, microscopic changes in the neurolemma, fibrosis, and, later, degeneration of the nerve.
Clinical features include a gradual onset with sudden attacks of neuralgic pain or paraesthesia during walking, often in the third and fourth toe. Examination may reveal …
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